Local and regional anaesthesia: brachial plexus approach in COPD: 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 · Local and regional anaesthesia: brachial plexus approach in COPD

Sample item

A patient with severe COPD needs forearm arteriovenous fistula surgery under regional anaesthesia. Which brachial plexus approach avoids both phrenic nerve palsy and pneumothorax?

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

The answer and the reasoning

C. Axillary

The axillary approach blocks the plexus around the axillary artery, far from the phrenic nerve and pleura, and suits forearm and hand surgery. Interscalene block nearly always paralyses the ipsilateral hemidiaphragm, and supraclavicular block carries the risk of pneumothorax.

Option by option

  • A. Cervical paravertebral

    A cervical paravertebral block is near the phrenic nerve and is not used for this surgery.

  • B. Interscalene

    Interscalene block almost always affects the phrenic nerve, which is unsafe in severe COPD.

  • C. Axillary (correct)

    Correct. It lies away from the pleura and phrenic nerve, and covers forearm surgery.

  • D. Supraclavicular

    The supraclavicular block lies over the pleural dome and risks pneumothorax.

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.

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Questions about this Anaesthesia question

What is the answer to this Anaesthesia question?

The best answer is C, Axillary. The axillary approach blocks the plexus around the axillary artery, far from the phrenic nerve and pleura, and suits forearm and hand surgery.

Why is "Cervical paravertebral" not the answer?

A cervical paravertebral block is near the phrenic nerve and is not used for this surgery.

Why is "Interscalene" not the answer?

Interscalene block almost always affects the phrenic nerve, which is unsafe in severe COPD.

Why is "Supraclavicular" not the answer?

The supraclavicular block lies over the pleural dome and risks pneumothorax.

What concept does this question test?

It tests Local and regional anaesthesia: brachial plexus approach in COPD in Anaesthesia. Interscalene block nearly always paralyses the ipsilateral hemidiaphragm, and supraclavicular block carries the risk of pneumothorax.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. 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 Local and regional anaesthesia: brachial plexus approach in COPD?

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.