Preoperative assessment: MAO inhibitors: 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: MAO inhibitors

Sample item

A patient on phenelzine needs an operation and postoperative analgesia. Which opioid is contraindicated?

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

The answer and the reasoning

A. Pethidine

Pethidine combined with MAO inhibitors can cause a serotonin-syndrome-like reaction with hyperthermia, agitation and rigidity. Morphine and fentanyl are safer, and indirect sympathomimetics such as ephedrine should also be avoided.

Option by option

  • A. Pethidine (correct)

    Correct. Pethidine with MAOIs risks serotonin syndrome.

  • B. Morphine in small doses

    Titrated morphine is acceptable.

  • C. Fentanyl

    Fentanyl is considered relatively safe.

  • D. Paracetamol

    Paracetamol is not an opioid and is safe.

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 A, Pethidine. Pethidine combined with MAO inhibitors can cause a serotonin-syndrome-like reaction with hyperthermia, agitation and rigidity.

Why is "Morphine in small doses" not the answer?

Titrated morphine is acceptable.

Why is "Fentanyl" not the answer?

Fentanyl is considered relatively safe.

Why is "Paracetamol" not the answer?

Paracetamol is not an opioid and is safe.

What concept does this question test?

It tests Preoperative assessment: MAO inhibitors in Anaesthesia. Morphine and fentanyl are safer, and indirect sympathomimetics such as ephedrine should also be avoided.

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: MAO inhibitors?

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.