PLAB 1 Perioperative medicine Questions: 10 Free Practice MCQs

Ten PLAB 1-style perioperative medicine questions with the answer and the reasoning behind it. They come from the UK.med bank, which has 34 perioperative medicine questions and many more across every topic.

1. 1 / 10

   A 72 year old is being assessed before elective major surgery and has several medical comorbidities.

   How should the surgical risk assessment be supported?

   • A. Use a validated risk stratification tool alongside clinical assessment and discuss the results
   • B. Use an online calculator as the sole basis for deciding whether surgery can proceed
   • C. Avoid discussing risk because it may cause anxiety
   • D. Assess risk only after the operation
   Show answer

   Answer: A. Use a validated risk stratification tool alongside clinical assessment and discuss the results

   Why: Use a validated risk stratification tool to supplement clinical assessment, then discuss the person's risks and surgical options with them. NICE NG180 recommends this approach to support informed shared decision making when planning surgery.

   • B. A risk tool supplements clinical assessment and does not replace clinician review or shared decision making.
   • C. NICE NG180 recommends discussing risks and surgical options to support informed shared decisions.
   • D. Preoperative risk stratification is used when planning surgery, not deferred until after the procedure.

   Sources: NICE NG180 recommendation 1.3.1

2. 2 / 10

   A 74-year-old with chronic kidney disease, frailty and mild cognitive impairment is due to have elective surgery. Before the operation, they ask what pain relief they will receive and are concerned about sedation and being able to mobilise.

   Which approach best follows NICE guidance when planning postoperative pain management?

   • A. Discuss options before surgery, considering frailty, renal function, cognition, current medicines and the person's preferences
   • B. Plan analgesia solely by the operation name, without reviewing comorbidities, kidney function or current medicines
   • C. Select a standard opioid dose now and discuss it only if pain becomes severe
   • D. Avoid discussing pain relief because the final choice must be made after surgery by the recovery team
   Show answer

   Answer: A. Discuss options before surgery, considering frailty, renal function, cognition, current medicines and the person's preferences

   Why: NICE NG180 recommendation 1.6.1 advises discussing postoperative pain-management options before surgery. Relevant factors include comorbidities, age, frailty, renal and liver function, allergies, current medicines, cognitive function, urgency of surgery, expected pain, preferences, pain history, benefits and risks of options, and discharge plans. This lets the team agree an individual multimodal plan and avoid selecting an analgesic solely by operation type.

   • B. NICE directs the team to individualise the discussion using clinical features and the person's preferences rather than relying on procedure type alone.
   • C. NICE recommends discussing postoperative pain options before surgery and taking the person's clinical features, expectations and preferences into account.
   • D. NICE recommends a preoperative discussion that includes the likely impact of the procedure, preferences, pain history, benefits and risks, and discharge plans.

   Sources: NICE NG180 recommendation 1.6.1

3. 3 / 10

   A 45-year-old without diagnosed diabetes is being assessed before elective surgery. There are no symptoms or other clinical reasons to test for diabetes.

   Should HbA1c be routinely measured solely because surgery is planned?

   • A. Yes. HbA1c is mandatory before every operation to detect undiagnosed diabetes
   • B. Only if the person is ASA grade 1
   • C. Only after surgery
   • D. No. NICE advises against routine preoperative HbA1c testing in people without diagnosed diabetes
   Show answer

   Answer: D. No. NICE advises against routine preoperative HbA1c testing in people without diagnosed diabetes

   Why: NICE NG45 recommendation 1.5.1 says not to routinely offer HbA1c testing before surgery to people without diagnosed diabetes. This does not prevent testing when there is a separate clinical indication.

   • A. NICE does not recommend routine preoperative HbA1c for people without diagnosed diabetes.
   • B. ASA grade does not change the recommendation against routine HbA1c testing in people without diagnosed diabetes.
   • C. The question concerns routine preoperative testing; NICE advises against routinely offering HbA1c in this group.

   Sources: NICE NG45 recommendation 1.5.1

4. Like these? UK.med has 1645 more, plus timed mock exams. Free to start: App Store · Google Play

5. 4 / 10

   A 61-year-old is planning elective major colorectal surgery. The team is discussing how to organise care before, during and after the operation to support recovery.

   What should an enhanced recovery programme for this patient include?

   • A. Preoperative preparation and postoperative care, with no intraoperative component
   • B. A fixed protocol identical for every type of operation
   • C. Postoperative rehabilitation only, beginning after discharge
   • D. Preoperative preparation, intraoperative care and postoperative care
   Show answer

   Answer: D. Preoperative preparation, intraoperative care and postoperative care

   Why: NICE NG180 recommendations 1.2.1 and 1.2.2 say to offer an enhanced recovery programme to people having elective major or complex surgery and to include preoperative, intraoperative and postoperative components. The exact components depend on the type of surgery. This patient is having elective major surgery, so the programme should cover the full perioperative journey rather than only one phase.

   • A. The NICE programme is expected to include intraoperative care as well as preoperative and postoperative components.
   • B. NICE specifies the three phases but notes that programme components depend on the type of surgery; it does not prescribe one identical checklist for all operations.
   • C. NICE expects an enhanced recovery programme to span all three perioperative phases, not only postoperative rehabilitation.

   Sources: NICE NG180 recommendations 1.2.1 and 1.2.2

6. 5 / 10

   On the day of elective surgery, a 29-year-old who could become pregnant says there is a possibility they may be pregnant.

   What should the team do about pregnancy testing?

   • A. Explain the anaesthetic and procedural risks, discuss testing sensitively, obtain consent if there is doubt, and document the discussion
   • B. Perform a pregnancy test without discussion or consent, as it is a routine part of preoperative checks for everyone
   • C. Proceed without asking because pregnancy status is private and the operation is elective
   • D. Cancel surgery automatically without assessment and rebook after the next period
   Show answer

   Answer: A. Explain the anaesthetic and procedural risks, discuss testing sensitively, obtain consent if there is doubt, and document the discussion

   Why: NICE NG45 recommendations 1.3.1 to 1.3.4 advise sensitively asking on the day of surgery, explaining anaesthetic and procedural risks to the fetus, documenting discussions, and testing with consent if there is doubt about possible pregnancy.

   • B. NICE recommends a test with the person’s consent if there is doubt.
   • C. NICE recommends sensitively asking all women of childbearing potential on the day of surgery.
   • D. NICE calls for discussion and consent-based testing where doubt exists, not automatic cancellation in every case.

   Sources: NICE NG45 recommendations 1.3.1 to 1.3.4

7. 6 / 10

   A 70-year-old with several stable long-term conditions is being assessed before elective surgery. The clinician has completed a history and examination and is discussing the balance of operative risks and alternatives with the patient.

   How should a perioperative risk stratification tool be used under NICE guidance?

   • A. Use an unvalidated local score because it is faster
   • B. Use a validated tool only after surgery to estimate complication risk retrospectively for audit
   • C. Use a validated tool to supplement clinical assessment, then discuss risks and options for shared decision making
   • D. Replace clinical assessment with a risk score and make the decision without the patient, to avoid bias
   Show answer

   Answer: C. Use a validated tool to supplement clinical assessment, then discuss risks and options for shared decision making

   Why: NICE NG180 recommendation 1.3.1 advises using a validated risk stratification tool to supplement clinical assessment when planning surgery, including dental surgery. The person's risks and surgical options should then be discussed to support informed shared decision making. A numerical tool is one input: it does not replace the clinician's assessment or the person's participation in the decision.

   • A. The recommendation specifies a validated risk stratification tool.
   • B. NICE recommends the tool when planning surgery, so the results can inform preoperative discussion and planning.
   • D. NICE says the tool supplements, rather than replaces, clinical assessment and calls for discussion with the person.

   Sources: NICE NG180 recommendation 1.3.1

8. 7 / 10

   A 67-year-old is being assessed before elective surgery. They have a newly detected heart murmur and exertional syncope.

   Which preoperative cardiac assessment is consistent with NICE NG45?

   • A. Order a chest X-ray instead of ECG and echocardiography
   • B. Consider resting echocardiography; first obtain a resting ECG and discuss the findings with an anaesthetist
   • C. Order echocardiography routinely for every surgical patient
   • D. Proceed without cardiac assessment because the procedure is elective and the murmur is likely benign
   Show answer

   Answer: B. Consider resting echocardiography; first obtain a resting ECG and discuss the findings with an anaesthetist

   Why: NICE NG45 recommendations 1.9.1 and 1.9.2 advise against routine resting echocardiography, but say to consider it for a murmur with a cardiac symptom such as syncope. Before ordering, carry out a resting ECG and discuss findings with an anaesthetist.

   • A. NICE does not recommend routine chest X-rays; it specifies ECG and anaesthetist discussion before echo in this situation.
   • C. NICE advises against routine preoperative echocardiography.
   • D. A murmur with syncope is a symptom combination for which NICE says to consider echocardiography.

   Sources: NICE NG45 recommendations 1.9.1 and 1.9.2

9. 8 / 10

   A 46-year-old adult is scheduled for elective surgery under general anaesthesia. They ask the preoperative nurse whether they must avoid all drinks from midnight, despite having no condition that changes the usual fasting plan.

   What should the team tell this adult about clear fluids before the operation, in line with NICE perioperative guidance?

   • A. Avoid all food and fluids from midnight in every case
   • B. Clear fluids may be taken until 2 hours before the operation
   • C. Clear fluids are permitted until 30 minutes before induction
   • D. Only milk-containing drinks are permitted during the 2 hours before surgery
   Show answer

   Answer: B. Clear fluids may be taken until 2 hours before the operation

   Why: NICE NG180 recommendation 1.4.1 says adults having surgery, including dental surgery, should be told that they may drink clear fluids until 2 hours before their operation. Examples are water, fruit juice without pulp, coffee or tea without milk, and ice lollies. The scenario asks for routine adult advice; an individual anaesthetic or surgical plan may differ when clinically indicated, so the candidate should communicate the agreed local plan rather than invent a longer fasting interval.

   • A. A blanket instruction to avoid clear fluids from midnight is not what NICE recommends for adults having surgery.
   • C. The NICE recommendation specifies a 2-hour interval before the operation, not 30 minutes.
   • D. Milk is not included in NICE's examples of clear fluids; the guidance gives water, pulp-free juice, tea or coffee without milk, and ice lollies.

   Sources: NICE NG180 recommendation 1.4.1

10. 9 / 10

    A 58-year-old is booked for an intermediate elective operation. During preoperative assessment, the team reviews nutritional risk and asks which screening action is recommended by NICE.

    What should be offered before this operation?

    • A. Defer all nutrition assessment until after the operation
    • B. Nutritional screening only if the patient has already lost weight
    • C. A fasting blood test instead of nutritional screening
    • D. Offer preoperative nutritional screening
    Show answer

    Answer: D. Offer preoperative nutritional screening

    Why: NICE NG180 recommendation 1.3.10 says to offer preoperative nutritional screening to people having intermediate surgery or major or complex surgery. If screening identifies a need, recommendation 1.3.11 directs clinicians to NICE guidance on nutrition support for adults for screening, indications and what to provide. The operation in this scenario is intermediate, so screening should be offered before surgery.

    • A. The recommendation is for preoperative screening, so waiting until after surgery would miss the stated timing.
    • B. NICE recommends offering preoperative nutritional screening to people having intermediate surgery; documented weight loss is not required first.
    • C. NICE specifically recommends preoperative nutritional screening for intermediate surgery; a blood test is not a substitute for that assessment.

    Sources: NICE NG180 recommendations 1.3.10 and 1.3.11

11. 10 / 10

    A 54-year-old with no urinary symptoms is scheduled for elective joint replacement. Finding asymptomatic bacteriuria would not change the decision to operate.

    What preoperative urine testing does NICE recommend?

    • A. Perform microscopy and culture in every patient
    • B. Use urine testing instead of clinical assessment
    • C. Do not routinely offer a urine dipstick test
    • D. Perform dipstick and culture in every patient
    Show answer

    Answer: C. Do not routinely offer a urine dipstick test

    Why: NICE NG45 recommendations 1.7.1 and 1.7.2 say not to routinely offer preoperative urine dipstick tests. Consider microscopy and culture if the presence of a urinary tract infection would influence the decision to operate.

    • A. NICE says to consider microscopy and culture only if UTI presence would influence the decision to operate.
    • B. Routine urine dipstick testing is not recommended, and tests should be targeted to whether results would affect management.
    • D. NICE advises against routine dipstick and limits consideration of culture to circumstances where UTI would affect the decision to operate.

    Sources: NICE NG45 recommendations 1.7.1 and 1.7.2

Exam-style questions written by MedHub for practice. They are not official exam questions.