Preoperative assessment: diabetic autonomic neuropathy: 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: diabetic autonomic neuropathy

Sample item

A 62-year-old man with diabetes for 20 years has postural hypotension and a resting heart rate of 96 per minute that does not vary with deep breathing. He also vomits food eaten the previous day. He is listed for elective surgery. Which perioperative concerns follow?

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

The answer and the reasoning

B. Haemodynamic instability on induction with a poor heart-rate response, and a high risk of aspiration

Autonomic neuropathy removes the reflex heart-rate and vascular responses, so blood pressure falls sharply with induction or position change. Gastroparesis delays emptying and raises aspiration risk, so a rapid-sequence technique and an H2 blocker or prokinetic are considered.

Option by option

  • A. Prolonged neuromuscular block and a risk of hyperkalaemia with suxamethonium

    Neuromuscular block is not specifically prolonged by autonomic neuropathy.

  • B. Haemodynamic instability on induction with a poor heart-rate response, and a high risk of aspiration (correct)

    Correct. Fixed heart rate and postural hypotension signal labile blood pressure, and the vomiting indicates gastroparesis.

  • C. Resistance to vasopressors and a marked tendency to bronchospasm

    Denervated vessels tend to be hypersensitive to vasopressors, and bronchospasm is not a feature of the neuropathy.

  • D. Susceptibility to malignant hyperthermia and a need for dantrolene prophylaxis

    Malignant hyperthermia is not linked to diabetes or autonomic neuropathy.

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 B, Haemodynamic instability on induction with a poor heart-rate response, and a high risk of aspiration. Autonomic neuropathy removes the reflex heart-rate and vascular responses, so blood pressure falls sharply with induction or position change.

Why is "Prolonged neuromuscular block and a risk of hyperkalaemia with suxame…" not the answer?

Neuromuscular block is not specifically prolonged by autonomic neuropathy.

Why is "Resistance to vasopressors and a marked tendency to bronchospasm" not the answer?

Denervated vessels tend to be hypersensitive to vasopressors, and bronchospasm is not a feature of the neuropathy.

Why is "Susceptibility to malignant hyperthermia and a need for dantrolene pr…" not the answer?

Malignant hyperthermia is not linked to diabetes or autonomic neuropathy.

What concept does this question test?

It tests Preoperative assessment: diabetic autonomic neuropathy in Anaesthesia. Gastroparesis delays emptying and raises aspiration risk, so a rapid-sequence technique and an H2 blocker or prokinetic are considered.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. 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: diabetic autonomic neuropathy?

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.