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Surgical Stress Response — FRCA Primary MCQ

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HardPhysiology - Endocrine & MetabolicSurgical Stress ResponseFRCA Primary

A patient undergoes major abdominal surgery without neuraxial analgesia. Which metabolic pattern is most consistent with the early surgical stress response?

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Correct answer: B — Increased hepatic glucose output with peripheral insulin resistance

The best answer is “Increased hepatic glucose output with peripheral insulin resistance”. Surgical stress activates sympathetic and HPA pathways, increasing catecholamines, cortisol and other counter-regulatory influences. Hepatic glucose output rises while peripheral insulin resistance limits glucose uptake, producing stress hyperglycaemia. The remaining options describe the opposite anabolic pattern and do not fit the early catabolic response to major surgery.

Reference: RCoA, Primary FRCA syllabus: https://www.rcoa.ac.uk/sites/default/files/documents/2026-01/Primary-FRCA-Syllabus.pdf; Surgical stress response: endocrine, immune and metabolic changes: https://pmc.ncbi.nlm.nih.gov/articles/PMC12831963/