Regional anaesthesia: 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 · Regional anaesthesia

Sample item

An epidural catheter is inserted for labour analgesia. A test dose of 3 ml of 1.5% lignocaine with adrenaline 1:200,000 is given. Within a minute the woman has palpitations, tachycardia and a sharp rise in blood pressure. What does this indicate?

ACorrect epidural placementBAnaphylaxis to lignocaineCIntrathecal placement of the catheterDIntravascular placement of the catheter

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

The answer and the reasoning

D. Intravascular placement of the catheter

An epinephrine-containing test dose causes a prompt rise in heart rate (usually more than 20 beats per minute) if injected into an epidural vein. The catheter should be withdrawn and resited. A rapidly developing dense motor block suggests an intrathecal position instead.

Option by option

A. Correct epidural placement
Correct epidural placement produces no marked cardiovascular response to the test dose.
B. Anaphylaxis to lignocaine
Anaphylaxis would cause hypotension, bronchospasm and urticaria rather than hypertension and tachycardia.
C. Intrathecal placement of the catheter
Intrathecal injection of the test dose would produce rapid sensory and motor block of the legs.
D. Intravascular placement of the catheter (correct)
Correct. A rapid heart rate and blood pressure rise after adrenaline signals intravenous injection.

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.

Questions about this Anaesthesia question

What is the answer to this Anaesthesia question?

The best answer is D, Intravascular placement of the catheter. An epinephrine-containing test dose causes a prompt rise in heart rate (usually more than 20 beats per minute) if injected into an epidural vein.

Why is "Correct epidural placement" not the answer?

Correct epidural placement produces no marked cardiovascular response to the test dose.

Why is "Anaphylaxis to lignocaine" not the answer?

Anaphylaxis would cause hypotension, bronchospasm and urticaria rather than hypertension and tachycardia.

Why is "Intrathecal placement of the catheter" not the answer?

Intrathecal injection of the test dose would produce rapid sensory and motor block of the legs.

What concept does this question test?

It tests Regional anaesthesia in Anaesthesia. The catheter should be withdrawn and resited. A rapidly developing dense motor block suggests an intrathecal position instead.

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 Regional anaesthesia?

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.