Preoperative Medical Assessment AND Optimisation — Written Clinical Reasoning · Phys Written Answers

Prompt

DCE-style written reasoning for Preoperative Medical Assessment AND Optimisation.

SAQ 1 — Integrated plan (12 marks)

Prompt: Provide a prioritised problem list and management sequence for this presentation. [1] [2]

Model Answer

1. Frame and red flags (3 marks) [1]

State the working diagnosis/syndrome, acuity, and what would force emergency treatment now. [1] [2]

2. Discriminating assessment (3 marks) [2]

List the key history, examination and investigations that separate dangerous differentials from benign mimics. [1] [2]

3. Treatment sequence (4 marks) [1] [3]

Immediate stabilisation, disease-specific therapy, monitoring, and complications prevention. [1] [2] [3]

4. Follow-up and communication (2 marks) [2]

Disposition, safety-net advice, and who owns follow-up. [1] [2]

SAQ 2 — Exam trap defence (8 marks)

Prompt: Name two high-yield traps in Preoperative Medical Assessment AND Optimisation and how you avoid them. [1] [2]

Model Answer

Trap one: delayed escalation of a high-risk feature — avoid by explicit red-flag checklist. [1]

Trap two: therapy mismatched to mechanism — avoid by confirming the discriminating test before escalating treatment. [2] [3]

References

[1]Nmezi J Anaesthetic Management of a Patient With Severe Bipolar Disorder: A Case Report Cureus, 2026.PMID 42368232
[2]Krnojelac M, Andjelković L Surgical Resection of a Giant Hepatocellular Carcinoma in an 89-Year-Old Patient with Multiple Comorbidities: The Role of Frailty Assessment and Preoperative Optimisation-A Case Report and Literature Review Diagnostics (Basel), 2026.PMID 42351561
[3]Charles AE, Castillo Suárez AA, Chhajed M, Jimenez Gallardo M, et al. Perioperative sleep optimisation and brain health in older adults (SLEEP-BOOST): protocol for a randomised controlled trial BMJ Open, 2026.PMID 42209013
[4]Dreher D, Honnef G, Zoidl P, Auinger D, et al. Patient Blood Management: a systematic review of current international guidelines Br J Anaesth, 2026.PMID 42115060
[5]Melgaard E, Westergaard LM, Olesen AS, Miger K, et al. Heart size on chest CT and its association with acute heart failure in the emergency department Dan Med J, 2026.PMID 42095314
[6]Sørensen TB, Angaard LK, Axelsen DR, Lauridsen MC Preoperative imaging lowers the negative appendectomy rate in acute appendicitis Dan Med J, 2026.PMID 41978449
[7]Doan HN, Chang MC Comparative Effectiveness of Unstable Versus Stable Resistance Training on Lower Limb Strength, Mobility, and Fear of Falling in Older Adults: A Systematic Review and Meta-analysis of Randomized Controlled Trials Am J Phys Med Rehabil, 2026.PMID 42468010
[8]Liu HW, Tsai TL Virtual Reality-assisted Physiotherapeutic Training for Patients With Knee Osteoarthritis: A Systematic Review and Meta-analysis Am J Phys Med Rehabil, 2026.PMID 42468005

SAQ 1 — Integrated plan (12 marks)

Prompt: Provide a prioritised problem list and management sequence for this presentation. [1] [2]

Model Answer

1. Frame and red flags (3 marks) [1]

State the working diagnosis/syndrome, acuity, and what would force emergency treatment now. [1] [2]

2. Discriminating assessment (3 marks) [2]

List the key history, examination and investigations that separate dangerous differentials from benign mimics. [1] [2]

3. Treatment sequence (4 marks) [1] [3]

Immediate stabilisation, disease-specific therapy, monitoring, and complications prevention. [1] [2] [3]

4. Follow-up and communication (2 marks) [2]

Disposition, safety-net advice, and who owns follow-up. [1] [2]

SAQ 2 — Exam trap defence (8 marks)

Prompt: Name two high-yield traps in Preoperative Medical Assessment AND Optimisation and how you avoid them. [1] [2]

Model Answer

Trap one: delayed escalation of a high-risk feature — avoid by explicit red-flag checklist. [1]

Trap two: therapy mismatched to mechanism — avoid by confirming the discriminating test before escalating treatment. [2] [3]

References

[1]Nmezi J Anaesthetic Management of a Patient With Severe Bipolar Disorder: A Case Report Cureus, 2026.PMID 42368232
[2]Krnojelac M, Andjelković L Surgical Resection of a Giant Hepatocellular Carcinoma in an 89-Year-Old Patient with Multiple Comorbidities: The Role of Frailty Assessment and Preoperative Optimisation-A Case Report and Literature Review Diagnostics (Basel), 2026.PMID 42351561
[3]Charles AE, Castillo Suárez AA, Chhajed M, Jimenez Gallardo M, et al. Perioperative sleep optimisation and brain health in older adults (SLEEP-BOOST): protocol for a randomised controlled trial BMJ Open, 2026.PMID 42209013
[4]Dreher D, Honnef G, Zoidl P, Auinger D, et al. Patient Blood Management: a systematic review of current international guidelines Br J Anaesth, 2026.PMID 42115060
[5]Melgaard E, Westergaard LM, Olesen AS, Miger K, et al. Heart size on chest CT and its association with acute heart failure in the emergency department Dan Med J, 2026.PMID 42095314
[6]Sørensen TB, Angaard LK, Axelsen DR, Lauridsen MC Preoperative imaging lowers the negative appendectomy rate in acute appendicitis Dan Med J, 2026.PMID 41978449
[7]Doan HN, Chang MC Comparative Effectiveness of Unstable Versus Stable Resistance Training on Lower Limb Strength, Mobility, and Fear of Falling in Older Adults: A Systematic Review and Meta-analysis of Randomized Controlled Trials Am J Phys Med Rehabil, 2026.PMID 42468010
[8]Liu HW, Tsai TL Virtual Reality-assisted Physiotherapeutic Training for Patients With Knee Osteoarthritis: A Systematic Review and Meta-analysis Am J Phys Med Rehabil, 2026.PMID 42468005