Welcome to your Test 26 A 31-year-old primigravida with severe preeclampsia is undergoing emergency Caesarean section under spinal anaesthesia. Baseline: • BP 175/110 mmHg • HR 95/min Five minutes after spinal injection: • BP 80/40 mmHg • HR 120/min • Fetal heart rate falls from 140 bpm to 85 bpm What is the MOST likely explanation for the fetal bradycardia? Magnesium toxicity Local anaesthetic toxicity Reduced uteroplacental perfusion secondary to maternal hypotension Fetal congenital heart disease None A 68-year-old man undergoes cemented hemiarthroplasty for fractured neck of femur. Five minutes after cement insertion: • BP 130/80 → 65/35 mmHg • SpO₂ 99% → 82% • ETCO₂ 34 → 14 mmHg The surgeon asks: "Could this be a pulmonary embolism?" What feature MOST strongly supports Bone Cement Implantation Syndrome rather than thrombotic pulmonary embolism? Reduced ETCO₂ Hypotension Timing immediately after cement insertion Hypoxaemia None A 4-year-old child undergoes adenotonsillectomy. In recovery: • HR 165/min • BP 75/40 mmHg • SpO₂ 98% • Repeated swallowing noted • Child increasingly restless A junior doctor attributes the agitation to emergence delirium. What is the MOST likely diagnosis? Emergence delirium Pain Occult post-tonsillectomy haemorrhage Residual anaesthesia None A patient undergoes posterior fossa craniotomy in the sitting position. Suddenly: • ETCO₂ falls from 35 to 18 mmHg • SpO₂ falls to 90% • BP falls to 80/40 mmHg The surgeon reports: "I just entered a venous sinus." What is the MOST appropriate immediate action? Increase volatile agent concentration Give atropine Inform surgeon, administer 100% oxygen, stop nitrous oxide Extubate the patient None A 70-year-old patient undergoes robotic radical prostatectomy. After 6 hours in steep Trendelenburg: • Face swollen • Tongue swollen • Conjunctival oedema present The surgeon says: "The operation is finished." What is the MOST important question before extubation? Is the patient warm? Is the haemoglobin acceptable? Is there evidence of airway oedema? Is the blood glucose normal? None A 58-year-old woman undergoes laparoscopic hemicolectomy. Two hours after pneumoperitoneum: • ETCO₂ gradually rises from 36 to 55 mmHg • Peak airway pressure rises slightly • SpO₂ remains 99% • HR 82/min • Temperature 36.7°C The trainee becomes concerned about malignant hyperthermia. What is the MOST likely explanation? Malignant hyperthermia Carbon dioxide absorption from pneumoperitoneum Thyroid storm Circuit malfunction None A 34-year-old woman in labour develops the following CTG: • Baseline 170 bpm • Variability 3 bpm • Recurrent late decelerations BP is 75/40 mmHg following epidural top-up. What is the MOST likely primary cause of the CTG abnormality? Fetal congenital heart disease Umbilical cord compression Maternal hypotension causing uteroplacental insufficiency Maternal fever None A 5-year-old child undergoes emergency bronchoscopy for suspected peanut aspiration. During bronchoscopy: • HR falls from 120 to 55/min • SpO₂ falls from 98% to 78% What is the MOST appropriate immediate action? Atropine Adrenaline Improve oxygenation and ventilation Defibrillation None A patient undergoing scoliosis correction develops: • Sudden loss of MEP signals • SSEPs remain normal • MAP 48 mmHg What is the MOST likely explanation? Permanent spinal cord injury Monitoring equipment failure Inadequate spinal cord perfusion affecting motor pathways Neuromuscular blockade overdose None A 72-year-old man undergoes TURP under spinal anaesthesia. After 90 minutes: • Restless • Confused • HR 52/min • BP 180/95 mmHg Serum sodium returns: 118 mmol/L What is the MOST dangerous immediate complication? Myocardial infarction Cerebral oedema Hyperglycaemia Pulmonary fibrosis None A patient undergoing VATS lobectomy is on one-lung ventilation. Suddenly: • SpO₂ falls to 84% • FiO₂ already 100% • DLT position confirmed bronchoscopically What is the BEST next step? Remove DLT Apply CPAP to the non-ventilated lung Increase volatile concentration Give furosemide None A 67-year-old diabetic patient is undergoing carotid endarterectomy under regional anaesthesia. During carotid clamping he suddenly says: "I cannot move my right arm." What is the MOST important interpretation? Local anaesthetic toxicity Anxiety Cerebral hypoperfusion Cerebral hypoperfusion None A patient undergoing thyroidectomy is extubated. Ten minutes later: • Increasing stridor • Neck swelling • Anxiety • Oxygen saturation falling What is the MOST dangerous mistake? Calling the surgeon Reopening the wound if necessary Assuming it is laryngospasm and waiting Preparing for reintubation None A patient receives an interscalene block before shoulder arthroscopy. After surgery: • Ptosis • Miosis • Hoarse voice but normal oxygenation. What is the MOST likely explanation? Stroke Local anaesthetic toxicity Expected spread of local anaesthetic Pulmonary embolism None A septic ICU patient has: • Lactate 8 mmol/L • ScvO₂ 44% • Hb 11 g/dL • Cardiac Index 1.6 L/min/m² Which intervention is MOST likely to improve oxygen delivery? Increase PEEP Dobutamine Furosemide Sodium bicarbonate None A 67-year-old woman is undergoing total knee replacement under spinal anaesthesia with sedation. Thirty minutes after tourniquet inflation: • BP 125/75 mmHg • HR 72/min Immediately after tourniquet release: • BP 85/45 mmHg • ETCO₂ rises from 34 to 42 mmHg • HR 105/min What is the MOST likely explanation? Pulmonary embolism Local anaesthetic toxicity . Washout of metabolites and vasodilation following tourniquet release High spinal block None A 5-year-old child undergoes adenotonsillectomy. In recovery: • Stridor • Suprasternal recession • SpO₂ 92% • Good air movement What is the MOST likely diagnosis? Complete laryngospasm Bronchospasm Upper airway oedema Aspiration None A 72-year-old man undergoing robotic prostatectomy develops: • Peak pressure 40 cmH₂O • Plateau pressure 38 cmH₂O Which interpretation is MOST accurate? Bronchospasm Reduced compliance from pneumoperitoneum and Trendelenburg Circuit obstruction None A woman with severe postpartum haemorrhage has: • Blood loss 2500 mL • BP 75/40 mmHg • HR 140/min Despite fluids, hypotension persists. Laboratory values: • Fibrinogen 0.9 g/L What is the MOST concerning finding? Tachycardia Blood loss Low fibrinogen Hypotension None A patient undergoes clipping of an anterior communicating artery aneurysm. During temporary clipping: • MEP amplitude decreases by 70% • SSEPs unchanged What is the MOST likely interpretation? Global cerebral ischaemia Selective motor pathway ischaemia Monitoring failure Hypercapnia None A 62-year-old diabetic patient undergoes carotid endarterectomy. Immediately after unclamping: • BP 220/120 mmHg • HR 105/min What complication is the surgeon most concerned about? Carotid stenosis recurrence Cerebral hyperperfusion syndrome Hypoglycaemia Pulmonary oedema None A patient undergoing thyroidectomy suddenly develops: • HR 38/min • BP 70/40 mmHg during surgical manipulation. The surgeon is dissecting near the carotid sheath. What is the MOST likely mechanism? Hyperkalaemia Carotid sinus stimulation Myocardial infarction Anaphylaxis None A patient undergoing VATS develops: • ETCO₂ 18 mmHg • BP 70/35 mmHg • SpO₂ 85% Immediately after central venous catheter insertion. What is the MOST likely diagnosis? • Vagal activation • Bradycardia • Hypotension Usually resolves when the stimulus is removed. Prometric Pearl Neck surgery can trigger profound vagal reflexes. Bronchospasm Tension pneumothorax Pulmonary oedema Malignant hyperthermia None A 3-year-old child with Tetralogy of Fallot develops: • SpO₂ 50% • Severe cyanosis • Tachypnoea during induction. Which intervention is MOST likely to improve oxygenation? Nitroglycerin Phenylephrine Furosemide Adenosine None A patient undergoes endoscopic sinus surgery. The surgeon reports progressively worsening visibility despite minimal bleeding earlier. ABG: • pH 7.31 • PaCO₂ 58 mmHg What is the MOST likely explanation? Hypercapnia causing mucosal vasodilation Hypothermia Hypoglycaemia Hyperkalaemia None A 64-year-old man is undergoing laparoscopic right hemicolectomy. During trocar insertion, the capnograph suddenly changes: • ETCO₂ falls from 36 mmHg to 12 mmHg • BP falls from 130/80 to 70/40 mmHg • SpO₂ falls to 86% The surgeon says: "I just insufflated the abdomen." What is the MOST likely diagnosis? Bronchospasm Carbon dioxide embolism Malignant hyperthermia Tension pneumothorax None A 30-year-old woman in labour has the following CTG: • Baseline 145 bpm • Variability 10 bpm • Recurrent variable decelerations The obstetrician asks whether this suggests placental insufficiency. What is the MOST likely explanation? Uteroplacental insufficiency Umbilical cord compression Fetal anaemia Maternal hypotension None A 75-year-old man undergoes hip fracture fixation under spinal anaesthesia. Thirty minutes later: • BP 70/35 mmHg • HR 42/min The block level is T3. Which physiological mechanism BEST explains the bradycardia? Hyperkalaemia Carotid sinus stimulation Blockade of cardiac accelerator fibres Increased vagal tone from pain None A patient undergoing VATS lobectomy develops: • SpO₂ 85% • FiO₂ 100% • DLT position confirmed • CPAP to operative lung ineffective What is the MOST appropriate next step? Increase volatile concentration Temporary two-lung ventilation Remove DLT Administer furosemide None A 66-year-old diabetic patient undergoes carotid endarterectomy under regional anaesthesia. During clamping: • Speech becomes slurred • Contralateral arm weakness develops BP is 105/60 mmHg. What is the BEST immediate action? Reduce blood pressure Increase blood pressure Give insulin Administer atropine None A 4-year-old child undergoes adenotonsillectomy. Ten minutes after extubation: • Severe inspiratory effort • No air movement • SpO₂ 68% Jaw thrust and CPAP fail. What is the BEST next step? Salbutamol Dexamethasone Succinylcholine Nebulised adrenaline None A patient undergoing pituitary surgery develops: • Urine output 1500 mL over 2 hours • Serum sodium rises from 139 to 151 mmol/L What is the MOST likely diagnosis? SIADH Cerebral salt wasting Diabetes insipidus Acute kidney injury None A patient undergoes thyroidectomy. Twenty minutes after extubation: • Stridor • Neck swelling • Oxygen saturation 88% What is the MOST dangerous error? Calling for help Preparing reintubation equipment Waiting to see if symptoms improve Informing the surgeon None A septic ICU patient has: • Lactate 9 mmol/L • ScvO₂ 43% • Cardiac Index 1.5 L/min/m² • Hb 11 g/dL What is the MOST likely physiological problem? Anaemia Excess oxygen extraction due to inadequate delivery Hyperoxia Measurement error None A patient undergoes shoulder arthroscopy under general anaesthesia with an interscalene block. Postoperatively: • Ptosis • Miosis • Hoarseness SpO₂ 98% What is the MOST likely interpretation? Stroke Local anaesthetic toxicity Expected block spread Pulmonary embolism None A 29-year-old woman with severe postpartum haemorrhage has received: • 4 units PRBC • 4 units FFP • Uterotonics • Tranexamic acid Current observations: • BP 85/45 mmHg • HR 138/min Laboratory results: • Hb 8.2 g/dL • Platelets 42 × 10⁹/L • Fibrinogen 0.8 g/L What is the MOST important blood product to administer next? Packed red blood cells Fresh frozen plasma Platelets and fibrinogen replacement Albumin None A 7-year-old child undergoes emergency appendicectomy. During induction: • Difficult mask ventilation • Increasing ETCO₂ • Progressive desaturation Laryngoscopy reveals: • Large tonsils • Copious secretions • Poor view What is the MOST important mistake to avoid? Calling for help Optimising positioning Repeated traumatic laryngoscopy attempts Using a videolaryngoscope None A patient undergoing clipping of a ruptured aneurysm develops: • MAP 55 mmHg • MEP amplitude reduced by 80% • SSEPs unchanged What is the MOST appropriate immediate intervention? Increase volatile agent concentration Increase blood pressure Administer furosemide Hyperventilate aggressively None A patient undergoing robotic cystectomy has been in steep Trendelenburg for 7 hours. At the end of surgery: • Facial oedema • Tongue swelling • Conjunctival oedema What is the BEST assessment before extubation? Temperature measurement Cuff leak assessment Blood glucose Urine output None A patient undergoing TURBT develops: • Sudden violent adductor contraction • Bladder wall perforation The surgeon asks how this might have been prevented. What is the BEST answer? Sciatic nerve block Femoral nerve block Obturator nerve block TAP block None A patient undergoing one-lung ventilation has: • FiO₂ 100% • SpO₂ 86% • DLT correctly positioned ABG: • PaO₂ 55 mmHg • PaCO₂ 38 mmHg What physiological process is MOST responsible for maintaining oxygenation during OLV? Hypercapnic vasoconstriction Hypoxic pulmonary vasoconstriction Bronchodilation Increased cardiac output None A woman in labour develops: • Sudden hypoxaemia • Hypotension • Cardiac arrest immediately after delivery. ROSC is achieved. Laboratory tests later reveal: • DIC • Low fibrinogen What is the MOST likely diagnosis? Pulmonary embolism Magnesium toxicity Amniotic fluid embolism High spinal block None A 4-year-old child weighing 20 kg has: • Estimated blood volume 1400 mL During surgery, blood loss reaches 350 mL. The child remains normotensive. What is the MOST important lesson? Blood loss is insignificant Children become hypotensive early Significant blood loss may occur before hypotension develops Blood pressure is the best marker of volume status None A patient receives an interscalene block. Thirty minutes later: • Mild dyspnoea • Reduced diaphragmatic movement on ultrasound • SpO₂ 98% What is the MOST likely explanation? Pneumothorax Phrenic nerve blockade Pulmonary embolism Local anaesthetic toxicity None A patient undergoing posterior fossa surgery develops: • ETCO₂ 14 mmHg • BP 65/35 mmHg • SpO₂ 88% The surgeon reports opening a large venous channel. What diagnosis BEST integrates all the findings? Bronchospasm Myocardial infarction Venous air embolism Malignant hyperthermia None A 68-year-old man is undergoing endovascular abdominal aortic aneurysm repair (EVAR). Thirty minutes after deployment of the stent graft: • Urine output falls sharply • BP remains 130/75 mmHg • HR 78/min The surgeon reports difficulty cannulating the renal arteries during the procedure. What is the MOST likely explanation? Hypovolaemia Acute tubular necrosis Renal artery compromise Diabetes insipidus None A 32-year-old woman undergoes emergency Caesarean section under spinal anaesthesia. Five minutes later: • BP 65/35 mmHg • HR 45/min • Difficulty breathing • Unable to move upper limbs What is the MOST likely diagnosis? Amniotic fluid embolism Magnesium toxicity High spinal block Local anaesthetic toxicity None A patient undergoing VATS lobectomy develops: • SpO₂ 82% • FiO₂ 100% • DLT correctly positioned The surgeon says: "I can pause if needed." What is the MOST effective immediate manoeuvre? Increase volatile concentration Temporary reinflation of the operative lung Reduce PEEP Give atropine None A 70-year-old woman undergoes thyroidectomy. Twenty minutes after extubation: • Stridor • SpO₂ 90% • Neck swelling • Anxiety The surgeon is still in the recovery area. What is the MOST appropriate immediate action? Nebulised salbutamol Wait for imaging Open the wound if airway compromise is progressing Administer furosemide None A 6-year-old child undergoes tonsillectomy. In recovery: • HR 160/min • BP 75/40 mmHg • Repeated swallowing • Pallor The surgical site appears dry. What is the MOST likely diagnosis? Emergence delirium Pain Concealed post-tonsillectomy haemorrhage Residual anaesthesia None A patient undergoing clipping of an intracranial aneurysm develops: • BP 90/50 mmHg • MEPs disappear • SSEPs unchanged What is the MOST important first intervention? Increase propofol Hyperventilate Increase cerebral perfusion pressure Stop monitoring None A patient undergoing TURP develops: • Restlessness • Confusion • Sodium 116 mmol/L What is the MOST dangerous neurological complication? Peripheral neuropathy Cerebral oedema Dementia Parkinsonism None A patient with severe COPD undergoes laparoscopic colectomy. During pneumoperitoneum: • ETCO₂ rises from 38 to 58 mmHg • HR stable • Temperature normal What is the MOST appropriate management? Dantrolene Increase minute ventilation Stop surgery immediately Give bicarbonate None A patient receives an adductor canal block before TKR. Postoperatively: • Excellent analgesia • Able to perform straight-leg raise What is the BEST explanation? Block failure Expected motor-sparing effect Sciatic nerve injury Femoral nerve damage None A patient undergoing posterior fossa surgery develops: • ETCO₂ falls from 35 to 15 mmHg • BP 70/40 mmHg • SpO₂ 88% TEE demonstrates air in the right atrium. What is the MOST important immediate anaesthetic change? Start nitrous oxide Stop nitrous oxide and administer 100% oxygen Increase volatile concentration Reduce FiO₂ None A 65-year-old man is undergoing total hip replacement under spinal anaesthesia. Thirty minutes after cement insertion: • BP 65/35 mmHg • SpO₂ 82% • ETCO₂ 15 mmHg The surgeon asks whether he should continue with wound closure. What is the MOST important physiological process causing the ETCO₂ fall? Increased CO₂ production Reduced pulmonary blood flow Reduced alveolar ventilation Increased oxygen consumption None A woman undergoing emergency Caesarean section develops: • Sudden hypotension • Bronchospasm • Severe hypoxaemia immediately after delivery. Twenty minutes later: • Oozing from IV sites • Fibrinogen 0.7 g/L What diagnosis BEST explains the entire picture? High spinal block Pulmonary embolism Amniotic fluid embolism Magnesium toxicity None A patient undergoes awake craniotomy. During cortical stimulation: • Speech suddenly stops • Patient remains conscious • No motor weakness What is the MOST likely interpretation? Seizure Air embolism Language cortex localisation Stroke None A 4-year-old child weighing 18 kg develops: • HR 170/min • Capillary refill 4 seconds • BP 90/60 mmHg after prolonged abdominal surgery. Estimated blood loss is 350 mL. What is the MOST important interpretation? Blood pressure is normal therefore shock is unlikely Significant compensated hypovolaemia is present Hypertension is present Blood loss is trivial None A patient undergoing one-lung ventilation has: • FiO₂ 100% • SpO₂ 84% • DLT position correct The surgeon asks: "Why is this happening if the lung is isolated properly?" What is the BEST explanation? Equipment failure Physiological shunt through the non-ventilated lung Hypermetabolism Reduced oxygen consumption None A patient undergoes thyroidectomy. During dissection: • HR falls from 75 to 35/min • BP falls to 70/40 mmHg The surgeon reports working close to the carotid bifurcation. What is the MOST likely mechanism? Hyperkalaemia Carotid sinus reflex Myocardial infarction Hypovolaemia None A patient with septic shock has: • MAP 72 mmHg • Lactate 8 mmol/L • ScvO₂ 74% • Oliguria The junior doctor says: "The ScvO₂ is normal, so perfusion must be adequate." What is the BEST response? Agree completely ScvO₂ alone cannot exclude tissue hypoperfusion Lactate is irrelevant Oliguria is unrelated None A patient receives an interscalene block. Thirty minutes later: • Mild dyspnoea • Reduced ipsilateral diaphragmatic excursion • SpO₂ 99% What is the MOST likely explanation? Pulmonary embolism Pneumothorax Phrenic nerve blockade LAST None A patient undergoing robotic prostatectomy develops: • Facial oedema • Tongue swelling • Peak airway pressure rise after 6 hours in steep Trendelenburg. What is the MOST important concern? Hyperglycaemia Difficult extubation Hypothermia Hyperkalaemia None The scenario is really an airway question. Airway oedema may make: • Extubation hazardous • Reintubation difficult A structured extubation plan is essential. Prometric Pearl Safe extubation requires the same planning as safe intubation. Pulse oximetry ECG TEE Temperature probe None A 62-year-old woman is undergoing laparoscopic hysterectomy. Ninety minutes into surgery: • ETCO₂ rises gradually from 35 to 52 mmHg • Temperature remains 36.8°C • HR remains 78/min • BP remains stable The trainee is concerned about malignant hyperthermia. What finding most strongly argues AGAINST malignant hyperthermia? Elevated ETCO₂ Stable haemodynamics and normal temperature Laparoscopic surgery Female gender None A 75-year-old man undergoes carotid endarterectomy under regional anaesthesia. During carotid cross-clamping: • He becomes confused • Speech becomes slurred • Contralateral arm weakness develops Blood pressure is 110/65 mmHg. What is the BEST immediate management? Lower blood pressure to reduce stroke risk Increase blood pressure and inform surgeon Give midazolam Continue surgery because BP is normal None A 28-year-old woman undergoes emergency Caesarean section. Ten minutes after delivery she develops: • Persistent uterine bleeding • BP 80/40 mmHg • HR 135/min The uterus is: • Soft • Enlarged • Poorly contracted What is the MOST likely cause of the haemorrhage? Cervical laceration Uterine atony Amniotic fluid embolism Placental abruption None A patient undergoing thoracotomy develops: • Severe postoperative pain • Poor cough • Reduced inspiratory effort Despite IV opioids. Which regional technique would most likely improve all three problems? Wrist block Femoral block Thoracic epidural Ankle block None A 5-year-old child presents for emergency bronchoscopy. History: • Sudden choking episode • Persistent unilateral wheeze • Reduced air entry on the right What is the MOST likely diagnosis? Asthma Bronchiolitis Foreign body aspiration Croup None A patient undergoing scoliosis correction develops: • MEP amplitudes fall by 80% • SSEPs unchanged • MAP 45 mmHg What is the MOST likely explanation? Permanent cord injury Motor pathway hypoperfusion Equipment failure Hyperglycaemia None A patient receives an interscalene block. Thirty minutes later: • Ptosis • Miosis • Facial anhidrosis but no neurological deficit. What is the MOST likely diagnosis? Stroke Horner syndrome Brainstem anaesthesia LAST None A patient undergoing pituitary surgery develops: • Urine output 1200 mL in 90 minutes • Serum sodium 152 mmol/L What is the MOST appropriate treatment? Fluid restriction Desmopressin Furosemide Mannitol None A patient undergoing robotic prostatectomy has: • Peak pressure 42 cmH₂O • Plateau pressure 39 cmH₂O What is the BEST interpretation? Bronchospasm Tube obstruction Reduced compliance from Trendelenburg and pneumoperitoneum Circuit leak None A patient undergoing posterior fossa surgery develops: • Sudden ETCO₂ drop • Hypotension • Desaturation The surgeon reports entering a venous sinus. What is the MOST likely diagnosis? Bronchospasm Pulmonary oedema Venous air embolism Myocardial infarction None A 72-year-old woman undergoes cemented hemiarthroplasty for fractured neck of femur. Immediately after cement insertion: • ETCO₂ falls from 34 to 12 mmHg • BP falls from 140/80 to 60/30 mmHg • SpO₂ falls to 78% The surgeon asks: "Why did the ETCO₂ drop so dramatically?" What is the BEST physiological explanation? Increased alveolar ventilation Reduced CO₂ production Reduced pulmonary perfusion Increased oxygen consumption None A 30-year-old primigravida develops: • Persistent fetal bradycardia • Maternal BP 65/35 mmHg 5 minutes after spinal anaesthesia for Caesarean section. What is the MOST appropriate first intervention? Emergency neonatal delivery Correct maternal hypotension Fetal scalp electrode Magnesium sulfate None A patient undergoing carotid endarterectomy under regional anaesthesia suddenly develops: • Contralateral arm weakness • Slurred speech BP is 95/55 mmHg. What is the MOST likely diagnosis? Stroke Local anaesthetic toxicity Cerebral hypoperfusion during carotid clamping Anxiety None A 4-year-old child undergoes tonsillectomy. In recovery: • HR 165/min • Pale • Repeated swallowing • BP 85/50 mmHg The nurse reports: "The throat looks clean." What is the MOST likely diagnosis? Emergence delirium Concealed post-tonsillectomy haemorrhage Pain Residual anaesthesia None A patient undergoing one-lung ventilation develops: • SpO₂ 84% • FiO₂ 100% • DLT position correct What physiological mechanism is MOST responsible for preventing even worse hypoxaemia? Bronchodilation Hyperventilation Hypoxic pulmonary vasoconstriction Increased cardiac output None A patient undergoing thyroidectomy develops: • HR 35/min • BP 70/40 mmHg during dissection around the carotid bifurcation. What is the MOST likely mechanism? Hyperkalaemia Carotid sinus stimulation Myocardial infarction Hypovolaemia None A patient with septic shock has: • Lactate 9 mmol/L • ScvO₂ 78% • Oliguria • Mottled skin The junior trainee says: "ScvO₂ is normal, so tissue perfusion must be adequate." What is the BEST response? Agree Lactate is irrelevant ScvO₂ alone does not exclude tissue hypoxia Stop monitoring lactate None A patient receives an interscalene block. After surgery: • Mild dyspnoea • Reduced diaphragmatic movement • SpO₂ 99% What is the MOST likely explanation? Pulmonary embolism Pneumothorax Phrenic nerve blockade Local anaesthetic toxicity None A patient undergoes robotic radical prostatectomy. After 7 hours in steep Trendelenburg: • Facial oedema • Tongue swelling • Conjunctival oedema What is the MOST important concern before extubation? Hyperglycaemia Difficult airway due to airway oedema Hypothermia Hyperkalaemia None A patient undergoing posterior fossa surgery develops: • Sudden ETCO₂ fall • Hypotension • SpO₂ 88% TEE demonstrates air in the right atrium. What is the MOST important immediate intervention? Start nitrous oxide Administer 100% oxygen and stop nitrous oxide Increase volatile anaesthetic Reduce FiO₂ None A 68-year-old man undergoing laparotomy under TIVA has: • BIS 32 • BP 85/45 mmHg • HR 52/min The trainee decides to increase the propofol target because: "The patient is moving slightly." What is the MOST important concern with this decision? BIS is too high The patient is already deeply hypnotised Propofol does not affect blood pressure BIS should always be below 20 None A patient undergoing thoracic surgery on OLV develops: • SpO₂ 85% • FiO₂ 100% • DLT correctly positioned The surgeon asks: "Why isn't the oxygen level normal if the ventilated lung is receiving 100% oxygen?" What is the BEST explanation? Hypercapnia Right-to-left shunt Equipment malfunction Reduced oxygen consumption None A labouring woman develops the following CTG: • Baseline 145 bpm • Variability 12 bpm • Recurrent variable decelerations What is the MOST likely cause? Placental insufficiency Maternal hypotension Umbilical cord compression Fetal anaemia None A patient undergoing laparoscopic colectomy develops: • ETCO₂ rises from 38 to 65 mmHg • Temperature 40°C • HR 145/min • Generalised rigidity What is the MOST likely diagnosis? CO₂ absorption Malignant hyperthermia Thyroid storm Sepsis None A patient undergoing posterior fossa surgery develops: • Sudden ETCO₂ drop • Hypotension • Desaturation The surgeon reports: "I entered a large venous sinus." Which monitor would have detected this complication earliest? Pulse oximeter ECG TEE Temperature probe None A 5-year-old child undergoes adenotonsillectomy. Following extubation: • Severe inspiratory effort • No airflow • SpO₂ 60% Jaw thrust and CPAP fail. What is the BEST next step? Salbutamol Nebulised adrenaline Succinylcholine Dexamethasone None A patient with severe sepsis has: • Lactate 8 mmol/L • ScvO₂ 42% • Cardiac index 1.7 L/min/m² What is the MOST likely haemodynamic problem? Excess oxygen delivery Inadequate oxygen delivery Hyperoxia Increased oxygen reserve None During endoscopic sinus surgery, visibility progressively worsens. ABG: • PaCO₂ 60 mmHg What is the MOST likely explanation? Hypercapnia causing mucosal vasodilation Hypothermia Hypoglycaemia Anaemia None A patient receives an interscalene block. Postoperatively: • Ptosis • Miosis • Facial anhidrosis No weakness elsewhere. What is the MOST likely diagnosis? Stroke Horner syndrome Brainstem anaesthesia LAST None A patient undergoing robotic prostatectomy has: • Peak pressure 42 cmH₂O • Plateau pressure 40 cmH₂O What is the MOST likely explanation? Bronchospasm Tube obstruction Reduced compliance due to Trendelenburg and pneumoperitoneum Circuit leak None A patient undergoing laser excision of a vocal cord lesion develops flames from the airway. What is the FIRST action? Continue ventilation Disconnect oxygen supply and stop ventilation Administer adrenaline Increase fresh gas flow None A trauma patient has: • Eyes open to speech • Confused conversation • Localises pain What is the GCS? 11 12 13 14 None A patient undergoing scoliosis correction develops: • MEP loss • MAP 45 mmHg What is the MOST important first intervention? Wake-up test Increase MAP Increase volatile agent Stop monitoring None A patient undergoing Caesarean section develops: • Sudden hypoxaemia • Severe hypotension • DIC What diagnosis best explains all findings? Pulmonary embolism High spinal block Amniotic fluid embolism Magnesium toxicity None A 72-year-old man undergoes hip fracture fixation under spinal anaesthesia. Thirty minutes later: • BP 65/35 mmHg • HR 38/min • Sensory block T2 What is the MOST likely diagnosis? Myocardial infarction Bone Cement Implantation Syndrome High Spinal Block Pulmonary Embolism None Name Email Time's up
