A 67-year-old man with diabetes mellitus, ischemic heart disease, chronic kidney disease (creatinine 2.4 mg/dL), and previous stroke is scheduled for elective colectomy. According to the Revised Cardiac Risk Index (RCRI), which factor contributes to his score?

A 32-year-old woman in labour has the following CTG: • Baseline: 165 bpm • Variability: 3 bpm • Recurrent late decelerations How should this trace be classified?

A patient undergoing major abdominal surgery has a BIS value of 88. Heart rate and blood pressure are increasing during skin incision. What is the most likely interpretation?

A patient undergoing upper abdominal surgery develops progressive hypothermia. Which mechanism accounts for the greatest intraoperative heat loss?

A laser is being used during microlaryngoscopy. Which factor contributes most to operating theatre fire risk?

A patient presents after head injury. Examination reveals: • Eyes open to pain • Incomprehensible sounds • Withdraws from pain What is the GCS?

A flow-volume loop demonstrates: • Flattened inspiratory limb • Normal expiratory limb What is the most likely diagnosis?

During OLV, oxygen saturation falls to 86%. Bronchoscopy confirms correct DLT position. CPAP to the operative lung fails to improve oxygenation. What is the next best step?

A patient with sickle cell disease presents for emergency laparotomy. Which perioperative factor most strongly promotes sickling?

During spinal surgery, MEPs disappear but SSEPs remain normal. What structure is most likely affected?

A 58-year-old diabetic man is scheduled for elective hemicolectomy. During preoperative assessment, he reports climbing two flights of stairs daily without stopping and has no cardiac symptoms. Which finding best indicates adequate functional capacity?

A labouring woman develops sudden fetal bradycardia after epidural top-up. Maternal observations: • BP 65/35 mmHg • HR 58/min What is the most likely cause of fetal bradycardia?

A patient undergoing TIVA for scoliosis surgery has: • BIS = 28 • MAP = 60 mmHg • HR = 45/min What is the most likely interpretation?

During a prolonged laparotomy, core temperature falls from 36.8°C to 34.9°C. Which complication is most likely?

A laser airway procedure is being performed. Which intervention most effectively reduces airway fire risk?

A trauma patient has: • Eyes open spontaneously • Confused conversation • Localizes pain What is the GCS?

A flow-volume loop demonstrates flattening of both inspiratory and expiratory limbs. What is the most likely diagnosis?

During OLV, oxygen saturation falls to 88%. DLT position is correct. CPAP and recruitment manoeuvres have failed. What physiological mechanism is causing hypoxaemia?

A patient with sickle cell disease develops: • Fever • Chest pain • New pulmonary infiltrate • Hypoxaemia 48 hours after surgery. What is the most likely diagnosis?

During scoliosis correction, SSEPs decrease by 70%, while MEPs remain unchanged. What structure is most likely affected?

A 32-year-old primigravida with severe preeclampsia is undergoing emergency Caesarean section under spinal anaesthesia. Five minutes after the block: • BP falls from 160/100 mmHg to 75/40 mmHg • HR 58/min • Fetal heart rate falls from 145 bpm to 80 bpm The obstetrician asks whether immediate delivery should begin. What is the most appropriate next step?

A 4-year-old child is brought to the operating theatre for control of post-tonsillectomy haemorrhage. In the emergency department: • HR: 165/min • BP: 72/38 mmHg • RR: 32/min • SpO₂: 97% • The child is pale and lethargic • Parents report repeated swallowing over the previous hour • Approximately 250 mL of blood has been vomited On arrival in theatre, the surgeon asks whether a rapid sequence induction (RSI) is necessary because the child has been "fasted" since the original operation. What is the most appropriate anaesthetic approach?

A 68-year-old man is admitted to the ICU with septic shock secondary to perforated sigmoid diverticulitis. He has already received: • 30 mL/kg crystalloid • Broad-spectrum antibiotics • Norepinephrine infusion at 0.18 µg/kg/min Current observations: Parameter Value MAP 67 mmHg HR 118/min Lactate 7.1 mmol/L ScvO₂ 44% Hb 10.8 g/dL Cardiac Index 1.6 L/min/m² Urine Output 0.2 mL/kg/hr The ICU consultant asks: "Should we simply increase the norepinephrine further?" What is the most appropriate next intervention?

A 31-year-old primigravida at 40 weeks gestation is in active labour. She has been receiving an oxytocin infusion for augmentation of labour. The midwife becomes concerned about the CTG. CTG Findings • Baseline fetal heart rate: 170 bpm • Variability: 3 bpm • Recurrent late decelerations • Contractions: 6 contractions every 10 minutes Maternal observations: • BP: 122/74 mmHg • HR: 96/min • SpO₂: 99% • Temperature: 36.8°C The obstetric registrar asks: "Should we continue observing for another 30 minutes?" What is the most appropriate immediate management?

A 62-year-old man with COPD is scheduled for elective right upper lobectomy for bronchogenic carcinoma. A left-sided double-lumen tube has been inserted uneventfully. After positioning the patient in the left lateral decubitus position and commencing one-lung ventilation (OLV), the following occurs: Parameter Before OLV 15 min After OLV SpO₂ 99% 86% FiO₂ 0.5 1.0 ETCO₂ 35 mmHg 37 mmHg BP 128/74 124/70 HR 78 82 You perform fibreoptic bronchoscopy. The DLT is perfectly positioned. A recruitment manoeuvre to the dependent lung has already been performed. The surgeon asks: "Can we continue? The saturation is still 86%." What is the MOST appropriate next step?

A 24-year-old man is brought to the Emergency Department following a high-speed road traffic collision. On arrival: Parameter Finding Eyes Open to pain Verbal Response Inappropriate words Motor Response Withdraws from pain BP 168/92 mmHg HR 52/min RR Irregular SpO₂ 94% on 15 L oxygen A CT scan is being arranged. The emergency physician asks: "Should we intubate now, or wait for the CT scan first?" What is the MOST appropriate next step?

A 35-year-old woman presents for emergency laparotomy with severe abdominal pain. Past history reveals: • Recurrent episodes of severe abdominal pain • Multiple previous admissions with "unexplained abdominal crises" • Hypertension • Dark reddish urine during previous attacks In the emergency department she becomes increasingly agitated and develops: • HR: 135/min • BP: 190/110 mmHg • Mild proximal muscle weakness The surgical trainee suspects bowel ischemia and requests urgent anaesthesia review. Which of the following is the MOST likely diagnosis?

A 29-year-old primigravida at 39 weeks gestation is taken for an emergency Caesarean section because of a pathological CTG. A spinal anaesthetic is performed successfully. Ten minutes after delivery, the obstetrician says: "The uterus is very atonic." Oxytocin 5 IU is administered slowly intravenously. Within 60 seconds the following occurs: Parameter Before Oxytocin After Oxytocin BP 128/76 mmHg 68/34 mmHg HR 88/min 142/min SpO₂ 99% 98% ETCO₂ 34 mmHg 24 mmHg The patient complains of: • Dizziness • Nausea • Feeling faint The obstetric SHO asks: "Has she developed a pulmonary embolism?" What is the MOST likely explanation for the sudden deterioration?

A 7-year-old child weighing 25 kg is undergoing posterior spinal fusion for scoliosis. The anaesthetic technique consists of: • Propofol infusion • Remifentanil infusion • No additional neuromuscular blocker after intubation The surgery has been uneventful for 3 hours. Suddenly, the neurophysiology technician reports: "The motor evoked potentials (MEPs) from both lower limbs have disappeared." The monitoring screen shows: Parameter Value MAP 48 mmHg HR 105/min SpO₂ 100% ETCO₂ 37 mmHg Temperature 36.5°C BIS 42 The surgeon immediately asks: "Have I injured the spinal cord?" What is the MOST appropriate first action?

A 56-year-old man with obesity (BMI 38 kg/m²), hypertension, and type 2 diabetes is scheduled for elective laparoscopic colectomy. Anaesthesia is induced uneventfully with: Propofol Fentanyl Rocuronium The trachea is intubated successfully. Approximately 15 minutes after pneumoperitoneum is established, the ventilator alarms. Current findings: Parameter Before Pneumoperitoneum Current Peak Airway Pressure 22 cmH₂O 42 cmH₂O Plateau Pressure 18 cmH₂O 36 cmH₂O ETCO₂ 36 mmHg 39 mmHg SpO₂ 99% 96% BP 132/76 138/82 Auscultation reveals: Bilateral breath sounds No wheeze The surgical registrar asks: "Has the patient developed bronchospasm?" What is the MOST likely explanation?

A 56-year-old man with obesity (BMI 38 kg/m²), hypertension, and type 2 diabetes is scheduled for elective laparoscopic colectomy. Anaesthesia is induced uneventfully with: • Propofol • Fentanyl • Rocuronium The trachea is intubated successfully. Approximately 15 minutes after pneumoperitoneum is established, the ventilator alarms. Current findings: Parameter Before Pneumoperitoneum Current Peak Airway Pressure 22 cmH₂O 42 cmH₂O Plateau Pressure 18 cmH₂O 36 cmH₂O ETCO₂ 36 mmHg 39 mmHg SpO₂ 99% 96% BP 132/76 138/82 Auscultation reveals: • Bilateral breath sounds • No wheeze The surgical registrar asks: "Has the patient developed bronchospasm?"

A 3-year-old child (weight 15 kg) is undergoing emergency laparotomy for intussusception. The procedure has been complicated by bowel ischemia and difficult surgical dissection. After 2 hours of surgery, the anaesthetist notices: Parameter Value HR 165/min BP 68/35 mmHg ETCO₂ 22 mmHg SpO₂ 99% Temperature 36.7°C The surgeon estimates blood loss at: "About 250 mL" The surgical trainee comments: "The blood loss doesn't sound too significant." What is the MOST appropriate interpretation?

A 72-year-old man is scheduled for an emergency laparotomy for perforated sigmoid diverticulitis. His past medical history includes: • Previous myocardial infarction (3 years ago) • Insulin-dependent diabetes mellitus • Chronic kidney disease (Creatinine 2.4 mg/dL) • Hypertension On examination: • BP 135/80 mmHg • HR 82/min • SpO₂ 97% on room air The surgical registrar says: "His ECG is okay today, so his cardiac risk should be low." During the anaesthetic assessment, you calculate his Revised Cardiac Risk Index (RCRI). What is his RCRI score?

A 3-year-old child (weight 15 kg) is undergoing emergency laparotomy for intussusception. The procedure has been complicated by bowel ischemia and difficult surgical dissection. After 2 hours of surgery, the anaesthetist notices: Parameter Value HR 165/min BP 68/35 mmHg ETCO₂ 22 mmHg SpO₂ 99% Temperature 36.7°C The surgeon estimates blood loss at: "About 250 mL" The surgical trainee comments: "The blood loss doesn't sound too significant." What is the MOST appropriate interpretation?

A 28-year-old woman is undergoing an emergency Caesarean section for fetal distress. A spinal anaesthetic is performed uneventfully. The baby is delivered within 8 minutes. Immediately after delivery, the obstetrician says: "The uterus feels firm, but there is much more bleeding than expected." Current observations: Parameter Value BP 105/62 mmHg HR 118/min SpO₂ 99% Estimated Blood Loss 1200 mL The uterus remains: Well contracted The obstetrician asks: "Could this still be uterine atony?" What is the MOST likely cause of postpartum haemorrhage?

A 5-year-old child (20 kg) is undergoing adenotonsillectomy. Anaesthesia and surgery are uneventful. The child is extubated awake and transferred to recovery. Five minutes later, the recovery nurse calls urgently. The child has: • Marked inspiratory effort • No air movement heard • Oxygen saturation falling from 99% to 82% • Suprasternal and intercostal recession • Paradoxical chest movement The recovery nurse says: "I think this is bronchospasm." What is the MOST likely diagnosis?

A 65-year-old man is undergoing laparoscopic cholecystectomy. Thirty minutes after pneumoperitoneum, the capnograph shows a gradual rise in ETCO₂ from 36 mmHg to 52 mmHg. Observations: • BP: 130/78 mmHg • HR: 84/min • Temperature: 36.8°C • SpO₂: 99% What is the most likely cause?

A 34-year-old woman in labour develops the following CTG pattern: • Baseline: 140 bpm • Variability: 10 bpm • Recurrent variable decelerations What is the most likely cause?

During major spinal surgery, the neurophysiology technician reports: "SSEP amplitudes have decreased by 60%." The patient's MAP is 50 mmHg. What should be done first?

A 58-year-old patient undergoing general anaesthesia has: • BIS = 85 • Tachycardia • Hypertension during skin incision What is the most likely interpretation?

A patient with severe asthma undergoes general anaesthesia. Shortly after intubation: • Peak airway pressure rises significantly • Plateau pressure remains unchanged • Wheeze is heard What is the most likely diagnosis?

A 2-day-old neonate develops bradycardia during induction of anaesthesia. Heart rate falls from 140/min to 70/min. What is the most appropriate initial intervention?

A patient undergoing laparoscopic appendicectomy suddenly develops: • ETCO₂ drop from 38 to 15 mmHg • BP 70/40 mmHg • SpO₂ 88% What is the most likely diagnosis?

A patient undergoing thoracic surgery develops hypoxaemia during one-lung ventilation. The DLT position is confirmed bronchoscopically. What is the next best step?

A labouring woman has the following CTG: • Baseline: 125 bpm • Variability: 12 bpm • Accelerations present • No decelerations How should this CTG be classified?

A patient develops the following ECG changes: • Tall peaked T waves • QRS widening What electrolyte abnormality is most likely?

A 4-year-old child weighing 18 kg requires maintenance fluids. Using the 4-2-1 rule, what is the hourly maintenance rate?

During major abdominal surgery, core temperature falls to 34.8°C. Which complication is most likely?

A patient undergoing scoliosis correction develops sudden loss of MEP signals. MAP is 45 mmHg. What is the most appropriate first action?

A septic ICU patient has: • Lactate: 7 mmol/L • ScvO₂: 42% • Hb: 11 g/dL • Cardiac Index: 1.5 L/min/m² What is the most likely haemodynamic problem?

A 26-year-old woman receives an epidural for labour analgesia. Ten minutes after a top-up dose, she complains of: • Tinnitus • Metallic taste • Perioral numbness What is the most likely diagnosis?

A 70-year-old patient undergoes hip fracture fixation under spinal anaesthesia. Twenty minutes later: • BP: 72/40 mmHg • HR: 42/min What is the most likely cause?

A 65-year-old smoker undergoes spirometry. Flow-volume loop demonstrates: • Flattened inspiratory limb • Normal expiratory limb What is the most likely diagnosis?

A trauma patient has: • Eyes open to speech • Confused conversation • Localises pain What is the GCS?

A patient undergoing thyroidectomy develops: • Stridor • Respiratory distress • Neck swelling 30 minutes after surgery. What is the most likely diagnosis?

A 24-year-old woman with postpartum haemorrhage has lost approximately 1800 mL of blood. Which intervention has been shown to reduce mortality when given early?

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

During laparoscopic surgery, a fire starts near the surgical drapes. Which element of the fire triad is most commonly increased by anaesthetic practice?

A patient with severe COPD undergoes general anaesthesia. ABG shows: • pH 7.31 • PaCO₂ 60 mmHg • PaO₂ 95 mmHg What is the primary acid-base disorder?

A patient in ICU with septic shock has: • MAP 68 mmHg • Lactate 5.8 mmol/L • Urine output 0.2 mL/kg/hr • ScvO₂ 72% What is the most likely interpretation?

A 32-year-old woman undergoes emergency Caesarean section under spinal anaesthesia. Five minutes after delivery, the obstetrician administers oxytocin. Shortly afterwards: • BP falls from 130/80 to 75/40 mmHg • HR increases from 85 to 135/min • ETCO₂ falls from 34 to 24 mmHg What is the most likely explanation?

A patient undergoing carotid endarterectomy develops: • Sudden right arm weakness • Inability to move the right leg during carotid cross-clamping. What is the most likely cause?

A 6-year-old child develops stridor immediately after extubation following tonsillectomy. The child is conscious and maintaining oxygen saturation at 98%. What is the most likely cause?

A patient undergoing major surgery has: • Temperature 39.5°C • ETCO₂ rising rapidly • Generalised muscle rigidity • Tachycardia What is the most likely diagnosis?

A 75-year-old patient develops new-onset atrial fibrillation during surgery. Heart rate is 160/min and blood pressure is 75/40 mmHg. What is the most appropriate management?

A 4-year-old child weighing 20 kg loses 300 mL blood during surgery. Approximately what percentage of blood volume has been lost?

During labour, a CTG shows: • Baseline 140 bpm • Variability 8 bpm • Recurrent late decelerations What is the most likely underlying problem?

A patient undergoing thyroid surgery develops: • Hoarseness • Weak cough • Breathy voice after extubation. What nerve injury is most likely?

A patient with severe sepsis has: • Lactate 8 mmol/L • MAP 72 mmHg • ScvO₂ 45% What is the most likely interpretation?

A patient undergoing scoliosis surgery has: • SSEPs unchanged • MEPs absent What structure is most likely affected?

A 68-year-old man with severe COPD is undergoing laparoscopic colectomy. Two hours into surgery, the capnogram shows a gradual increase in ETCO₂ from 38 mmHg to 58 mmHg. The ventilator settings have not changed. What is the most appropriate initial management?

A 30-year-old woman undergoes emergency Caesarean section for fetal distress. The newborn has: • HR 90/min • Poor respiratory effort • Poor tone What is the most important initial step in neonatal resuscitation?

A patient develops the following ECG changes during surgery: • ST elevation in leads II, III and aVF What is the most likely diagnosis?

A patient undergoes laser excision of a vocal cord lesion. Which measure most effectively reduces airway fire risk?

A 55-year-old man with cirrhosis is undergoing emergency laparotomy. Preoperative labs: • INR 2.4 • Platelets 48,000/mm³ The surgeon asks whether the patient is at increased bleeding risk. What is the best response?

A 4-year-old child undergoing bronchoscopy develops: • HR 60/min • SpO₂ 82% What is the most likely cause of the bradycardia?

A trauma patient has: • Eyes open spontaneously • Inappropriate words • Withdraws from pain What is the GCS?

A patient with myasthenia gravis is undergoing thymectomy. Which neuromuscular blocker characteristic is expected?

During labour, a CTG shows: • Baseline 175 bpm • Variability 2 bpm • Recurrent late decelerations How should this trace be classified?

A patient in ICU with septic shock has: • Lactate 6.5 mmol/L • ScvO₂ 48% • Hb 12 g/dL • Cardiac index 1.7 L/min/m² What is the most appropriate next haemodynamic intervention?

A 29-year-old woman with severe preeclampsia is receiving magnesium sulfate. Monitoring shows: • Respiratory rate: 10/min • Patellar reflexes present • Urine output: 15 mL/hr Which finding most increases the risk of magnesium toxicity?

A 6-year-old child weighing 20 kg requires emergency transfusion. Estimated blood volume is approximately:

During general anaesthesia, the BIS monitor suddenly reads 92. The patient simultaneously develops: • Tachycardia • Hypertension What is the most likely explanation?

A patient undergoing laparoscopic surgery suddenly develops: • ETCO₂ falls from 35 to 12 mmHg • BP falls to 70/40 mmHg • SpO₂ falls to 85% What is the most likely diagnosis?

A labouring woman develops recurrent variable decelerations on CTG. What is the most likely cause?

A patient with hyperkalaemia develops progressive ECG changes. Which ECG abnormality usually appears first?

A patient undergoing one-lung ventilation becomes hypoxaemic. The DLT position is correct. CPAP to the operative lung has failed. What is the next best step?

A patient develops: • BP 190/100 mmHg • HR 42/min during neurosurgery. What does this combination most strongly suggest?

A patient develops postpartum haemorrhage. The uterus is: • Soft • Enlarged • Poorly contracted What is the most likely diagnosis?

A septic ICU patient has: • Lactate 8 mmol/L • ScvO₂ 40% • Cardiac index 1.5 L/min/m² What is the most likely physiological problem?

A 4-week-old infant is scheduled for pyloromyotomy for hypertrophic pyloric stenosis. Preoperative blood gas: • pH 7.56 • HCO₃⁻ 36 mmol/L • Cl⁻ 88 mmol/L • K⁺ 3.0 mmol/L The surgeon says: "The baby has been vomiting for days. Let's proceed urgently." What is the MOST appropriate management?

A 2-year-old child suddenly develops severe coughing while eating peanuts. On examination: • Unilateral wheeze on the right • Reduced air entry on the right • Normal temperature What is the most likely diagnosis?

A 3-year-old child undergoes adenotonsillectomy. Thirty minutes later: • HR 155/min • BP 70/40 mmHg • Repeated swallowing observed What is the most likely diagnosis?

A neonate develops: • HR 55/min • SpO₂ 78% immediately after induction. What is the first intervention?

A 5-year-old child develops: • Generalised rigidity • ETCO₂ rising from 38 to 75 mmHg • Temperature 40°C shortly after induction. What is the most likely diagnosis?

A 10-kg infant has lost 150 mL blood during surgery. Approximately what percentage of blood volume has been lost?

A child with Tetralogy of Fallot develops sudden: • Cyanosis • Tachypnoea • Irritability • SpO₂ 55% during induction. What is the most likely event?

A premature infant presents for inguinal hernia repair. Why is postoperative apnoea a major concern?

A child with Down syndrome presents for dental surgery. Which airway feature is commonly encountered?

A 2-year-old child develops complete laryngospasm after extubation. Jaw thrust and CPAP fail. SpO₂ falls to 60%. What is the most appropriate next step?