Preoperative Investigations — FRCA Final MCQ

Instant feedback + full explanation. One question, done properly.

EasyPreoperative AssessmentPreoperative InvestigationsFRCA Final

A 50-year-old man who is ASA physical status 1 is scheduled for elective arthroscopic anterior cruciate ligament reconstruction as a day case. This is classified as intermediate surgery. He has no relevant symptoms, comorbidities or medication use identified during preoperative assessment. According to NICE NG45, which of the following routine preoperative investigations should be offered?

Educational content. Not a substitute for clinical judgement or local policy.

Reveal the answer and explanation

Correct answer: D — None of these tests routinely

Explanation lettering: D = shown as B · E = shown as C · B = shown as D · C = shown as E

The correct answer is B. NICE NG45 classifies knee arthroscopy as intermediate surgery. For an ASA 1 patient undergoing intermediate surgery, full blood count, kidney function testing and resting ECG are all designated “not routinely” required. General anaesthesia or day-case status alone does not create an indication for these tests. Therefore, options A, C, D and E each include at least one investigation that should not be offered routinely. Tests may still be appropriate when prompted by the history, examination, medication use or a specific perioperative concern. The original results being normal does not retrospectively justify ordering them. NICE NG45 does not use an age threshold of 60 years for ASA 1 patients having intermediate surgery; age over 65 is relevant to consideration of ECG in ASA 1 patients undergoing major or complex surgery.

Reference: National Institute for Health and Care Excellence. Routine preoperative tests for elective surgery (NG45), Recommendations, Table 2: Intermediate surgery. 2016. https://www.nice.org.uk/guidance/ng45/chapter/Recommendations