Welcome to your Test 23 A 33-year-old primigravida at 39 weeks gestation is undergoing emergency Caesarean section under spinal anaesthesia for non-reassuring fetal heart rate tracing. Five minutes after spinal injection, blood pressure decreases from 125/75 mmHg to 70/35 mmHg. The CTG shows recurrent prolonged decelerations. What is the most appropriate immediate management? Immediate delivery without intervention Phenylephrine bolus and left uterine displacement Magnesium sulfate administration Emergency hysterectomy None A 4-year-old child weighing 18 kg presents with severe dehydration. What is the estimated circulating blood volume? 900 mL 1080 mL 1260 mL 1440 mL None A 67-year-old patient is admitted to ICU with septic shock. Current observations: • MAP: 58 mmHg • Lactate: 6.2 mmol/L • Urine output: 0.2 mL/kg/hr He has already received 30 mL/kg crystalloid. What is the most appropriate next step? Sodium bicarbonate infusion Norepinephrine infusion Furosemide administration Immediate dialysis None A patient undergoing robotic prostatectomy develops progressively increasing peak airway pressures. Ventilator data: • Peak pressure: 42 cmH₂O • Plateau pressure: 24 cmH₂O What is the most likely explanation? ARDS Reduced compliance Increased airway resistance Pulmonary oedema None A patient undergoing thyroidectomy suddenly develops: • ETCO₂ 65 mmHg • Generalized rigidity • Tachycardia • Temperature 39.5°C What is the most likely diagnosis? Thyroid storm Neuroleptic malignant syndrome Malignant hyperthermia Pheochromocytoma crisis None A patient undergoing lung resection is ventilated with a double-lumen tube. Thirty minutes after initiation of one-lung ventilation, oxygen saturation falls to 85%. What should be checked first? Pulmonary artery pressure DLT position using fibreoptic bronchoscopy Arterial blood gas Hemoglobin level None A labouring patient develops recurrent variable decelerations on CTG. What is the most likely underlying mechanism? Placental insufficiency Umbilical cord compression Maternal hyperglycaemia Fetal anaemia None A 7-year-old child weighing 25 kg requires maintenance fluids. What is the hourly maintenance fluid requirement according to the 4-2-1 rule? 55 mL/hr 65 mL/hr 75 mL/hr 85 mL/hr None A patient in ICU has: • ScvO₂: 48% • Lactate: 5.4 mmol/L • Cardiac index: 1.9 L/min/m² What is the most likely interpretation? Excess oxygen delivery Inadequate oxygen delivery Hyperdynamic septic shock Laboratory error None A patient undergoing scoliosis correction demonstrates sudden disappearance of motor evoked potentials. Blood pressure, temperature, and anaesthetic depth remain stable. What should be suspected first? Surgical compromise of the spinal cord Hyperglycaemia Hypocalcaemia Equipment overheating None A 28-year-old woman in labour receives an epidural top-up for Caesarean section. Within minutes she complains of difficulty breathing and tingling in her fingers. Her blood pressure is 120/70 mmHg, oxygen saturation is 100%, and she is able to speak in full sentences. What is the most likely explanation? High spinal block Local anaesthetic systemic toxicity Anxiety with hyperventilation Pulmonary embolism None A 5-year-old child weighing 20 kg presents with post-tonsillectomy haemorrhage. Estimated blood loss is 300 mL. Approximately what percentage of blood volume has been lost? 10% 21% 30% 40% None A mechanically ventilated patient has the following arterial blood gas: • pH 7.52 • PaCO₂ 28 mmHg • HCO₃⁻ 23 mmol/L What is the primary acid-base disorder? Metabolic alkalosis Respiratory alkalosis Respiratory acidosis None A patient develops severe bronchospasm during anaesthesia. Which capnography waveform is most likely? Elevated baseline Flat trace Shark-fin appearance Saw-tooth oscillations None A patient develops ventricular fibrillation shortly after induction. What is the single most important intervention? Amiodarone Epinephrine Immediate defibrillation Sodium bicarbonate None A patient undergoing pneumonectomy has an FEV₁ of 32% predicted. What is the major perioperative concern? Awareness Postoperative respiratory failure Malignant hyperthermia Difficult intravenous access None A CTG demonstrates: • Baseline 170 bpm • Normal variability • No decelerations How should the baseline heart rate be classified? Fetal bradycardia Normal baseline Fetal tachycardia Sinus rhythm None A neonate weighs 3 kg. What is the approximate circulating blood volume? 150 mL 210 mL 270 mL 360 mL None During spinal surgery, SSEP amplitude decreases by 60%. Simultaneously, mean arterial pressure decreases from 85 mmHg to 48 mmHg. What should be corrected first? BIS value Blood pressure Temperature Blood glucose None A septic patient has: • Lactate 5.8 mmol/L • ScvO₂ 45% • Cardiac index 1.8 L/min/m² Which therapy is most likely to improve oxygen delivery? Dobutamine Adenosine Furosemide Magnesium sulfate None A 34-year-old woman with placenta previa undergoes elective Caesarean section under spinal anaesthesia. Ten minutes after delivery, brisk vaginal bleeding occurs. Estimated blood loss is 1800 mL. Blood pressure is 85/45 mmHg and heart rate is 125/min. Which blood product should be immediately available in anticipation of massive haemorrhage? Cryoprecipitate only Packed red cells only Balanced blood component therapy including red cells, plasma, and platelets Albumin None A 3-year-old child weighing 15 kg presents for emergency laparotomy. What is the estimated maximum allowable blood loss if: • Starting Hb = 12 g/dL • Lowest acceptable Hb = 8 g/dL • Blood volume = 70 mL/kg 175 mL 350 mL 350 mL None A ventilated ICU patient develops: • Increasing peak airway pressure • Increasing plateau pressure • Bilateral infiltrates on chest X-ray What is the most likely explanation? Bronchospasm Tube obstruction Reduced lung compliance Circuit leak None During laparoscopic colectomy, ETCO₂ rises progressively from 35 mmHg to 55 mmHg. Blood pressure, heart rate, and temperature remain normal. What is the most likely explanation? Malignant hyperthermia Carbon dioxide absorption from pneumoperitoneum Pulmonary embolism Circuit disconnection None A patient develops narrow-complex tachycardia at 180/min. The rhythm is regular. Blood pressure is stable. What is the most appropriate initial treatment? Immediate defibrillation Vagal manoeuvres Amiodarone Magnesium sulfate None A patient undergoing one-lung ventilation develops hypoxaemia. Bronchoscopy confirms correct DLT position. Which intervention is most likely to improve oxygenation? Apply CPAP to the operative lung Increase volatile concentration Remove PEEP from the dependent lung Administer nitroglycerin None A CTG demonstrates: • Baseline 140 bpm • Moderate variability • Recurrent late decelerations What is the most likely underlying problem? Umbilical cord compression Umbilical cord compression Fetal arrhythmia Maternal hyperglycaemia None A 1-year-old infant weighs 10 kg. What is the maintenance fluid requirement per hour using the 4-2-1 rule? 20 mL/hr 30 mL/hr 40 mL/hr 50 mL/hr None During scoliosis surgery, MEPs suddenly decrease. Blood pressure is 45 mmHg mean arterial pressure. What is the most appropriate immediate intervention? Increase sevoflurane concentration Increase sevoflurane concentration Give additional rocuronium Ignore the change None A patient with septic shock has: • MAP 64 mmHg • Lactate 7 mmol/L • ScvO₂ 42% • Cardiac index 1.6 L/min/m² What is the most likely physiological problem? Excess oxygen delivery Inadequate oxygen delivery Hyperdynamic circulation Excessive oxygen extraction failure None A 27-year-old woman undergoing emergency Caesarean section under spinal anaesthesia suddenly complains that she cannot feel herself breathing. She is able to speak normally, oxygen saturation is 99%, respiratory rate is 18/min, and blood pressure is 118/72 mmHg. What is the most appropriate management? Immediate tracheal intubation Reassurance and continued observation Administer intralipid Perform emergency CT pulmonary angiography None A 6-year-old child weighing 24 kg requires emergency fluid resuscitation following trauma. What is the recommended initial crystalloid bolus? 240 mL 360 mL 480 mL 600 mL None A mechanically ventilated ICU patient has: • Peak pressure: 38 cmH₂O • Plateau pressure: 37 cmH₂O What is the most likely diagnosis? Bronchospasm Kinked endotracheal tube Severe reduction in lung compliance Circuit obstruction None During laparoscopic surgery, ETCO₂ suddenly falls from 38 mmHg to 12 mmHg. Blood pressure simultaneously decreases from 120/70 mmHg to 70/40 mmHg. What diagnosis should be suspected first? Bronchospasm Carbon dioxide embolism Malignant hyperthermia Rebreathing None A patient develops torsades de pointes in the recovery room. What is the first-line pharmacological treatment? Adenosine Magnesium sulfate Verapamil Atropine None A patient undergoing thoracic surgery develops hypoxaemia during OLV. Which physiological mechanism is primarily responsible for maintaining arterial oxygenation? Increased dead space Hypoxic pulmonary vasoconstriction Increased cardiac output Increased oxygen extraction None A labouring patient develops recurrent late decelerations immediately after a spinal top-up. Blood pressure is 68/35 mmHg. What is the most appropriate initial treatment? Phenylephrine Magnesium sulfate Oxytocin infusion Furosemide None A 2-year-old child weighing 14 kg presents with haemorrhagic shock. Estimated blood loss is 350 mL. What percentage of blood volume has been lost? 18% 25% 36% 50% None During scoliosis surgery, motor evoked potentials disappear immediately after administration of a rocuronium bolus. What is the most likely explanation? Spinal cord ischemia Equipment failure Neuromuscular blockade interference Hypotension None A septic ICU patient demonstrates: • Lactate 7.2 mmol/L • ScvO₂ 44% • Haemoglobin 6.8 g/dL What intervention is most likely to improve oxygen delivery? Blood transfusion Sodium bicarbonate Furosemide Magnesium sulfate None A 32-year-old woman with severe preeclampsia is receiving magnesium sulfate. During routine review, she is noted to have: • Respiratory rate: 10/min • Absent patellar reflexes • Oxygen saturation: 96% What is the most appropriate immediate action? Increase magnesium infusion Administer calcium gluconate Administer phenylephrine Start oxytocin None A 5-year-old child weighing 20 kg presents for adenotonsillectomy. What is the most appropriate uncuffed endotracheal tube size? 4.0 mm 4.5 mm 5.0 mm 5.5 mm None A ventilated ICU patient develops: • Sudden hypoxaemia • Peak pressure increase • Plateau pressure unchanged What is the most likely cause? Pulmonary oedema ARDS Bronchospasm Pleural effusion None During laparoscopic surgery, ETCO₂ increases from 38 to 60 mmHg over several minutes. Temperature remains normal, heart rate is stable, and ventilation has not changed. What is the most likely cause? Malignant hyperthermia Carbon dioxide absorption Pulmonary embolism Circuit leak None A patient develops atrial fibrillation with a ventricular rate of 150/min. Blood pressure is 70/40 mmHg. What is the most appropriate treatment? Oral beta-blocker Intravenous magnesium Synchronized cardioversion Observation None A patient undergoing thoracic surgery develops hypoxaemia during OLV. What is the principal cause? Dead space ventilation Right-to-left shunt Hypercapnia Increased oxygen extraction None A CTG demonstrates: • Baseline 145 bpm • Moderate variability • Accelerations present • No decelerations How should this CTG be classified? Pathological Suspicious Normal Non-reassuring None A term neonate weighs 3.8 kg. Assuming a blood volume of 90 mL/kg, what is the estimated circulating blood volume? 228 mL 304 mL 342 mL 380 mL None During scoliosis surgery, SSEP amplitude decreases by 70%. Mean arterial pressure is 52 mmHg. What is the most appropriate first intervention? Increase volatile anaesthetic concentration Correct hypotension Administer rocuronium Stop monitoring None A septic ICU patient has: • Lactate 6.5 mmol/L • ScvO₂ 48% • Cardiac index 1.7 L/min/m² • Hemoglobin 10 g/dL Which intervention is most likely to improve oxygen delivery? Dobutamine Furosemide Adenosine Sodium bicarbonate None A 25-year-old woman undergoes emergency Caesarean section under spinal anaesthesia. Shortly after delivery, she develops sudden hypoxaemia, hypotension, altered consciousness, and diffuse bleeding from intravenous cannulation sites. What is the most likely diagnosis? High spinal block Pulmonary thromboembolism Amniotic fluid embolism Local anaesthetic systemic toxicity None A 7-year-old child weighing 25 kg presents for emergency appendicectomy. What is the estimated blood volume? 1250 mL 1500 mL 1750 mL 2000 mL None A mechanically ventilated ICU patient develops severe hypoxaemia. Ventilator parameters: • Plateau pressure 34 cmH₂O • Bilateral infiltrates • PaO₂/FiO₂ ratio 95 What is the most likely diagnosis? Cardiogenic pulmonary oedema Severe ARDS Pulmonary embolism Asthma None During laparoscopic surgery, a capnograph suddenly demonstrates an elevated baseline that fails to return to zero. What is the most likely explanation? Bronchospasm Rebreathing of carbon dioxide Pulmonary embolism Oesophageal intubation None An ECG demonstrates: • Tall peaked T waves • Progressive QRS widening Which diagnosis should be suspected first? Hypocalcaemia Hyperkalaemia Hypokalaemia Hypermagnesaemia None A patient undergoing one-lung ventilation develops persistent hypoxaemia despite correct DLT position. Which intervention may worsen oxygenation? CPAP to operative lung High-dose volatile anaesthetic Recruitment manoeuvre Temporary two-lung ventilation None A CTG demonstrates: • Baseline 135 bpm • Moderate variability • Recurrent variable decelerations What is the most likely cause? Placental insufficiency Umbilical cord compression Fetal anaemia Maternal hypotension None A 9-month-old infant weighing 8 kg is scheduled for surgery. What is the hourly maintenance fluid requirement? 24 mL/hr 32 mL/hr 40 mL/hr 48 mL/hr None During scoliosis surgery, MEP amplitude suddenly decreases following an increase in sevoflurane concentration. What is the most likely explanation? Improved spinal cord function Volatile anaesthetic suppression of MEPs Hyperglycaemia Hypocalcaemia None A septic ICU patient has: • MAP 67 mmHg • Lactate 7 mmol/L • ScvO₂ 44% • Hemoglobin 11 g/dL • Cardiac index 1.5 L/min/m² Which intervention is most likely to improve tissue oxygen delivery? Dobutamine Blood transfusion Furosemide Adenosine None A 30-year-old woman undergoes emergency Caesarean section under general anaesthesia. During laryngoscopy, only the epiglottis is visible despite optimal external laryngeal manipulation. According to the Cormack-Lehane classification, what grade view is this? Grade I Grade II Grade III Grade IV None A 10-year-old child weighing 30 kg presents following trauma. Estimated blood loss is 600 mL. What percentage of circulating blood volume has been lost? 20% 29% 40% 50% None A ventilated ICU patient develops: • PaO₂ 55 mmHg on FiO₂ 0.8 • Bilateral infiltrates • Plateau pressure 33 cmH₂O Which intervention has been shown to improve survival in severe ARDS? Routine nitric oxide High tidal volume ventilation Prone positioning Hyperventilation None During laparoscopy, the capnograph suddenly becomes completely flat. Blood pressure and oxygen saturation remain normal. What should be checked first? Pulmonary embolism Malignant hyperthermia Sampling line disconnection Bronchospasm None An ECG demonstrates: • ST-segment elevation in leads II, III, and aVF Which myocardial territory is most likely affected? Anterior wall Lateral wall Inferior wall Septal wall None A patient undergoing OLV develops severe hypoxaemia. DLT position is correct. What is the next most appropriate intervention? Increase sevoflurane concentration Apply CPAP to the non-dependent lung Administer nitroglycerin Remove all PEEP None A CTG demonstrates: • Baseline 170 bpm • Reduced variability • Recurrent late decelerations How should this trace be classified? Normal Suspicious Pathological Reactive None A 4 kg term neonate develops surgical bleeding. What is the estimated circulating blood volume? 280 mL 320 mL 360 mL 400 mL None During scoliosis surgery, MEPs disappear following an increase in volatile anaesthetic concentration. What is the most likely explanation? Spinal cord injury Neuromuscular blockade Volatile-induced suppression Hyperglycaemia None A septic ICU patient has: • Lactate 8 mmol/L • ScvO₂ 40% • Hemoglobin 12 g/dL • Cardiac index 1.4 L/min/m² What is the most likely cause of inadequate oxygen delivery? Anaemia Low cardiac output Hyperoxia Excess oxygen extraction failure None A 29-year-old woman undergoes emergency Caesarean section for cord prolapse. Following rapid-sequence induction, oxygen saturation begins to fall. Direct laryngoscopy reveals oesophageal intubation. Which monitor would have identified the problem earliest and most reliably? Pulse oximetry ECG Capnography Non-invasive blood pressure None A 6-year-old child weighing 20 kg presents with septic shock. What is the recommended initial crystalloid bolus according to current paediatric resuscitation principles? 100 mL 200 mL 400 mL 600 mL None A ventilated ICU patient develops: • PaO₂ 58 mmHg • FiO₂ 0.6 • Bilateral infiltrates What is the PaO₂/FiO₂ ratio? 58 97 150 None During laparoscopic surgery, ETCO₂ suddenly decreases from 35 mmHg to 10 mmHg. Simultaneously: • Blood pressure falls • Oxygen saturation decreases What is the most likely diagnosis? Malignant hyperthermia Bronchospasm Carbon dioxide embolism Rebreathing None A patient develops monomorphic broad-complex tachycardia at 190/min. Blood pressure is 65/35 mmHg. What is the most appropriate treatment? Adenosine Synchronized cardioversion Observation Verapamil None A patient undergoing OLV becomes hypoxaemic. DLT position is confirmed. CPAP has been applied. Which rescue manoeuvre may temporarily improve oxygenation? Temporary two-lung ventilation Nitroglycerin infusion Increasing volatile anaesthetic concentration Hyperventilation None A labouring patient develops uterine tachysystole after oxytocin administration. CTG demonstrates prolonged fetal bradycardia. What is the most appropriate immediate intervention? Increase oxytocin infusion Stop oxytocin infusion Administer additional oxytocin bolus Administer furosemide None A 12-month-old infant weighing 10 kg undergoes surgery. What is the estimated blood volume? 700 mL 800 mL 900 mL 1000 mL None During scoliosis surgery, MEP signals disappear after a large rocuronium bolus. What is the most likely explanation? Spinal cord infarction Neuromuscular blockade Hypotension Hypoglycaemia None A septic ICU patient demonstrates: • MAP 68 mmHg • Lactate 8 mmol/L • ScvO₂ 42% • Cardiac index 1.5 L/min/m² What is the most likely physiological abnormality? Excess oxygen delivery Oxygen extraction failure Inadequate oxygen delivery Hyperoxia None A 34-year-old woman with severe preeclampsia undergoes emergency Caesarean section. Shortly after delivery, uterine atony results in major postpartum haemorrhage. Which coagulation factor is most likely to reach critically low levels first? Factor VIII Factor IX Fibrinogen Factor XII None A 4-year-old child weighing 16 kg receives 10 mL/kg packed red cells. What increase in haemoglobin would be expected? 1 g/dL 2 g/dL 3 g/dL 4 g/dL None A ventilated ICU patient develops sudden: • Hypoxaemia • Hypotension • Distended neck veins • Unilateral absent breath sounds What is the most likely diagnosis? Pulmonary oedema Tension pneumothorax Bronchospasm ARDS None During laparoscopic surgery, a capnograph demonstrates a classic shark-fin appearance. What is the most likely diagnosis? Rebreathing Bronchospasm Oesophageal intubation Pulmonary embolism None A patient develops ventricular fibrillation. After immediate defibrillation, what should occur next? Pulse check Immediate chest compressions Arterial blood gas Amiodarone None A patient undergoing thoracic surgery develops severe hypoxaemia during OLV. Which physiological process normally improves oxygenation in this situation? Hyperventilation Hypoxic pulmonary vasoconstriction Increased dead space Increased oxygen extraction None A CTG demonstrates: • Baseline 130 bpm • Moderate variability • Accelerations present • No decelerations How should this CTG be interpreted? Pathological Suspicious Normal Non-reassuring None A 3 kg term neonate undergoes surgery. Assuming blood volume is 90 mL/kg, what is the estimated circulating blood volume? 210 mL 240 mL 270 mL 300 mL None During scoliosis surgery, MEP amplitude decreases significantly after increasing sevoflurane concentration from 0.5 MAC to 1.5 MAC. What is the most likely explanation? Improved spinal cord function Volatile anaesthetic suppression Hypocalcaemia Hyperglycaemia None A septic ICU patient has: • Lactate 7 mmol/L • ScvO₂ 45% • Haemoglobin 12 g/dL • Cardiac index 1.6 L/min/m² What is the most likely cause of inadequate oxygen delivery? Severe anaemia Low cardiac output Hyperoxia Measurement error None A 36-year-old obese parturient undergoes emergency Caesarean section under general anaesthesia. Immediately after extubation she develops inspiratory stridor, paradoxical chest movements, and rapidly falling oxygen saturation. What is the most likely diagnosis? Bronchospasm Pulmonary embolism Laryngospasm High spinal block None A 5-year-old child weighing 18 kg requires maintenance intravenous fluids. Using the 4-2-1 rule, what is the maintenance rate? 46 mL/hr 52 mL/hr 56 mL/hr 60 mL/hr None A ventilated ICU patient with ARDS is receiving: • Tidal volume: 6 mL/kg predicted body weight • Plateau pressure: 26 cmH₂O Which ventilation strategy is being applied? Permissive hyperinflation Lung-protective ventilation High-frequency ventilation Pressure support ventilation None During laparoscopic surgery, ETCO₂ suddenly falls from 36 mmHg to 14 mmHg. Blood pressure falls simultaneously. What diagnosis should be suspected first? Bronchospasm Carbon dioxide embolism Malignant hyperthermia Rebreathing None An ECG demonstrates: • Broad QRS complexes • Regular rhythm • Rate 180/min • No visible P waves What is the most likely diagnosis? Atrial fibrillation Sinus tachycardia Ventricular tachycardia Atrial flutter None During one-lung ventilation, which factor contributes most to hypoxaemia? Hypercapnia Increased oxygen consumption Right-to-left shunt Metabolic acidosis None A labouring patient develops severe postpartum haemorrhage. ROTEM suggests severe hypofibrinogenaemia. Which product is most appropriate? Packed red cells Platelets Cryoprecipitate Albumin None A term neonate has: • Heart rate 90/min • Poor respiratory effort What is the most appropriate next step? Chest compressions Positive pressure ventilation Defibrillation Epinephrine immediately None During scoliosis surgery, MEP signals disappear immediately after administration of rocuronium. What is the most likely explanation? Spinal cord injury Hypotension Neuromuscular blockade Hypocalcaemia None A septic ICU patient demonstrates: • MAP 65 mmHg • Lactate 8 mmol/L • ScvO₂ 42% • Cardiac index 1.4 L/min/m² What is the most likely haemodynamic abnormality? Excess oxygen delivery High-output septic shock Inadequate oxygen delivery due to low cardiac output Measurement artifact None Name Email Time's up
