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ANZCA Final Exam study materials
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ANZCA Final Exam practice questions

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Question 1Anaesthesia

A 70 kg adult is to receive an intravenous bolus of a drug with a volume of distribution of 0.5 L/kg. What approximate dose is required to achieve a plasma concentration of 4 mg/L, assuming no elimination has occurred?

  1. 560 mg
  2. 280 mg
  3. 35 mg
  4. 140 mg Correct answer.

Explanation

Volume of distribution equals dose divided by plasma concentration, so dose equals Vd multiplied by target concentration. Vd here is 0.5 L/kg × 70 kg = 35 L, and 35 L × 4 mg/L = 140 mg. This calculation gives the loading dose needed to fill the apparent distribution volume.

Question 2Anaesthesia

Which volatile anaesthetic has the lowest blood:gas partition coefficient and therefore the fastest equilibration between alveolar and arterial partial pressures?

  1. Desflurane Correct answer.
  2. Isoflurane
  3. Sevoflurane
  4. Enflurane

Explanation

A low blood:gas partition coefficient means less agent must dissolve in blood before the arterial partial pressure rises, so induction and recovery are rapid. Desflurane has the lowest blood:gas solubility of the commonly used volatiles, followed by sevoflurane, isoflurane and enflurane.

Question 3Anaesthesia

A patient with a suspected difficult airway is being preoxygenated. Which technique best prolongs the safe apnoea time?

  1. Tidal volume breathing of 100% oxygen for 3 minutes Correct answer.
  2. Two deep breaths of 100% oxygen via a non-rebreather mask
  3. Four vital capacity breaths of 100% oxygen over 30 seconds
  4. Nasal prongs at 2 L/min of oxygen for 5 minutes

Explanation

Tidal volume breathing of 100% oxygen for three minutes reliably denitrogenates the functional residual capacity and achieves an end-tidal oxygen fraction above 0.9. This maximises the oxygen reservoir and prolongs safe apnoea time in a patient at risk of difficult intubation.

Question 4Anaesthesia

Which nerve block is most appropriate for analgesia after a shoulder arthroscopy, targeting the plexus supplying the shoulder joint?

  1. Interscalene brachial plexus block Correct answer.
  2. Supraclavicular brachial plexus block
  3. Femoral nerve block
  4. Axillary brachial plexus block

Explanation

The interscalene approach to the brachial plexus reliably blocks the C5 and C6 roots that supply the shoulder. It provides excellent analgesia for shoulder surgery but carries a predictable risk of ipsilateral phrenic nerve palsy.

Question 5Anaesthesia

A patient with severe aortic stenosis is undergoing emergency surgery. Which physiological goal best preserves coronary perfusion during induction of anaesthesia?

  1. Aim for deep hypotension to reduce myocardial work
  2. Maintain sinus rhythm, preload and systemic vascular resistance Correct answer.
  3. Induce a controlled tachycardia to reduce afterload
  4. Maintain a high heart rate with vasodilation

Explanation

In aortic stenosis the hypertrophied left ventricle needs adequate preload, sinus rhythm and systemic vascular resistance to maintain coronary perfusion pressure. Tachycardia and vasodilation both reduce diastolic coronary filling and can precipitate ischaemia.

Question 6Anaesthesia

Which statement about the mechanism of action of propofol is most accurate?

  1. It is a partial agonist at opioid receptors
  2. It potentiates GABA-A receptor chloride currents Correct answer.
  3. It blocks voltage-gated sodium channels
  4. It primarily antagonises NMDA receptors

Explanation

Propofol enhances the inhibitory effect of GABA at GABA-A receptors, increasing chloride conductance and neuronal hyperpolarisation. This accounts for its rapid hypnotic action and its potentiation by other GABAergic agents.

Question 7Anaesthesia

A patient receives 100 mg of a drug with a clearance of 10 L/h. What is the approximate elimination half-life if the volume of distribution is 50 L?

  1. 7 hours
  2. 3.5 hours Correct answer.
  3. 1.7 hours
  4. 5 hours

Explanation

Half-life equals 0.693 multiplied by Vd divided by clearance, so 0.693 × 50 L ÷ 10 L/h ≈ 3.5 hours. Note that the dose does not affect half-life in first-order kinetics.

Question 8Anaesthesia

Which finding on preoperative assessment most strongly predicts difficult mask ventilation in an obese patient?

  1. Full dentition with a normal neck range of motion
  2. Mallampati class I
  3. Thyromental distance greater than 6.5 cm
  4. Body mass index above 30 with a beard and edentulous state Correct answer.

Explanation

The recognised predictors of difficult mask ventilation include obesity, presence of a beard, edentulous state, age over 55 and a history of snoring. These features impair the seal and airway patency during bag-mask ventilation.

Question 9Anaesthesia

Which agent is the first-line treatment for local anaesthetic systemic toxicity with cardiovascular collapse?

  1. Intravenous calcium chloride
  2. Intravenous sodium bicarbonate
  3. Intravenous adrenaline infusion alone
  4. Intravenous 20% lipid emulsion Correct answer.

Explanation

Intravenous lipid emulsion is the specific antidote for local anaesthetic systemic toxicity and should be given early in cardiac arrest or severe cardiovascular compromise. Standard resuscitation including airway support and adrenaline should continue alongside it.

Question 10Anaesthesia

During one-lung ventilation, which strategy best reduces the risk of hypoxaemia?

  1. Increase the tidal volume of the ventilated lung to 12 mL/kg
  2. Ventilate both lungs with high inspired oxygen only
  3. Use zero end-expiratory pressure on the ventilated lung
  4. Apply positive end-expiratory pressure to the dependent lung and continuous positive airway pressure to the non-dependent lung Correct answer.

Explanation

Positive end-expiratory pressure to the dependent ventilated lung and continuous positive airway pressure to the non-dependent lung reduce shunt and improve oxygenation during one-lung ventilation. Tidal volumes should be limited to protect the ventilated lung.

Question 11Anaesthesia

Which statement about the pharmacology of suxamethonium is correct?

  1. It is hydrolysed by plasma cholinesterase Correct answer.
  2. It is a non-depolarising neuromuscular blocker
  3. It has a duration of action of about 30 minutes
  4. It is reversed by neostigmine

Explanation

Suxamethonium is a depolarising neuromuscular blocker metabolised rapidly by plasma butyrylcholinesterase, giving a short duration of about five to ten minutes. Prolonged block occurs in patients with enzyme deficiency.

Question 12Anaesthesia

A patient with chronic kidney disease is being assessed for anaesthesia. Which neuromuscular blocker has the most prolonged duration in this setting?

  1. Atracurium
  2. Rocuronium
  3. Cisatracurium
  4. Pancuronium Correct answer.

Explanation

Pancuronium is predominantly cleared renally and its active metabolites accumulate in renal failure, greatly prolonging blockade. Cisatracurium and atracurium undergo organ-independent Hofmann degradation.

Question 13Anaesthesia

Which is the most reliable early sign of malignant hyperthermia during general anaesthesia?

  1. Unexpected rise in end-tidal carbon dioxide with masseter spasm Correct answer.
  2. Hypothermia with shivering
  3. Bradycardia with hypotension
  4. Decreased end-tidal carbon dioxide

Explanation

Malignant hyperthermia typically presents with an unexplained rise in end-tidal carbon dioxide and masseter muscle rigidity, reflecting hypermetabolism. Hyperthermia is often a late sign, and tachycardia with acidosis commonly accompanies it.

Question 14Anaesthesia

Which local anaesthetic property determines the onset of a peripheral nerve block?

  1. The lipid solubility
  2. The plasma protein binding
  3. The pKa relative to tissue pH Correct answer.
  4. The rate of hepatic metabolism

Explanation

The pKa determines the proportion of drug in the uncharged base form that can cross the nerve membrane, so agents with pKa closer to physiological pH have faster onset. Lipid solubility mainly determines potency.

Question 15Anaesthesia

A patient with a suspected pneumothorax develops progressive hypotension and tracheal deviation after central line insertion. What is the most appropriate immediate management?

  1. Increase positive end-expiratory pressure
  2. Urgent chest radiograph before any intervention
  3. Needle decompression followed by intercostal catheter insertion Correct answer.
  4. Administer intravenous fluids and observe

Explanation

Tension pneumothorax is a clinical diagnosis requiring immediate needle decompression followed by definitive tube thoracostomy. Delay for imaging or fluid resuscitation risks cardiovascular collapse.

Question 16Anaesthesia

Which is the most appropriate reversal agent for a patient with residual non-depolarising neuromuscular blockade and a train-of-four ratio of 0.7?

  1. Suxamethonium
  2. Flumazenil
  3. Sugammadex for rocuronium, or neostigmine if deep block is excluded Correct answer.
  4. Neostigmine for any depth of block

Explanation

Sugammadex rapidly reverses rocuronium and vecuronium even at deep block, while neostigmine can reverse moderate block but has a ceiling effect and is unreliable at deep block. Reversal should be guided by quantitative monitoring.

Question 17Anaesthesia

Which physiological change occurs in pregnancy that most increases the risk of rapid desaturation during apnoea?

  1. Increased functional residual capacity
  2. Increased residual volume
  3. Decreased oxygen consumption
  4. Reduced functional residual capacity with increased oxygen consumption Correct answer.

Explanation

Pregnancy reduces functional residual capacity through diaphragmatic elevation while oxygen consumption rises by about 20%. This combination accelerates desaturation during apnoea and shortens safe apnoea time.

Question 18Anaesthesia

Which agent is most appropriate for procedural sedation in a patient with a history of emergence delirium and a need for preserved respiratory drive?

  1. Thiopentone
  2. Propofol
  3. Dexmedetomidine Correct answer.
  4. Etomidate

Explanation

Dexmedetomidine is an alpha-2 agonist that provides sedation and analgesia while preserving respiratory drive. It is useful when respiratory depression is a concern, though it can cause bradycardia and hypotension.

Question 19Anaesthesia

Which statement about the anaesthetic implications of a patient with myasthenia gravis is correct?

  1. They require higher doses of neostigmine for reversal
  2. They show increased sensitivity to non-depolarising neuromuscular blockers Correct answer.
  3. They are resistant to non-depolarising neuromuscular blockers
  4. Suxamethonium has no effect in these patients

Explanation

Myasthenia gravis involves reduced acetylcholine receptors at the neuromuscular junction, so patients are sensitive to non-depolarising blockers and require reduced doses. Neuromuscular monitoring is essential to avoid residual weakness.

Question 20Anaesthesia

Which statement about the effect of volatile anaesthetics on the hypoxic pulmonary vasoconstriction response is correct?

  1. They have no effect on hypoxic pulmonary vasoconstriction
  2. They only affect it at concentrations above 3 MAC
  3. They inhibit hypoxic pulmonary vasoconstriction in a dose-dependent manner Correct answer.
  4. They potentiate hypoxic pulmonary vasoconstriction

Explanation

Volatile anaesthetics inhibit hypoxic pulmonary vasoconstriction in a dose-dependent way, which can worsen shunt and hypoxaemia. This effect is relevant during one-lung ventilation and in patients with lung disease.

Question 21Anaesthesia

Which monitoring modality most reliably detects intraoperative awareness during total intravenous anaesthesia?

  1. Pulse oximetry
  2. Capnography
  3. Processed electroencephalogram monitoring Correct answer.
  4. Central venous pressure monitoring

Explanation

Processed electroencephalogram monitoring such as bispectral index provides an estimate of depth of hypnosis and can reduce awareness during total intravenous anaesthesia. Clinical signs alone are unreliable.

Question 22Anaesthesia

Which factor most increases the risk of aspiration pneumonitis during induction of anaesthesia?

  1. Age over 80 years
  2. Mallampati class I
  3. Gastro-oesophageal reflux with a full stomach Correct answer.
  4. Use of a supraglottic airway

Explanation

A full stomach combined with gastro-oesophageal reflux increases the risk of regurgitation and aspiration during induction. Rapid sequence induction with cricoid pressure is often considered in these patients.

Question 23Anaesthesia

Which of the following best describes the mechanism of action of ketamine?

  1. Alpha-2 agonism
  2. NMDA receptor antagonism Correct answer.
  3. GABA-A potentiation
  4. Sodium channel blockade

Explanation

Ketamine is a non-competitive antagonist at the NMDA receptor, producing dissociative anaesthesia and analgesia. This mechanism underlies its preserved respiratory drive and its psychotomimetic side effects.

Question 24Anaesthesia

A patient with a history of anaphylaxis to rocuronium requires general anaesthesia. Which approach is most appropriate?

  1. Administer rocuronium at a reduced dose
  2. Avoid neuromuscular blockers and use an alternative technique Correct answer.
  3. Use sugammadex prophylactically
  4. Premedicate with antihistamines and give rocuronium

Explanation

Anaphylaxis to a neuromuscular blocker is a contraindication to re-exposure, so an alternative technique avoiding the culprit agent is required. Cross-reactivity between neuromuscular blockers can occur and should be assessed.

Question 25Anaesthesia

Which statement about the use of nitrous oxide is correct?

  1. It increases the risk of diffusion hypoxia on emergence
  2. It is contraindicated in patients with a pneumothorax Correct answer.
  3. It has no analgesic effect
  4. It is the most potent volatile agent available

Explanation

Nitrous oxide diffuses into gas-filled spaces faster than nitrogen leaves, expanding a pneumothorax and worsening respiratory compromise. It should be avoided in patients with pneumothorax, bowel obstruction or middle ear disease.

Question 26Anaesthesia

Which intravenous induction agent is most appropriate for a haemodynamically unstable patient with a fixed cardiac output who requires general anaesthesia?

  1. Thiopentone
  2. Propofol
  3. Midazolam
  4. Etomidate Correct answer.

Explanation

Etomidate maintains sympathetic outflow and causes minimal depression of myocardial contractility and vascular tone, so it is the induction agent of choice when cardiovascular stability is critical. Propofol and thiopentone both cause significant vasodilatation and negative inotropy, which can precipitate collapse in a fixed-output state.

Question 27Anaesthesia

A patient with a documented egg allergy and previous anaphylaxis during anaesthesia requires a muscle relaxant. Which agent should be avoided because of its recognised association with anaphylaxis?

  1. Rocuronium Correct answer.
  2. Suxamethonium
  3. Cisatracurium
  4. Vecuronium

Explanation

Rocuronium and suxamethonium are the neuromuscular blocking drugs most frequently implicated in perioperative anaphylaxis, with rocuronium particularly associated with IgE-mediated reactions. When a relaxant is essential, an agent with a lower reaction rate such as cisatracurium is usually selected.

Question 28Anaesthesia

Which statement about the pharmacokinetics of neostigmine when used for reversal of neuromuscular blockade is most accurate?

  1. It is eliminated unchanged by the kidney and accumulates in renal failure Correct answer.
  2. It has a short duration and may require repeat dosing for profound blockade
  3. It is metabolised primarily by plasma cholinesterase
  4. It crosses the blood-brain barrier readily and causes central excitation

Explanation

Neostigmine is cleared largely unchanged by renal excretion, so its effect is prolonged in renal impairment and repeat dosing can produce cholinergic toxicity. Its duration is usually long enough to outlast residual blockade, so the main concern is accumulation rather than underdosing.

Question 29Anaesthesia

Which preoperative finding most strongly suggests that a patient has an increased risk of aspiration during induction of anaesthesia?

  1. A history of asthma with good control
  2. A recent upper respiratory tract infection
  3. A history of gastro-oesophageal reflux requiring daily proton pump inhibitor therapy Correct answer.
  4. A body mass index of 31 kg/m2

Explanation

Symptomatic gastro-oesophageal reflux is a recognised risk factor for aspiration because of impaired lower oesophageal sphincter function and increased gastric volume. Obesity and recent respiratory infection increase the risk of desaturation and airway complications but are weaker predictors of aspiration than reflux disease.

Question 30Anaesthesia

A patient with severe aortic stenosis is undergoing general anaesthesia. Which haemodynamic goal is most important to maintain?

  1. Systemic vasodilatation to reduce afterload
  2. A rapid heart rate to reduce filling time
  3. A slow heart rate with adequate preload and afterload Correct answer.
  4. Aggressive fluid restriction to avoid pulmonary oedema

Explanation

In severe aortic stenosis, cardiac output is fixed by the stenotic valve, so maintaining preload, afterload and a slow heart rate preserves coronary perfusion and stroke volume. Tachycardia shortens diastolic filling and reduces coronary perfusion, while vasodilatation can cause profound hypotension.

Question 31Anaesthesia

Which statement about the use of a supraglottic airway device during positive pressure ventilation is most accurate?

  1. It is contraindicated in all patients with a body mass index over 30 kg/m2
  2. It should be avoided in patients with a high risk of aspiration Correct answer.
  3. It eliminates the risk of aspiration of gastric contents
  4. It provides a reliable seal at pressures up to 40 cmH2O

Explanation

Supraglottic airway devices do not reliably protect the airway from regurgitated gastric contents, so they are generally avoided when aspiration risk is high. They provide a lower seal pressure than a tracheal tube and do not eliminate aspiration risk even when correctly positioned.

Question 32Anaesthesia

A patient receiving a peripheral nerve block develops a seizure after inadvertent intravascular injection of local anaesthetic. Which is the most appropriate immediate management step after securing the airway and giving oxygen?

  1. Give intravenous calcium chloride
  2. Administer intravenous flumazenil
  3. Give intravenous adrenaline as a bolus
  4. Administer intravenous lipid emulsion Correct answer.

Explanation

Intravenous lipid emulsion is the specific treatment for systemic local anaesthetic toxicity and should be given early once seizures or cardiovascular collapse occur. Airway support, oxygenation and benzodiazepines for seizures are also part of management, but lipid emulsion addresses the underlying toxicity.

Question 33Anaesthesia

Which physiological change in a patient with a large pneumothorax most directly explains the development of hypotension?

  1. Reduced venous return due to increased intrathoracic pressure Correct answer.
  2. Reflex bradycardia from vagal stimulation
  3. Increased left ventricular afterload
  4. Increased right ventricular preload

Explanation

A large pneumothorax raises intrathoracic pressure, which impedes venous return to the right heart and reduces cardiac output, causing hypotension. This is the mechanism underlying tension pneumothorax and explains why decompression restores haemodynamics.

Question 34Anaesthesia

Which statement about the effect of positive end-expiratory pressure on cardiac output is most accurate?

  1. It increases cardiac output by increasing left ventricular afterload
  2. It always increases cardiac output by recruiting alveoli
  3. It can reduce cardiac output by decreasing venous return Correct answer.
  4. It has no effect on ventricular filling

Explanation

Positive end-expiratory pressure raises intrathoracic pressure, which reduces venous return and right ventricular filling, and can therefore lower cardiac output. The net effect depends on the patient's volume status and ventricular function, so it is not uniformly beneficial.

Question 35Anaesthesia

Which agent is most appropriate for rapid sequence induction in a patient with hyperkalaemia who requires emergency surgery?

  1. Suxamethonium
  2. Rocuronium Correct answer.
  3. Atracurium
  4. Vecuronium

Explanation

Suxamethonium causes potassium efflux from depolarised muscle and can precipitate dangerous hyperkalaemia, so a non-depolarising agent such as rocuronium is preferred when rapid intubation is needed. Rocuronium at an appropriate dose provides rapid onset without the potassium rise.

Question 36Anaesthesia

Which statement about the pharmacology of morphine is most accurate?

  1. It is eliminated primarily by hepatic metabolism to inactive compounds
  2. It causes histamine release that can produce hypotension Correct answer.
  3. It has no active metabolites
  4. It is a more potent respiratory depressant than fentanyl

Explanation

Morphine can cause histamine release from mast cells, leading to vasodilatation and hypotension, particularly with rapid administration. Its metabolites, including morphine-6-glucuronide, are active and accumulate in renal failure.

Question 37Anaesthesia

A patient with a history of chronic opioid use requires postoperative analgesia. Which strategy is most appropriate?

  1. Give a fixed low dose of opioid regardless of pain score
  2. Withhold all opioids to prevent dependence
  3. Use multimodal analgesia with opioid doses titrated to effect Correct answer.
  4. Use only non-steroidal anti-inflammatory drugs

Explanation

Opioid-tolerant patients require multimodal analgesia with careful titration to effect, as they may need higher doses than opioid-naive patients and are at risk of withdrawal if opioids are withheld. Fixed low doses may provide inadequate analgesia, and NSAIDs alone are usually insufficient.

Question 38Anaesthesia

Which statement about the mechanism of action of volatile anaesthetics is most accurate?

  1. They act solely through opioid receptor agonism
  2. They act primarily by blocking voltage-gated sodium channels
  3. They produce anaesthesia by inhibiting acetylcholinesterase
  4. They enhance inhibitory GABA-A receptor activity and inhibit excitatory transmission Correct answer.

Explanation

Volatile anaesthetics potentiate inhibitory neurotransmission through GABA-A receptors and other channels while suppressing excitatory pathways, producing amnesia, hypnosis and immobility. Their effects are not mediated by a single receptor but by multiple synaptic targets.

Question 39Anaesthesia

A patient is undergoing surgery with a volatile anaesthetic at 1.2 MAC. Which factor would most increase the minimum alveolar concentration required?

  1. Chronic alcohol use Correct answer.
  2. Increasing age
  3. Acute alcohol intoxication
  4. Concurrent opioid administration

Explanation

Chronic alcohol use increases MAC through central nervous system tolerance, meaning higher concentrations are needed to produce immobility. Opioids, acute intoxication and increasing age all reduce MAC.

Question 40Anaesthesia

Which monitoring finding is most consistent with anaphylaxis under anaesthesia?

  1. Progressive hypothermia
  2. Bradycardia with hypertension
  3. Unexplained hypotension with tachycardia and increased airway resistance Correct answer.
  4. Isolated rise in end-tidal carbon dioxide

Explanation

Anaphylaxis under anaesthesia commonly presents with unexplained hypotension, tachycardia, bronchospasm and a rise in airway pressures. Cutaneous signs may be absent because of draping and vasodilatation, so a high index of suspicion is needed.

Question 41Anaesthesia

Which statement about the use of tranexamic acid in perioperative bleeding is most accurate?

  1. It directly activates factor X
  2. It activates plasminogen to promote clot breakdown
  3. It should be given only after massive transfusion is complete
  4. It inhibits fibrinolysis by blocking lysine binding sites on plasminogen Correct answer.

Explanation

Tranexamic acid is an antifibrinolytic that binds lysine sites on plasminogen, preventing plasmin-mediated clot breakdown. Early administration improves outcomes in major haemorrhage and it does not act by activating coagulation factors.

Question 42Anaesthesia

A patient with a spinal cord injury at T4 sustained two weeks ago is undergoing surgery. Which haemodynamic problem is most likely during induction?

  1. Increased cardiac output from sympathetic overactivity
  2. Severe hypertension from autonomic dysreflexia
  3. Bradycardia and hypotension from loss of sympathetic tone Correct answer.
  4. Hypertension from unopposed alpha-adrenergic stimulation

Explanation

After acute spinal cord injury above T6, loss of supraspinal sympathetic control causes bradycardia and hypotension, which can be profound during induction. Autonomic dysreflexia typically occurs later and presents with hypertension rather than hypotension.

Question 43Anaesthesia

Which statement about the anaesthetic implications of a patient with a permanent pacemaker is most accurate?

  1. The pacemaker should be converted to an asynchronous mode for surgery using diathermy above the umbilicus Correct answer.
  2. Monopolar diathermy is always safe if the return electrode is placed on the thigh
  3. Bipolar diathermy is contraindicated in all pacemaker patients
  4. Magnet application always restores normal sensing

Explanation

For surgery requiring diathermy near the pacemaker, reprogramming to an asynchronous mode prevents inappropriate inhibition from electromagnetic interference. Monopolar diathermy can interfere with pacing, and magnet application produces asynchronous pacing only in some devices.

Question 44Anaesthesia

Which statement about oxygen delivery and consumption in sepsis is most accurate?

  1. Mixed venous oxygen saturation is typically elevated because of impaired oxygen extraction Correct answer.
  2. Arterial oxygen content is the main determinant of oxygen delivery
  3. Lactate clearance is unrelated to outcome
  4. Mixed venous oxygen saturation is usually low because of increased extraction

Explanation

In septic shock, microcirculatory shunting and impaired cellular oxygen utilisation can produce an elevated mixed venous oxygen saturation despite inadequate tissue oxygenation. This reflects extraction failure rather than adequate delivery.

Question 45Anaesthesia

Which agent is most appropriate for treating bronchospasm during general anaesthesia in a patient with severe asthma?

  1. Inhaled nitric oxide
  2. Intravenous metoprolol
  3. Intravenous neostigmine
  4. Inhaled salbutamol via the breathing circuit Correct answer.

Explanation

Inhaled beta-2 agonists delivered through the breathing circuit are first-line for intraoperative bronchospasm, often supplemented with intravenous or inhaled adrenaline in severe cases. Beta-blockers would worsen bronchospasm, and neostigmine can increase airway secretions and bronchoconstriction.

Question 46Anaesthesia

A patient with severe pre-eclampsia requires caesarean delivery. Which statement about anaesthetic management is most accurate?

  1. A carefully titrated spinal or combined spinal-epidural is often appropriate with vasopressor support Correct answer.
  2. General anaesthesia is preferred because it avoids hypotension
  3. Spinal anaesthesia is contraindicated because of the risk of hypotension
  4. Epidural anaesthesia is contraindicated in all cases

Explanation

Neuraxial anaesthesia is often preferred in pre-eclampsia because it avoids the hypertensive response to laryngoscopy, provided hypotension is managed with careful titration and vasopressors. General anaesthesia is reserved for specific indications because of airway and hypertensive risks.

Question 47Anaesthesia

Which statement about the effect of hyperventilation on cerebral blood flow is most accurate?

  1. It increases cerebral blood flow by raising carbon dioxide
  2. It reduces cerebral blood flow by lowering arterial carbon dioxide Correct answer.
  3. It has no effect on cerebral blood flow
  4. It increases cerebral blood flow by increasing arterial pH

Explanation

Cerebral blood flow is strongly dependent on arterial carbon dioxide, and hyperventilation lowers PaCO2, causing cerebral vasoconstriction and reduced blood flow. This effect is used briefly to reduce intracranial pressure but can cause ischaemia if prolonged.

Question 48Anaesthesia

A patient is recovering from general anaesthesia and has a train-of-four count of two with no fade. Which statement is most accurate?

  1. This indicates adequate recovery of neuromuscular function
  2. This indicates an overdosage of reversal agent
  3. This pattern is normal and requires no action
  4. This indicates significant residual blockade requiring reversal or continued ventilation Correct answer.

Explanation

A train-of-four count of two indicates substantial residual non-depolarising blockade, and the patient requires reversal with an appropriate agent or continued ventilation until recovery. Adequate recovery is usually defined by a train-of-four ratio above 0.9.

Question 49Anaesthesia

Which statement about the pharmacology of dexmedetomidine is most accurate?

  1. It is a benzodiazepine receptor agonist
  2. It is a competitive opioid antagonist
  3. It is a selective alpha-2 adrenergic agonist producing sedation with minimal respiratory depression Correct answer.
  4. It increases sympathetic outflow and heart rate

Explanation

Dexmedetomidine is a highly selective alpha-2 agonist that provides sedation and analgesia with relatively little respiratory depression. Its common adverse effects include bradycardia and hypotension from reduced sympathetic outflow.

Question 50Anaesthesia

A patient with a known difficult airway is being prepared for surgery. Which statement about awake fibreoptic intubation is most accurate?

  1. It is contraindicated in all patients with a history of failed intubation
  2. It requires deep general anaesthesia before insertion of the scope
  3. It eliminates the need for supplemental oxygen
  4. It preserves spontaneous ventilation and airway tone during intubation Correct answer.

Explanation

Awake fibreoptic intubation allows the airway to be secured while the patient maintains spontaneous ventilation and protective reflexes, which is valuable when mask ventilation and laryngoscopy are predicted to be difficult. Adequate topical anaesthesia and sedation are used, but general anaesthesia is not required before scope insertion.