Preoperative assessment: Eisenmenger syndrome: 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.

Try it

Anaesthesia · Preoperative assessment: Eisenmenger syndrome

Sample item

A 30-year-old woman with Eisenmenger syndrome (pulmonary hypertension with reversed shunt through a ventricular septal defect) needs a non-cardiac operation. Which change would worsen her cyanosis?

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

The answer and the reasoning

D. A fall in systemic vascular resistance

In Eisenmenger syndrome the direction of the shunt depends on the balance of systemic and pulmonary resistance. A fall in systemic vascular resistance, as from a spinal block, vasodilators or deep volatile anaesthesia, increases the right-to-left shunt and cyanosis. Systemic resistance is therefore maintained, and pulmonary vasoconstrictors such as hypoxia and hypercarbia are avoided.

Option by option

  • A. Mild hyperventilation lowering PaCO2

    Lowering PaCO2 reduces pulmonary vascular resistance and helps.

  • B. A rise in systemic vascular resistance with phenylephrine

    Raising systemic resistance opposes the right-to-left shunt and is therapeutic.

  • C. An increase in the inspired oxygen concentration

    Oxygen dilates the pulmonary vessels and helps reduce the shunt.

  • D. A fall in systemic vascular resistance (correct)

    Correct. Lower systemic resistance pushes more blood across the defect from right to left.

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.

More Anaesthesia questions

Questions about this Anaesthesia question

What is the answer to this Anaesthesia question?

The best answer is D, A fall in systemic vascular resistance. In Eisenmenger syndrome the direction of the shunt depends on the balance of systemic and pulmonary resistance.

Why is "Mild hyperventilation lowering PaCO2" not the answer?

Lowering PaCO2 reduces pulmonary vascular resistance and helps.

Why is "A rise in systemic vascular resistance with phenylephrine" not the answer?

Raising systemic resistance opposes the right-to-left shunt and is therapeutic.

Why is "An increase in the inspired oxygen concentration" not the answer?

Oxygen dilates the pulmonary vessels and helps reduce the shunt.

What concept does this question test?

It tests Preoperative assessment: Eisenmenger syndrome in Anaesthesia. A fall in systemic vascular resistance, as from a spinal block, vasodilators or deep volatile anaesthesia, increases the right-to-left shunt and cyanosis. Systemic resistance is therefore maintained, and pulmonary vasoconstrictors such as hypoxia and hypercarbia are avoided.

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 Preoperative assessment: Eisenmenger syndrome?

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.