SU10.1-4 | Perioperative Management — Practice Quiz

Correct. Perioperative management is the coordinated care across preoperative, intraoperative and postoperative phases — it is where most preventable surgical harm is avoided, depending more on the system of care than operative skill alone.

Perioperative care = coordinated care across pre-, intra- and post-operative phases.

Perioperative management spans all three phases — preoperative, intraoperative and postoperative — not just the operation or the postoperative ward.

Correct. The ASA physical status classification grades the patient's systemic fitness (from ASA I, a normal healthy patient, upward) to stratify perioperative risk so it can be understood and shared.

ASA grades patient fitness for risk stratification, not the operation itself.

ASA grades the PATIENT'S physical status/systemic disease, not the operation's difficulty or duration. It is a risk-stratification tool.

Correct. The WHO checklist runs Sign In (before induction), Time Out (after induction, before incision, team confirms patient/site/procedure), and Sign Out (before the patient leaves theatre).

WHO checklist: Sign In (pre-induction), Time Out (pre-incision), Sign Out (before leaving theatre).

Sign In is before induction; Time Out is after induction and just before skin incision with the whole team; Sign Out is before the patient leaves the operating room.

Correct. In the bleeding patient a normal blood pressure is falsely reassuring — tachycardia and a narrowed pulse pressure appear early. Hypotension means a large volume has already been lost.

In haemorrhage, tachycardia and narrowed pulse pressure precede hypotension — a normal BP is falsely reassuring.

Compensated haemorrhage shows tachycardia and a NARROWED pulse pressure with a still-normal blood pressure. Hypotension is a late sign of large volume loss.

Correct. Antibiotic prophylaxis is timed so adequate tissue levels are present at incision, and VTE prophylaxis (mechanical and/or pharmacological) is given according to assessed risk. Prolonged routine antibiotics are not appropriate.

Antibiotic prophylaxis before incision; VTE prophylaxis by assessed risk.

Prophylactic antibiotics must be timed before incision (correct timing matters), and VTE prophylaxis is risk-assessed and given to prevent clots, not started only after one forms.

Correct. Valid consent requires capacity (ability to decide), voluntariness (free from coercion) and disclosure of the material information needed to decide. Absence of any one makes consent invalid.

Consent stands on capacity, voluntariness and disclosure.

The three pillars are capacity, voluntariness and disclosure. A signature alone is only a record; the principles of medical ethics underpin but do not name the three pillars.

Correct. A signed form is the record of a valid consent process, not the consent itself. If the patient did not understand or was pressured, the consent is invalid and proceeding could amount to battery.

The signed form is a record, not the consent; understanding and voluntariness are essential.

Consent is a process, not a signature. Without understanding (disclosure) and voluntariness, the consent is invalid regardless of the signature, and a relative cannot consent for a competent adult.

Correct. In India the age of majority is 18 years (Indian Majority Act). For a 15-year-old, a parent or legal guardian gives consent for an elective procedure, while the child's assent should still be sought.

Age of majority in India is 18; a parent/guardian consents for a minor.

The age of majority in India is 18. A 15-year-old is a minor, so a parent/legal guardian provides consent for elective surgery (the child's assent is still sought).

Correct. The sterile team — surgeon, assistant(s) and scrub nurse — are scrubbed, gowned and gloved and may touch the field. The non-sterile team (circulating nurse, anaesthetist) supports from outside the field.

Sterile team = surgeon + assistant(s) + scrub nurse; they alone touch the field.

Only the scrubbed team (surgeon, assistant(s), scrub nurse) may touch the sterile field. The anaesthetist and circulating nurse are part of the non-sterile team.

Correct. Keeping the field exposed and dry — steady retraction and well-aimed suction without blocking the surgeon's view — is the most useful thing a junior assistant can do.

Good assisting = field exposed and dry, view unobstructed.

The most useful assisting skill is keeping the field exposed and dry with steady retraction and suction, never obscuring the surgeon's view. Independent cutting or leaning over the field is unsafe.

Correct. Plain lignocaine maximum is 3 mg/kg (about 150 mg in a 50 kg adult). The 7 mg/kg ceiling applies only WITH adrenaline. Always calculate in mg/kg.

Lignocaine ceiling: 3 mg/kg plain, 7 mg/kg with adrenaline — always per kg.

Plain lignocaine ceiling is 3 mg/kg; 7 mg/kg applies only when combined with adrenaline. For 50 kg, plain = 150 mg. Local anaesthetics always have a dose ceiling.

Correct. A contaminated/dirty wound should be cleaned and debrided, and primary closure avoided in favour of delayed closure; tetanus prophylaxis must be given according to wound type and immunisation status.

Dirty wounds: debride, avoid primary closure, give tetanus prophylaxis.

Heavily contaminated wounds should not be closed primarily — clean, debride and consider delayed closure, and always address tetanus prophylaxis based on wound and immunisation status.