A 78-year-old man presents for emergency laparotomy. Preoperative ECG shows: • Regular rhythm • Heart rate 38/min • P waves completely independent of QRS complexes • QRS rate slower than atrial rate What is the MOST likely diagnosis?

A patient undergoing bowel surgery develops: • HR 150/min • Wide complex tachycardia • BP 80/40 mmHg What should be assumed until proven otherwise?

A labouring woman has: • Baseline 140 bpm • Normal variability • Decelerations mirroring contractions What is the MOST likely interpretation?

A labouring woman develops: • Baseline 170 bpm • Variability 3 bpm • Recurrent late decelerations What is the MOST likely classification?

A patient presents with: • Flattened inspiratory limb • Normal expiratory limb What is the MOST likely diagnosis?

A patient with tracheal stenosis undergoes spirometry. Both inspiratory and expiratory limbs are flattened. What pattern is present?

During TIVA: • BIS = 82 • BP 140/80 • HR 105/min The surgeon makes incision. What is the MOST concerning interpretation?

Which mechanism accounts for the greatest proportion of perioperative heat loss?

An airway fire occurs during laser surgery. Which three elements form the fire triangle?

A patient with: • Previous MI • Diabetes on insulin • CKD (Creatinine 2.4 mg/dL) is undergoing major abdominal surgery. Which tool is most commonly used to estimate perioperative cardiac risk?

A 72-year-old patient is brought to theatre for emergency laparotomy. ECG shows: • Regular rhythm • Rate 42/min • PR interval progressively lengthens • Followed by a dropped QRS complex What is the MOST likely diagnosis?

A patient in recovery develops: • HR 34/min • BP 70/40 mmHg ECG: • Constant PR intervals • Sudden dropped QRS complexes • No progressive PR prolongation What is the MOST likely diagnosis?

A patient with renal failure develops: • Muscle weakness • Bradycardia ECG shows: • Tall peaked T waves • Narrow QRS complexes What is the MOST likely diagnosis?

During induction of anaesthesia: • HR 150/min • Narrow QRS • Regular rhythm What is the MOST likely diagnosis?

A labouring woman develops: • Baseline 145 bpm • Normal variability • Abrupt decelerations varying in shape What is the MOST likely diagnosis?

A labouring woman has: • Baseline 150 bpm • Variability absent • No accelerations • Recurrent late decelerations What is the MOST concerning interpretation?

Spirometry demonstrates: • Normal inspiratory limb • Flattened expiratory limb What is the MOST likely diagnosis?

A patient has severe COPD. What flow-volume loop feature is MOST characteristic?

During TIVA: • BIS 28 • BP 75/40 • HR 42 What is the MOST likely interpretation?

A patient undergoing laparotomy receives: • Rocuronium infusion • TIVA At the end of surgery the patient reports: "I remember hearing voices but couldn't move." What complication occurred?

A patient arrives in recovery with: • Temperature 34.5°C • Shivering • Hypertension What is the MOST likely explanation?

Which warming strategy is MOST effective intraoperatively?

During laser airway surgery, what is the MOST effective way to reduce fire risk?

A patient has: • Previous MI • CKD • Insulin-dependent diabetes What does an increasing RCRI score indicate?

A patient has: • BMI 39 • Loud snoring • Daytime somnolence • Hypertension What condition is the STOP-BANG score designed to identify?

A 83-year-old woman presents for laparoscopic surgery. Preoperative ECG shows: • PR interval 240 ms • Every P wave followed by a QRS complex • Heart rate 65/min What is the MOST likely diagnosis?

After induction with propofol and fentanyl in an elderly patient: ECG shows: • Regular rhythm • Heart rate 45/min • Narrow QRS • No visible preceding P waves What is the MOST likely rhythm?

A patient develops: • Irregularly irregular rhythm • No identifiable P waves • Ventricular rate 140/min What is the MOST likely diagnosis?

An ECG demonstrates: • Regular atrial activity at 300/min • Sawtooth waves in leads II, III, aVF • Ventricular rate 150/min What is the MOST likely diagnosis?

A mechanically ventilated patient suddenly develops: • Rising ETCO₂ • Sloping expiratory plateau ("shark-fin") What is the MOST likely diagnosis?

During anaesthesia: • ETCO₂ abruptly falls from 35 mmHg to 5 mmHg • BP becomes unrecordable What is the MOST concerning diagnosis?

A capnogram suddenly returns to zero. The patient remains pink and stable. What is the MOST likely explanation?

At the end of surgery: TOF count: 4/4 twitches TOF ratio: 0.45 What is the MOST appropriate interpretation?

A patient is unable to lift their head for 5 seconds after extubation. TOF ratio is: 0.6 What is the MOST likely explanation?

During scoliosis surgery: • SSEPs disappear • MEPs preserved • MAP 50 mmHg What is the MOST likely concern?

During scoliosis correction: • MEPs disappear • SSEPs remain normal What structure is MOST likely affected?

A patient has: • Mallampati IV • Mouth opening 2 cm • Limited neck extension What is the MOST likely airway challenge?

After three unsuccessful laryngoscopy attempts: • SpO₂ falls to 88% What is the MOST important priority?

A mechanically ventilated ICU patient has: • PPV 18% • SVV 17% • MAP 60 mmHg What is the MOST likely interpretation?

A septic patient has: • Lactate 8 mmol/L • MAP 75 mmHg The trainee says: "The blood pressure is normal so perfusion is adequate." What is the BEST response?

A labouring woman develops: • Baseline fetal heart rate 90 bpm • Variability absent • Prolonged deceleration lasting 5 minutes Maternal BP is: 65/35 mmHg following epidural top-up. What is the MOST appropriate first intervention?

A CTG demonstrates: • Smooth sine-wave pattern • Absent normal variability • Regular oscillations What is the MOST concerning diagnosis?

During TIVA: • BIS suddenly rises from 45 to 85 • BP unchanged • HR unchanged • Diathermy is activated What is the MOST likely explanation?

A patient in ICU receives: • Propofol infusion • BIS 8 EEG shows burst suppression. What does this MOST likely indicate?

During laser surgery of the larynx: The endotracheal tube ignites. After stopping oxygen and removing the tube, what is the NEXT priority?

A patient suddenly develops: • ETCO₂ = 0 • Ventilator alarm • Stable SpO₂ • Stable BP What is the MOST appropriate first action?

A septic patient has: • Hb 6 g/dL • ScvO₂ 50% • Lactate 7 mmol/L Which intervention is MOST likely to improve oxygen delivery immediately?

A mechanically ventilated septic patient has: • PPV 4% • SVV 3% • CVP 14 mmHg What is the MOST likely interpretation?

A patient develops: • Peaked T waves • PR prolongation • QRS widening What is the MOST likely next ECG change if untreated?

A 78-year-old woman with: • Hypertension • First-degree AV block • Previous MI undergoes cemented hip hemiarthroplasty. Five minutes after cement insertion: • BP falls from 150/85 to 60/35 mmHg • ETCO₂ falls from 34 to 12 mmHg • SpO₂ falls to 80% The surgeon asks: "Is this a myocardial infarction?" What is the SINGLE MOST IMPORTANT clue suggesting Bone Cement Implantation Syndrome instead?