Preoperative assessment: starting a beta blocker: practice question

A Anaesthesia question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Anaesthesia · Preoperative assessment: starting a beta blocker

Sample item

A patient with risk factors for coronary disease is scheduled for major surgery tomorrow and is not on a beta blocker. Which is the correct approach?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

C. Do not start a high-dose beta blocker on the day of surgery

The POISE trial showed that starting high-dose extended-release metoprolol on the day of surgery reduced myocardial infarction but increased stroke and mortality because of hypotension and bradycardia. Patients already on beta blockers should continue them, and new therapy should be started well before surgery and titrated.

Option by option

  • A. Start high-dose metoprolol on the morning of surgery

    This regimen was associated with higher mortality and stroke.

  • B. Start a beta blocker intraoperatively without titration

    Untitrated intraoperative dosing risks hypotension and bradycardia.

  • C. Do not start a high-dose beta blocker on the day of surgery (correct)

    Correct. Starting a fixed high dose just before surgery causes harm.

  • D. Withdraw all beta blockers from patients already taking them

    Abrupt withdrawal of chronic beta blockers causes rebound tachycardia and ischaemia.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this Anaesthesia question

What is the answer to this Anaesthesia question?

The best answer is C, Do not start a high-dose beta blocker on the day of surgery. The POISE trial showed that starting high-dose extended-release metoprolol on the day of surgery reduced myocardial infarction but increased stroke and mortality because of hypotension and bradycardia.

Why is "Start high-dose metoprolol on the morning of surgery" not the answer?

This regimen was associated with higher mortality and stroke.

Why is "Start a beta blocker intraoperatively without titration" not the answer?

Untitrated intraoperative dosing risks hypotension and bradycardia.

Why is "Withdraw all beta blockers from patients already taking them" not the answer?

Abrupt withdrawal of chronic beta blockers causes rebound tachycardia and ischaemia.

What concept does this question test?

It tests Preoperative assessment: starting a beta blocker in Anaesthesia. Patients already on beta blockers should continue them, and new therapy should be started well before surgery and titrated.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Preoperative assessment: starting a beta blocker?

Make a table of each agent, its key advantage and its main side effect. Then use the flashcards and the other Anaesthesia questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.