Preoperative assessment: severe hypothyroidism: 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: severe hypothyroidism

Sample item

A 55-year-old woman with untreated severe hypothyroidism is brought for urgent surgery. Which feature should the anaesthetist anticipate?

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

The answer and the reasoning

D. Sensitivity to sedatives, with hypothermia, bradycardia and delayed emergence

Severe hypothyroidism lowers metabolic rate, cardiac output and ventilatory drive, and reduces drug requirements. Hypothermia, bradycardia, hypotension, hyponatraemia and delayed awakening are expected, and an enlarged tongue or goitre may complicate the airway.

Option by option

  • A. Hyperkalaemia with exaggerated airway reflexes

    Hyperkalaemia is not a feature; hyponatraemia is more typical.

  • B. Resistance to usual induction doses with brisk, rapid emergence

    Hypothyroid patients need less, not more, anaesthetic, and wake slowly.

  • C. Tachycardia and hyperthermia from rapid drug metabolism

    Tachycardia and fever with rapid metabolism describe thyrotoxicosis.

  • D. Sensitivity to sedatives, with hypothermia, bradycardia and delayed emergence (correct)

    Correct. A low metabolic rate makes the patient sensitive to depressants and slow to wake.

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 D, Sensitivity to sedatives, with hypothermia, bradycardia and delayed emergence. Severe hypothyroidism lowers metabolic rate, cardiac output and ventilatory drive, and reduces drug requirements.

Why is "Hyperkalaemia with exaggerated airway reflexes" not the answer?

Hyperkalaemia is not a feature; hyponatraemia is more typical.

Why is "Resistance to usual induction doses with brisk, rapid emergence" not the answer?

Hypothyroid patients need less, not more, anaesthetic, and wake slowly.

Why is "Tachycardia and hyperthermia from rapid drug metabolism" not the answer?

Tachycardia and fever with rapid metabolism describe thyrotoxicosis.

What concept does this question test?

It tests Preoperative assessment: severe hypothyroidism in Anaesthesia. Hypothermia, bradycardia, hypotension, hyponatraemia and delayed awakening are expected, and an enlarged tongue or goitre may complicate the airway.

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: severe hypothyroidism?

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.