AS Pre-Anaesthetic Assessment — SCE Rheumatology MCQ

Correct answer: D — Focused airway and cervical spine assessment, including mouth opening, neck position and cervical mobility

The correct answer is D. Ankylosing spondylitis may cause fixed cervical kyphosis, markedly restricted neck movement and temporomandibular joint limitation, making direct laryngoscopy difficult and potentially hazardous. Assessment should therefore include mouth opening, resting neck position, cervical mobility, neurological symptoms or signs, and the patient's ability to tolerate positioning. This informs an airway plan that minimises cervical manipulation; awake tracheal intubation may be appropriate when substantial difficulty is anticipated but is not required routinely. Whole-spine MRI is not an essential screening investigation before every general anaesthetic. Lumbar assessment alone does not address intubation risk, and absence of neck pain does not exclude severe restriction or a difficult airway.

Reference: Royal College of Anaesthetists. Guide to the FRCA Examination—The Final, Fourth Edition. Section 3, SOE 2 answers: perioperative problems posed by ankylosing spondylitis. 2020. https://www.rcoa.ac.uk/sites/default/files/documents/2025-08/Final2020-REVISED%20FOR%20WEBSITE.pdf