Preoperative assessment: unstable angina before elective surgery: 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: unstable angina before elective surgery

Sample item

A 66-year-old man listed for elective knee replacement reports chest pain at rest, increasing over the last week and relieved by sublingual nitrate. What is the best next step?

APostpone the operation and refer for cardiac evaluation and treatmentBProceed under general anaesthesia after a beta blocker an hour beforeCProceed under spinal anaesthesia, as it avoids the stress of intubationDProceed after a normal resting ECG on the day of surgery

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

The answer and the reasoning

A. Postpone the operation and refer for cardiac evaluation and treatment

Rest angina of recent onset and worsening is unstable angina, an active cardiac condition. Elective non-cardiac surgery is postponed until the condition has been evaluated and treated, since proceeding carries a high risk of perioperative infarction.

Option by option

A. Postpone the operation and refer for cardiac evaluation and treatment (correct)
Correct. Unstable angina requires evaluation and treatment before elective surgery.
B. Proceed under general anaesthesia after a beta blocker an hour before
A single early beta-blocker dose does not stabilise an active coronary syndrome and may cause harm.
C. Proceed under spinal anaesthesia, as it avoids the stress of intubation
A regional technique does not remove the risk of infarction in an unstable coronary syndrome.
D. Proceed after a normal resting ECG on the day of surgery
A normal resting ECG does not exclude unstable coronary 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.

Questions about this Anaesthesia question

What is the answer to this Anaesthesia question?

The best answer is A, Postpone the operation and refer for cardiac evaluation and treatment. Rest angina of recent onset and worsening is unstable angina, an active cardiac condition.

Why is "Proceed under general anaesthesia after a beta blocker an hour before" not the answer?

A single early beta-blocker dose does not stabilise an active coronary syndrome and may cause harm.

Why is "Proceed under spinal anaesthesia, as it avoids the stress of intubati…" not the answer?

A regional technique does not remove the risk of infarction in an unstable coronary syndrome.

Why is "Proceed after a normal resting ECG on the day of surgery" not the answer?

A normal resting ECG does not exclude unstable coronary disease.

What concept does this question test?

It tests Preoperative assessment: unstable angina before elective surgery in Anaesthesia. Elective non-cardiac surgery is postponed until the condition has been evaluated and treated, since proceeding carries a high risk of perioperative infarction.

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: unstable angina before elective surgery?

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.