A 29-year-old primigravida undergoes emergency Caesarean section under spinal anaesthesia for fetal distress. Five minutes after intrathecal injection, her blood pressure falls from 130/80 mmHg to 75/40 mmHg. Simultaneously, the fetal heart rate decreases from 145 bpm to 85 bpm. What is the most appropriate immediate management?

A 4-year-old child weighing 16 kg is scheduled for adenotonsillectomy. During surgery, estimated blood loss is 250 mL. Approximately what percentage of the child's total blood volume has been lost?

A 68-year-old man is admitted to ICU with septic shock secondary to pneumonia. He is mechanically ventilated and receiving norepinephrine 0.25 µg/kg/min. His current observations are: • HR: 122 bpm • BP: 82/48 mmHg • CVP: 6 mmHg • Lactate: 5.8 mmol/L • Urine output: 10 mL/hour Bedside echocardiography demonstrates a hyperdynamic left ventricle with a small end-diastolic cavity. What is the most appropriate next step?

A 62-year-old man is undergoing thoracoscopic left upper lobectomy. Thirty minutes after initiation of one-lung ventilation, oxygen saturation falls from 99% to 86% despite FiO₂ of 1.0. What is the most appropriate initial intervention?

A 30-year-old woman receives an epidural for labour analgesia. Fifteen minutes later she complains of circumoral numbness, tinnitus, and metallic taste. What is the most likely diagnosis?

A 75-year-old man is being assessed for elective colectomy. His medical history includes: • Ischaemic heart disease • Previous myocardial infarction • Insulin-dependent diabetes • Chronic kidney disease with creatinine 2.3 mg/dL According to the Revised Cardiac Risk Index (RCRI), which factor is NOT included?

A 56-year-old patient undergoes prolonged abdominal surgery lasting six hours. At the end of surgery, the core temperature is 34.5°C. Which mechanism contributes most to heat loss during surgery?

A patient is admitted following a road traffic accident. On examination: • Eyes open to pain • Incomprehensible sounds • Withdraws from painful stimulus What is the Glasgow Coma Scale score?

During scoliosis correction surgery with sensory evoked potential monitoring, a sudden loss of SSEP signals is noted. What is the most appropriate immediate action?

A patient with known sickle cell disease presents for emergency laparotomy. Which perioperative factor is most likely to precipitate sickling?

A 32-year-old primigravida in labour is undergoing continuous fetal heart rate monitoring. The CTG demonstrates: • Baseline fetal heart rate 170 bpm • Absent baseline variability • Recurrent late decelerations with more than 50% of contractions What is the most appropriate interpretation?

A patient undergoing TIVA for intracranial aneurysm clipping has a BIS value of 18. Blood pressure and heart rate are stable. What is the most likely interpretation?

During laser excision of a vocal cord lesion, flames are suddenly seen emerging from the patient's mouth. What is the immediate first step?

A 3-year-old child weighing 15 kg requires endotracheal intubation. What is the most appropriate uncuffed endotracheal tube size?

A mechanically ventilated ICU patient suddenly develops the following flow-volume loop: • Expiratory limb demonstrates a marked scooped-out appearance. • Peak airway pressures have increased. What is the most likely diagnosis?

A patient develops the following ECG rhythm in recovery: • Irregularly irregular rhythm • No visible P waves • Ventricular rate 140/min What is the diagnosis?

A woman with severe preeclampsia is receiving magnesium sulfate. Which clinical finding is most suggestive of magnesium toxicity?

During laparoscopic surgery, the capnograph suddenly changes from a normal square waveform to a progressively rising baseline that fails to return to zero. What is the most likely explanation?

Immediately after administration of cefazolin during induction, a patient develops: • BP 60/30 mmHg • HR 130/min • Bronchospasm • Generalised erythema What is the first-line treatment?

A term neonate weighs 3.5 kg. What is the estimated circulating blood volume?

A 28-year-old woman undergoes emergency Caesarean section under spinal anaesthesia. Ten minutes after delivery, she develops brisk vaginal bleeding. Estimated blood loss is 1500 mL. The uterus is soft and poorly contracted. What is the most likely cause?

A 2-year-old child develops complete airway obstruction immediately following extubation after adenotonsillectomy. Which of the following is the most common cause?

A mechanically ventilated ICU patient has the following ABG: • pH: 7.28 • PaCO₂: 60 mmHg • HCO₃⁻: 27 mmol/L What is the primary acid-base disorder?

During surgery, train-of-four monitoring demonstrates: • Four twitches present • Significant fade noted What is the most likely interpretation?

A patient undergoing major abdominal surgery develops the ECG shown below: • Tall peaked T waves • Progressive widening of the QRS complex What electrolyte abnormality should be suspected first?

A patient with severe COPD undergoes thoracic surgery. Which ventilatory strategy is most appropriate during one-lung ventilation?

A labouring patient receiving epidural analgesia suddenly develops: • Tinnitus • Perioral numbness • Agitation • Generalised seizure What is the most appropriate next step?

A head-injured patient has: • Eyes open spontaneously • Confused conversation • Localises pain What is the GCS score?

A patient undergoing spinal surgery is monitored with motor evoked potentials (MEPs). Which anaesthetic technique best preserves MEP signals?

A patient with septic shock remains hypotensive despite adequate fluid resuscitation. Current observations: • MAP 55 mmHg • Lactate 4.8 mmol/L Which vasopressor is recommended as first-line therapy?

A 35-year-old woman undergoes Caesarean section under spinal anaesthesia. Shortly after delivery, she becomes restless and complains of difficulty breathing. Her blood pressure is 60/30 mmHg, heart rate is 45/min, and she is unable to move her upper limbs. What is the most likely diagnosis?

A 6-year-old child weighing 20 kg requires fluid therapy after an overnight fast. According to the Holliday-Segar formula, what is the maintenance fluid requirement per hour?

A mechanically ventilated patient develops sudden hypotension and desaturation. Ventilator findings: • Increased peak airway pressure • Increased plateau pressure • Absent breath sounds on the right side What is the most likely diagnosis?

A patient undergoing general anaesthesia demonstrates the following capnography trace: • Gradually rising expiratory upstroke • Slanted alveolar plateau What is the most likely diagnosis?

A patient develops ventricular fibrillation during surgery. What is the first priority?

A patient scheduled for lung resection has an FEV₁ of 35% predicted. What is the most important concern?

A labouring patient has the following CTG: • Baseline 140 bpm • Moderate variability • Accelerations present • No decelerations How should this trace be classified?

A patient with acute porphyria presents for emergency surgery. Which induction agent should generally be considered safe?

During prolonged spinal surgery, the surgeon requests motor evoked potential monitoring. Which anaesthetic drug is most likely to interfere significantly with MEP interpretation?

A septic ICU patient has: • MAP 68 mmHg • Lactate 6 mmol/L • ScvO₂ 52% What does the low ScvO₂ most likely indicate?

A 34-year-old woman with severe preeclampsia is receiving magnesium sulfate infusion. During assessment, the nurse reports a respiratory rate of 8 breaths/min and absent patellar reflexes. What is the most appropriate immediate management?

A 5-year-old child weighing 18 kg is scheduled for inguinal hernia repair. What is the estimated blood volume?

A ventilated ICU patient suddenly develops: • ETCO₂ drop from 35 mmHg to 12 mmHg • Tachycardia • Hypotension • Increased dead space ventilation What is the most likely diagnosis?

During general anaesthesia, train-of-four monitoring demonstrates no twitches. Post-tetanic count is 2. What is the best description of the level of blockade?

A patient develops a wide-complex tachycardia at 180 bpm during surgery. The rhythm is regular and no P waves are visible. What is the most likely diagnosis?

During one-lung ventilation, oxygen saturation decreases to 88%. DLT position has been confirmed bronchoscopically. What is the next most appropriate intervention?

A CTG demonstrates recurrent variable decelerations with preserved baseline variability. What is the most likely cause?

A patient with sickle cell disease presents for emergency laparotomy. Which perioperative measure is most important to minimize sickling?

A patient undergoing craniotomy demonstrates a BIS value of 92 despite receiving propofol infusion. Blood pressure and heart rate are increasing. What is the most likely interpretation?

A patient with septic shock remains hypotensive despite norepinephrine 0.4 µg/kg/min. MAP is 58 mmHg. What is the most appropriate additional vasopressor?

A 30-year-old woman undergoes emergency Caesarean section for fetal distress. Following delivery, the neonate is noted to have poor respiratory effort, hypotonia, and a heart rate of 90/min. The mother received repeated doses of intravenous fentanyl during labour. What is the most likely cause?

A 10-month-old infant weighing 9 kg presents for pyloromyotomy. What is the estimated blood volume?

A patient with ARDS is receiving lung-protective ventilation. Which tidal volume is recommended?

A patient undergoing laparoscopic surgery develops: • ETCO₂ rising from 38 to 60 mmHg • Tachycardia • Increasing temperature • Generalised muscle rigidity What is the most likely diagnosis?

A patient develops the following ECG abnormality: • Prolonged QT interval Which electrolyte abnormality is most commonly associated?

A patient undergoing thoracic surgery develops severe hypoxaemia during OLV despite optimal positioning and CPAP. What physiological mechanism normally helps maintain oxygenation during OLV?

A labouring patient develops sudden maternal hypotension after epidural top-up. Shortly afterward, fetal bradycardia develops. What is the most likely mechanism?

A patient with acute intermittent porphyria requires emergency surgery. Which drug should generally be avoided?

During scoliosis surgery, SSEP amplitude suddenly decreases by 60%. Blood pressure is 60/35 mmHg. What is the most appropriate immediate action?

A septic ICU patient has: • Lactate 7 mmol/L • MAP 70 mmHg • Urine output 0.2 mL/kg/hr What does the elevated lactate most strongly suggest?

A 26-year-old woman undergoes emergency Caesarean section under general anaesthesia. Immediately after induction, direct laryngoscopy reveals a Cormack-Lehane Grade IV view. Mask ventilation remains adequate and oxygen saturation is 100%. What is the most appropriate next step?

A 4-year-old child weighing 20 kg requires emergency fluid resuscitation following trauma. What is the recommended initial crystalloid bolus?

A mechanically ventilated ICU patient has: • Plateau pressure: 34 cmH₂O • Peak pressure: 36 cmH₂O What does this finding most strongly suggest?

During laparoscopic cholecystectomy, the surgeon accidentally damages a major blood vessel. The patient becomes hypotensive and tachycardic. Which physiological response is expected first?

A patient receiving massive transfusion develops: • Prolonged QT interval • Hypotension • Tetany What is the most likely cause?

A patient undergoing lung isolation develops persistent hypoxaemia. Which intervention is most likely to worsen oxygenation?

A labouring patient develops recurrent late decelerations after spinal anaesthesia. Blood pressure is 70/40 mmHg. What is the most appropriate first treatment?

A patient with severe sickle cell disease develops postoperative chest pain, hypoxaemia, and pulmonary infiltrates. What is the most likely diagnosis?

During spine surgery, MEP signals suddenly disappear. Blood pressure, temperature, and anaesthetic depth are unchanged. What should be considered next?

A septic patient has: • MAP 68 mmHg • Cardiac index 1.8 L/min/m² • ScvO₂ 48% • Lactate 5.5 mmol/L What is the most appropriate additional therapy?

A 31-year-old primigravida receiving oxytocin augmentation develops recurrent fetal bradycardia. CTG demonstrates a fetal heart rate of 80 bpm lasting more than 3 minutes. Uterine contractions are occurring every minute. What is the most appropriate immediate management?

A 6-month-old infant weighing 7 kg is scheduled for pyloromyotomy. Which electrolyte abnormality is classically associated with pyloric stenosis?

A mechanically ventilated patient has the following ventilator parameters: • Peak pressure: 42 cmH₂O • Plateau pressure: 22 cmH₂O What is the most likely explanation?

During laparoscopic surgery, the capnograph suddenly becomes completely flat. Blood pressure and oxygen saturation remain normal. What is the most likely cause?

A patient develops pulseless ventricular tachycardia in the operating theatre. What is the next step after delivering the first shock?

A patient undergoing thoracic surgery develops severe hypoxaemia. Which factor is most likely to impair hypoxic pulmonary vasoconstriction?

A woman with severe postpartum haemorrhage receives: • 8 units packed red cells • 8 units FFP • 1 adult dose platelets Despite transfusion, bleeding continues. What coagulation abnormality should be suspected?

A child develops inspiratory stridor immediately following extubation. The oxygen saturation falls to 85%. What is the most appropriate initial intervention?

During spine surgery, the anaesthetist is asked to facilitate motor evoked potential monitoring. Which drug is most likely to interfere with MEP interpretation?

A patient with septic shock demonstrates: • Lactate 8 mmol/L • MAP 65 mmHg • Urine output 0.1 mL/kg/hr • Cool peripheries What is the most likely interpretation?

A 29-year-old woman with severe preeclampsia is undergoing emergency Caesarean section. Her platelet count is 58,000/mm³. What is the most important concern regarding neuraxial anaesthesia?

A 3-year-old child weighing 15 kg requires emergency blood transfusion following trauma. The child's haemoglobin is 5 g/dL. What is the expected rise in haemoglobin after transfusing 10 mL/kg packed red cells?

A ventilated ICU patient develops: • Acute hypoxaemia • Hypotension • Distended neck veins • Unilateral absent breath sounds What is the most appropriate immediate management?

During laparoscopic surgery, ETCO₂ gradually rises despite increasing minute ventilation. The patient develops tachycardia, hyperthermia, and metabolic acidosis. What is the definitive treatment?

An ECG demonstrates: • Absent P waves • Irregularly irregular ventricular rhythm • Narrow QRS complexes What is the diagnosis?

A patient undergoing one-lung ventilation develops persistent hypoxaemia despite CPAP and confirmed DLT position. What manoeuvre may provide temporary improvement?

A labouring patient develops sudden chest pain, hypoxaemia, severe hypotension, and coagulopathy immediately after delivery. What is the most likely diagnosis?

A neonate has: • Heart rate 80/min • Poor respiratory effort What is the most appropriate next step in neonatal resuscitation?

During spinal surgery, SSEP amplitude decreases by 70%. Mean arterial pressure is 50 mmHg. What is the most likely explanation?

A septic ICU patient has: • Lactate 6 mmol/L • ScvO₂ 50% • Haemoglobin 6.5 g/dL What intervention is most likely to improve oxygen delivery?

A 36-year-old woman undergoing emergency Caesarean section under spinal anaesthesia suddenly complains of nausea and dizziness. Her blood pressure falls from 135/80 mmHg to 75/40 mmHg and fetal bradycardia develops. Which physiological mechanism best explains the fetal heart rate change?

A 2-year-old child weighing 12 kg presents with severe dehydration secondary to gastroenteritis. What is the estimated circulating blood volume?

A mechanically ventilated ICU patient develops worsening oxygenation despite FiO₂ 1.0. Chest X-ray demonstrates bilateral diffuse infiltrates. PaO₂/FiO₂ ratio is 90. What is the most likely diagnosis?

During anaesthesia, a patient develops the following capnograph: • Sudden fall in ETCO₂ from 36 mmHg to 8 mmHg • Blood pressure simultaneously decreases What diagnosis should be considered first?

A patient develops ventricular fibrillation during surgery. After three shocks and administration of epinephrine, ventricular fibrillation persists. Which drug should now be administered?

A patient undergoing thoracic surgery develops hypoxaemia during OLV. Which factor contributes most to hypoxaemia during OLV?

A postpartum patient develops severe haemorrhage. ROTEM demonstrates markedly reduced clot amplitude consistent with low fibrinogen. Which blood product is most appropriate?

A neonate is born at term. What is the approximate normal heart rate immediately after successful neonatal resuscitation?

During scoliosis surgery, motor evoked potentials suddenly disappear. Which anaesthetic change is most likely to improve monitoring quality?

A patient with septic shock has: • MAP 66 mmHg • Lactate 5.5 mmol/L • ScvO₂ 45% • Cardiac index 1.7 L/min/m² What is the most likely haemodynamic problem?