Preoperative assessment: Marfan syndrome: 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: Marfan syndrome

Sample item

A tall 28-year-old man with long fingers, lens subluxation and an aortic root diameter of 45 mm is listed for an elective procedure under general anaesthesia. Which haemodynamic aim is most important?

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

The answer and the reasoning

B. Avoid surges in blood pressure and heart rate that increase aortic wall stress

Marfan syndrome weakens the aortic media, so aortic dilatation, dissection and rupture are the major risks. Laryngoscopy, pain and light anaesthesia produce pressor responses that raise wall stress, so these are blunted, and beta blockade is usually continued.

Option by option

  • A. Give large fluid boluses to keep the aorta well filled

    Volume loading raises aortic wall tension and has no protective role.

  • B. Avoid surges in blood pressure and heart rate that increase aortic wall stress (correct)

    Correct. Limiting wall stress protects the dilated aorta from dissection.

  • C. Maintain a high systemic vascular resistance with a vasopressor infusion

    Raising afterload increases wall tension and the risk of dissection.

  • D. Keep the heart rate high with atropine to maintain cardiac output

    Tachycardia raises aortic wall stress and is undesirable.

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 B, Avoid surges in blood pressure and heart rate that increase aortic wall stress. Marfan syndrome weakens the aortic media, so aortic dilatation, dissection and rupture are the major risks.

Why is "Give large fluid boluses to keep the aorta well filled" not the answer?

Volume loading raises aortic wall tension and has no protective role.

Why is "Maintain a high systemic vascular resistance with a vasopressor infus…" not the answer?

Raising afterload increases wall tension and the risk of dissection.

Why is "Keep the heart rate high with atropine to maintain cardiac output" not the answer?

Tachycardia raises aortic wall stress and is undesirable.

What concept does this question test?

It tests Preoperative assessment: Marfan syndrome in Anaesthesia. Laryngoscopy, pain and light anaesthesia produce pressor responses that raise wall stress, so these are blunted, and beta blockade is usually continued.

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: Marfan syndrome?

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.