Anaesthesia MCQs for NEET PG
964 worked Anaesthesia questions across 149 areas. Each one has its own page with the reasoning for every option.
What this set is
Anaesthesia is a small subject focused on drugs, airway, regional techniques and complications. It rewards recalling specific agents and their effects.
This page lists the 964 Anaesthesia questions that have a full worked page: 692 application questions that put a fact to use on a patient or a finding, and 272 multi-step questions that combine two or more ideas. Plain one-fact recall items are left out here on purpose. The Anaesthesia practice bank in the app is larger, with 3,500 questions in all, and is where timed tests and daily practice draw from.
How to use it
- Pick an area you are weak in, below.
- Answer first, then read why each wrong option fails.
- Write a three-line note for every miss, and revisit it in a week.
- Move to a timed Anaesthesia test once an area feels steady.
These are original practice items, not recalled exam questions, and they are not yet reviewed by independent faculty. Confirm important facts in a standard textbook.
What Anaesthesia covers in the exam
- Preoperative assessment
- Intravenous and inhalational agents
- Muscle relaxants
- Local and regional anaesthesia
- Airway management
- Complications and emergencies
- Basic resuscitation
A study map from the standard curriculum; the NBEMS bulletin is the authority. See the Anaesthesia study guide.
Worked questions by area
149 areas, largest first. Open an area to see its questions.
Airway management56
- Airway management · Multi-stepA 30-year-old man with a distended abdomen from acute intestinal obstruction, who vomited an hour ago, needs emergency laparotomy. Which induction plan best reduces the…
- Airway management: cricoid pressure · Multi-stepWhat force is applied to the cricoid cartilage in an awake patient and after loss of consciousness during rapid sequence induction?
- Airway management: rapid sequence induction · ApplicationWhich neuromuscular blocker and dose provides intubating conditions comparable to suxamethonium in a rapid sequence induction?
- Airway management: cannot intubate cannot oxygenate · ApplicationAfter failed intubation and failed supraglottic airway, a patient remains hypoxic with no oxygenation by face mask. What is the next step?
- Airway management: awake fibreoptic intubation · ApplicationIn which patient is an awake fibreoptic intubation especially appropriate?
- Airway management: ankylosing spondylitis · Multi-stepA 45-year-old man with advanced ankylosing spondylitis has a fixed flexion deformity of the neck and a rigid spine and requires general anaesthesia. Which airway approa…
- Airway management: Pierre Robin sequence · Multi-stepA neonate with Pierre Robin sequence (micrognathia and glossoptosis) needs general anaesthesia for a cleft palate procedure. Which strategy is preferred for securing th…
- Airway management: superior laryngeal nerve block · ApplicationWhich nerve is blocked to anaesthetise the larynx above the vocal cords for awake intubation, by injection through the thyrohyoid membrane?
- Airway management: transtracheal jet ventilation · Multi-stepWhat is the main danger of jet ventilation through a cricothyroid cannula in complete upper airway obstruction?
- Airway management: early tracheostomy dislodgement · Multi-stepA patient with a 3-day-old tracheostomy is decannulated accidentally and becomes hypoxic. What is the safest approach?
- Airway management: hypoxaemia during one-lung ventilation · Multi-stepDuring right thoracotomy with left lung ventilation, saturation falls to 85% and the double-lumen tube position has been confirmed by bronchoscope on 100% oxygen. What…
- Airway management: videolaryngoscopy after a poor view · ApplicationDirect laryngoscopy shows only the tip of the epiglottis in a patient with limited neck extension. Which device best improves the glottic view?
- Airway management: desaturation in obesity · ApplicationWhy does a morbidly obese patient desaturate within minutes of apnoea despite preoxygenation?
- Airway management: obstructing laryngeal tumour · Multi-stepAn elderly man with a bulky laryngeal tumour has inspiratory stridor at rest and needs an airway before biopsy. Which is the safest technique?
- Airway management: capnograph with a notch in the plateau · Multi-stepIn a ventilated patient on a relaxant infusion, the end-tidal CO2 waveform shows a dip in the plateau. What does this indicate?
- Airway management: Combitube · ApplicationA paramedic inserts a blind double-lumen airway with two cuffs, and it usually ends in the oesophagus after insertion, allowing ventilation through pharyngeal perforati…
- Airway management: needle cricothyroidotomy in children · Multi-stepA 4-year-old with an impacted foreign body at the glottis cannot be intubated, and SpO2 is falling despite bag-mask ventilation. What is the preferred emergency front-o…
- Airway management: timing of tracheostomy · ApplicationA patient with Guillain-Barre syndrome has been ventilated through an oral tracheal tube for 12 days and is not expected to wean for several more weeks. What is the bes…
- Airway management: lung isolation in a child · ApplicationA 5-year-old needs lung isolation for thoracoscopic surgery, but even the smallest double-lumen tube is too large. Which device is suitable?
- Airway management: retrograde intubation · ApplicationIn a patient with a fixed cervical spine deformity who cannot be intubated by direct laryngoscopy, a guidewire is passed through the cricothyroid membrane, up through t…
- Airway management: Ludwig angina · Multi-stepA 45-year-old with a molar infection has fever, bilateral woody submandibular swelling, trismus and a raised tongue, and is listed for drainage. Which airway plan is sa…
- Airway management: upper lip bite test · ApplicationDuring airway assessment, a patient is asked to bite the upper lip with the lower incisors and cannot bite it at all (class III). What does this predict?
- Airway management: positioning for internal jugular cannulation · ApplicationBefore right internal jugular vein cannulation in an adult, the patient is placed head down by about 15 degrees. What is the main benefit?
- Airway management: oxygen concentrator · ApplicationWhich statement about a pressure swing adsorption oxygen concentrator is correct?
- Airway management: high-flow nasal oxygen · ApplicationHow does heated humidified high-flow nasal oxygen improve oxygenation during apnoea or in hypoxaemic respiratory failure?
- Airway management: tracheal stenosis after intubation · Multi-stepA 40-year-old develops progressive exertional dyspnoea and stridor six weeks after a three-week stay in intensive care with a tracheal tube. The flow-volume loop shows…
- Airway management: nitrous oxide and cuff pressure · ApplicationDuring a 5-hour operation with 66 percent nitrous oxide in oxygen, the cuff pressure of the tracheal tube rises from 25 to above 50 cm H2O. What explains this?
- Airway management: escalation of laryngospasm · Multi-stepDuring emergence from sevoflurane a child has complete upper airway obstruction with a silent bag and paradoxical chest movement. Despite 100 percent oxygen, CPAP, jaw…
- Airway management: retrosternal goitre · ApplicationA 55-year-old with a long-standing goitre extending behind the sternum has positional dyspnoea and is listed for thyroidectomy. Which investigation best predicts airway…
- Airway management: tracheo-innominate fistula · Multi-stepTen days after a tracheostomy a patient has a small bleed from the stoma, and soon after a sudden torrential bright red haemorrhage that pulsates with the tube. What is…
- Airway management: level of tracheostomy · ApplicationA surgeon places a tracheostomy through the first tracheal ring, immediately below the cricoid cartilage. Which late complication is the main concern?
- Airway management: avoiding deep extubation · ApplicationDeep extubation, before airway reflexes return, is generally avoided in which patient?
- Airway management: inhalation injury · ApplicationA man rescued from a fire in a closed room has singed nasal hair, facial burns, a hoarse voice and carbonaceous sputum. He is speaking and SpO2 is 96 percent. What is t…
- Airway management: transtracheal injection · ApplicationTo anaesthetise the trachea and the larynx below the vocal cords before awake intubation, local anaesthetic is injected through the cricothyroid membrane into the airwa…
- Airway management: neck flexion and tube position · ApplicationAfter intubation with the head in the sniffing position, the patient is repositioned with the neck flexed for surgery. What happens to the tracheal tube?
- Airway management: intubating laryngeal mask · ApplicationWhich supraglottic device is designed to act as a conduit for blind passage of a tracheal tube in an anticipated difficult airway?
- Airway management: regurgitation during induction · ApplicationDuring a rapid sequence induction, gastric contents are seen welling up in the pharynx before the tube has been passed. What is the immediate action?
- Airway management: oesophageal detector device · ApplicationA syringe or self-inflating bulb is attached to a tracheal tube just placed, and aspiration meets marked resistance and the bulb fails to re-expand. What does this sugg…
- Airway management: aspiration pneumonitis treatment · ApplicationA witnessed aspiration of gastric contents occurs at induction and the saturation falls to 88 percent. After suction of the airway, what is the best ongoing management?
- Airway management: vomiting with cricoid pressure · Multi-stepDuring rapid sequence induction cricoid pressure is applied, and before the tube is passed the patient starts to vomit actively. What should be done?
- Airway management · ApplicationWhat device is commonly used to deliver oxygen by face mask?
- Airway management · ApplicationWhat tube secures the airway for controlled ventilation during general anesthesia?
- Airway management · ApplicationWhat is the purpose of preoxygenation before induction?
- Airway management · ApplicationWhat equipment is used to visualize the vocal cords for intubation?
- Airway management · ApplicationWhat is a supraglottic airway device positioned above?
- Airway management · ApplicationWhat is a difficult-airway plan intended to ensure?
- Airway management · ApplicationWhat is the purpose of cricoid pressure in selected rapid-sequence inductions?
- Airway management · ApplicationWhat best confirms endotracheal tube placement?
- Airway management · ApplicationWhat device delivers oxygen and ventilation manually by mask?
- Airway management · ApplicationWhat tube permits controlled ventilation during general anesthesia?
- Airway management · ApplicationWhat is the purpose of preoxygenation before induction?
- Airway management · ApplicationWhen is rapid-sequence induction commonly used?
- Airway management: Mallampati · ApplicationA Mallampati class IV airway shows which finding when the patient opens the mouth and protrudes the tongue?
- Airway management: rapid sequence induction · ApplicationRapid sequence induction is most appropriate when which risk is high?
- Airway management · ApplicationWhy is ramped positioning used before induction in many patients with obesity?
- Airway management · ApplicationWhat is the role of a supraglottic airway device?
Critical care56
- Critical care: types of shock · ApplicationIn a patient with early septic (distributive) shock, which haemodynamic profile is expected before fluid resuscitation is complete?
- Critical care: sepsis fluids · ApplicationIn the initial resuscitation of sepsis-induced hypoperfusion, what is the suggested fluid volume and type?
- Critical care: haemorrhagic shock classification · ApplicationA trauma patient has a pulse of 130 per minute, blood pressure 90/60 mmHg, respiratory rate 32 and an estimated blood loss of 35%. Which ATLS class is this?
- Critical care: anion gap · ApplicationA patient with severe diarrhoea has pH 7.28, HCO3 14 mEq/L and a normal anion gap. What is the type of acidosis?
- Critical care: ARDS definition · ApplicationWhich finding is required for a diagnosis of ARDS by the Berlin definition?
- Critical care: lung-protective ventilation · ApplicationWhich ventilator strategy improves survival in ARDS?
- Critical care: prone positioning · Multi-stepIn which patients does prone positioning reduce mortality?
- Critical care: PEEP · ApplicationWhat is the main physiological effect of PEEP in lung injury?
- Critical care: ventilator modes · ApplicationIn which mode does every breath receive a preset tidal volume irrespective of the patient's own effort?
- Critical care: weaning · Multi-stepA rapid shallow breathing index (respiratory rate divided by tidal volume in litres) below which value predicts successful weaning?
- Critical care: central venous catheter · ApplicationWhere should the tip of a central venous catheter placed via the internal jugular vein lie?
- Critical care: qSOFA criteria · ApplicationWhich set of findings makes up the quick SOFA (qSOFA) screening score?
- Critical care: Sepsis-3 definition · ApplicationAccording to the Sepsis-3 definition, sepsis is best described as which of the following?
- Critical care: septic shock vasopressor target · ApplicationIn septic shock, what initial mean arterial pressure target is recommended with norepinephrine?
- Critical care: initial fluid in sepsis-induced hypoperfusion · ApplicationFor sepsis-induced hypoperfusion or septic shock, what initial crystalloid volume do guidelines suggest within the first 3 hours?
- Critical care: adding vasopressin in septic shock · Multi-stepA patient in septic shock remains hypotensive on norepinephrine at 0.3 mcg/kg/min after adequate fluids. Which is the recommended next step?
- Critical care: hydrocortisone in refractory septic shock · ApplicationWhen is intravenous hydrocortisone suggested in septic shock?
- Critical care: central line site and infection · ApplicationWhich central venous insertion site carries the lowest infection risk and which the highest?
- Critical care: pulmonary artery wedge pressure · Multi-stepA patient with bilateral infiltrates and severe hypoxaemia has a pulmonary artery wedge pressure of 10 mmHg. What does this suggest?
- Critical care: haemodynamic profiles of shock · Multi-stepWhich haemodynamic profile is typical of established cardiogenic shock?
- Critical care: oxygen delivery · ApplicationWhich change produces the largest increase in oxygen delivery in a severely anaemic patient with normal saturation and cardiac output?
- Critical care: oxyhaemoglobin dissociation curve · ApplicationWhich condition shifts the oxyhaemoglobin dissociation curve to the right?
- Critical care: A-a gradient · Multi-stepA patient with an opioid overdose has a PaCO2 of 80 mmHg and hypoxaemia on room air. What is expected of the alveolar-arterial oxygen gradient?
- Critical care: respiratory compensation in metabolic acidosis · Multi-stepA patient has a bicarbonate of 12 mmol/L. According to Winter's formula, what PaCO2 is expected with appropriate compensation?
- Critical care: bicarbonate in lactic acidosis · Multi-stepIn septic shock with lactic acidosis, when is sodium bicarbonate suggested?
- Critical care: correction of chronic hyponatraemia · Multi-stepA patient with chronic hyponatraemia of 112 mmol/L has seizures. After a 3 percent saline bolus, what is the maximum safe correction in 24 hours?
- Critical care: hypokalaemia on ECG · ApplicationWhich ECG finding is characteristic of hypokalaemia?
- Critical care: hypocalcaemia after thyroidectomy · ApplicationA patient develops perioral tingling and carpopedal spasm 24 hours after total thyroidectomy. Which ECG change is expected?
- Critical care: refeeding syndrome · ApplicationWhich electrolyte abnormality is most characteristic of refeeding syndrome?
- Critical care: delirium assessment · ApplicationWhich tool is commonly used to diagnose delirium in a ventilated patient?
- Critical care: sedation scale · ApplicationOn the Richmond Agitation-Sedation Scale, which score represents a patient who is unarousable?
- Critical care: ECMO configurations · Multi-stepA young patient with severe refractory ARDS has adequate cardiac function. Which ECMO configuration is appropriate?
- Critical care: diabetic ketoacidosis management · Multi-stepA patient with DKA has a glucose of 520 mg/dL, pH 7.05 and potassium of 2.9 mmol/L. What is the next step?
- Critical care: ventilation in severe asthma · Multi-stepA ventilated patient with severe asthma has high peak pressures and breath stacking. Which ventilator strategy is appropriate?
- Critical care: cardiac tamponade · ApplicationWhich finding is part of Beck's triad in cardiac tamponade?
- Critical care: abdominal compartment syndrome · ApplicationWhich measurement is used to estimate intra-abdominal pressure?
- Critical care: auto-PEEP · Multi-stepA ventilated COPD patient has expiratory flow that does not return to zero before the next breath and is hypotensive. What is the best action?
- Critical care: volume versus pressure control · ApplicationIn pressure-controlled ventilation, what happens to delivered tidal volume if lung compliance worsens?
- Critical care: oxygen toxicity · ApplicationWhich problem is associated with prolonged exposure to a high FiO2?
- Critical care: sudden deterioration on a ventilator · ApplicationA ventilated patient suddenly desaturates with rising airway pressures. Which mnemonic helps in troubleshooting?
- Critical care: burns fluid resuscitation · Multi-stepA 70 kg adult has 40 percent total body surface area burns. Using the Parkland formula (4 mL/kg/%TBSA), what volume is given in the first 8 hours?
- Critical care: albumin in traumatic brain injury · Multi-stepIn critically ill patients, in which group did albumin resuscitation increase mortality in the SAFE trial?
- Critical care: restrictive transfusion threshold · ApplicationWhat haemoglobin threshold is generally used for red cell transfusion in a stable critically ill adult without active bleeding or myocardial ischaemia?
- Critical care: thromboelastography interpretation · Multi-stepOn thromboelastography, a prolonged reaction (R) time suggests deficiency of which component?
- Critical care: tranexamic acid in trauma · ApplicationIn the CRASH-2 trial, tranexamic acid reduced mortality in bleeding trauma patients when given within which time?
- Critical care: DIC laboratory pattern · ApplicationWhich laboratory pattern is typical of disseminated intravascular coagulation?
- Critical care: heparin-induced thrombocytopenia · Multi-stepA patient on heparin for 7 days has platelets fall from 250,000 to 90,000 with a new limb thrombosis. What is the correct management?
- Critical care: heparin reversal with protamine · ApplicationHow much protamine is generally given to neutralise heparin?
- Critical care: warfarin reversal in life-threatening bleeding · ApplicationA patient on warfarin has a life-threatening intracranial haemorrhage with an INR of 5. Which is the preferred reversal?
- Critical care: dabigatran reversal · ApplicationWhich agent specifically reverses the anticoagulant effect of dabigatran?
- Critical care: organ donor diabetes insipidus · Multi-stepA brain-dead organ donor develops polyuria of 400 mL/hour with a serum sodium of 158 mmol/L. What is the treatment?
- Critical care: first-line treatment of status epilepticus · ApplicationWhat is the first-line drug for status epilepticus in adults?
- Critical care: organophosphate poisoning · ApplicationA farmer has miosis, salivation, bronchorrhoea, bradycardia and fasciculations after pesticide exposure. What is the treatment?
- Critical care: ARDS · Multi-stepWhich ventilatory strategy reduces ventilator-induced lung injury in acute respiratory distress syndrome?
- Critical care · ApplicationWhat is the purpose of a rapid-sequence induction?
- Critical care · ApplicationWhat is capnography particularly useful for confirming after intubation?
Preoperative assessment55
- Preoperative assessment: fasting in infants · ApplicationA 6-month-old exclusively breastfed infant is scheduled for elective inguinal hernia repair. How long should breast milk be withheld before induction?
- Preoperative assessment: smoking cessation · ApplicationA heavy smoker stops smoking 24 hours before surgery. Which benefit is realistically achieved by this time?
- Preoperative assessment: anticoagulants · ApplicationA patient on warfarin for atrial fibrillation is scheduled for elective cholecystectomy. What is the usual plan?
- Preoperative assessment: ACE inhibitors · ApplicationWhy are ACE inhibitors and angiotensin receptor blockers often omitted on the morning of surgery?
- Preoperative assessment: SGLT2 inhibitors · Multi-stepA diabetic patient on empagliflozin is scheduled for elective surgery. What is the recommended preoperative step and why?
- Preoperative assessment: steroid cover · ApplicationA patient on prednisolone 10 mg daily for 6 months is scheduled for a major abdominal surgery. What perioperative step is needed?
- Preoperative assessment: MAO inhibitors · Multi-stepA patient on phenelzine needs an operation and postoperative analgesia. Which opioid is contraindicated?
- Preoperative assessment: cardiac risk index · Multi-stepWhich of the following is NOT an independent predictor in the Revised Cardiac Risk Index?
- Preoperative assessment: functional capacity · ApplicationA patient cannot climb two flights of stairs without stopping. How is this functional capacity classified?
- Preoperative assessment: GLP-1 agonist and aspiration · Multi-stepA 52-year-old woman with type 2 diabetes takes weekly semaglutide. On the morning of elective surgery she reports nausea and abdominal bloating, although she has fasted…
- Preoperative assessment: timing after myocardial infarction · ApplicationA patient had a myocardial infarction 3 weeks ago without revascularisation and now needs elective hernia repair. What is the best advice?
- Preoperative assessment: starting a beta blocker · ApplicationA patient with risk factors for coronary disease is scheduled for major surgery tomorrow and is not on a beta blocker. Which is the correct approach?
- Preoperative assessment: thyrotoxicosis preparation · Multi-stepA patient with Graves disease is scheduled for elective thyroidectomy. Which preoperative preparation is standard?
- Preoperative assessment: hypertension · ApplicationA patient on amlodipine has a clinic BP of 165/100 mmHg and is due for elective surgery with no end-organ damage. What is the usual approach?
- Preoperative assessment: screening for sleep apnoea · ApplicationA 56-year-old man with hypertension, a BMI of 38 kg/m2 and a neck circumference of 45 cm is listed for elective hernia repair. He snores loudly, is tired during the day…
- Preoperative assessment: recent coronary stent and antiplatelets · Multi-stepA 62-year-old man had a drug-eluting coronary stent placed three months ago and takes aspirin and clopidogrel. He now needs an urgent laparotomy for a perforated viscus…
- Preoperative assessment: MAO inhibitor and vasopressors · Multi-stepA woman on long-term phenelzine for depression becomes hypotensive after spinal anaesthesia. A usual dose of ephedrine is followed by a dangerous rise in blood pressure…
- Preoperative assessment: pacemaker and diathermy · Multi-stepA pacemaker-dependent patient with a permanent pacemaker is scheduled for an abdominal operation, and monopolar diathermy will be used. Electromagnetic interference may…
- Preoperative assessment: Parkinson disease · ApplicationA 70-year-old man with Parkinson disease takes levodopa-carbidopa every six hours and is listed for elective cholecystectomy under general anaesthesia. Which perioperat…
- Preoperative assessment: Marfan syndrome · Multi-stepA tall 28-year-old man with long fingers, lens subluxation and an aortic root diameter of 45 mm is listed for an elective procedure under general anaesthesia. Which hae…
- Preoperative assessment: refusal of blood products · ApplicationA competent 45-year-old woman who is a Jehovah's Witness has signed an informed refusal of blood transfusion and is booked for elective hysterectomy. What is the best a…
- Preoperative assessment: blood request for low-risk surgery · ApplicationA 30-year-old woman with a normal haemoglobin is listed for elective laparoscopic cholecystectomy, a procedure with a low probability of transfusion. Which blood bank r…
- Preoperative assessment: severe hypothyroidism · ApplicationA 55-year-old woman with untreated severe hypothyroidism is brought for urgent surgery. Which feature should the anaesthetist anticipate?
- Preoperative assessment: Cushing syndrome · Multi-stepA 38-year-old woman with Cushing syndrome is scheduled for adrenalectomy. Which preoperative and positioning concern is most relevant?
- Preoperative assessment: renal transplant recipient · Multi-stepA patient who received a kidney transplant two years ago and takes tacrolimus and prednisolone needs elective surgery. Which perioperative management is appropriate?
- Preoperative assessment: predicted postoperative FEV1 · Multi-stepA smoker is planned for lobectomy for lung cancer. Calculation from spirometry and perfusion scanning gives a predicted postoperative FEV1 of 25 percent of the normal v…
- Preoperative assessment: chronic opioid therapy · Multi-stepA 50-year-old man takes oral morphine daily for chronic cancer pain and is listed for surgery. What is the best perioperative analgesic plan?
- Preoperative assessment: ASA class for dialysis-dependent renal failure · ApplicationA 58-year-old man with end-stage renal disease attends thrice-weekly haemodialysis without missed sessions. He has no other significant illness and is listed for electi…
- Preoperative assessment: ASA class for morbid obesity · ApplicationA 35-year-old woman with a BMI of 42 kg/m2, normal blood pressure, normal glucose and no other illness is listed for elective surgery. Which ASA physical status is usua…
- Preoperative assessment: fasting after a fatty meal · ApplicationA man ate a large meal of fried food and meat late last evening and is listed for elective surgery tomorrow morning. According to the standard ASA fasting guidelines, w…
- Preoperative assessment: sulfonylurea on the day of surgery · ApplicationA type 2 diabetic takes glibenclamide every morning. He is nil by mouth from midnight for an elective morning operation. What is the best advice for the morning of surg…
- Preoperative assessment: clonidine withdrawal · ApplicationA hypertensive patient takes oral clonidine regularly and is listed for elective surgery. What is the correct perioperative advice and its reason?
- Preoperative assessment: symptomatic severe aortic stenosis · Multi-stepA 74-year-old man has had exertional syncope for 3 months. Echocardiography shows a calcific aortic valve with an area of 0.7 cm2 and a mean gradient of 55 mmHg. He is…
- Preoperative assessment: timing of dialysis before surgery · ApplicationA patient with end-stage renal disease on maintenance haemodialysis is booked for elective surgery. When should dialysis ideally be arranged?
- Preoperative assessment: liver function tests in cirrhosis · ApplicationA man with alcoholic cirrhosis is listed for an elective inguinal hernia repair. Which investigation best reflects the synthetic function of his liver?
- Preoperative assessment: alcohol dependence and withdrawal · Multi-stepA 48-year-old man who drinks heavily every day has an open hernia repair. On the second postoperative night he becomes agitated and tremulous, sweating, with tachycardi…
- Preoperative assessment: high-risk surgery in the cardiac risk index · ApplicationIn the Revised Cardiac Risk Index, which operation counts as high-risk surgery?
- Preoperative assessment: diabetic autonomic neuropathy · Multi-stepA 62-year-old man with diabetes for 20 years has postural hypotension and a resting heart rate of 96 per minute that does not vary with deep breathing. He also vomits f…
- Preoperative assessment: Eisenmenger syndrome · Multi-stepA 30-year-old woman with Eisenmenger syndrome (pulmonary hypertension with reversed shunt through a ventricular septal defect) needs a non-cardiac operation. Which chan…
- Preoperative assessment: respiratory infection in a child · ApplicationA 4-year-old has had a runny nose, cough and low-grade fever for two days and is listed for elective squint surgery. Which anaesthetic complications are more likely?
- Preoperative assessment: obstructive jaundice · ApplicationA 60-year-old man with obstructive jaundice from carcinoma of the head of the pancreas is planned for surgery. Which preoperative measure lowers the risk of postoperati…
- Preoperative assessment: unstable angina before elective surgery · ApplicationA 66-year-old man listed for elective knee replacement reports chest pain at rest, increasing over the last week and relieved by sublingual nitrate. What is the best ne…
- Preoperative assessment: statin therapy · ApplicationA 68-year-old man with coronary artery disease takes atorvastatin daily and is scheduled for elective major vascular surgery. What should be done with the statin?
- Preoperative assessment: echocardiography for a murmur · ApplicationA 70-year-old man with exertional breathlessness and a new ejection systolic murmur radiating to the carotids is listed for elective hip replacement. Which preoperative…
- Preoperative assessment · ApplicationWhat is a primary purpose of preoperative assessment?
- Preoperative assessment · ApplicationWhat information is important when assessing aspiration risk before anesthesia?
- Preoperative assessment · ApplicationWhat history is relevant to planning anesthesia for a patient?
- Preoperative assessment · ApplicationWhat purpose does ASA physical-status classification serve?
- Preoperative assessment · ApplicationWhy is medication reconciliation important before anesthesia?
- Preoperative assessment · ApplicationWhat information is essential before anesthesia regarding allergies?
- Preoperative assessment · ApplicationWhy are fasting instructions given before elective anesthesia?
- Preoperative assessment · ApplicationWhat is the purpose of an ASA physical-status classification?
- Preoperative assessment: functional capacity · ApplicationA patient reports they can climb two flights of stairs without chest pain or undue breathlessness. This history most directly provides an estimate of what?
- Preoperative assessment · ApplicationWhy is fasting assessed before general anaesthesia?
- Preoperative assessment · ApplicationWhich airway feature may predict difficult laryngoscopy?
Intravenous and inhalational agents39
- Intravenous and inhalational agents: halothane and catecholamines · ApplicationDuring halothane anaesthesia, a surgeon infiltrates the wound with adrenaline and ventricular ectopics appear. What is the mechanism?
- Intravenous and inhalational agents: stages of anaesthesia · ApplicationDuring a mask induction with ether, a child becomes agitated, breathes irregularly with breath holding, has dilated pupils and roving eyeballs, and shows exaggerated re…
- Intravenous and inhalational agents: laudanosine · ApplicationA patient with renal failure on a prolonged atracurium infusion in intensive care has a generalised seizure. Sedation is adequate and the electrolytes are normal. Which…
- Intravenous and inhalational agents: dopamine dose effects · ApplicationA dopamine infusion is increased step by step in a hypotensive patient. At high infusion rates, which action predominates and raises blood pressure by vasoconstriction?
- Intravenous and inhalational agents: myotonic dystrophy and suxamethonium · Multi-stepA 32-year-old man with myotonic dystrophy and a cardiac conduction defect needs general anaesthesia. Why is suxamethonium best avoided?
- Intravenous and inhalational agents: lithium and neuromuscular blockers · Multi-stepA man on long-term lithium for bipolar disorder recovers more slowly than expected from rocuronium. What is the explanation?
- Intravenous and inhalational agents: neuroleptic malignant syndrome versus malignant hyperthermia · Multi-stepA patient develops fever, muscle rigidity, tachycardia and a raised creatine kinase after surgery. Which finding favours neuroleptic malignant syndrome over malignant h…
- Intravenous and inhalational agents: methylene blue and pulse oximetry · Multi-stepAfter a methylene blue infusion for refractory vasoplegia, the pulse oximeter reading drops suddenly from 98 to 82 percent, yet the patient is pink and stable and an ar…
- Intravenous and inhalational agents: cholinesterase inhibition and suxamethonium · Multi-stepA farmer with organophosphate poisoning has been stabilised with atropine and pralidoxime and needs surgery. After suxamethonium for intubation, he remains apnoeic for…
- Intravenous and inhalational agents: burst suppression on EEG · ApplicationDuring deep propofol anaesthesia for neurosurgery, the processed EEG shows periods of high-voltage activity alternating with flat isoelectric segments. What is this pat…
- Intravenous and inhalational agents: central sensitisation and pre-emptive analgesia · ApplicationCentral sensitisation, or wind-up, after tissue injury makes the dorsal horn hyperexcitable and underlies the use of ketamine and magnesium in analgesia. Which receptor…
- Intravenous and inhalational agents: midazolam water solubility · ApplicationMidazolam is supplied as an aqueous solution that causes little pain on injection, yet it enters the brain quickly after intravenous use. Which property accounts for bo…
- Intravenous and inhalational agents: benzodiazepine in hepatic impairment · ApplicationA frail 80-year-old woman with cirrhosis needs a benzodiazepine for sedation. Which drug is least likely to accumulate, because it is conjugated directly and has no act…
- Intravenous and inhalational agents: re-sedation after flumazenil · ApplicationFlumazenil 0.2 mg wakes a patient who received intravenous diazepam for a procedure. Forty minutes later he is drowsy again with slow respiration. What is the explanati…
- Intravenous and inhalational agents: thiopentone and muscle relaxant in one line · ApplicationSoon after thiopentone induction, rocuronium is injected through the same cannula without a flush, and the line turns cloudy with a white precipitate. What is the reason?
- Intravenous and inhalational agents: thiopentone in hypoalbuminaemia · Multi-stepA malnourished 55-year-old man with serum albumin 20 g/L and uraemia receives the usual 5 mg/kg of thiopentone and becomes deeply anaesthetised with marked hypotension.…
- Intravenous and inhalational agents: effect of acidosis on thiopentone · Multi-stepThiopentone is a weak acid with a pKa of about 7.6. How does a metabolic acidosis alter its action?
- Intravenous and inhalational agents: bacterial growth in propofol · ApplicationPropofol syringes and infusion lines must be prepared aseptically and discarded within a few hours of opening. Which property of the formulation makes this necessary?
- Intravenous and inhalational agents: ketamine salivation · ApplicationA 5-year-old receives intramuscular ketamine for a burns dressing, and copious salivation threatens the airway. Which premedication would best have prevented this?
- Intravenous and inhalational agents: ketamine in catecholamine depletion · Multi-stepA young man in prolonged haemorrhagic shock, whose catecholamine stores are exhausted, becomes more hypotensive after ketamine induction. What explains this?
- Intravenous and inhalational agents: ketamine in ischaemic heart disease · ApplicationA 66-year-old man with severe uncontrolled hypertension and angina needs a short procedure under intravenous anaesthesia. Why is ketamine a poor choice?
- Intravenous and inhalational agents: dexmedetomidine loading bolus · Multi-stepA rapid loading bolus of dexmedetomidine causes a brief rise in blood pressure followed by hypotension and bradycardia. What explains the biphasic response?
- Intravenous and inhalational agents: stopping a remifentanil infusion · Multi-stepAfter a four-hour high-dose remifentanil infusion for spine surgery, the infusion is stopped at skin closure with no other analgesic. Within minutes the patient wakes i…
- Intravenous and inhalational agents: tolerance to morphine effects · ApplicationA cancer patient on long-term oral morphine needs increasing doses for the same pain relief but still has constricted pupils and constipation. Which statement is correct?
- Intravenous and inhalational agents: morphine and the biliary tract · ApplicationA man with gallstones receives intravenous morphine for pain, which worsens, and cholangiography shows delayed emptying of contrast into the duodenum. Which morphine ef…
- Intravenous and inhalational agents: pentazocine in myocardial infarction · ApplicationWhich opioid analgesic is relatively undesirable in acute myocardial infarction because it raises heart rate, systemic pressure and pulmonary arterial pressure, and can…
- Intravenous and inhalational agents: naloxone titration · ApplicationAn opioid-sedated patient in recovery, breathing six times a minute, is given a full 0.4 mg bolus of naloxone and suddenly becomes agitated, hypertensive and tachycardi…
- Intravenous and inhalational agents: nitrous oxide and pulmonary hypertension · ApplicationWhich statement describes the effect of nitrous oxide in a patient with pulmonary hypertension?
- Intravenous and inhalational agents: nitrous oxide in tympanoplasty · ApplicationA patient undergoing tympanoplasty with a tympanic membrane graft is given nitrous oxide. Why is this undesirable?
- Intravenous and inhalational agents: tube cuff pressure with nitrous oxide · ApplicationDuring a three-hour anaesthetic with 66 percent nitrous oxide, the pilot balloon feels tighter and cuff pressure is above 40 cm H2O. What is the explanation?
- Intravenous and inhalational agents: desflurane sympathetic response · ApplicationDuring maintenance, the anaesthetist abruptly raises desflurane from 4 to 10 percent, and heart rate and blood pressure surge. What is the mechanism?
- Intravenous and inhalational agents: carbon monoxide from dry absorbent · Multi-stepSeveral children operated on first on a Monday morning under desflurane through circle systems wake with headache and drowsiness. Pulse oximetry is normal, but co-oxime…
- Intravenous and inhalational agents: mechanism of halothane hepatitis · Multi-stepA middle-aged obese woman develops fever and jaundice a week after her second halothane anaesthetic in two months, with eosinophilia. What is the proposed mechanism of…
- Intravenous and inhalational agents: volatile agents and breathing pattern · ApplicationIn a patient breathing spontaneously under increasing concentrations of a volatile agent, which breathing pattern develops?
- Intravenous and inhalational agents: factors lowering MAC · ApplicationWhich of the following decreases the minimum alveolar concentration of volatile anaesthetics?
- Intravenous and inhalational agents: ventilation and rise in alveolar concentration · ApplicationDuring inhalational induction with a blood-soluble volatile agent, how does increasing alveolar ventilation affect the rate of rise of alveolar concentration?
- Intravenous and inhalational agents: maintenance agent in malignant hyperthermia susceptibility · ApplicationA patient whose sibling had malignant hyperthermia is scheduled for knee surgery. Which is a safe choice for maintenance of anaesthesia?
- Intravenous and inhalational agents: additive MAC of nitrous oxide · ApplicationAdding 60 percent nitrous oxide to the anaesthetic allows a lower sevoflurane concentration for the same depth. Why?
- Intravenous and inhalational agents: transdermal fentanyl and fever · ApplicationA man using a transdermal fentanyl patch for cancer pain develops a fever of 39.5 degrees C and becomes drowsy with slow respiration. What is the explanation?
Regional anaesthesia37
- Regional anaesthesia · ApplicationWhat is the definitive treatment for persistent post-dural puncture headache that does not respond to conservative measures?
- Regional anaesthesia · ApplicationTen minutes after a spinal block for caesarean section, a woman feels nauseated and her blood pressure falls markedly. What is the main mechanism of the hypotension?
- Regional anaesthesia · Multi-stepA patient with severe COPD is scheduled for shoulder surgery. Why is an interscalene brachial plexus block relatively undesirable in this patient?
- Regional anaesthesia · Multi-stepAn 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 palpitat…
- Regional anaesthesia · Multi-stepA patient on prophylactic-dose low molecular weight heparin has been planned for spinal anaesthesia. What is the minimum recommended interval between the last prophylac…
- Regional anaesthesia · ApplicationA spinal anaesthetic is performed in the sitting position with hyperbaric bupivacaine and the patient remains seated for several minutes before lying supine. What is th…
- Regional anaesthesia: dermatomal levels · ApplicationWhich sensory level is required for lower segment caesarean section under spinal anaesthesia?
- Regional anaesthesia: caudal block · ApplicationA caudal epidural block in a child is performed through which anatomical landmark?
- Regional anaesthesia: Bier's block · ApplicationWhich local anaesthetic is appropriate for intravenous regional anaesthesia (Bier's block)?
- Regional anaesthesia: Bier's block tourniquet · Multi-stepWhat is the minimum tourniquet time before cuff deflation after Bier's block, to minimise toxicity?
- Regional anaesthesia: interscalene block · ApplicationInterscalene block commonly results in ipsilateral diaphragmatic paralysis. Which nerve is blocked?
- Regional anaesthesia: axillary block · Multi-stepWhich nerve is often missed in an axillary brachial plexus block because it leaves the sheath early?
- Regional anaesthesia: fascia iliaca block · ApplicationAn elderly patient with a fractured neck of femur is in severe pain in the emergency room. Which block provides rapid analgesia?
- Regional anaesthesia: ankle block · Multi-stepHow many nerves are blocked in a complete ankle block?
- Regional anaesthesia: TAP block · ApplicationA transversus abdominis plane block is deposited between which two muscle layers?
- Regional anaesthesia: adductor canal block · ApplicationA patient after total knee replacement receives an adductor canal block. Which nerve is mainly anaesthetised, with preserved quadriceps strength?
- Regional anaesthesia: ilioinguinal block · ApplicationAn ilioinguinal-iliohypogastric block is useful for which paediatric surgery?
- Regional anaesthesia: epidural versus spinal · ApplicationWhich statement about epidural anaesthesia compared with spinal is true?
- Regional anaesthesia: sympathetic block effect on bowel · Multi-stepSpinal anaesthesia up to T10 produces which gastrointestinal effect?
- Regional anaesthesia: total spinal after epidural top-up · Multi-stepWithin minutes of an epidural top-up for caesarean section, a parturient becomes hypotensive and bradycardic, stops breathing and has dilated pupils. What is the most a…
- Regional anaesthesia: epidural abscess · Multi-stepFive days after labour epidural analgesia, a woman has severe back pain, fever and new weakness of both legs. What is the most appropriate next step?
- Regional anaesthesia: popliteal sciatic block · ApplicationA popliteal sciatic nerve block is performed for foot surgery. Which area is not anaesthetised unless an additional block is added?
- Regional anaesthesia: obturator nerve block · ApplicationDuring transurethral resection of a tumour on the lateral bladder wall under spinal anaesthesia, sudden violent adduction of the thigh occurs. Which nerve block would p…
- Regional anaesthesia: scalp block · ApplicationA scalp block for an awake craniotomy includes which of the following nerves?
- Regional anaesthesia: paravertebral block · ApplicationWhich block gives unilateral somatic and sympathetic blockade over several dermatomes and is suited to mastectomy and rib fractures?
- Regional anaesthesia: erector spinae plane block · ApplicationIn an erector spinae plane block, where is the local anaesthetic deposited?
- Regional anaesthesia: cervical plexus block · ApplicationWhich regional technique allows awake neurological assessment during carotid endarterectomy?
- Regional anaesthesia: retrobulbar block complication · Multi-stepMinutes after a retrobulbar block for cataract surgery, a patient becomes drowsy, apnoeic and bradycardic with contralateral pupil dilation. What is the likely cause?
- Regional anaesthesia: nerve stimulator threshold · Multi-stepDuring a nerve-stimulator-guided block, a motor response persists at a current of 0.15 mA. What is the best action?
- Regional anaesthesia: ultrasound needle approach · ApplicationIn ultrasound-guided blocks, what is the advantage of the in-plane needle approach?
- Regional anaesthesia: infraclavicular block · ApplicationAn infraclavicular brachial plexus block is chosen for forearm and hand surgery in a patient with severe lung disease. What is a reason for the choice?
- Regional anaesthesia: sub-Tenon block · ApplicationWhat is a recognised advantage of a sub-Tenon block over a sharp-needle retrobulbar block for cataract surgery?
- Regional anaesthesia: PECS block · ApplicationA PECS I block, performed for modified radical mastectomy, deposits local anaesthetic in which plane?
- Regional anaesthesia: PENG block for hip fracture · ApplicationA pericapsular nerve group (PENG) block is increasingly used in hip fracture. What is its main advantage?
- Regional anaesthesia: epidural · ApplicationWhich feature distinguishes epidural from spinal anaesthesia?
- Regional anaesthesia · ApplicationWhat is the main site of action of spinal anaesthesia?
- Regional anaesthesia · ApplicationWhat is an important complication of high spinal block?
Complications and emergencies36
- Complications and emergencies: amniotic fluid embolism · Multi-stepDuring labour a woman suddenly becomes breathless and hypotensive, has a seizure and then bleeds from intravenous sites. What is the most likely diagnosis?
- Complications and emergencies: PONV risk score · ApplicationWhich patient has the highest risk of postoperative nausea and vomiting based on the Apfel score?
- Complications and emergencies: thyroid storm · Multi-stepA patient develops fever of 40 C, heart rate 160 and agitation on the first day after thyroidectomy for Graves disease. Which drug should be avoided?
- Complications and emergencies: genetics of malignant hyperthermia · ApplicationA 20-year-old develops rigidity, rising temperature and tachycardia after volatile anaesthesia, and a paternal uncle died during a similar operation. How is susceptibil…
- Complications and emergencies: lithotomy position nerve injury · Multi-stepAfter a four-hour operation in the lithotomy position with the leg holders pressing behind the lateral knee, a patient cannot dorsiflex the foot and has numbness over t…
- Complications and emergencies: stress ulcer prophylaxis · ApplicationWhich pair are the major independent risk factors for clinically important gastrointestinal bleeding in intensive care, and so the main indications for stress ulcer pro…
- Complications and emergencies: placenta accreta at caesarean · Multi-stepA woman with two previous caesarean sections and an anterior placenta praevia with imaging features of accreta is booked for caesarean hysterectomy. Which preparation i…
- Complications and emergencies: hypertonic saline in head injury · Multi-stepA hypotensive polytrauma patient with a severe head injury and raised intracranial pressure needs osmotherapy. Why might hypertonic saline be preferred to mannitol?
- Complications and emergencies: magnesium toxicity · Multi-stepA woman with severe pre-eclampsia is on a magnesium sulphate infusion. What is the earliest clinical sign of toxicity to look for?
- Complications and emergencies: hyperventilation and potassium · Multi-stepA patient is mechanically hyperventilated to a PaCO2 of 20 mmHg during neurosurgery, and the serum potassium falls. What is the mechanism?
- Complications and emergencies: flail chest · Multi-stepA 58-year-old with five consecutive right rib fractures has paradoxical chest movement, pain-limited breathing and an SpO2 of 90 percent. Which measure is most importan…
- Complications and emergencies: massive haemoptysis · Multi-stepA patient with massive haemoptysis from the right lung becomes hypoxic. Which airway strategy best protects the healthy lung?
- Complications and emergencies: hereditary angioedema · Multi-stepA 30-year-old has recurrent non-itchy facial swelling and abdominal pain, a family history of similar episodes and a low C4. He needs dental extraction under general an…
- Complications and emergencies: hypocalcaemia after thyroidectomy · ApplicationOn the second day after total thyroidectomy, a woman has perioral tingling, carpopedal spasm and a positive Chvostek sign. What is the most appropriate immediate treatm…
- Complications and emergencies: negative-pressure pulmonary oedema · ApplicationA muscular 22-year-old has laryngospasm at the end of a knee arthroscopy and makes forceful inspiratory efforts against a closed glottis. Once the spasm breaks, he coug…
- Complications and emergencies: managing post-obstruction oedema · Multi-stepA 20-year-old develops negative-pressure pulmonary oedema after post-extubation laryngospasm. He is alert, haemodynamically stable and has an SpO2 of 88 percent on a fa…
- Complications and emergencies: perioperative monocular visual loss · Multi-stepA patient wakes after a 7-hour prone spinal fusion with painless loss of vision in the right eye only. The right periorbital area is swollen and bruised from resting on…
- Complications and emergencies: lateral cutaneous nerve of thigh injury · ApplicationAfter a long operation in the lithotomy position with the pelvis tightly strapped, a woman reports burning numbness over the anterolateral thigh. There is no muscle wea…
- Complications and emergencies: radial nerve palsy from arm positioning · ApplicationAfter surgery during which his right arm hung over the edge of the table, pressed against a metal bar, a man cannot extend the wrist or fingers and has sensory loss ove…
- Complications and emergencies: brachial plexus injury from positioning · ApplicationDuring a 5-hour supine operation, the left arm lay abducted well beyond 90 degrees on an arm board while the head was turned to the right. Afterwards the arm is weak wi…
- Complications and emergencies: febrile non-haemolytic transfusion reaction · Multi-stepThirty minutes into a platelet transfusion a patient develops chills and a 1.5 degree C rise in temperature. Blood pressure and oxygen saturation are normal, there is n…
- Complications and emergencies: crush injury resuscitation · Multi-stepA man has been trapped under rubble for six hours, with both legs swollen, cold and pulseless. Rescuers are about to free him. Which measure should be started before th…
- Complications and emergencies: transfusion-related acute lung injury · Multi-stepTwo hours after receiving fresh frozen plasma, a patient develops acute breathlessness, fever and hypoxaemia with bilateral fluffy infiltrates on chest X-ray. The jugul…
- Complications and emergencies: septic transfusion reaction · Multi-stepA patient receiving a platelet pool stored for five days develops rigors, a temperature of 39.5 degrees C and a fall in blood pressure to 80/50 mmHg within 15 minutes.…
- Complications and emergencies: perioperative adrenal crisis · Multi-stepA woman on long-term oral prednisolone for rheumatoid arthritis, who received no perioperative steroid cover, becomes profoundly hypotensive during a hip replacement de…
- Complications and emergencies: methaemoglobinaemia treatment · ApplicationAfter benzocaine spray for awake intubation, a patient is cyanosed with a persistent SpO2 of 85 percent on 100 percent oxygen. PaO2 is normal and the arterial blood loo…
- Complications and emergencies: methylene blue and enzyme deficiency · Multi-stepMethylene blue is relatively contraindicated for treating methaemoglobinaemia in patients deficient in which red cell enzyme, because it may fail to work and can precip…
- Complications and emergencies: carbon monoxide poisoning treatment · Multi-stepA man rescued from an enclosed house fire is drowsy with a headache. SpO2 reads 99 percent on room air and co-oximetry shows a carboxyhaemoglobin level of 30 percent. W…
- Complications and emergencies: osmotic demyelination after hyponatraemia correction · Multi-stepA malnourished man with chronic alcohol use and a serum sodium of 108 mmol/L is treated, and the sodium reaches 130 mmol/L within 24 hours. Three days later he becomes…
- Complications and emergencies: neck haematoma after thyroidectomy · Multi-stepForty minutes after total thyroidectomy, a patient in the recovery room has a tense swelling of the neck, noisy breathing and an SpO2 falling to 88 percent. What is the…
- Complications and emergencies: follow-up after perioperative anaphylaxis · ApplicationA patient recovers from a suspected anaphylactic reaction at induction of anaesthesia. What follow-up is advised before any further anaesthetic?
- Complications and emergencies: ergometrine in hypertensive disease · ApplicationA woman with severe pre-eclampsia and blood pressure 170/110 mmHg has atonic postpartum haemorrhage after delivery. Which drug given for postpartum haemorrhage is best…
- Complications and emergencies: refractory anaphylaxis on beta-blocker · Multi-stepA patient on long-term metoprolol develops anaphylaxis with severe hypotension and bradycardia that remain refractory to repeated intravenous adrenaline. Which addition…
- Complications and emergencies: pulmonary hypertensive crisis · Multi-stepA patient with severe pulmonary arterial hypertension develops sudden right ventricular failure, hypotension and a falling end-tidal CO2 after induction. Which approach…
- Complications and emergencies: paradoxical air embolism · Multi-stepA patient has a venous air embolism during a sitting-position posterior fossa craniotomy and wakes with a new right hemiparesis, although the chest is clear. Which mech…
- Complications and emergencies: digoxin toxicity antidote · ApplicationA patient with chronic kidney disease on digoxin develops nausea, visual disturbance, bidirectional ventricular tachycardia and a serum potassium of 6.8 mmol/L. Which s…
Monitoring33
- Monitoring · ApplicationImmediately after intubation, chest movement is poor and breath sounds are doubtful. Which finding most reliably confirms tracheal placement of the tube?
- Monitoring · ApplicationA patient rescued from a house fire is breathless and has a headache, but pulse oximetry reads 99% on room air. Why is the reading unreliable?
- Monitoring · Multi-stepDuring a laparoscopic cholecystectomy, there is an abrupt fall in end-tidal CO2 from 38 to 10 mmHg with hypotension, tachycardia and a mill-wheel murmur. What is the mo…
- Monitoring: pulse oximetry · ApplicationWhich wavelengths are used by a conventional two-wavelength pulse oximeter?
- Monitoring: pulse oximetry in CO poisoning · ApplicationA smoke inhalation victim has an SpO2 of 99% but is confused and tachypnoeic. What explains the normal reading?
- Monitoring: methaemoglobinaemia and pulse oximetry · Multi-stepIn significant methaemoglobinaemia, the pulse oximeter reading tends towards which value?
- Monitoring: capnograph waveforms · ApplicationA capnograph shows a sloping upstroke with no plateau (shark-fin pattern). What is the likely cause?
- Monitoring: rebreathing on capnography · Multi-stepOn capnography the inspiratory baseline fails to return to zero. What does this show?
- Monitoring: invasive arterial pressure · ApplicationWhere should the transducer be zeroed for invasive arterial pressure monitoring?
- Monitoring: arterial waveform · ApplicationWhat does the dicrotic notch on an arterial pressure waveform represent?
- Monitoring: core temperature · ApplicationWhich site best reflects core temperature during general anaesthesia?
- Monitoring: intraoperative blood pressure target · ApplicationWhich intraoperative blood pressure target is generally advised to reduce the risk of myocardial injury and acute kidney injury in adults?
- Monitoring: evoked potentials and volatile agents · Multi-stepWhich effect do volatile anaesthetics have on somatosensory and motor evoked potential monitoring during spinal surgery?
- Monitoring · ApplicationWhat does capnography measure?
- Monitoring · ApplicationWhat does noninvasive BP cuff measure intermittently?
- Monitoring · ApplicationWhat is the minimum routine monitor for arterial oxygen saturation?
- Monitoring · ApplicationWhat does capnography primarily monitor?
- Monitoring · ApplicationWhy is noninvasive blood-pressure monitoring used during anesthesia?
- Monitoring · ApplicationWhat monitor detects hypoxemia early during anesthesia?
- Monitoring · ApplicationWhat parameter does an electrocardiogram monitor intraoperatively?
- Monitoring · ApplicationWhy is temperature monitored during prolonged anesthesia?
- Monitoring · ApplicationWhat does end-tidal carbon dioxide primarily reflect during controlled ventilation?
- Monitoring · ApplicationWhat monitor may be used to follow depth of neuromuscular blockade?
- Monitoring · ApplicationWhat monitor continuously measures oxygen saturation?
- Monitoring · ApplicationWhat does capnography primarily display?
- Monitoring · ApplicationWhat does continuous capnography directly monitor?
- Monitoring · ApplicationWhat does pulse oximetry estimate?
- Monitoring: pulse oximetry · ApplicationA pulse oximeter continues to display 99% during apnea immediately after preoxygenation. Which limitation best explains why ventilation failure may initially be missed?
- Monitoring: capnography · ApplicationDuring controlled ventilation, the capnogram baseline fails to return to zero between breaths. What is the most likely physiological explanation?
- Monitoring: pulse oximetry · ApplicationPulse oximetry may appear reassuring in a carbon-monoxide-poisoned patient because it cannot reliably distinguish what?
- Monitoring: capnography · ApplicationA sudden sustained fall in end-tidal carbon dioxide during anaesthesia should raise concern for which event?
- Monitoring · ApplicationWhat does pulse oximetry measure?
- Monitoring · ApplicationWhat does a rising end-tidal carbon dioxide trace usually indicate during ventilation?
Muscle relaxants31
- Muscle relaxants: suxamethonium hyperkalaemia · ApplicationA patient with 30% burns sustained 10 days ago needs urgent debridement. Why should suxamethonium be avoided?
- Muscle relaxants: suxamethonium and eye surgery · ApplicationWhich effect of suxamethonium is a concern in a patient with an open globe injury?
- Muscle relaxants: pseudocholinesterase deficiency · Multi-stepA patient remains apnoeic for 3 hours after suxamethonium. The dibucaine number is 20. What is the genotype?
- Muscle relaxants: phase II block · Multi-stepWhich feature favours a phase II (dual) block after large doses of suxamethonium?
- Muscle relaxants: masseter spasm · ApplicationAfter suxamethonium a child shows jaw rigidity that makes laryngoscopy impossible. Which condition must be considered?
- Muscle relaxants: atracurium · ApplicationWhy is atracurium suitable for a patient with hepatic and renal failure?
- Muscle relaxants: cisatracurium · ApplicationWhat advantage does cisatracurium have over atracurium?
- Muscle relaxants: rocuronium · ApplicationWhich non-depolarising agent has the fastest onset?
- Muscle relaxants: sugammadex · ApplicationHow does sugammadex reverse neuromuscular block?
- Muscle relaxants: sugammadex dosing · Multi-stepWhat dose of sugammadex is used for immediate reversal after a rapid-sequence dose of rocuronium?
- Muscle relaxants: reversal timing · ApplicationWhen is neostigmine unlikely to reverse neuromuscular block effectively?
- Muscle relaxants: pancuronium · ApplicationPancuronium causes tachycardia and a rise in blood pressure because of which action?
- Muscle relaxants: mivacurium · ApplicationWhich non-depolarising relaxant is metabolised by plasma cholinesterase?
- Muscle relaxants: myasthenia gravis · ApplicationHow does a patient with myasthenia gravis respond to neuromuscular blockers?
- Muscle relaxants: drug interactions · ApplicationWhich drug potentiates non-depolarising neuromuscular block?
- Muscle relaxants: Eaton-Lambert syndrome · ApplicationA patient with small-cell lung cancer has proximal muscle weakness that improves with repeated effort. How will the patient respond to neuromuscular blocking drugs?
- Muscle relaxants: sugammadex and hormonal contraception · Multi-stepA woman using an oral contraceptive pill receives sugammadex to reverse rocuronium. What advice should be given?
- Muscle relaxants: succinylcholine and bradycardia · Multi-stepA 6-year-old receives two doses of succinylcholine five minutes apart for persistent laryngospasm, and the ECG shows sinus bradycardia. What is the mechanism?
- Muscle relaxants: renal excretion of gallamine · ApplicationA patient in renal failure needs a non-depolarising relaxant. Which agent, almost entirely excreted unchanged by the kidney, must be avoided?
- Muscle relaxants: double burst stimulation · Multi-stepAt the end of surgery, the anaesthetist cannot reliably judge fade on the train-of-four by touch as the ratio approaches 0.5. Which stimulation pattern makes fade easie…
- Muscle relaxants: diaphragm sensitivity · Multi-stepWhile the adductor pollicis twitch is abolished after rocuronium, the patient coughs and moves the diaphragm when the tracheal tube touches the carina. What explains th…
- Muscle relaxants: aminoglycoside interaction · ApplicationWhich class of antibiotic potentiates non-depolarising neuromuscular block by reducing presynaptic acetylcholine release?
- Muscle relaxants: hypercapnia and failed reversal · Multi-stepHalf an hour after rocuronium, a ventilated patient still shows fade on train-of-four stimulation. Neostigmine with glycopyrrolate was given 10 minutes ago and twitch h…
- Muscle relaxants: resistance after major burns · ApplicationA man three weeks after 40 percent burns needs much larger and more frequent doses of atracurium than a healthy patient to maintain paralysis. Which change best explain…
- Muscle relaxants: volatile agents potentiate block · ApplicationDuring a long laparotomy under 1.5 MAC sevoflurane, the interval between rocuronium top-ups is much longer than it was in an earlier case under propofol infusion. What…
- Muscle relaxants: neostigmine after suxamethonium · Multi-stepTen minutes after suxamethonium for intubation, a patient still has depressed twitches without fade on train-of-four. The anaesthetist gives neostigmine hoping to haste…
- Muscle relaxants: reversal in severe asthma · ApplicationA man with poorly controlled asthma and a resting heart rate of 48 per minute needs reversal of rocuronium at the end of surgery. Which reversal agent avoids muscarinic…
- Muscle relaxants: prolonged apnoea after suxamethonium · ApplicationA 30-year-old remains flaccid and apnoeic two hours after suxamethonium for appendicectomy. Train-of-four shows no response and he is haemodynamically stable. What is t…
- Muscle relaxants: critical illness myopathy · Multi-stepA 28-year-old with status asthmaticus received vecuronium infusion and high-dose intravenous steroids for 10 days. He cannot be weaned, with flaccid limbs, intact sensa…
- Muscle relaxants: relaxant choice with hyperkalaemia · ApplicationA patient in renal failure with potassium 6.2 mmol/L needs a rapid sequence induction for bowel obstruction and intubating conditions are needed within about a minute.…
- Muscle relaxants: potency and speed of onset · Multi-stepRocuronium has a faster onset than vecuronium, although both are aminosteroid relaxants. What is the main reason?
Local and regional anaesthesia26
- Local and regional anaesthesia: differential block in spinal anaesthesia · ApplicationIn spinal anaesthesia, which modality of block extends to the highest spinal level?
- Local and regional anaesthesia: spinal cord termination · Multi-stepA neonate needs a lumbar puncture. Compared with an adult, where does the spinal cord end in a neonate?
- Local and regional anaesthesia: ropivacaine differential block · ApplicationA woman in labour wants effective analgesia but wishes to keep her legs strong so she can move and push. Which local anaesthetic, by producing less motor than sensory b…
- Local and regional anaesthesia: seizure from local anaesthetic toxicity · ApplicationTen minutes after a supraclavicular block with bupivacaine, a patient develops a generalised tonic-clonic seizure. Which drug is the preferred first choice to stop the…
- Local and regional anaesthesia: post-dural puncture headache management · ApplicationA 28-year-old woman has a mild frontal and occipital headache on sitting up, relieved on lying flat, one day after spinal anaesthesia. She has no fever or neurological…
- Local and regional anaesthesia: cauda equina syndrome after continuous spinal · Multi-stepAfter continuous spinal anaesthesia through a microcatheter with repeated doses of hyperbaric 5 percent lignocaine, a patient develops bladder and bowel incontinence, s…
- Local and regional anaesthesia: Horner syndrome after interscalene block · ApplicationAfter an interscalene block for shoulder surgery, the patient has ptosis, miosis and anhidrosis on the same side of the face. What is the cause?
- Local and regional anaesthesia: interscalene block distribution · ApplicationAfter an interscalene block for shoulder surgery, the shoulder is anaesthetised but the little finger and the ulnar border of the hand remain sensate. Which dermatomes…
- Local and regional anaesthesia: Bezold-Jarisch reflex · Multi-stepFifteen minutes after a spinal block, a young volume-depleted man in the sitting position suddenly becomes severely bradycardic with profound hypotension and loses cons…
- Local and regional anaesthesia: urinary retention after neuraxial block · ApplicationEight hours after spinal anaesthesia for hernia repair, a young man cannot pass urine despite a full bladder. Blockade of which outflow explains the retention?
- Local and regional anaesthesia: epidural analgesia in labour · ApplicationA primigravida requests pain relief in labour. Compared with systemic opioids such as pethidine, which statement about epidural analgesia is supported by evidence?
- Local and regional anaesthesia: pain on injection during a nerve block · ApplicationDuring an ultrasound-guided sciatic nerve block, the patient reports severe lancinating pain as injection begins, and the injection pressure is high. What is the correc…
- Local and regional anaesthesia: pruritus with intrathecal morphine · ApplicationA woman given intrathecal morphine for caesarean delivery develops intense facial itching two hours later, with no rash and stable blood pressure. Which treatment is ap…
- Local and regional anaesthesia: spinal anaesthesia in former preterm infants · ApplicationA former preterm infant needs inguinal hernia repair. Which technique can reduce the incidence of early postoperative apnoea compared with general anaesthesia?
- Local and regional anaesthesia: sympathetic level after spinal · ApplicationAfter a spinal anaesthetic, the pinprick level is T6. Compared with this sensory level, where is the sympathetic block and why?
- Local and regional anaesthesia: anterior spinal artery syndrome · Multi-stepAfter prolonged hypotension during aortic aneurysm repair with a thoracic epidural, a patient wakes with flaccid paralysis of both legs and loss of pain and temperature…
- Local and regional anaesthesia: unilateral epidural block · ApplicationTwenty minutes after an epidural top-up in labour through a catheter threaded 8 cm into the space, analgesia is absent on the right but good on the left. What is the be…
- Local and regional anaesthesia: aspirin and neuraxial block · ApplicationA 70-year-old taking aspirin 75 mg daily alone for ischaemic heart disease is booked for transurethral resection under spinal anaesthesia. Platelet count and clotting t…
- Local and regional anaesthesia: spinal in severe aortic stenosis · Multi-stepA frail patient with severe aortic stenosis needs hip fracture repair. Why is a conventional single-shot spinal generally avoided?
- Local and regional anaesthesia: paracervical block risk · ApplicationA paracervical block with bupivacaine is given for pain in the first stage of labour. Which fetal complication is characteristic?
- Local and regional anaesthesia: brachial plexus approach in COPD · ApplicationA patient with severe COPD needs forearm arteriovenous fistula surgery under regional anaesthesia. Which brachial plexus approach avoids both phrenic nerve palsy and pn…
- Local and regional anaesthesia: subdural injection · Multi-stepFifteen minutes after an epidural top-up, a woman develops an unexpectedly high but patchy block that spares some segments, with mild hypotension, a Horner-type picture…
- Local and regional anaesthesia: chloroprocaine in urgent caesarean · ApplicationAn epidural catheter in place for labour must be extended urgently for an emergency caesarean section. Which agent gives the fastest onset and is rapidly hydrolysed in…
- Local and regional anaesthesia: bladder perforation under spinal · Multi-stepA man having transurethral prostate resection under spinal anaesthesia to T10 suddenly complains of pain in the shoulder tip, and his abdomen becomes distended and he i…
- Local and regional anaesthesia: contraindication to blood patch · ApplicationA woman with a severe postural headache after dural puncture is considered for an epidural blood patch. Which condition is a contraindication at present?
- Local and regional anaesthesia: thoracic kyphosis and spinal spread · Multi-stepHyperbaric bupivacaine is injected at L3-4 in a supine patient and spreads to the mid-thoracic region, then stops rising. Which anatomical feature mainly limits further…
Complications24
- Complications: perioperative anaphylaxis · ApplicationMinutes after induction of anaesthesia and administration of a neuromuscular blocker and antibiotic, a patient develops sudden hypotension, bronchospasm and facial flus…
- Complications: malignant hyperthermia mechanism · ApplicationDantrolene treats malignant hyperthermia by acting on which structure?
- Complications: malignant hyperthermia first sign · ApplicationWhich is the earliest and most sensitive sign of malignant hyperthermia under general anaesthesia?
- Complications: malignant hyperthermia association · Multi-stepSusceptibility to malignant hyperthermia is associated with which congenital myopathy?
- Complications: malignant hyperthermia treatment · Multi-stepWhy should calcium channel blockers not be given together with dantrolene during MH treatment?
- Complications: anaphylaxis cause · ApplicationWhich group of drugs is the most common cause of perioperative anaphylaxis?
- Complications: anaphylaxis management · ApplicationA patient develops hypotension, bronchospasm and urticaria after induction. What is the first drug of choice?
- Complications: anaphylaxis investigation · Multi-stepWhich blood test supports the diagnosis of anaphylaxis in the 1 to 2 hours after the event?
- Complications: latex allergy · ApplicationLatex allergy is especially common in which group of patients?
- Complications: awareness · ApplicationWhich surgery carries the highest risk of intraoperative awareness?
- Complications: venous air embolism · ApplicationA patient in the sitting position for posterior fossa surgery develops sudden hypotension, a sharp fall in end-tidal CO2 and a mill-wheel murmur. What should be done?
- Complications: TURP syndrome · ApplicationA patient undergoing TURP under spinal anaesthesia becomes confused, nauseated and complains of blurred vision. What is the most likely cause?
- Complications: TURP irrigation fluid · Multi-stepWhich irrigating fluid is least likely to cause haemolysis if absorbed, and is used with monopolar TURP?
- Complications: positioning nerve injury · ApplicationWhich nerve is most vulnerable to injury in the lithotomy position with leg support pressing on the lateral fibular head?
- Complications: postoperative hypoxia · ApplicationWhat is the most common cause of hypoxaemia in the immediate postoperative period?
- Complications: laparoscopy · ApplicationA bradycardia occurs when the peritoneum is insufflated with carbon dioxide at the start of laparoscopic surgery. What is the best first step?
- Complications: carcinoid · Multi-stepWhich drug is used to prevent or treat carcinoid crisis perioperatively?
- Complications: geriatric anaesthesia · ApplicationWhich postoperative complication is notably more frequent in elderly patients after general anaesthesia?
- Complications: airway fire · Multi-stepDuring laser excision of a laryngeal lesion, the tracheal tube ignites. What is the first action?
- Complications: postoperative visual loss · Multi-stepA patient wakes with painless bilateral visual loss after a 9-hour prone spine fusion with major blood loss and hypotension. What is the most likely diagnosis?
- Complications: tourniquet deflation · Multi-stepA lower limb tourniquet has been inflated for 2 hours. What changes are expected shortly after deflation?
- Complications: protamine reaction · Multi-stepWhich patient is at highest risk of a severe reaction to protamine given to reverse heparin?
- Complications: recurrent laryngeal nerve injury · ApplicationWhich finding follows bilateral recurrent laryngeal nerve injury after thyroidectomy?
- Complications: tension pneumothorax under positive pressure ventilation · ApplicationA ventilated patient suddenly has rising airway pressure, falling saturation, hypotension and absent breath sounds on one side. What is the immediate treatment?
Special anaesthesia24
- Special anaesthesia: ECT · ApplicationWhich neuromuscular blocker and dose are used for electroconvulsive therapy?
- Special anaesthesia: hyperbaric oxygen · ApplicationWhat is the elimination half-life of carboxyhaemoglobin when the patient breathes 100% oxygen at normal atmospheric pressure?
- Special anaesthesia: thyroid surgery · ApplicationA patient with thyrotoxicosis is being prepared for thyroidectomy. Which drug is useful for rapid control of the adrenergic symptoms?
- Special anaesthesia: phaeochromocytoma · ApplicationIn the preoperative preparation of a phaeochromocytoma, which sequence of blockade is correct?
- Special anaesthesia: diabetic patient · ApplicationHow should a patient with type 1 diabetes be managed for a morning operation?
- Special anaesthesia: obstructive sleep apnoea · ApplicationWhich is the most appropriate approach to the airway of an obese patient with obstructive sleep apnoea?
- Special anaesthesia: aortic stenosis · Multi-stepWhich haemodynamic goal is appropriate for a patient with severe aortic stenosis undergoing non-cardiac surgery?
- Special anaesthesia: raised intracranial pressure · ApplicationWhich measure helps lower intracranial pressure during neuroanaesthesia?
- Special anaesthesia: renal failure · ApplicationWhy must serum potassium be checked before giving suxamethonium to a patient with chronic renal failure?
- Special anaesthesia: hepatic disease · ApplicationWhich inhalational agent is best avoided in a patient with liver disease?
- Special anaesthesia: ICD and diathermy · Multi-stepA 64-year-old man with an implantable cardioverter-defibrillator (ICD) is scheduled for open cholecystectomy with monopolar diathermy. What is the appropriate periopera…
- Special anaesthesia: mitral stenosis · ApplicationA patient with severe mitral stenosis is to receive a general anaesthetic. Which haemodynamic goal is most important?
- Special anaesthesia: hypertrophic cardiomyopathy · Multi-stepA patient with hypertrophic obstructive cardiomyopathy becomes hypotensive after induction of anaesthesia. Which drug is the most appropriate?
- Special anaesthesia: right-to-left shunt · Multi-stepA child with a cyanotic congenital heart lesion and a right-to-left shunt needs an intravenous line for a minor procedure. Which precaution is specifically important?
- Special anaesthesia: tetralogy of Fallot spell · Multi-stepA child with tetralogy of Fallot develops sudden deep cyanosis, falling saturation and hyperpnoea under anaesthesia. Which drug is most appropriate along with 100% oxyg…
- Special anaesthesia: Duchenne muscular dystrophy · Multi-stepA 7-year-old boy with Duchenne muscular dystrophy is scheduled for an orthopaedic procedure. Which anaesthetic plan is safest?
- Special anaesthesia: sickle cell disease · ApplicationWhich perioperative measure helps to prevent sickling in a patient with sickle cell disease?
- Special anaesthesia: anterior mediastinal mass · Multi-stepA 25-year-old man with a large anterior mediastinal mass and orthopnoea needs a biopsy under general anaesthesia. Which induction technique is safest?
- Special anaesthesia: thyroid storm · Multi-stepA patient develops fever of 40 degrees C, heart rate of 160 per minute and agitation a few hours after thyroidectomy. Which drug controls the adrenergic features?
- Special anaesthesia: autonomic hyperreflexia · Multi-stepA man with a T4 spinal cord injury undergoes cystoscopy. During bladder distension his BP rises to 230/130 mmHg with a heart rate of 45 per minute and flushing above th…
- Special anaesthesia: oculocardiac reflex · Multi-stepA 6-year-old child undergoing squint surgery develops sudden bradycardia of 40 per minute when the surgeon pulls on the medial rectus. What is the first action?
- Special anaesthesia: pulmonary hypertension · ApplicationWhich perioperative factor increases pulmonary vascular resistance and should be avoided in a patient with pulmonary hypertension?
- Special anaesthesia: hip fracture surgery · ApplicationAn 82-year-old woman with a hip fracture is medically stable. What is the recommended timing of surgery?
- Special anaesthesia: MRI suite · ApplicationA child needs general anaesthesia in the MRI suite. Which precaution is essential?
Pain21
- Pain: neuropathic pain · ApplicationWhich drug is a first-line treatment for painful diabetic neuropathy?
- Pain: PCA background infusion · ApplicationWhich patient-controlled analgesia (PCA) setting increases the risk of respiratory depression in an opioid-naive adult and is therefore generally avoided?
- Pain: paracetamol overdose · Multi-stepA 20-year-old presents 6 hours after ingesting about 20 g of paracetamol. What is the appropriate treatment?
- Pain: tramadol · ApplicationWhich statement about tramadol is correct?
- Pain: serotonin syndrome · Multi-stepA patient on an SSRI receives pethidine and develops agitation, fever, sweating, diarrhoea, hyperreflexia and inducible clonus. Which drug is used if benzodiazepines an…
- Pain: complex regional pain syndrome · Multi-stepSix weeks after a wrist fracture and cast removal, a woman has burning pain out of proportion to the injury, a swollen shiny hand with temperature change and allodynia.…
- Pain: phantom limb pain · ApplicationA patient has burning pain in an amputated leg. Which of the following is a recognised treatment option?
- Pain: codeine and CYP2D6 · Multi-stepWhy is codeine contraindicated in children after tonsillectomy?
- Pain: methadone · ApplicationWhich adverse effect of methadone requires ECG monitoring in patients on long-term therapy?
- Pain: transdermal fentanyl · ApplicationWhy is a transdermal fentanyl patch unsuitable for treating acute postoperative pain in an opioid-naive patient?
- Pain: spinal cord stimulation · ApplicationWhich condition is a well-established indication for spinal cord stimulation?
- Pain: coeliac plexus neurolysis · Multi-stepA patient with pancreatic cancer receives a coeliac plexus neurolysis for severe upper abdominal pain. Which adverse effects are commonly expected?
- Pain: ganglion impar block · ApplicationA patient with rectal cancer has intractable perineal pain with a burning, poorly localised quality. Which block targets the sympathetic ganglion for this pain?
- Pain: lumbar sympathetic block · Multi-stepA patient with severe peripheral vascular disease has ischaemic rest pain in the foot and is unfit for revascularisation. Which block may improve pain and perfusion?
- Pain: epidural steroid injection · ApplicationFor which problem is an epidural steroid injection most appropriate?
- Pain: radiofrequency ablation of facet joint pain · ApplicationRadiofrequency ablation of the medial branch nerves is used for which kind of pain?
- Pain: opioid-induced hyperalgesia · Multi-stepA patient on escalating opioid doses for cancer pain develops more widespread pain with allodynia, despite increasing doses. What is the best next step?
- Pain: ketorolac contraindications · Multi-stepWhich patient should not receive ketorolac for postoperative analgesia?
- Pain: selective COX-2 inhibitors · ApplicationWhat is an advantage and a concern of celecoxib compared with non-selective NSAIDs?
- Pain: opioid conversion · Multi-stepA patient is taking 120 mg of oral morphine in 24 hours and becomes nil by mouth. Using an oral to intravenous ratio of 3 to 1, what is the approximate intravenous morp…
- Pain: epidural clonidine · ApplicationWhat are the main side effects of clonidine added to an epidural local anaesthetic?
Local anaesthetics20
- Local anaesthetics · ApplicationFor a Bier block (intravenous regional anaesthesia) of the forearm, which local anaesthetic is contraindicated because of the risk of cardiac arrest if the cuff fails?
- Local anaesthetics · ApplicationA patient reports urticaria and bronchospasm after a dental local anaesthetic injection. Which statement about local anaesthetic allergy is correct?
- Local anaesthetics: dosing · ApplicationWhat is the approximate maximum volume of 1% plain lignocaine that can be given by infiltration to a 70 kg adult, using a safe dose of 4.5 mg/kg?
- Local anaesthetics: adjuvants · ApplicationWhy is adrenaline added to lignocaine for infiltration, and in which site must the combination be avoided?
- Local anaesthetics: ester allergy · ApplicationWhy are ester local anaesthetics more likely to cause allergic reactions than amides?
- Local anaesthetics: ropivacaine · ApplicationWhy is ropivacaine often preferred to bupivacaine for prolonged epidural infusion?
- Local anaesthetics: bupivacaine cardiotoxicity · ApplicationWhy is cardiac arrest from bupivacaine particularly difficult to treat?
- Local anaesthetics: prilocaine · ApplicationWhich complication is classically associated with large doses of prilocaine?
- Local anaesthetics: pKa and onset · Multi-stepWhy does lignocaine have a faster onset than bupivacaine at physiological pH?
- Local anaesthetics: infected tissue · ApplicationWhy is a local anaesthetic often ineffective when infiltrated into an abscess?
- Local anaesthetics: differential block · ApplicationIn spinal anaesthesia, which sequence describes the order of loss of function?
- Local anaesthetics: bicarbonate · ApplicationWhy is sodium bicarbonate sometimes added to lignocaine for infiltration?
- Local anaesthetics: chloroprocaine · Multi-stepChloroprocaine is attractive for short spinal anaesthesia because of which property?
- Local anaesthetics: lignocaine as antiarrhythmic · ApplicationIntravenous lignocaine is used for ventricular arrhythmias. To which class of antiarrhythmic does it belong?
- Local anaesthetics: articaine · Multi-stepArticaine, widely used in dental anaesthesia, has which distinguishing structural feature?
- Local anaesthetics: absorption after regional blocks · ApplicationAfter injection of the same dose of local anaesthetic, which block results in the highest peak plasma concentration?
- Local anaesthetics: tumescent anaesthesia · Multi-stepIn tumescent liposuction, lignocaine doses far above the usual 7 mg/kg maximum can be used. Why?
- Local anaesthetics: toxicity · Multi-stepDuring bupivacaine regional anaesthesia, a patient develops tinnitus, perioral numbness, seizures and ventricular arrhythmia. What is the best immediate treatment in ad…
- Local anaesthetics · ApplicationWhat is an early symptom of local anaesthetic systemic toxicity?
- Local anaesthetics · ApplicationWhy is lipid emulsion used in severe local anaesthetic toxicity?
Inhalational agents17
- Inhalational agents · ApplicationMinimum alveolar concentration (MAC) is a measure of:
- Inhalational agents · Multi-stepA patient with a known untreated pneumothorax needs emergency anaesthesia before a chest drain can be placed. Which agent should be avoided, and why?
- Inhalational agents · ApplicationAt the end of a long anaesthetic with nitrous oxide, the patient is breathing room air, becomes drowsy and cyanosed and the saturation falls. This is best explained by:
- Inhalational agents: nitrous oxide and vitamin B12 · ApplicationProlonged nitrous oxide exposure causes megaloblastic changes and neuropathy by inhibiting which enzyme?
- Inhalational agents: second gas effect · ApplicationWhat is the second gas effect?
- Inhalational agents: MAC values · Multi-stepWhich inhalational agent has the highest MAC (lowest potency)?
- Inhalational agents: factors altering MAC · ApplicationWhich of the following increases MAC?
- Inhalational agents: Meyer-Overton · ApplicationThe Meyer-Overton hypothesis states that anaesthetic potency is directly related to what property?
- Inhalational agents: desflurane · ApplicationWhich feature of desflurane requires a special heated and pressurised vaporiser?
- Inhalational agents: sevoflurane degradation · Multi-stepWhich product formed by sevoflurane in contact with soda lime at low fresh gas flows is nephrotoxic in rats?
- Inhalational agents: isoflurane coronary steal · Multi-stepIsoflurane has been linked to coronary steal. What is the mechanism?
- Inhalational agents: bronchospasm and asthma · ApplicationWhich volatile agent is considered best for a patient with severe asthma undergoing surgery?
- Inhalational agents: methoxyflurane · ApplicationProlonged use of methoxyflurane for analgesia is limited by which toxicity?
- Inhalational agents: enflurane · Multi-stepWhich volatile agent can produce epileptiform EEG activity, especially with hyperventilation?
- Inhalational agents: Entonox · Multi-stepEntonox is a 50:50 mixture of nitrous oxide and oxygen. What happens at temperatures below minus 6 degrees C?
- Inhalational agents: xenon · Multi-stepWhich statement about xenon is correct?
- Inhalational agents: brain effects · ApplicationWhich volatile anaesthetic effect is relevant in a patient with raised intracranial pressure?
Equipment15
- Equipment: Mapleson circuits · ApplicationWhich Mapleson circuit is the most efficient for spontaneous ventilation?
- Equipment: Bain circuit · ApplicationThe Bain circuit is a coaxial modification of which Mapleson system?
- Equipment: carbon dioxide absorbers · Multi-stepWhat is the principal component of soda lime?
- Equipment: nitrous oxide cylinder · ApplicationHow is the amount of nitrous oxide remaining in a cylinder best determined?
- Equipment: oxygen cylinder · ApplicationA full oxygen cylinder has a pressure of about 137 bar (about 2000 psi). How is the content estimated?
- Equipment: vaporisers · ApplicationA modern agent-specific vaporiser delivers a constant output across fluctuating flows and temperatures. Which design features account for this?
- Equipment: oxygen flush · Multi-stepAn anaesthesia machine's oxygen flush delivers oxygen at about what flow?
- Equipment: anaesthesia machine safety · ApplicationWhich device ensures the delivered oxygen concentration is not less than 25% when nitrous oxide is turned on?
- Equipment: Reynolds number and heliox · Multi-stepWhy is heliox useful in upper airway obstruction?
- Equipment: paramagnetic oxygen analyser · ApplicationOn which principle does a paramagnetic oxygen analyser work?
- Equipment: rotameter · ApplicationA rotameter on an anaesthesia machine measures gas flow using which principle?
- Equipment: monopolar diathermy · ApplicationWhich statement about monopolar diathermy is correct?
- Equipment: electrical safety · Multi-stepWhich feature of an isolated power supply with line isolation monitoring protects patients in theatre?
- Equipment: hypoxic guard · ApplicationWhat is the role of the hypoxic guard on an anaesthesia machine?
- Equipment: nitrous oxide critical temperature · Multi-stepNitrous oxide in a cylinder exists as a liquid in equilibrium with vapour because of which property?
Intravenous agents15
- Intravenous agents · ApplicationWhich intravenous induction agent is a dissociative anaesthetic that tends to preserve blood pressure?
- Intravenous agents · ApplicationA young man in the ICU has been sedated with a high-dose propofol infusion for 4 days after head injury. He develops metabolic acidosis, rhabdomyolysis, hyperkalaemia,…
- Intravenous agents · ApplicationA woman with a history of recurrent abdominal pain, port-wine coloured urine and neuropathy is posted for surgery. Which induction agent is contraindicated?
- Intravenous agents: propofol in egg allergy · Multi-stepA patient with egg allergy needs general anaesthesia. What is the position on propofol?
- Intravenous agents: thiopentone intra-arterial injection · Multi-stepThiopentone is accidentally injected into the radial artery and the patient complains of severe burning pain with a blanched hand. What is the appropriate management?
- Intravenous agents: redistribution · ApplicationWhy is the clinical effect of a single induction dose of thiopentone short-lived?
- Intravenous agents: ketamine emergence phenomena · ApplicationWhich drug is best given to reduce the emergence reactions of ketamine?
- Intravenous agents: etomidate · ApplicationWhich adverse effect of a single dose of etomidate is of concern in septic shock?
- Intravenous agents: etomidate adverse effects · ApplicationWhich pair of side effects is characteristic of etomidate?
- Intravenous agents: dexmedetomidine · ApplicationWhich feature makes dexmedetomidine useful for sedation of an awake fibreoptic intubation?
- Intravenous agents: flumazenil risk · Multi-stepWhy should flumazenil be used cautiously in a patient on long-term benzodiazepines and tricyclic antidepressants?
- Intravenous agents: midazolam premedication in children · ApplicationWhich route and dose of midazolam is commonly used for premedication of an anxious 4-year-old?
- Intravenous agents: context-sensitive half-time · Multi-stepWhat does the context-sensitive half-time describe?
- Intravenous agents: total intravenous anaesthesia · ApplicationWhich agent is most commonly used for TIVA with target-controlled infusion?
- Intravenous agents: dosing in the elderly · ApplicationWhy is the induction dose of propofol reduced in an elderly patient?
Obstetric anaesthesia15
- Obstetric anaesthesia: pregnancy physiology · ApplicationWhich respiratory change occurs in term pregnancy and makes hypoxia develop quickly on apnoea?
- Obstetric anaesthesia: general anaesthesia for caesarean · ApplicationWhich is the greatest risk of general anaesthesia for caesarean section?
- Obstetric anaesthesia: magnesium in pre-eclampsia · ApplicationA woman with severe pre-eclampsia on magnesium sulphate needs caesarean section. How does magnesium influence anaesthetic management?
- Obstetric anaesthesia: bupivacaine 0.75 percent · ApplicationWhich local anaesthetic preparation is contraindicated for obstetric epidural anaesthesia because of reports of cardiac arrest?
- Obstetric anaesthesia: oxytocin bolus · ApplicationWhat is the main haemodynamic hazard of a rapid intravenous bolus of oxytocin at caesarean section?
- Obstetric anaesthesia: carboprost in asthma · ApplicationA woman with asthma has atonic postpartum haemorrhage unresponsive to oxytocin. Which uterotonic is contraindicated?
- Obstetric anaesthesia: pudendal nerve block · ApplicationA pudendal nerve block for the second stage of labour is administered transvaginally. Which landmark is used?
- Obstetric anaesthesia: amniotic fluid embolism · Multi-stepDuring labour a multiparous woman suddenly develops dyspnoea, cyanosis, hypotension and seizure, followed by bleeding from the puncture sites. What is the cornerstone o…
- Obstetric anaesthesia: vasopressor for spinal at caesarean · Multi-stepWhich vasopressor is generally preferred as a prophylactic infusion to prevent hypotension after spinal anaesthesia for caesarean section in a woman with a normal heart…
- Obstetric anaesthesia: spinal dose requirement in pregnancy · Multi-stepCompared with a non-pregnant woman, how does the spinal local anaesthetic dose requirement change in pregnancy?
- Obstetric anaesthesia: volatile agents and uterine tone · Multi-stepAt caesarean section under general anaesthesia, why are volatile agents kept at 0.5 MAC or below after delivery?
- Obstetric anaesthesia: pre-eclampsia and laryngoscopy · Multi-stepA woman with severe pre-eclampsia requires general anaesthesia for an emergency caesarean section. Which drug attenuates the pressor response to laryngoscopy?
- Obstetric anaesthesia · ApplicationWhy is left uterine displacement used for a term pregnant patient undergoing caesarean delivery?
- Obstetric anaesthesia · ApplicationWhy is left uterine displacement used in late pregnancy during resuscitation?
- Obstetric anaesthesia · ApplicationWhat is a common physiological reason pregnant patients desaturate rapidly during apnea?
Basic resuscitation14
- Basic resuscitation: confirming asystole · ApplicationA monitor shows a flat line in a collapsed patient. What should be checked before accepting the diagnosis of asystole?
- Basic resuscitation: Glasgow Coma Scale scoring · ApplicationA patient opens his eyes only to painful stimulus, makes incomprehensible sounds and withdraws from pain. What is his Glasgow Coma Scale score?
- Basic resuscitation: oxygen after return of circulation · ApplicationA ventilated patient who has just had return of spontaneous circulation after cardiac arrest has SpO2 of 100 percent on FiO2 of 1.0. What should be done with the inspir…
- Basic resuscitation: end-tidal CO2 during CPR · ApplicationDuring CPR in an intubated patient, the end-tidal CO2 abruptly rises from 12 to 40 mmHg without any change in compression quality. What is the most likely interpretation?
- Basic resuscitation: newborn after maternal opioid · ApplicationA newborn is apnoeic with a heart rate of 80 per minute after the mother received pethidine within the previous hour. What is the initial priority?
- Basic resuscitation: agonal breathing · ApplicationA man collapses in a market. He is unresponsive, and a trained rescuer sees only occasional slow snoring gasps about twice a minute and cannot feel a carotid pulse with…
- Basic resuscitation: thrombolysis in suspected pulmonary embolism arrest · Multi-stepA 38-year-old woman collapses six days after a long-haul flight, with a swollen painful calf. She is in pulseless electrical activity, and bedside echocardiography show…
- Basic resuscitation: preterm thermal care · ApplicationA baby born at 28 weeks is placed under a radiant warmer for stabilisation. Which additional measure best reduces heat loss?
- Basic resuscitation: route of drugs in newborn resuscitation · ApplicationA newborn has a heart rate of 40 per minute after 60 seconds of coordinated compressions and ventilation with 100 percent oxygen through an effective airway. What is th…
- Basic resuscitation: ventilation targets after return of circulation · ApplicationA comatose patient is ventilated after return of spontaneous circulation, and the arterial PaCO2 is 24 mmHg. What is the appropriate ventilation goal?
- Basic resuscitation: witnessed ventricular fibrillation · ApplicationA patient on a cardiac monitor in the coronary care unit suddenly develops ventricular fibrillation, witnessed by the nurse, and a defibrillator is at the bedside. What…
- Basic resuscitation: infant choking · ApplicationA health professional finds a 6-month-old who is conscious, silent and cyanosed, unable to cry or cough after choking on a toy. What is the correct first-aid sequence?
- Basic resuscitation: choking adult becomes unresponsive · ApplicationAn adult with foreign body airway obstruction becomes unresponsive and stops breathing while being given abdominal thrusts. What should the rescuer do next?
- Basic resuscitation: AED pads with an implanted device · ApplicationAn adult in ventricular fibrillation has a visible bulge under the left clavicle from an implanted pacemaker. How should AED pads be placed?
Cardiovascular physiology, fluids, and blood management14
- Cardiovascular physiology, fluids, and blood management: curriculum recognition · Multi-stepAn anaesthetised, ventilated patient is tilted from supine to a 60-degree head-up sitting position for shoulder surgery, and the blood pressure falls. Which change best…
- Cardiovascular physiology, fluids, and blood management: curriculum recognition · Multi-stepA patient has a mean arterial pressure of 90 mmHg, a central venous pressure of 10 mmHg and a cardiac output of 5 L/min. What is the systemic vascular resistance?
- Cardiovascular physiology, fluids, and blood management: curriculum recognition · Multi-stepAn anaesthetised patient with severe aortic stenosis becomes tachycardic and hypotensive, and then develops ST depression. Which pressure difference determines the driv…
- Cardiovascular physiology, fluids, and blood management: curriculum recognition · ApplicationA nitroglycerin infusion is started and mainly dilates venous capacitance vessels, pooling blood peripherally. Which determinant of cardiac output falls most?
- Cardiovascular physiology, fluids, and blood management: curriculum recognition · Multi-stepAfter a sudden fall in arterial pressure, stretch receptors in the carotid sinus and aortic arch reduce their firing. Which change in autonomic outflow follows?
- Cardiovascular physiology, fluids, and blood management: curriculum recognition · Multi-stepA 70-year-old receives a standard propofol induction dose, and within two minutes his blood pressure falls from 140/80 to 80/40 mmHg with a heart rate of 70 per minute…
- Cardiovascular physiology, fluids, and blood management: curriculum recognition · Multi-stepA 58-year-old man on amlodipine arrives for elective inguinal hernia repair. His blood pressure is 154/96 mmHg and he has no symptoms or end-organ damage. What is the b…
- Cardiovascular physiology, fluids, and blood management: curriculum recognition · Multi-stepA patient receives several litres of Hartmann's solution. The lactate it contains is metabolised, mainly in the liver, to which buffering anion?
- Cardiovascular physiology, fluids, and blood management: curriculum recognition · Multi-stepWhich finding best predicts that a fluid bolus will raise the stroke volume of a mechanically ventilated patient in sinus rhythm?
- Cardiovascular physiology, fluids, and blood management: curriculum recognition · Multi-stepA trauma patient in haemorrhagic shock is receiving a massive transfusion protocol. Which ratio of red cells, plasma and platelets is generally aimed for, to approximat…
- Cardiovascular physiology, fluids, and blood management: curriculum recognition · Multi-stepA woman with postpartum haemorrhage has lost 3 L of blood, and the fibrinogen is 0.8 g/L despite red cells and plasma. Which product is the most concentrated source of…
- Cardiovascular physiology, fluids, and blood management: curriculum recognition · ApplicationDuring repair of a ruptured aortic aneurysm, blood is aspirated from the operative field, anticoagulated, centrifuged, washed and returned to the patient. Which techniq…
- Cardiovascular physiology, fluids, and blood management: curriculum recognition · Multi-stepA bedside whole-blood test traces clot initiation, clot strength and clot breakdown in real time and helps to guide product replacement in a bleeding patient. What is i…
- Cardiovascular physiology, fluids, and blood management: curriculum recognition · Multi-stepIn recovery after major abdominal surgery, a patient has tachycardia, a blood pressure of 85/50 mmHg, cold peripheries, a narrow pulse pressure and low urine output. Wh…
Respiratory physiology and ventilation14
- Respiratory physiology and ventilation: curriculum recognition · Multi-stepA 60-year-old smoker has SpO2 91 percent on room air with PaCO2 of 38 mmHg and a widened alveolar-arterial gradient. Oxygen by mask partly corrects the hypoxaemia, and…
- Respiratory physiology and ventilation: curriculum recognition · ApplicationA ventilated adult receives a tidal volume of 500 mL at 12 breaths per minute, and the dead space is 150 mL. What is the alveolar ventilation per minute?
- Respiratory physiology and ventilation: curriculum recognition · ApplicationIn a paralysed patient on controlled ventilation with constant CO2 production, the volume of fresh gas reaching perfused alveoli each minute is doubled. What happens to…
- Respiratory physiology and ventilation: curriculum recognition · Multi-stepA hypovolaemic trauma patient becomes profoundly hypotensive within minutes of intubation and the start of controlled ventilation, although no drug effect explains it.…
- Respiratory physiology and ventilation: curriculum recognition · ApplicationA paralysed patient on volume control with a fixed set breath size has a PaCO2 of 58 mmHg and pH 7.26, with adequate oxygenation. Which single ventilator change most di…
- Respiratory physiology and ventilation: curriculum recognition · ApplicationA ventilator trace shows every breath delivering the same preset quantity of gas with a square flow waveform, while the peak airway pressure climbs as the patient's lun…
- Respiratory physiology and ventilation: curriculum recognition · ApplicationA spontaneously breathing intubated patient triggers every breath. The ventilator adds a fixed inspiratory boost and ends the breath when the flow falls to a fraction o…
- Respiratory physiology and ventilation: curriculum recognition · Multi-stepIn an obese patient who develops basal lung collapse after induction, a brief sustained inflation to a high airway pressure is followed by a moderate end-expiratory pre…
- Respiratory physiology and ventilation: curriculum recognition · Multi-stepA paralysed patient receives a tidal volume of 400 mL, with a plateau pressure of 25 cmH2O and PEEP of 5 cmH2O. What is the static compliance?
- Respiratory physiology and ventilation: curriculum recognition · Multi-stepTen minutes after induction in a ventilated patient, the pulse oximeter, with a good trace, falls from 99 percent to 88 percent. What is the most appropriate first acti…
- Respiratory physiology and ventilation: curriculum recognition · Multi-stepDuring one-lung ventilation, blood flow to the collapsed, non-ventilated lung is partly diverted by a local mechanism that limits the shunt. What is this mechanism?
- Respiratory physiology and ventilation: curriculum recognition · Multi-stepIn recovery, a drowsy patient with no prior lung disease who received a large dose of opioid has pH 7.22, PaCO2 68 mmHg and bicarbonate 26 mmol/L. Which acid-base disor…
- Respiratory physiology and ventilation: curriculum recognition · ApplicationA very anxious patient hyperventilates before an awake fibreoptic intubation and develops perioral tingling and carpopedal spasm. The blood gas shows pH 7.52, PaCO2 26…
- Respiratory physiology and ventilation: curriculum recognition · ApplicationWhich of these operations carries the highest risk of postoperative pulmonary complications, because of diaphragmatic dysfunction and pain-limited breathing?
Induction agents13
- Induction agents · ApplicationWhat hemodynamic effect can propofol commonly cause?
- Induction agents · ApplicationWhat dissociative anesthetic can increase sympathetic activity?
- Induction agents · ApplicationWhat property makes etomidate useful in selected hemodynamically unstable patients?
- Induction agents · ApplicationWhich intravenous agent is widely used for induction?
- Induction agents · ApplicationWhich induction agent commonly causes vasodilation and hypotension?
- Induction agents · ApplicationWhich property makes ketamine useful in some hypotensive patients?
- Induction agents: propofol · ApplicationWhich feature makes propofol a common induction agent for brief ambulatory procedures?
- Induction agents: ketamine · ApplicationWhich induction agent is especially useful when preservation of spontaneous breathing and bronchodilation are desirable, while recognizing it may increase secretions?
- Induction agents: propofol · ApplicationWhich haemodynamic effect is common after a bolus of propofol for induction?
- Induction agents: ketamine · ApplicationWhich property makes ketamine useful for induction in a hypotensive trauma patient?
- Induction agents: etomidate · ApplicationWhich adverse effect is associated with etomidate, particularly after repeated exposure?
- Induction agents · ApplicationWhich induction agent is associated with haemodynamic stability and bronchodilation?
- Induction agents · ApplicationWhich effect is common after propofol induction?
Complications, recovery, and safety culture12
- Complications, recovery, and safety culture: curriculum recognition · ApplicationDuring tonsillar surgery with diathermy near the airway, an operating room fire is a risk. Which gas, apart from oxygen, supports combustion?
- Complications, recovery, and safety culture: curriculum recognition · ApplicationA child with spina bifida is scheduled for surgery. Which precaution is most appropriate?
- Complications, recovery, and safety culture: curriculum recognition · Multi-stepA 4-year-old wakes from sevoflurane anaesthesia for adenotonsillectomy within 15 minutes, thrashing, crying and failing to recognise his parents. Analgesia has been giv…
- Complications, recovery, and safety culture: curriculum recognition · ApplicationSixty minutes after a routine two-hour general anaesthetic, a 40-year-old woman has not woken. Airway, oxygenation, ventilation, temperature and blood glucose are norma…
- Complications, recovery, and safety culture: curriculum recognition · Multi-stepTwo days after a long supine operation with the arms tucked at the sides in pronation, a man has tingling in the little finger and weak finger abduction. Sensation over…
- Complications, recovery, and safety culture: curriculum recognition · ApplicationA woman recalls hearing the obstetrician's voice and feeling unable to move during a caesarean section under general anaesthesia, with no memory of pain. Which factor m…
- Complications, recovery, and safety culture: curriculum recognition · ApplicationImmediately before the first skin incision, every member of the operating team pauses, introduces themselves and confirms the patient's identity, the procedure and the…
- Complications, recovery, and safety culture: curriculum recognition · ApplicationDuring a laparotomy the ventilator of the anaesthesia machine stops and cannot be restarted, and the cause is not obvious. What is the immediate priority?
- Complications, recovery, and safety culture: curriculum recognition · ApplicationWhile running on pipeline gas, the oxygen failure alarm sounds on the anaesthesia machine, the pipeline oxygen pressure reads zero and the flow of nitrous oxide stops a…
- Complications, recovery, and safety culture: curriculum recognition · ApplicationA 22-year-old man has a closed femoral shaft fracture. Thirty-six hours later he becomes breathless and confused with hypoxaemia and a petechial rash over the chest, ax…
- Complications, recovery, and safety culture: curriculum recognition · ApplicationEarly ambulation and intermittent pneumatic compression after major surgery reduce the risk of deep vein thrombosis mainly by countering which factor?
- Complications, recovery, and safety culture: curriculum recognition · ApplicationIn the recovery room, a patient after general anaesthesia is snoring with paradoxical see-saw chest and abdominal movements and a falling SpO2. Which is the most approp…
Critical care, resuscitation, and emergency principles12
- Critical care, resuscitation, and emergency principles: curriculum recognition · Multi-stepAfter 30 mL/kg of crystalloid for pneumonia with infection, a patient still needs noradrenaline to keep the mean arterial pressure at 65 mmHg, and the serum lactate is…
- Critical care, resuscitation, and emergency principles: curriculum recognition · Multi-stepA young man with a stab wound to the abdomen has a heart rate of 135 per minute, a blood pressure of 80/40 mmHg and cold peripheries. After airway and access are secure…
- Critical care, resuscitation, and emergency principles: curriculum recognition · ApplicationA patient with a stab wound to the chest has hypotension, distended neck veins, absent breath sounds on the right and tracheal deviation to the left. To which category…
- Critical care, resuscitation, and emergency principles: curriculum recognition · ApplicationA patient with pneumonia breathing room air has a PaO2 of 52 mmHg, a PaCO2 of 30 mmHg and a pH of 7.47. Which classification applies?
- Critical care, resuscitation, and emergency principles: curriculum recognition · Multi-stepWhich urine output criterion contributes to the KDIGO definition of acute kidney injury in a critically ill adult?
- Critical care, resuscitation, and emergency principles: curriculum recognition · ApplicationAn intubated, deeply sedated ICU patient cannot report pain. Which tool is suited to assess analgesia?
- Critical care, resuscitation, and emergency principles: curriculum recognition · ApplicationWhich skin antiseptic is preferred for preparing the site before inserting a central venous catheter, to lower the risk of bloodstream infection?
- Critical care, resuscitation, and emergency principles: curriculum recognition · ApplicationA haemodynamically stable ventilated patient with a functioning gut needs nutritional support. Which approach is recommended?
- Critical care, resuscitation, and emergency principles: curriculum recognition · ApplicationWhich blood glucose range is generally targeted in critically ill adults, with an insulin infusion started once the glucose exceeds about 180 mg/dL?
- Critical care, resuscitation, and emergency principles: curriculum recognition · Multi-stepAfter three weeks of sepsis and mechanical ventilation, a patient fails weaning because of symmetric flaccid limb weakness with reduced reflexes and spared facial muscl…
- Critical care, resuscitation, and emergency principles: curriculum recognition · Multi-stepA patient with a severe head injury is to be moved to a neurosurgical centre by ambulance. Which principle applies?
- Critical care, resuscitation, and emergency principles: curriculum recognition · Multi-stepAt a train accident, using the START triage method, a victim who cannot walk is breathing at 36 per minute, has a palpable radial pulse and obeys commands. Which catego…
Neuromuscular blockade12
- Neuromuscular blockade · ApplicationWhat is the purpose of a neuromuscular blocking drug during intubation?
- Neuromuscular blockade · ApplicationWhat monitoring can assess recovery from neuromuscular blockade?
- Neuromuscular blockade · ApplicationWhat is succinylcholine commonly used for?
- Neuromuscular blockade · ApplicationWhat electrolyte change can succinylcholine worsen in susceptible patients?
- Neuromuscular blockade · ApplicationWhat is the purpose of a neuromuscular blocker during intubation?
- Neuromuscular blockade · ApplicationWhat monitoring assesses recovery from neuromuscular blockade?
- Neuromuscular blockade: succinylcholine · Multi-stepA patient with a major crush injury sustained three weeks ago requires emergency intubation. Which reason makes succinylcholine potentially dangerous in this setting?
- Neuromuscular blockade: rocuronium reversal · ApplicationAt the end of surgery, which drug can rapidly reverse a rocuronium-induced neuromuscular block by encapsulating the blocker?
- Neuromuscular blockade: succinylcholine · ApplicationWhich patient is at greatest risk of dangerous hyperkalaemia after succinylcholine?
- Neuromuscular blockade: rocuronium reversal · ApplicationSugammadex reverses rocuronium primarily by what mechanism?
- Neuromuscular blockade · ApplicationWhat is the major reason succinylcholine is avoided in major burns after 24 hours?
- Neuromuscular blockade · ApplicationWhat monitoring assesses recovery from nondepolarizing neuromuscular block?
Paediatric anaesthesia12
- Paediatric anaesthesia: pyloric stenosis · ApplicationAn infant with pyloric stenosis has repeated vomiting. Which metabolic derangement is expected, and when should surgery be done?
- Paediatric anaesthesia: epiglottitis · Multi-stepA drooling child with stridor and fever sits leaning forward. What is the safest approach to airway management?
- Paediatric anaesthesia: foreign body in bronchus · Multi-stepDuring rigid bronchoscopy for an inhaled foreign body in a child, which ventilation strategy is preferred during induction?
- Paediatric anaesthesia: apnoea of prematurity · ApplicationA former preterm infant of low postconceptional age is scheduled for an inguinal hernia repair under general anaesthesia. What is the recommended perioperative plan?
- Paediatric anaesthesia: penile block · ApplicationA dorsal penile nerve block is used for circumcision in a child. Where is the local anaesthetic deposited?
- Paediatric anaesthesia: oxygen consumption in neonates · ApplicationWhy do neonates desaturate faster than adults during apnoea?
- Paediatric anaesthesia: allowable blood loss · Multi-stepA 20 kg child has an estimated blood volume of 75 mL/kg and a haematocrit of 36%. The lowest acceptable haematocrit is 24%. What is the maximum allowable blood loss, us…
- Paediatric anaesthesia: Down syndrome · ApplicationWhich airway-related problem is increased in a child with Down syndrome?
- Paediatric anaesthesia: congenital diaphragmatic hernia · Multi-stepA newborn with a prenatal diagnosis of left congenital diaphragmatic hernia is born with respiratory distress. Which step should be avoided?
- Paediatric anaesthesia: tracheo-oesophageal fistula · Multi-stepIn a neonate with oesophageal atresia and a distal tracheo-oesophageal fistula, how is the tracheal tube best positioned?
- Paediatric anaesthesia: post-tonsillectomy bleeding · Multi-stepA 6-year-old returns 8 hours after tonsillectomy with active bleeding from the tonsillar bed and tachycardia. What is the best management?
- Paediatric anaesthesia · ApplicationWhy do infants desaturate rapidly during apnoea?
Perioperative complications12
- Perioperative complications · ApplicationWhat is the first priority in suspected anaphylaxis during anesthesia?
- Perioperative complications · ApplicationWhat complication is suggested by rising end-tidal carbon dioxide and rigidity after triggering agents?
- Perioperative complications · ApplicationWhat drug is used to treat malignant hyperthermia?
- Perioperative complications · ApplicationWhat is postoperative nausea and vomiting managed with when indicated?
- Perioperative complications · ApplicationWhat is a postoperative sign of airway obstruction?
- Perioperative complications · ApplicationWhat is the immediate response priority to laryngospasm?
- Perioperative complications · ApplicationWhat is an early concern after extubation in a high-risk patient?
- Perioperative complications · ApplicationWhat is the first priority in suspected intraoperative anaphylaxis?
- Perioperative complications · ApplicationWhat finding suggests malignant hyperthermia during anesthesia?
- Perioperative complications · ApplicationWhat drug treats malignant hyperthermia?
- Perioperative complications · ApplicationWhat is the first response to suspected intraoperative anaphylaxis?
- Perioperative complications · ApplicationWhat finding suggests awareness under general anaesthesia after surgery?
ACLS11
- ACLS: defibrillation energy · ApplicationWhat energy is used for the initial biphasic defibrillation shock in an adult in ventricular fibrillation?
- ACLS: adrenaline dosing · ApplicationIn a non-shockable cardiac arrest (asystole), what is the recommended adrenaline regimen?
- ACLS: amiodarone · ApplicationA patient with refractory ventricular fibrillation has received three shocks and adrenaline. What is the dose of amiodarone?
- ACLS: torsades de pointes · ApplicationPulseless polymorphic ventricular tachycardia of torsades type in a patient with long QT should be treated with defibrillation and which drug?
- ACLS: reversible causes · ApplicationWhich pair is listed among the reversible causes (Hs and Ts) of cardiac arrest?
- ACLS: capnography in CPR · ApplicationDuring CPR, a sudden sustained rise in end-tidal CO2 to above 40 mmHg is most suggestive of what?
- ACLS: bradycardia · ApplicationA patient with symptomatic bradycardia and hypotension is treated. What is the first-line drug according to the AHA algorithm?
- ACLS: extracorporeal CPR · ApplicationIn which situation may extracorporeal CPR be considered?
- ACLS: end-tidal CO2 and prognosis · Multi-stepAfter 20 minutes of advanced life support in an intubated patient, the end-tidal CO2 remains below 10 mmHg. How is this interpreted?
- ACLS: ventilation with an advanced airway · ApplicationDuring CPR with a tracheal tube in place in an adult, what ventilation rate is recommended?
- ACLS: adenosine administration · Multi-stepWhich statement about adenosine for supraventricular tachycardia is correct?
Opioids11
- Opioids: remifentanil · ApplicationWhy does remifentanil have a context-sensitive half-time of about 3 to 4 minutes regardless of infusion duration?
- Opioids: morphine adverse effects · ApplicationWhich statement about morphine is correct?
- Opioids: pethidine · ApplicationPethidine is used to treat postoperative shivering, but it is avoided with repeated dosing in renal failure. What is the reason?
- Opioids: naloxone · ApplicationNaloxone reverses opioid respiratory depression, but the patient may become drowsy again after an hour. Why?
- Opioids: chest wall rigidity · ApplicationRapid intravenous injection of a large dose of fentanyl causes difficulty ventilating a patient because of rigid chest wall. What is the treatment?
- Opioids: buprenorphine · ApplicationWhich statement about buprenorphine is correct?
- Opioids: nalbuphine · ApplicationNalbuphine acts on opioid receptors in which way?
- Opioids · ApplicationMost dangerous opioid adverse effect is what?
- Opioids · ApplicationWhat can naloxone reverse?
- Opioids · ApplicationWhat drug reverses opioid-induced respiratory depression?
- Opioids: remifentanil · ApplicationWhich property of remifentanil is most important when planning postoperative analgesia?
Regional anesthesia11
- Regional anesthesia · ApplicationWhat is the target space for spinal anesthesia?
- Regional anesthesia · ApplicationWhere is an epidural catheter placed?
- Regional anesthesia · ApplicationWhat physiological effect can occur after spinal anesthesia?
- Regional anesthesia · ApplicationWhat is a contraindication concern before neuraxial anesthesia?
- Regional anesthesia · ApplicationWhat is a peripheral nerve block intended to provide?
- Regional anesthesia · ApplicationWhat complication can occur if local anesthetic enters the bloodstream in high concentration?
- Regional anesthesia · ApplicationWhat is an epidural test dose used to help detect?
- Regional anesthesia · ApplicationWhat space receives a spinal anesthetic injection?
- Regional anesthesia · ApplicationAfter accidental dural puncture during neuraxial analgesia, which positional complication can develop over the next few days?
- Regional anesthesia · ApplicationWhat is a major advantage of a peripheral nerve block?
- Regional anesthesia: interscalene block · Multi-stepAfter an interscalene brachial plexus block, a patient with severe chronic lung disease becomes more breathless. Which predictable associated effect is the most likely…
Pharmacology10
- Pharmacology: ondansetron · ApplicationWhich statement about ondansetron is correct?
- Pharmacology: PONV prophylaxis with long QT · Multi-stepA patient with congenital long QT syndrome needs PONV prophylaxis for laparoscopic surgery. Which regimen is most appropriate?
- Pharmacology: ephedrine tachyphylaxis · Multi-stepRepeated doses of ephedrine produce progressively less pressor response. What explains this tachyphylaxis?
- Pharmacology: phenylephrine · ApplicationWhich effect is characteristic of a phenylephrine bolus?
- Pharmacology: sodium nitroprusside toxicity · Multi-stepA patient receiving a high-dose sodium nitroprusside infusion for controlled hypotension develops tachyphylaxis, metabolic acidosis and bright red venous blood. What is…
- Pharmacology: esmolol · ApplicationWhy is esmolol suitable for short-term control of heart rate during anaesthesia?
- Pharmacology: milrinone · ApplicationMilrinone is classified as an inodilator because it does which of the following?
- Pharmacology: remimazolam · ApplicationWhat is a distinguishing feature of remimazolam?
- Pharmacology: alfentanil onset · Multi-stepAlfentanil has a faster onset than fentanyl, although it is less lipid soluble. What is the main explanation?
- Pharmacology: physostigmine · ApplicationWhich anticholinesterase crosses the blood-brain barrier and reverses central anticholinergic syndrome?
Airway anatomy, equipment, and airway management9
- Airway anatomy, equipment, and airway management: curriculum recognition · ApplicationAfter failed intubation and failed mask ventilation, a patient is desaturating rapidly. The anaesthetist makes a scalpel incision through the membrane between the thyro…
- Airway anatomy, equipment, and airway management: curriculum recognition · ApplicationWhen a laryngoscope blade touches the posterior pharyngeal wall, the patient gags. Which cranial nerve carries the afferent limb of this reflex?
- Airway anatomy, equipment, and airway management: curriculum recognition · Multi-stepAfter total thyroidectomy a woman can speak but her voice is weak and monotonous and she cannot produce high-pitched notes. Both cords abduct and adduct, though one loo…
- Airway anatomy, equipment, and airway management: curriculum recognition · ApplicationIn a supine adult, which surface landmark lies at the level where the trachea divides into the two main bronchi?
- Airway anatomy, equipment, and airway management: curriculum recognition · ApplicationDuring bag-mask ventilation of an apnoeic adult, the anaesthetist presses the mask on with the thumb and index finger and hooks the other three fingers under the angle…
- Airway anatomy, equipment, and airway management: curriculum recognition · Multi-stepA trauma patient in a rigid cervical collar has limited neck extension and a 3 cm mouth opening, and needs intubation. Which device lets the anaesthetist see the glotti…
- Airway anatomy, equipment, and airway management: curriculum recognition · Multi-stepA patient ventilated for 12 days after severe pneumonia fails repeated weaning trials because of high work of breathing and heavy secretions. The team replaces the tran…
- Airway anatomy, equipment, and airway management: curriculum recognition · Multi-stepDuring induction for intestinal obstruction, bilious fluid wells up in the pharynx, followed by coughing and a fall in saturation to 85%. What is the immediate step?
- Airway anatomy, equipment, and airway management: curriculum recognition · ApplicationA laryngeal papilloma is to be excised with a laser under general anaesthesia. Which approach reduces the risk of an airway fire?
Recovery9
- Recovery · ApplicationNoisy inspiration in sedated recovery patient suggests what?
- Recovery · ApplicationWhat causes common upper-airway obstruction in sedated patient?
- Recovery · ApplicationWhat should be checked first in acute desaturation?
- Recovery · ApplicationWhat is a key criterion before discharge from post-anesthesia care?
- Recovery · ApplicationWhat scoring tool type may help determine readiness for discharge from recovery?
- Recovery · ApplicationWhat should be addressed before a same-day surgery patient leaves?
- Recovery · ApplicationWhat criterion is important before discharge from post-anesthesia care?
- Recovery: residual neuromuscular block · ApplicationWhich bedside measurement most reliably suggests adequate recovery from nondepolarising neuromuscular blockade before extubation?
- Recovery: emergence delirium · ApplicationWhich patient group most commonly experiences emergence delirium after sevoflurane anaesthesia?
Special populations and acute pain9
- Special populations and acute pain: curriculum recognition · Multi-stepA woman at term needs general anaesthesia. Which change in the pregnant airway increases the risk of difficult intubation and bleeding during laryngoscopy?
- Special populations and acute pain: curriculum recognition · Multi-stepA term baby is apnoeic after drying and stimulation, and the heart rate is 70 per minute. What is the next step?
- Special populations and acute pain: curriculum recognition · Multi-stepA 9-point scale from very fit to terminally ill, based on the clinician's judgement of function and comorbidity, is used before surgery in older patients. Which tool is…
- Special populations and acute pain: curriculum recognition · ApplicationA 34-year-old woman has had an inguinal hernia repair as a day case under general anaesthesia. She is awake, comfortable and haemodynamically stable. Which condition is…
- Special populations and acute pain: curriculum recognition · ApplicationAfter a total knee replacement, a surgeon prescribes paracetamol, an NSAID, a femoral nerve block and a small dose of opioid together, so that each acts on a different…
- Special populations and acute pain: curriculum recognition · Multi-stepA 48-year-old woman has persistent burning pain and allodynia along her thoracotomy scar five months after lung resection. There is no infection or tumour recurrence, a…
- Special populations and acute pain: curriculum recognition · ApplicationA patient-controlled pump delivers a fixed bolus of morphine whenever the button is pressed, but ignores further presses for the next several minutes. What is the purpo…
- Special populations and acute pain: curriculum recognition · ApplicationA man is sent home after shoulder surgery under an interscalene block with a numb, heavy arm. Which advice is most important at discharge?
- Special populations and acute pain: curriculum recognition · ApplicationA surgical ward audit asks how pain should be recorded after laparotomy so that staff can judge whether the patient can breathe deeply and mobilise. Which record is mos…
Airway8
- Airway · ApplicationWhich of the following is a contraindication to using a classic laryngeal mask airway?
- Airway · Multi-stepAfter induction and neuromuscular blockade, repeated intubation attempts fail. Face-mask ventilation and a supraglottic airway also fail, and oxygen saturation is falli…
- Airway · ApplicationOn laryngoscopy the epiglottis is visible but no part of the glottis can be seen (Cormack-Lehane grade 3). Which device is most appropriate to help intubation?
- Airway: ramped position in obesity · ApplicationA patient with a BMI of 48 kg/m2 is being prepared for intubation. Which positioning technique improves both preoxygenation and the laryngoscopic view?
- Airway · ApplicationWhat does Mallampati assess?
- Airway · ApplicationWhich is an airway-assessment feature?
- Airway · ApplicationWhat does a cuffed tube help protect against?
- Airway: cricoid pressure · ApplicationWhat is the intended purpose of cricoid pressure during rapid sequence induction?
Airway assessment8
- Airway assessment: LEMON · ApplicationIn the LEMON method of predicting a difficult airway, what does the letter E stand for?
- Airway assessment: Cormack-Lehane · ApplicationAt laryngoscopy only the epiglottis is visible and no part of the glottis can be seen. Which Cormack-Lehane grade is this?
- Airway assessment: Wilson risk score · Multi-stepWhich of the following is NOT a component of the Wilson risk sum score for difficult intubation?
- Airway assessment: rheumatoid arthritis · ApplicationA patient with long-standing rheumatoid arthritis is to have general anaesthesia. Which preoperative airway assessment is most important?
- Airway assessment: acromegaly · ApplicationWhich feature of acromegaly makes airway management difficult?
- Airway assessment · ApplicationWhat bedside classification helps assess the view of the oropharynx?
- Airway assessment · ApplicationWhat classification examines visibility of oropharyngeal structures?
- Airway assessment · ApplicationWhat does a high Mallampati class suggest?
General anesthesia8
- General anesthesia · ApplicationWhat is the usual goal of induction of general anesthesia?
- General anesthesia · ApplicationWhich inhalational agent is commonly used to maintain general anesthesia?
- General anesthesia · ApplicationWhat component of general anesthesia prevents awareness?
- General anesthesia · ApplicationWhat component of anesthetic care addresses painful stimuli?
- General anesthesia · ApplicationWhat is balanced anesthesia?
- General anesthesia · ApplicationWhat is a concern with excessive depth of anesthesia?
- General anesthesia · ApplicationWhat is the primary goal of induction of general anesthesia?
- General anesthesia · ApplicationWhich inhaled drug may be used to maintain anesthesia?
Monitoring and anaesthesia workstation8
- Monitoring and anaesthesia workstation: curriculum recognition · ApplicationA catheter is placed through the internal jugular vein with its tip in the lower superior vena cava and connected to a transducer zeroed at the level of the right atriu…
- Monitoring and anaesthesia workstation: curriculum recognition · ApplicationOn a five-lead ECG in theatre, which lead is the most useful single lead for identifying arrhythmias through a clear P wave and for detecting inferior wall ischaemia?
- Monitoring and anaesthesia workstation: curriculum recognition · Multi-stepA patient with an upper arm circumference of 40 cm has a non-invasive blood pressure of 172/104 mmHg on a standard adult cuff, while an arterial line shows 138/82 mmHg.…
- Monitoring and anaesthesia workstation: curriculum recognition · ApplicationAn anaesthetist wants to stop a vaporiser calibrated for one volatile agent from being topped up with a different liquid agent by mistake. Which design feature of moder…
- Monitoring and anaesthesia workstation: curriculum recognition · Multi-stepDuring volume-controlled ventilation of an anaesthetised patient, the low expired minute volume alarm sounds, the peak inspiratory pressure is lower than before and the…
- Monitoring and anaesthesia workstation: curriculum recognition · ApplicationA pressure-sensitive component of an anaesthesia machine sounds an alarm and cuts off nitrous oxide when the supply of the vital gas drops. What is this component?
- Monitoring and anaesthesia workstation: curriculum recognition · Multi-stepDuring controlled ventilation, the high airway pressure alarm sounds. The peak inspiratory pressure has risen abruptly while the plateau pressure is essentially unchang…
- Monitoring and anaesthesia workstation: curriculum recognition · ApplicationA syringe pump delivering a vasoactive drug is placed well above the patient, and the plunger is not engaged in the drive. The patient receives an uncontrolled bolus of…
Spinal anaesthesia8
- Spinal anaesthesia: needle design and headache · ApplicationWhich needle is associated with the lowest risk of post-dural puncture headache?
- Spinal anaesthesia: hypotension management · ApplicationA patient has hypotension and a heart rate of 50 per minute after spinal anaesthesia. Which vasopressor is most appropriate?
- Spinal anaesthesia: high block · ApplicationA patient develops dyspnoea, difficulty speaking, bradycardia and hypotension 10 minutes after spinal injection. What is the diagnosis?
- Spinal anaesthesia: cardiac accelerators · Multi-stepA high spinal block causes bradycardia mainly through blockade of which nerves?
- Spinal anaesthesia: baricity · ApplicationHyperbaric bupivacaine 0.5% is given in the sitting position. What does hyperbaric mean?
- Spinal anaesthesia: transient neurological symptoms · Multi-stepWhich local anaesthetic given intrathecally is associated with transient neurological symptoms (back pain radiating to the buttocks and legs)?
- Spinal anaesthesia: epidural blood patch · Multi-stepA woman has a severe postural headache 3 days after a dural puncture with a large-bore epidural needle, unrelieved by fluids, caffeine and simple analgesics. What is th…
- Spinal anaesthesia · ApplicationProfound hypotension after spinal anaesthesia is primarily caused by blockade of which fibres?
Airway complications6
- Airway complications · ApplicationDuring emergence from light anaesthesia, a patient develops a crowing noise that suddenly becomes silent, with paradoxical chest and abdominal movement and falling satu…
- Airway complications: laryngospasm · ApplicationA child develops stridor and paradoxical chest movements with desaturation after emergence, suggesting laryngospasm. What is the first management?
- Airway complications: post-extubation stridor · ApplicationA patient develops stridor after extubation following prolonged intubation. Which initial treatment is appropriate?
- Airway complications: cuff leak test · Multi-stepWhat does a negative (absent) cuff leak test before extubation predict?
- Airway complications: aspiration site · Multi-stepIn a supine patient, aspirated gastric contents most commonly lodge in which segment?
- Airway complications: bronchospasm · ApplicationDuring light anaesthesia a patient develops wheeze, rising airway pressure and a shark-fin capnograph. What is the first step?
Fluid management6
- Fluid management · ApplicationWhat is a principal reason for giving intravenous fluid perioperatively?
- Fluid management · ApplicationWhat fluid is commonly used for initial isotonic crystalloid replacement?
- Fluid management · ApplicationWhat is a potential sign of inadequate circulating volume during surgery?
- Fluid management · ApplicationWhy is urine output monitored during major surgery?
- Fluid management · ApplicationWhy are intravenous fluids given perioperatively?
- Fluid management · ApplicationWhat clinical purpose can balanced crystalloid serve during surgery?
Malignant hyperthermia6
- Malignant hyperthermia · ApplicationDuring general anaesthesia with sevoflurane and succinylcholine, a patient develops unexplained tachycardia, jaw rigidity and a rapidly rising end-tidal CO2 despite inc…
- Malignant hyperthermia · Multi-stepA 20-year-old man is anaesthetised with sevoflurane and suxamethonium. Soon afterwards he develops masseter spasm, tachycardia, a rapidly climbing end-tidal CO2 and a r…
- Malignant hyperthermia · ApplicationSpecific therapy for MH is what?
- Malignant hyperthermia · ApplicationWhich sign should raise concern for malignant hyperthermia during anesthesia?
- Malignant hyperthermia · ApplicationWhat specific drug is used to treat malignant hyperthermia?
- Malignant hyperthermia · Multi-stepSoon after volatile anesthesia begins, end-tidal CO2 rises rapidly despite increased ventilation, with generalized rigidity, tachycardia, and increasing temperature. Wh…
Pain management6
- Pain management · ApplicationAfter major abdominal surgery, a patient receives paracetamol, a regional block, and an opioid only for breakthrough pain. Why is this strategy used?
- Pain management · ApplicationWhat is a benefit of regional analgesia after suitable surgery?
- Pain management · ApplicationWhat is a key benefit of scheduled nonopioid analgesics when appropriate?
- Pain management · ApplicationWhat is the principle of multimodal postoperative analgesia?
- Pain management · ApplicationWhat is the principle of multimodal postoperative analgesia?
- Pain management · ApplicationWhat is multimodal analgesia?
Postoperative care6
- Postoperative care: Aldrete score · ApplicationThe modified Aldrete score includes which of the following parameters?
- Postoperative care · ApplicationWhich factor increases postoperative nausea and vomiting risk?
- Postoperative care · ApplicationWhat opioid complication requires close monitoring after surgery?
- Postoperative care: residual neuromuscular block · Multi-stepIn recovery, a patient has shallow breathing, weak head lift, difficulty swallowing, and oxygen desaturation after receiving a nondepolarizing muscle relaxant. What sho…
- Postoperative care · ApplicationWhat is the most important initial assessment for postoperative opioid sedation?
- Postoperative care · ApplicationWhat intervention reduces postoperative pulmonary complications after abdominal surgery?
Pre-anaesthetic assessment and perioperative principles6
- Pre-anaesthetic assessment and perioperative principles: curriculum recognition · ApplicationBefore elective surgery an anaesthetist asks a patient to tilt the head back and look at the ceiling while the shoulders stay still. Which movement is being assessed, b…
- Pre-anaesthetic assessment and perioperative principles: curriculum recognition · Multi-stepA 38-year-old man with a BMI of 46 kg/m2 is preoxygenated and then made apnoeic for intubation. His saturation falls within about two minutes, much faster than in a lea…
- Pre-anaesthetic assessment and perioperative principles: curriculum recognition · ApplicationA preoperative questionnaire scores loud snoring, daytime tiredness, observed pauses in breathing at night, high blood pressure, BMI above 35 kg/m2, age above 50 years,…
- Pre-anaesthetic assessment and perioperative principles: curriculum recognition · Multi-stepA 62-year-old woman with a previous leg deep vein thrombosis is to have a 4-hour open pelvic operation for ovarian cancer. Which plan of thromboprophylaxis is most appr…
- Pre-anaesthetic assessment and perioperative principles: curriculum recognition · Multi-stepDuring a 3-hour laparotomy under general anaesthesia an adult's core temperature has fallen to 35 degrees C. Which is the most effective single active method of prevent…
- Pre-anaesthetic assessment and perioperative principles: curriculum recognition · ApplicationJust before skin incision the whole operating team pauses to confirm aloud the patient's identity, the operative site, the planned procedure and whether antibiotic prop…
Regional anaesthesia and pain anatomy6
- Regional anaesthesia and pain anatomy: curriculum recognition · ApplicationFor hand and forearm surgery, local anaesthetic is deposited around the median, ulnar and radial nerves near the artery at the armpit, and the musculocutaneous nerve is…
- Regional anaesthesia and pain anatomy: curriculum recognition · Multi-stepA 70-year-old man needs a 4-hour total knee replacement. The plan is a block that works quickly and densely, can be topped up if the operation runs long, and can then p…
- Regional anaesthesia and pain anatomy: curriculum recognition · ApplicationWhile a 25-gauge needle is advanced at the L3-L4 interspace, clear fluid drips steadily from the hub. In which space is the needle tip?
- Regional anaesthesia and pain anatomy: curriculum recognition · ApplicationWhile an epidural catheter is being threaded in a labouring woman, blood flows back through it. Which structure has most likely been entered?
- Regional anaesthesia and pain anatomy: curriculum recognition · ApplicationBefore an open umbilical hernia repair under spinal anaesthesia, the surgeon tests sensation with a cold swab at the umbilicus. Which dermatomal level does this corresp…
- Regional anaesthesia and pain anatomy: curriculum recognition · ApplicationAn alert adult in the recovery area after knee surgery can describe the pain. Which tool is the simplest validated way to measure its severity?
Transfusion6
- Transfusion: massive transfusion · ApplicationWhich complication of massive blood transfusion results from citrate in stored blood?
- Transfusion: cell salvage · ApplicationWhich setting is a relative contraindication to intraoperative cell salvage?
- Transfusion: TACO versus TRALI · Multi-stepA patient develops dyspnoea, hypertension, raised JVP and a raised BNP during transfusion, and improves with furosemide. What is the diagnosis?
- Transfusion: acute haemolytic reaction · Multi-stepTen minutes into a red cell transfusion, an anaesthetised patient develops hypotension, haemoglobinuria and oozing from wounds. What is the first step?
- Transfusion · ApplicationFirst action in suspected transfusion reaction?
- Transfusion: acute hemolytic reaction · Multi-stepMinutes after starting a blood transfusion under anesthesia, a patient develops hypotension, fever, hemoglobinuria, and diffuse bleeding. What is the first action regar…
Neuromuscular monitoring5
- Neuromuscular monitoring · ApplicationDuring surgery, train-of-four stimulation of the ulnar nerve shows four twitches that progressively fade, with an enhanced response after tetanic stimulation. Which blo…
- Neuromuscular monitoring: train-of-four · ApplicationWhat TOF ratio is considered adequate recovery from neuromuscular blockade before extubation?
- Neuromuscular monitoring: patterns of block · ApplicationA non-depolarising block is characterised by which findings on peripheral nerve stimulation?
- Neuromuscular monitoring: post-tetanic count · Multi-stepWhen is post-tetanic count (PTC) used?
- Neuromuscular monitoring · Multi-stepBefore extubation after nondepolarizing neuromuscular blockade, which quantitative train-of-four ratio best supports adequate recovery?
Post-cardiac arrest care5
- Post-cardiac arrest care: temperature · Multi-stepAfter return of spontaneous circulation, comatose adults should receive temperature control. Which target is recommended by AHA 2023 guidance?
- Post-cardiac arrest care: haemodynamic targets · ApplicationWhich blood pressure target is recommended after ROSC?
- Post-cardiac arrest care: ventilation target · ApplicationAfter ROSC, what PaCO2 range should be targeted?
- Post-cardiac arrest care: coronary angiography · ApplicationA resuscitated patient has ST elevation on the post-ROSC ECG. What is the recommended next step?
- Post-cardiac arrest care: timing of prognostication · Multi-stepWhen should multimodal neurological prognostication be performed after cardiac arrest?
Airway equipment4
- Airway equipment: Miller blade · ApplicationWhy is a straight Miller blade often preferred in infants?
- Airway equipment: bougie · ApplicationA gum elastic bougie is used in a grade III view. Which sign confirms its tracheal placement?
- Airway equipment: Magill forceps · ApplicationFor what purpose are Magill forceps used during nasotracheal intubation?
- Airway equipment: armoured tracheal tube · Multi-stepWhich statement about a reinforced (armoured) tracheal tube is correct?
Blood management4
- Blood management · ApplicationWhat is the first step before transfusing blood products?
- Blood management · ApplicationWhat action reduces wrong-blood transfusion risk?
- Blood management · ApplicationWhat is the purpose of a surgical time-out before incision?
- Blood management · ApplicationWhat reaction requires immediate stopping of a blood transfusion?
Paediatric ALS4
- Paediatric ALS: defibrillation dose · ApplicationWhat is the initial defibrillation energy for a child in shockable rhythm?
- Paediatric ALS: adrenaline dose · ApplicationWhat is the intravenous adrenaline dose for a child in cardiac arrest?
- Paediatric ALS: bradycardia · ApplicationA child has a heart rate of 50 per minute with poor perfusion despite oxygenation and ventilation. What is the next step?
- Paediatric ALS: synchronised cardioversion dose · Multi-stepWhat is the initial energy for synchronised cardioversion in a child with unstable supraventricular tachycardia?
Physiology4
- Physiology: preoxygenation · ApplicationWhat is the principle of preoxygenation before induction?
- Physiology: apnoeic oxygenation · ApplicationHow does nasal oxygen delivered during apnoea help maintain saturation?
- Physiology: functional residual capacity under anaesthesia · ApplicationBy how much does functional residual capacity typically fall after induction of general anaesthesia in an adult?
- Physiology: cerebral blood flow and PaCO2 · Multi-stepWithin the physiological range, how does cerebral blood flow respond to changes in PaCO2?
Special arrest4
- Special arrest: drowning · ApplicationIn a drowning victim in cardiac arrest, which step should be emphasised?
- Special arrest: hypothermia · ApplicationA patient is pulled from icy water with a core temperature of 24 degrees C and is pulseless. What is the principle?
- Special arrest: pregnancy · ApplicationIn cardiac arrest in a woman with a fundus above the umbilicus, what should accompany standard CPR?
- Special arrest: lightning injury · Multi-stepWhen several victims of a lightning strike appear lifeless, which approach to triage is recommended?
Airway devices3
- Airway devices: LMA sizing · ApplicationWhich LMA size is generally used for an average adult woman weighing 55 kg?
- Airway devices: i-gel · ApplicationWhich statement describes the i-gel supraglottic airway?
- Airway devices: ProSeal laryngeal mask · ApplicationHow does the ProSeal laryngeal mask differ from the classic LMA?
Anaesthetic pharmacology3
- Anaesthetic pharmacology: curriculum recognition · ApplicationBupivacaine blocks nerves at much lower concentrations than lignocaine. Which physicochemical property chiefly explains its greater potency?
- Anaesthetic pharmacology: curriculum recognition · ApplicationCompared with lignocaine, bupivacaine and ropivacaine produce longer-lasting blocks. Which property is chiefly responsible for the longer duration of action?
- Anaesthetic pharmacology: curriculum recognition · Multi-stepAfter a large intravenous dose of an opioid, a spontaneously breathing patient has a slow respiratory rate, is easily rousable and is hypercapnic. Which mechanism mainl…
Anaphylaxis3
Fluids3
Induction3
Local anaesthetic toxicity3
- Local anaesthetic toxicity · ApplicationDuring a brachial plexus block, a patient develops circumoral numbness and tinnitus, then a generalised seizure followed by ventricular arrhythmia. Which specific thera…
- Local anaesthetic toxicity: lipid emulsion · ApplicationA patient develops seizures and hypotension after a brachial plexus block. After airway support, what specific therapy is given?
- Local anaesthetic toxicity: resuscitation doses · Multi-stepIn cardiac arrest from local anaesthetic toxicity, how should adrenaline be dosed?
Neuromuscular blockers3
- Neuromuscular blockers · ApplicationAt the end of surgery, residual neuromuscular block from atracurium is reversed with neostigmine. Why is glycopyrrolate given with it?
- Neuromuscular blockers · Multi-stepA man with 30% burns, 3 weeks old, needs an emergency re-grafting under general anaesthesia. Which drug is best avoided for intubation?
- Neuromuscular blockers · ApplicationWhich muscle relaxant is the best choice for a patient with combined renal and hepatic failure because it is degraded by spontaneous chemical breakdown?
Sedation3
- Sedation: depth classification · Multi-stepA sedated patient responds purposefully only after repeated or painful stimulation, and may need help maintaining the airway. Which level of sedation does this describe?
- Sedation · ApplicationWhat is an essential safeguard during procedural sedation?
- Sedation · ApplicationWhat drug can reverse benzodiazepine sedation in selected circumstances?
Thoracic anaesthesia3
- Thoracic anaesthesia · Multi-stepA patient with a right lower lobe lesion undergoing lobectomy has one-lung ventilation with a double-lumen tube. The saturation falls shortly after the left lung is ven…
- Thoracic anaesthesia: hypoxaemia during one-lung ventilation · Multi-stepDuring one-lung ventilation for lobectomy, the saturation falls to 85%. What is the best immediate step?
- Thoracic anaesthesia: left-sided double-lumen tube · Multi-stepWhy is a left-sided double-lumen tube preferred in most cases of one-lung ventilation?
Volatile agents3
- Volatile agents · ApplicationLower blood-gas solubility causes what?
- Volatile agents: MAC · ApplicationWhat does a lower minimum alveolar concentration (MAC) of an inhaled anaesthetic indicate?
- Volatile agents: malignant hyperthermia · Multi-stepWhich drug is the specific treatment for malignant hyperthermia triggered by a volatile anaesthetic?
Airway adjuncts2
- Airway adjuncts: oropharyngeal airway · ApplicationAn unconscious patient on the ward is snoring and has partial upper airway obstruction from the tongue falling back. No gag reflex can be elicited. A curved plastic dev…
- Airway adjuncts: nasopharyngeal airway · ApplicationA man has a clenched jaw and snoring respiration after a generalised seizure. His gag reflex is intact and there are no signs of a basal skull fracture. Which airway ad…
Analgesia2
Aspiration prevention2
Consent2
Difficult airway2
- Difficult airway · ApplicationWhat is the safest response when intubation becomes unexpectedly difficult?
- Difficult airway: oxygenation · Multi-stepAfter induction, repeated intubation attempts are unsuccessful and mask ventilation is becoming ineffective. According to difficult-airway principles, what overarching…
Emergency2
Epidural2
Epidural anaesthesia2
- Epidural anaesthesia: test dose · ApplicationWhat is the purpose of the epidural test dose of 3 mL lignocaine 1.5% with adrenaline 1 in 200,000?
- Epidural anaesthesia: spinal haematoma · Multi-stepAfter epidural catheter removal, a patient on LMWH develops severe back pain and progressive leg weakness. What is the most appropriate management?
Inhalational anaesthetics2
- Inhalational anaesthetics · ApplicationWhich of the following inhalational agents has the lowest MAC, and so the highest potency?
- Inhalational anaesthetics: pharmacokinetics · ApplicationWhen nitrous oxide is given in high concentration together with a volatile agent during induction, the alveolar concentration of the volatile agent rises faster than ex…
Local anesthesia2
Local anesthetic systemic toxicity2
- Local anesthetic systemic toxicity · Multi-stepMinutes after a large-volume brachial plexus block with bupivacaine, a patient complains of circumoral numbness, tinnitus and a metallic taste. She then has a generalis…
- Local anesthetic systemic toxicity · Multi-stepDuring a peripheral nerve block, a patient reports metallic taste and tinnitus, then develops a seizure. What is the most appropriate immediate specific therapy in addi…
Local anesthetic toxicity2
Local anesthetics2
Neonatal resuscitation2
- Neonatal resuscitation: compression ratio · ApplicationIn neonatal resuscitation, chest compressions are started when the heart rate remains below what value after 30 seconds of effective ventilation?
- Neonatal resuscitation: initial oxygen · ApplicationA term baby requires positive pressure ventilation at birth. Which initial inspired oxygen concentration is recommended?
Neuraxial opioids2
Obstetric2
Opioid safety2
Paediatric airway2
- Paediatric airway: tube size · ApplicationWhat is the approximate internal diameter of a cuffed endotracheal tube for an 8-year-old child using the formula age/4 + 3.5?
- Paediatric airway: depth of insertion · ApplicationWhat is the approximate oral insertion depth at the lip of an endotracheal tube in a 6-year-old child using the formula age/2 + 12?
Pain physiology2
- Pain physiology: multimodal analgesia · ApplicationAfter a knee replacement, a patient receives regular paracetamol, an NSAID, a femoral nerve block and a low dose of opioid, which together provide better pain relief th…
- Pain physiology: neuropathic pain · ApplicationA 58-year-old diabetic describes burning pain in both feet with sudden electric-shock sensations. Light touch from bedsheets is painful, and there is a stocking pattern…
PONV2
Postoperative nausea and vomiting2
- Postoperative nausea and vomiting · ApplicationWhich anesthetic strategy generally reduces postoperative nausea and vomiting risk in a susceptible patient when clinically appropriate?
- Postoperative nausea and vomiting · ApplicationWhich patient factor increases risk of postoperative nausea and vomiting?
Premedication2
Preoperative fasting2
Safety2
Temperature2
Airway emergencies1
Arterial line1
Aspiration prophylaxis1
Epidural analgesia1
Epidural anesthesia1
Geriatric anaesthesia1
Inhalational anesthesia1
Intraoperative care1
Intravenous anaesthetics1
Intravenous anesthesia1
Local anesthetic1
Mechanical ventilation1
Neuraxial anaesthesia1
Neuraxial anesthesia1
Neuromuscular block1
Oxygen delivery1
Paediatric BLS1
Perioperative fluid therapy1
Perioperative hypothermia1
Post-anesthesia care1
Post-dural puncture headache1
Postoperative analgesia1
Postoperative complications1
Pre-anaesthetic assessment1
Pre-operative assessment1
Preoperative care1
Pulse oximetry1
Rapid sequence1
Recovery care1
Succinylcholine1
Temperature management1
Transfusion safety1
Common questions
How many Anaesthesia questions are there?
964 original questions across 714 topics, and the bank grows over time.
Which Anaesthesia topics are covered?
Intravenous anaesthetics, Regional anaesthesia, Inhalational anaesthetics, Pre-operative assessment, Intravenous agents, Pre-anaesthetic assessment, Inhalational agents, Monitoring, Airway management, Neuromuscular monitoring, Oxygen therapy, Local anaesthetic toxicity, and more.
How difficult are these Anaesthesia questions?
0 are recall, 692 are application and 272 are multi-step. The tags are our own editorial judgement, not an official difficulty rating.
Are these Anaesthesia questions from past papers?
No. They are original practice items. NBEMS does not publish its paper or an official key, and we do not use recalled or leaked questions.
Can I practise Anaesthesia for free?
Yes. The free plan includes 20 practice questions a day across all subjects, and the free 20-question assessment covers every subject. A paid term removes the daily limit.
Is there a timed Anaesthesia test?
Yes. The Anaesthesia subject test is included with a paid term, with a countdown and a question palette.
How should I use these Anaesthesia questions?
Answer before you look, read the reason for every option, and write a three-line note for each mistake. A few questions you fully review are worth more than many you skim.
Have these Anaesthesia questions been reviewed by faculty?
Not yet. They are original and drafted with AI assistance, then edited by our team. Independent faculty review is planned, and each item shows its status. Confirm important facts in a standard textbook.