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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.

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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.

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Preoperative assessment MCQ (B72-ANAESTHESIA-6)

Q: What is the answer to this Anaesthesia question?

The best answer is A, Give levodopa on the morning of surgery, restart it soon afterwards, and avoid dopamine antagonists such as metoclopramide and droperidol. Levodopa has a short half-life, and omission causes rigidity, swallowing and breathing difficulty, or even a neuroleptic malignant-like state.

Q: What concept does this question test?

It tests Preoperative assessment: Parkinson disease in Anaesthesia. It is continued up to surgery and restarted early, by nasogastric tube if needed. Dopamine antagonists such as metoclopramide, droperidol and haloperidol worsen parkinsonism.

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Anaesthesia · Preoperative assessment: Parkinson disease

Sample item

A 70-year-old man with Parkinson disease takes levodopa-carbidopa every six hours and is listed for elective cholecystectomy under general anaesthesia. Which perioperative plan is correct?

AGive levodopa on the morning of surgery, restart it soon afterwards, and avoid dopamine antagonists such as metoclopramide and droperidolBOmit levodopa until bowel function returns on the third day, then restartCStop levodopa 24 hours before surgery to avoid hypotension, and use metoclopramide for nauseaDContinue levodopa but treat nausea with metoclopramide, which is the antiemetic of choice

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

The answer and the reasoning

A. Give levodopa on the morning of surgery, restart it soon afterwards, and avoid dopamine antagonists such as metoclopramide and droperidol

Levodopa has a short half-life, and omission causes rigidity, swallowing and breathing difficulty, or even a neuroleptic malignant-like state. It is continued up to surgery and restarted early, by nasogastric tube if needed. Dopamine antagonists such as metoclopramide, droperidol and haloperidol worsen parkinsonism.

Option by option

A. Give levodopa on the morning of surgery, restart it soon afterwards, and avoid dopamine antagonists such as metoclopramide and droperidol (correct)
Correct. Levodopa is continued, and central dopamine antagonists are avoided.
B. Omit levodopa until bowel function returns on the third day, then restart
Prolonged omission risks severe rigidity and a withdrawal syndrome.
C. Stop levodopa 24 hours before surgery to avoid hypotension, and use metoclopramide for nausea
Abrupt withdrawal of levodopa causes rigidity, and metoclopramide worsens parkinsonism.
D. Continue levodopa but treat nausea with metoclopramide, which is the antiemetic of choice
Metoclopramide blocks central dopamine receptors and is best avoided in this disease.

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.

Preoperative assessment: Parkinson disease: practice question

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The answer and the reasoning

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