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A) ASA II

B) ASA III

C) ASA IV

D) ASA I

A) A 55-year-old with insulin-dependent diabetes mellitus undergoing laparoscopic cholecystectomy

B) A 70-year-old with prior myocardial infarction and creatinine 200 µmol/L undergoing elective colectomy

C) A 60-year-old with well-controlled hypertension undergoing knee arthroplasty

D) A 65-year-old with cerebrovascular disease undergoing cataract surgery

A) Proceed with surgery after stopping both antiplatelet agents five days preoperatively

B) Continue aspirin alone and stop the P2Y12 inhibitor five days preoperatively, then proceed

C) Defer elective surgery until dual antiplatelet therapy has been completed for at least 12 months

D) Proceed with surgery without altering antiplatelet therapy to prevent stent thrombosis

A) The patient can dress and walk around the house without breathlessness (2–3 METs)

B) The patient can climb a flight of stairs or walk briskly at 6 km/h without symptoms (≥4 METs)

C) The patient denies chest pain but has not exercised in two years

D) Resting ECG shows no ischaemic changes

A) Prescribe prophylactic anticoagulation postoperatively

B) Arrange formal sleep study and consider CPAP therapy perioperatively; plan enhanced postoperative monitoring

C) Cancel elective surgery until BMI is below 35 kg/m²

D) Administer prophylactic dexamethasone to reduce upper-airway oedema

A) Four hours

B) Six hours

C) Two hours

D) Eight hours

A) Transfuse two units of packed red cells preoperatively to raise haemoglobin above 120 g/L

B) Investigate the underlying cause of anaemia and consider intravenous iron or erythropoiesis-stimulating therapy; defer surgery if safe to do so

C) Proceed with surgery and arrange intraoperative transfusion if required

D) Cancel surgery permanently until haemoglobin normalises spontaneously

A) It is mandatory before any procedure requiring general anaesthesia

B) It is indicated only if the patient has smoked for more than 20 pack-years

C) It is not routinely indicated and should be requested only when clinically directed by history or examination

D) It should be obtained to provide a baseline for postoperative comparison in all patients over 50

A) Poor glycaemic control confers no additional perioperative risk beyond the procedural risk of laparoscopic surgery

B) Poor glycaemic control is associated with increased risk of surgical site infection, delayed wound healing, and cardiovascular events; elective surgery should be deferred to allow optimisation

C) Surgery should proceed as planned because insulin requirements will normalise intraoperatively

D) Only HbA1c values above 120 mmol/mol warrant surgical deferral

A) Serum albumin concentration

B) The CHA₂DS₂-VASc score in relation to the bleeding risk of the planned procedure

C) The patient’s INR on the day of the preoperative clinic

D) The platelet count

A) Presence of peripheral oedema

B) Neck circumference greater than 40 cm

C) Resting oxygen saturation below 94%

D) Serum bicarbonate greater than 28 mmol/L

A) Mitral stenosis is a low-risk condition for non-cardiac surgery as the mitral valve is not directly affected by anaesthetic agents

B) This patient carries elevated perioperative risk; cardiology review, echocardiographic confirmation of severity, and consideration of valve intervention before elective surgery are appropriate

C) The risk is acceptable provided the patient receives prophylactic antibiotics for endocarditis

D) General anaesthesia is contraindicated; only local anaesthesia is permissible

A) Chest radiograph to assess lung fields

B) Arterial blood gas to detect hypercapnia

C) Predicted postoperative FEV₁ and diffusing capacity for carbon monoxide (DLCO)

D) Peak expiratory flow rate measured at the bedside

A) To allow the surgical team additional time to obtain preoperative investigations

B) To increase a patient’s physiological reserve through structured exercise, nutritional optimisation, and psychological preparation prior to surgery

C) To administer prophylactic antibiotics and anticoagulants in the weeks before the procedure

D) To provide patient education about intraoperative anaesthetic techniques

A) ASA II

B) ASA III

C) ASA IV

D) ASA V

A) Uncontrolled hypertension increases the risk of intraoperative haemodynamic instability, myocardial ischaemia, and stroke

B) Antihypertensive medications directly reduce surgical blood loss by lowering platelet aggregation

C) Stage 1 hypertension alone doubles the risk of postoperative renal failure

D) Blood pressure control eliminates the need for invasive arterial monitoring intraoperatively

A) Risk of intraoperative bronchospasm due to adrenal hyperresponsiveness

B) Risk of adrenal insufficiency and haemodynamic collapse due to hypothalamic-pituitary-adrenal axis suppression

C) Risk of postoperative hypernatraemia due to mineralocorticoid excess

D) Risk of intraoperative hypoglycaemia due to inhibition of gluconeogenesis

A) A 45-year-old healthy marathon runner scheduled for appendicectomy

B) A 70-year-old with a known cardiac murmur and new exertional dyspnoea scheduled for elective total knee replacement

C) A 60-year-old with diet-controlled hypertension scheduled for cataract surgery under local anaesthesia

D) A 55-year-old with a remote history of hypertension now well controlled on a single agent, scheduled for laparoscopic cholecystectomy

A) Prescribe prophylactic oral antibiotics for 10 days preoperatively to prevent wound infection

B) Avoid nephrotoxic agents, ensure adequate hydration, and consider nephrology review to optimise renal function before surgery

C) Administer intravenous contrast medium the day before surgery to allow pre-conditioning of the renal tubules

D) Initiate peritoneal dialysis prophylactically before surgery to protect renal function

A) A history of hypertension treated with beta-blockers

B) A history of previous difficult intubation or failed laryngoscopy documented in prior anaesthetic records

C) A BMI of 28 kg/m²

D) Current use of an angiotensin-converting enzyme inhibitor