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Welcome to your Test 24
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?
Age >65 years
Previous stroke
Male gender
Hypertension
None
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?
Normal
Suspicious
Pathological
Reactive
None
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?
Excessively deep anaesthesia
Equipment failure is certain
Inadequate hypnotic depth
Excess neuromuscular blockade
None
A patient undergoing upper abdominal surgery develops progressive hypothermia. Which mechanism accounts for the greatest intraoperative heat loss?
Conduction
Convection
Radiation
Evaporation
None
A laser is being used during microlaryngoscopy. Which factor contributes most to operating theatre fire risk?
Nitrogen
Carbon dioxide
Oxygen-enriched atmosphere
Argon
None
A patient presents after head injury. Examination reveals: • Eyes open to pain • Incomprehensible sounds • Withdraws from pain What is the GCS?
6
7
8
9
None
A flow-volume loop demonstrates: • Flattened inspiratory limb • Normal expiratory limb What is the most likely diagnosis?
Fixed upper airway obstruction
Variable extrathoracic obstruction
Variable intrathoracic obstruction
Severe asthma
None
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?
Increase volatile concentration
Temporary two-lung ventilation
Nitroglycerin infusion
Remove arterial line
None
A patient with sickle cell disease presents for emergency laparotomy. Which perioperative factor most strongly promotes sickling?
Normothermia
Adequate hydration
Hypoxaemia
Supplemental oxygen
None
During spinal surgery, MEPs disappear but SSEPs remain normal. What structure is most likely affected?
Posterior columns
Corticospinal tracts
Spinothalamic tracts
Peripheral nerve
None
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?
Resting heart rate of 60/min
Ability to climb two flights of stairs
Normal chest X-ray
Normal hemoglobin
None
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?
Umbilical cord prolapse
Maternal hypotension causing reduced uteroplacental perfusion
Fetal arrhythmia
Placental abruption
None
A patient undergoing TIVA for scoliosis surgery has: • BIS = 28 • MAP = 60 mmHg • HR = 45/min What is the most likely interpretation?
Awareness
Excessively deep anaesthesia
Equipment malfunction
Inadequate analgesia
None
During a prolonged laparotomy, core temperature falls from 36.8°C to 34.9°C. Which complication is most likely?
Reduced blood loss
Improved coagulation
Increased surgical site infection risk
Increased MAC requirement
None
A laser airway procedure is being performed. Which intervention most effectively reduces airway fire risk?
Increase FiO₂ to 100%
Use nitrous oxide
Use the lowest feasible FiO₂
Increase fresh gas flow
None
A trauma patient has: • Eyes open spontaneously • Confused conversation • Localizes pain What is the GCS?
12
13
14
15
None
A flow-volume loop demonstrates flattening of both inspiratory and expiratory limbs. What is the most likely diagnosis?
Variable extrathoracic obstruction
Variable intrathoracic obstruction
Fixed upper airway obstruction
Asthma
None
During OLV, oxygen saturation falls to 88%. DLT position is correct. CPAP and recruitment manoeuvres have failed. What physiological mechanism is causing hypoxaemia?
Increased dead space
Right-to-left shunt
Increased oxygen consumption
Metabolic acidosis
None
A patient with sickle cell disease develops: • Fever • Chest pain • New pulmonary infiltrate • Hypoxaemia 48 hours after surgery. What is the most likely diagnosis?
Pulmonary oedema
Acute chest syndrome
Pneumothorax
Atelectasis
None
During scoliosis correction, SSEPs decrease by 70%, while MEPs remain unchanged. What structure is most likely affected?
Corticospinal tract
Posterior columns
Neuromuscular junction
Peripheral muscle
None
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?
Proceed immediately with delivery without intervention
Administer phenylephrine, perform left uterine displacement and reassess fetal heart rate
Administer magnesium sulfate
Convert to general anaesthesia
None
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?
Standard inhalational induction
Intravenous induction without cricoid pressure
Rapid sequence induction with preparation for a difficult airway
Awake fibreoptic intubation
None
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?
Increase norepinephrine dose
Administer sodium bicarbonate infusion
Commence dobutamine infusion
Administer furosemide
None
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?
Continue oxytocin and reassess after 30 minutes
Stop oxytocin infusion and initiate intrauterine resuscitation
Administer terbutaline only
Perform fetal scalp blood sampling before any intervention
None
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?
Increase sevoflurane concentration from 0.8 MAC to 1.5 MAC
Apply CPAP (5 cmH₂O) to the non-dependent lung
Accept the saturation because hypoxaemia is expected during OLV
Start nitroglycerin infusion
None
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?
Wait for CT scan because oxygen saturation is acceptable
Immediate tracheal intubation and controlled ventilation
Administer mannitol and reassess after CT
Observe for one hour and repeat neurological examination
None
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?
Sickle cell crisis
Acute intermittent porphyria (AIP)
Pheochromocytoma
Malignant hyperthermia susceptibility
None
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?
High spinal block
Amniotic fluid embolism
Rapid haemodynamic effects of oxytocin
Local anaesthetic toxicity
None
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?
Wake the patient up immediately
Increase propofol infusion
Correct the hypotension and reassess MEPs
Inform the surgeon that spinal cord injury has definitely occurred
None
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?
Bronchospasm
Endobronchial intubation
Reduced lung compliance caused by pneumoperitoneum
Pulmonary embolism
None
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?
Bronchospasm
Endobronchial intubation
Reduced lung compliance caused by pneumoperitoneum
Pulmonary embolism
None
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?
1
2
3
4
None
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?
Blood loss is minor and unlikely to explain the haemodynamic instability
Blood loss represents approximately 10% of blood volume
Blood loss represents approximately 25% of blood volume
Blood loss represents approximately 40% of blood volume and is likely contributing significantly to shock
None
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?
Uterine atony
Retained placenta
Genital tract trauma
Amniotic fluid embolism
None
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?
Bronchospasm
Residual neuromuscular blockade
Laryngospasm
Opioid-induced respiratory depression
None
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?
Malignant hyperthermia
Carbon dioxide absorption from pneumoperitoneum
Pulmonary embolism
Circuit disconnection
None
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?
Uteroplacental insufficiency
Umbilical cord compression
Fetal anaemia
Maternal hypotension
None
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?
Increase volatile anaesthetic concentration
Correct hypotension
Administer rocuronium
Stop monitoring
None
A 58-year-old patient undergoing general anaesthesia has: • BIS = 85 • Tachycardia • Hypertension during skin incision What is the most likely interpretation?
Excessively deep anaesthesia
Inadequate depth of anaesthesia
Neuromuscular blockade overdose
Equipment failure
None
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?
Pneumothorax
Bronchospasm
Pulmonary oedema
Endobronchial intubation
None
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?
Immediate chest compressions
Positive pressure ventilation
Defibrillation
Amiodarone
None
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?
Bronchospasm
Carbon dioxide embolism
Malignant hyperthermia
Rebreathing
None
A patient undergoing thoracic surgery develops hypoxaemia during one-lung ventilation. The DLT position is confirmed bronchoscopically. What is the next best step?
Increase volatile anaesthetic concentration
Apply CPAP to the non-ventilated lung
Administer nitroglycerin
Reduce FiO₂
None
A labouring woman has the following CTG: • Baseline: 125 bpm • Variability: 12 bpm • Accelerations present • No decelerations How should this CTG be classified?
Pathological
Suspicious
Normal
Non-reassuring
None
A patient develops the following ECG changes: • Tall peaked T waves • QRS widening What electrolyte abnormality is most likely?
Hypocalcaemia
Hyperkalaemia
Hypokalaemia
Hypermagnesaemia
None
A 4-year-old child weighing 18 kg requires maintenance fluids. Using the 4-2-1 rule, what is the hourly maintenance rate?
46 mL/hr
52 mL/hr
56 mL/hr
60 mL/hr
None
During major abdominal surgery, core temperature falls to 34.8°C. Which complication is most likely?
Reduced blood loss
Improved coagulation
Increased surgical site infection risk
Increased MAC requirement
None
A patient undergoing scoliosis correction develops sudden loss of MEP signals. MAP is 45 mmHg. What is the most appropriate first action?
Wake the patient immediately
Increase propofol infusion
Correct hypotension
Assume permanent spinal cord injury
None
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?
Anaemia
Excess oxygen delivery
Inadequate oxygen delivery due to low cardiac output
Measurement error
None
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?
High spinal block
Local anaesthetic systemic toxicity (LAST)
Anaphylaxis
Amniotic fluid embolism
None
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?
Pulmonary embolism
Sympathetic blockade from spinal anaesthesia
Myocardial infarction
Local anaesthetic toxicity
None
A 65-year-old smoker undergoes spirometry. Flow-volume loop demonstrates: • Flattened inspiratory limb • Normal expiratory limb What is the most likely diagnosis?
Asthma
Fixed upper airway obstruction
Variable extrathoracic obstruction
Variable intrathoracic obstruction
None
A trauma patient has: • Eyes open to speech • Confused conversation • Localises pain What is the GCS?
12
13
14
15
None
A patient undergoing thyroidectomy develops: • Stridor • Respiratory distress • Neck swelling 30 minutes after surgery. What is the most likely diagnosis?
Bronchospasm
Pulmonary oedema
Neck haematoma
Recurrent laryngeal nerve palsy
None
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?
Albumin
Mannitol
Tranexamic acid
Dobutamine
None
A patient with sickle cell disease presents for emergency surgery. Which factor is most likely to precipitate sickling?
Normothermia
Supplemental oxygen
Dehydration
Adequate analgesia
None
During laparoscopic surgery, a fire starts near the surgical drapes. Which element of the fire triad is most commonly increased by anaesthetic practice?
Ignition source
Fuel
Oxidizer
Smoke
None
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?
Metabolic acidosis
Respiratory acidosis
Metabolic alkalosis
Respiratory alkalosis
None
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?
Adequate perfusion
Persistent tissue hypoperfusion despite apparently adequate oxygen delivery
Hyperventilation
Measurement error
None
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?
Amniotic fluid embolism
Pulmonary embolism
Oxytocin-induced vasodilation
High spinal block
None
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?
Local anaesthetic toxicity
Cerebral ischaemia
Hypoglycaemia
Hypercapnia
None
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?
Laryngospasm
Upper airway oedema
Bronchospasm
Aspiration
None
A patient undergoing major surgery has: • Temperature 39.5°C • ETCO₂ rising rapidly • Generalised muscle rigidity • Tachycardia What is the most likely diagnosis?
Thyroid storm
Neuroleptic malignant syndrome
Malignant hyperthermia
Sepsis
None
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?
Amiodarone infusion
Adenosine
Immediate synchronized cardioversion
Digoxin
None
A 4-year-old child weighing 20 kg loses 300 mL blood during surgery. Approximately what percentage of blood volume has been lost?
10%
20%
30%
40%
None
During labour, a CTG shows: • Baseline 140 bpm • Variability 8 bpm • Recurrent late decelerations What is the most likely underlying problem?
Umbilical cord compression
Uteroplacental insufficiency
Fetal arrhythmia
Maternal hyperglycaemia
None
A patient undergoing thyroid surgery develops: • Hoarseness • Weak cough • Breathy voice after extubation. What nerve injury is most likely?
Hypoglossal nerve
Recurrent laryngeal nerve
Glossopharyngeal nerve
Vagus nerve trunk
None
A patient with severe sepsis has: • Lactate 8 mmol/L • MAP 72 mmHg • ScvO₂ 45% What is the most likely interpretation?
Excess oxygen delivery
Inadequate oxygen delivery
Hyperoxia
Normal physiology
None
A patient undergoing scoliosis surgery has: • SSEPs unchanged • MEPs absent What structure is most likely affected?
Posterior columns
Corticospinal tracts
Spinothalamic tracts
Cerebellum
None
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?
Administer sodium bicarbonate
Increase minute ventilation
Decrease FiO₂
Administer furosemide
None
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?
Chest compressions
Adrenaline
Positive pressure ventilation
Sodium bicarbonate
None
A patient develops the following ECG changes during surgery: • ST elevation in leads II, III and aVF What is the most likely diagnosis?
Anterior STEMI
Inferior STEMI
Hyperkalaemia
Pericarditis
None
A patient undergoes laser excision of a vocal cord lesion. Which measure most effectively reduces airway fire risk?
Increase FiO₂ to 100%
Use nitrous oxide
Use the lowest acceptable FiO₂
Increase fresh gas flow
None
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?
INR alone accurately predicts bleeding
Platelet count alone predicts bleeding
Both abnormalities suggest increased bleeding risk
Cirrhotic patients are always hypercoagulable
None
A 4-year-old child undergoing bronchoscopy develops: • HR 60/min • SpO₂ 82% What is the most likely cause of the bradycardia?
Hypoxia
Hyperglycaemia
Hyperkalaemia
Hypertension
None
A trauma patient has: • Eyes open spontaneously • Inappropriate words • Withdraws from pain What is the GCS?
9
10
11
12
None
A patient with myasthenia gravis is undergoing thymectomy. Which neuromuscular blocker characteristic is expected?
Resistance to non-depolarizing blockers
Increased sensitivity to non-depolarizing blockers
Resistance to all muscle relaxants
Increased sensitivity to succinylcholine only
None
During labour, a CTG shows: • Baseline 175 bpm • Variability 2 bpm • Recurrent late decelerations How should this trace be classified?
Normal
Suspicious
Pathological
Reactive
None
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?
Increase norepinephrine only
Consider inotropic support
Administer bicarbonate
Give furosemide
None
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?
Respiratory rate 10/min
Presence of reflexes
Oliguria
Hypertension
None
A 6-year-old child weighing 20 kg requires emergency transfusion. Estimated blood volume is approximately:
1000 mL
1200 mL
1400 mL
1600 mL
None
During general anaesthesia, the BIS monitor suddenly reads 92. The patient simultaneously develops: • Tachycardia • Hypertension What is the most likely explanation?
Deep anaesthesia
Inadequate hypnotic depth
Excess opioid administration
Hypothermia
None
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?
Bronchospasm
Carbon dioxide embolism
Malignant hyperthermia
Rebreathing
None
A labouring woman develops recurrent variable decelerations on CTG. What is the most likely cause?
Uteroplacental insufficiency
Umbilical cord compression
Maternal pyrexia
Placental abruption
None
A patient with hyperkalaemia develops progressive ECG changes. Which ECG abnormality usually appears first?
Sine-wave pattern
Ventricular fibrillation
Peaked T waves
Complete heart block
None
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?
Increase nitroglycerin infusion
Intermittent two-lung ventilation
Increase volatile anaesthetic concentration
Remove the DLT
None
A patient develops: • BP 190/100 mmHg • HR 42/min during neurosurgery. What does this combination most strongly suggest?
Hypovolaemia
Raised intracranial pressure
Anaphylaxis
Local anaesthetic toxicity
None
A patient develops postpartum haemorrhage. The uterus is: • Soft • Enlarged • Poorly contracted What is the most likely diagnosis?
Uterine atony
Cervical tear
Coagulopathy
Retained swab
None
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?
Excess oxygen delivery
Inadequate oxygen delivery
Hyperventilation
Equipment malfunction
None
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?
Immediate surgery because pyloric stenosis is a surgical emergency
Correct fluid and electrolyte abnormalities before surgery
Perform surgery under spinal anaesthesia
Administer sodium bicarbonate before surgery
None
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?
Viral bronchiolitis
Foreign body aspiration
Pneumonia
Asthma
None
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?
Emergence delirium
Residual neuromuscular blockade
Post-tonsillectomy haemorrhage
Bronchospasm
None
A neonate develops: • HR 55/min • SpO₂ 78% immediately after induction. What is the first intervention?
Adrenaline
Defibrillation
Chest compressions
Positive pressure ventilation
None
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?
Sepsis
Thyroid storm
Malignant hyperthermia
Neuroleptic malignant syndrome
None
A 10-kg infant has lost 150 mL blood during surgery. Approximately what percentage of blood volume has been lost?
10%
20%
30%
40%
None
A child with Tetralogy of Fallot develops sudden: • Cyanosis • Tachypnoea • Irritability • SpO₂ 55% during induction. What is the most likely event?
Bronchospasm
Hypercyanotic spell
Pulmonary oedema
Pneumothorax
None
A premature infant presents for inguinal hernia repair. Why is postoperative apnoea a major concern?
Increased opioid metabolism
Immature respiratory control
Increased lung compliance
Increased FRC
None
A child with Down syndrome presents for dental surgery. Which airway feature is commonly encountered?
Macroglossia
Trismus
Microglossia
Fixed cervical spine
None
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?
Salbutamol
Dexamethasone
Succinylcholine
Furosemide
None
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