Preoperative assessment: obstructive jaundice: 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: obstructive jaundice

Sample item

A 60-year-old man with obstructive jaundice from carcinoma of the head of the pancreas is planned for surgery. Which preoperative measure lowers the risk of postoperative acute kidney injury?

ARoutine NSAIDs for preoperative analgesiaBFluid restriction to avoid hepatic congestionCGenerous intravenous hydration with urine output monitoringDA high-dose aminoglycoside as routine prophylaxis

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

The answer and the reasoning

C. Generous intravenous hydration with urine output monitoring

Obstructive jaundice predisposes to acute kidney injury through endotoxaemia, bile salt effects on renal vessels and volume depletion. Adequate preoperative hydration is the key protective measure, along with vitamin K to correct the coagulopathy and avoidance of nephrotoxins.

Option by option

A. Routine NSAIDs for preoperative analgesia
NSAIDs are nephrotoxic and also affect platelet function.
B. Fluid restriction to avoid hepatic congestion
Fluid restriction would worsen volume depletion and renal risk.
C. Generous intravenous hydration with urine output monitoring (correct)
Correct. Volume loading and monitoring of urine output protect the kidney in jaundiced patients.
D. A high-dose aminoglycoside as routine prophylaxis
Aminoglycosides are nephrotoxic and are not given as routine prophylaxis.

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.

Questions about this Anaesthesia question

What is the answer to this Anaesthesia question?

The best answer is C, Generous intravenous hydration with urine output monitoring. Obstructive jaundice predisposes to acute kidney injury through endotoxaemia, bile salt effects on renal vessels and volume depletion.

Why is "Routine NSAIDs for preoperative analgesia" not the answer?

NSAIDs are nephrotoxic and also affect platelet function.

Why is "Fluid restriction to avoid hepatic congestion" not the answer?

Fluid restriction would worsen volume depletion and renal risk.

Why is "A high-dose aminoglycoside as routine prophylaxis" not the answer?

Aminoglycosides are nephrotoxic and are not given as routine prophylaxis.

What concept does this question test?

It tests Preoperative assessment: obstructive jaundice in Anaesthesia. Adequate preoperative hydration is the key protective measure, along with vitamin K to correct the coagulopathy and avoidance of nephrotoxins.

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: obstructive jaundice?

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.