Preoperative assessment: symptomatic severe aortic stenosis: 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: symptomatic severe aortic stenosis

Sample item

A 74-year-old man has had exertional syncope for 3 months. Echocardiography shows a calcific aortic valve with an area of 0.7 cm2 and a mean gradient of 55 mmHg. He is listed for elective total hip replacement. What is the best course?

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

The answer and the reasoning

C. Defer the elective surgery and treat the valve disease first

Symptomatic severe aortic stenosis carries a high risk of perioperative cardiac death, so elective non-cardiac surgery should wait until the valve has been replaced or otherwise treated. Spinal anaesthesia is relatively avoided because the fall in vascular resistance cannot be compensated by a fixed outflow obstruction.

Option by option

  • A. Proceed under general anaesthesia with a prophylactic nitroglycerin infusion

    Nitroglycerin lowers preload and coronary perfusion pressure, which a hypertrophied ventricle tolerates poorly.

  • B. Proceed with general anaesthesia and a beta agonist to keep the heart rate high

    Tachycardia shortens diastole and worsens subendocardial ischaemia; the heart rate should be kept low-normal.

  • C. Defer the elective surgery and treat the valve disease first (correct)

    Correct. Symptomatic severe stenosis is a reason to postpone elective surgery and treat the valve first.

  • D. Proceed under spinal anaesthesia, as regional blocks are safest in valve disease

    A spinal block lowers systemic vascular resistance abruptly, and a fixed obstruction prevents compensation.

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, Defer the elective surgery and treat the valve disease first. Symptomatic severe aortic stenosis carries a high risk of perioperative cardiac death, so elective non-cardiac surgery should wait until the valve has been replaced or otherwise treated.

Why is "Proceed under general anaesthesia with a prophylactic nitroglycerin i…" not the answer?

Nitroglycerin lowers preload and coronary perfusion pressure, which a hypertrophied ventricle tolerates poorly.

Why is "Proceed with general anaesthesia and a beta agonist to keep the heart…" not the answer?

Tachycardia shortens diastole and worsens subendocardial ischaemia; the heart rate should be kept low-normal.

Why is "Proceed under spinal anaesthesia, as regional blocks are safest in va…" not the answer?

A spinal block lowers systemic vascular resistance abruptly, and a fixed obstruction prevents compensation.

What concept does this question test?

It tests Preoperative assessment: symptomatic severe aortic stenosis in Anaesthesia. Spinal anaesthesia is relatively avoided because the fall in vascular resistance cannot be compensated by a fixed outflow obstruction.

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: symptomatic severe aortic stenosis?

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.