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?

A 4-year-old child weighing 18 kg presents with severe dehydration. What is the estimated circulating blood volume?

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?

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?

A patient undergoing thyroidectomy suddenly develops: • ETCO₂ 65 mmHg • Generalized rigidity • Tachycardia • Temperature 39.5°C What is the most likely diagnosis?

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?

A labouring patient develops recurrent variable decelerations on CTG. What is the most likely underlying mechanism?

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?

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?

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?

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?

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?

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?

A patient develops severe bronchospasm during anaesthesia. Which capnography waveform is most likely?

A patient develops ventricular fibrillation shortly after induction. What is the single most important intervention?

A patient undergoing pneumonectomy has an FEV₁ of 32% predicted. What is the major perioperative concern?

A CTG demonstrates: • Baseline 170 bpm • Normal variability • No decelerations How should the baseline heart rate be classified?

A neonate weighs 3 kg. What is the approximate circulating blood volume?

During spinal surgery, SSEP amplitude decreases by 60%. Simultaneously, mean arterial pressure decreases from 85 mmHg to 48 mmHg. What should be corrected first?

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?

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?

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

A ventilated ICU patient develops: • Increasing peak airway pressure • Increasing plateau pressure • Bilateral infiltrates on chest X-ray What is the most likely explanation?

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?

A patient develops narrow-complex tachycardia at 180/min. The rhythm is regular. Blood pressure is stable. What is the most appropriate initial treatment?

A patient undergoing one-lung ventilation develops hypoxaemia. Bronchoscopy confirms correct DLT position. Which intervention is most likely to improve oxygenation?

A CTG demonstrates: • Baseline 140 bpm • Moderate variability • Recurrent late decelerations What is the most likely underlying problem?

A 1-year-old infant weighs 10 kg. What is the maintenance fluid requirement per hour using the 4-2-1 rule?

During scoliosis surgery, MEPs suddenly decrease. Blood pressure is 45 mmHg mean arterial pressure. What is the most appropriate immediate intervention?

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?

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?

A 6-year-old child weighing 24 kg requires emergency fluid resuscitation following trauma. What is the recommended initial crystalloid bolus?

A mechanically ventilated ICU patient has: • Peak pressure: 38 cmH₂O • Plateau pressure: 37 cmH₂O What is the most likely diagnosis?

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?

A patient develops torsades de pointes in the recovery room. What is the first-line pharmacological treatment?

A patient undergoing thoracic surgery develops hypoxaemia during OLV. Which physiological mechanism is primarily responsible for maintaining arterial oxygenation?

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?

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?

During scoliosis surgery, motor evoked potentials disappear immediately after administration of a rocuronium bolus. What is the most likely explanation?

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?

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?

A 5-year-old child weighing 20 kg presents for adenotonsillectomy. What is the most appropriate uncuffed endotracheal tube size?

A ventilated ICU patient develops: • Sudden hypoxaemia • Peak pressure increase • Plateau pressure unchanged What is the most likely cause?

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?

A patient develops atrial fibrillation with a ventricular rate of 150/min. Blood pressure is 70/40 mmHg. What is the most appropriate treatment?

A patient undergoing thoracic surgery develops hypoxaemia during OLV. What is the principal cause?

A CTG demonstrates: • Baseline 145 bpm • Moderate variability • Accelerations present • No decelerations How should this CTG be classified?

A term neonate weighs 3.8 kg. Assuming a blood volume of 90 mL/kg, what is the estimated circulating blood volume?

During scoliosis surgery, SSEP amplitude decreases by 70%. Mean arterial pressure is 52 mmHg. What is the most appropriate first intervention?

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?

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?

A 7-year-old child weighing 25 kg presents for emergency appendicectomy. What is the estimated blood volume?

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?

During laparoscopic surgery, a capnograph suddenly demonstrates an elevated baseline that fails to return to zero. What is the most likely explanation?

An ECG demonstrates: • Tall peaked T waves • Progressive QRS widening Which diagnosis should be suspected first?

A patient undergoing one-lung ventilation develops persistent hypoxaemia despite correct DLT position. Which intervention may worsen oxygenation?

A CTG demonstrates: • Baseline 135 bpm • Moderate variability • Recurrent variable decelerations What is the most likely cause?

A 9-month-old infant weighing 8 kg is scheduled for surgery. What is the hourly maintenance fluid requirement?

During scoliosis surgery, MEP amplitude suddenly decreases following an increase in sevoflurane concentration. What is the most likely explanation?

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?

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?

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?

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?

During laparoscopy, the capnograph suddenly becomes completely flat. Blood pressure and oxygen saturation remain normal. What should be checked first?

An ECG demonstrates: • ST-segment elevation in leads II, III, and aVF Which myocardial territory is most likely affected?

A patient undergoing OLV develops severe hypoxaemia. DLT position is correct. What is the next most appropriate intervention?

A CTG demonstrates: • Baseline 170 bpm • Reduced variability • Recurrent late decelerations How should this trace be classified?

A 4 kg term neonate develops surgical bleeding. What is the estimated circulating blood volume?

During scoliosis surgery, MEPs disappear following an increase in volatile anaesthetic concentration. What is the most likely explanation?

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?

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?

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?

A ventilated ICU patient develops: • PaO₂ 58 mmHg • FiO₂ 0.6 • Bilateral infiltrates What is the PaO₂/FiO₂ ratio?

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?

A patient develops monomorphic broad-complex tachycardia at 190/min. Blood pressure is 65/35 mmHg. What is the most appropriate treatment?

A patient undergoing OLV becomes hypoxaemic. DLT position is confirmed. CPAP has been applied. Which rescue manoeuvre may temporarily improve oxygenation?

A labouring patient develops uterine tachysystole after oxytocin administration. CTG demonstrates prolonged fetal bradycardia. What is the most appropriate immediate intervention?

A 12-month-old infant weighing 10 kg undergoes surgery. What is the estimated blood volume?

During scoliosis surgery, MEP signals disappear after a large rocuronium bolus. What is the most likely explanation?

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?

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?

A 4-year-old child weighing 16 kg receives 10 mL/kg packed red cells. What increase in haemoglobin would be expected?

A ventilated ICU patient develops sudden: • Hypoxaemia • Hypotension • Distended neck veins • Unilateral absent breath sounds What is the most likely diagnosis?

During laparoscopic surgery, a capnograph demonstrates a classic shark-fin appearance. What is the most likely diagnosis?

A patient develops ventricular fibrillation. After immediate defibrillation, what should occur next?

A patient undergoing thoracic surgery develops severe hypoxaemia during OLV. Which physiological process normally improves oxygenation in this situation?

A CTG demonstrates: • Baseline 130 bpm • Moderate variability • Accelerations present • No decelerations How should this CTG be interpreted?

A 3 kg term neonate undergoes surgery. Assuming blood volume is 90 mL/kg, what is the estimated circulating blood volume?

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?

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?

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?

A 5-year-old child weighing 18 kg requires maintenance intravenous fluids. Using the 4-2-1 rule, what is the maintenance rate?

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?

During laparoscopic surgery, ETCO₂ suddenly falls from 36 mmHg to 14 mmHg. Blood pressure falls simultaneously. What diagnosis should be suspected first?

An ECG demonstrates: • Broad QRS complexes • Regular rhythm • Rate 180/min • No visible P waves What is the most likely diagnosis?

During one-lung ventilation, which factor contributes most to hypoxaemia?

A labouring patient develops severe postpartum haemorrhage. ROTEM suggests severe hypofibrinogenaemia. Which product is most appropriate?

A term neonate has: • Heart rate 90/min • Poor respiratory effort What is the most appropriate next step?

During scoliosis surgery, MEP signals disappear immediately after administration of rocuronium. What is the most likely explanation?

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?