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EDAIC Part I study materials
EDAIC Part I study resources

EDAIC Part I practice questions

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Question 1Anaesthesiology and intensive care (official content domains not enumerated in source)

A 70 kg adult is to receive a rapid-sequence induction with etomidate. Which dose range reflects standard practice for induction of anaesthesia in an unstressed adult?

  1. 3 mg/kg
  2. 30 mg/kg
  3. 0.3 mg/kg Correct answer.
  4. 0.03 mg/kg

Explanation

Etomidate is normally given at approximately 0.2 to 0.4 mg/kg intravenously for induction, so 0.3 mg/kg is the appropriate choice for a 70 kg adult. The very low figure corresponds to the much smaller doses used for adrenal suppression testing, while the higher figures would be far in excess of clinical induction doses.

Question 2Anaesthesiology and intensive care (official content domains not enumerated in source)

During a general anaesthetic a patient's end-tidal CO2 suddenly falls from 5.0 kPa to 1.8 kPa with a simultaneous fall in blood pressure and a rise in heart rate. Which is the most likely cause?

  1. Endobronchial intubation
  2. Pulmonary embolism Correct answer.
  3. Malignant hyperthermia
  4. Circuit disconnection

Explanation

A sudden fall in end-tidal CO2 combined with hypotension and tachycardia suggests a major reduction in pulmonary blood flow, classically a pulmonary embolism. Endobronchial intubation and malignant hyperthermia raise CO2, and a disconnection would usually be accompanied by loss of the capnography waveform rather than a small preserved trace.

Question 3Anaesthesiology and intensive care (official content domains not enumerated in source)

Which local anaesthetic has the longest duration of action when used for peripheral nerve blockade at equipotent doses?

  1. Mepivacaine
  2. Bupivacaine Correct answer.
  3. Lidocaine
  4. Chloroprocaine

Explanation

Bupivacaine is highly protein bound and has the longest duration among the amide local anaesthetics, commonly providing many hours of block. Lidocaine and mepivacaine are intermediate in duration, and chloroprocaine is rapidly hydrolysed by plasma esterases, giving a very short block.

Question 4Anaesthesiology and intensive care (official content domains not enumerated in source)

A patient receiving a high-dose infusion of bupivacaine develops perioral tingling, tinnitus and a metallic taste. Which is the most appropriate immediate management step?

  1. Give intravenous flumazenil
  2. Give intravenous adrenaline 1 mg immediately
  3. Stop the infusion and secure the airway with 100% oxygen Correct answer.
  4. Give a bolus of intravenous calcium chloride

Explanation

These symptoms indicate local anaesthetic systemic toxicity, and the first priorities are to stop further absorption, secure the airway and ventilate with 100% oxygen while monitoring for cardiovascular collapse. Intravenous lipid emulsion is the specific antidote and should be given early in significant toxicity, whereas adrenaline boluses and calcium are not first-line.

Question 5Anaesthesiology and intensive care (official content domains not enumerated in source)

Which neuromuscular blocking agent is metabolised by plasma cholinesterase and therefore has a prolonged effect in patients with pseudocholinesterase deficiency?

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

Explanation

Suxamethonium is a depolarising blocker hydrolysed by plasma cholinesterase, so genetically reduced enzyme activity produces prolonged paralysis. Rocuronium and vecuronium are aminosteroid non-depolarisers cleared hepatically or renally, and atracurium undergoes Hofmann degradation and ester hydrolysis independent of plasma cholinesterase.

Question 6Anaesthesiology and intensive care (official content domains not enumerated in source)

A patient with myasthenia gravis is being assessed before surgery. Which statement best describes the expected response to non-depolarising neuromuscular blockers?

  1. Normal sensitivity compared with other patients
  2. Complete immunity to their effects
  3. Increased sensitivity with prolonged blockade Correct answer.
  4. Marked resistance requiring much larger doses

Explanation

Myasthenia gravis involves loss of functional acetylcholine receptors at the motor endplate, so patients are typically very sensitive to non-depolarising blockers and may show prolonged paralysis. Doses should be reduced and titrated with neuromuscular monitoring, and reversal should be confirmed before extubation.

Question 7Anaesthesiology and intensive care (official content domains not enumerated in source)

Which inhalational agent is the most potent trigger of malignant hyperthermia?

  1. Desflurane
  2. Sevoflurane
  3. Halothane Correct answer.
  4. Nitrous oxide

Explanation

All volatile anaesthetics can trigger malignant hyperthermia, but halothane is the most potent trigger among those listed. Nitrous oxide is not a triggering agent, and sevoflurane and desflurane are weaker triggers than halothane.

Question 8Anaesthesiology and intensive care (official content domains not enumerated in source)

During a suspected malignant hyperthermia crisis, which drug is the specific treatment and at what initial dose is it given?

  1. Dantrolene 25 mg/kg intravenously
  2. Procainamide 2 mg/kg intravenously
  3. Sodium bicarbonate 1 mmol/kg intravenously
  4. Dantrolene 2.5 mg/kg intravenously Correct answer.

Explanation

Dantrolene is the specific antidote and is given as an initial intravenous bolus of about 2.5 mg/kg, repeated until the crisis is controlled. Procainamide and bicarbonate address arrhythmias and acidosis but do not treat the underlying disorder.

Question 9Anaesthesiology and intensive care (official content domains not enumerated in source)

Which finding on spirometry is characteristic of severe asthma in a patient presenting for elective surgery?

  1. Normal FEV1 with markedly increased diffusion capacity
  2. Reduced FEV1 with reduced FEV1/FVC ratio that improves after bronchodilator Correct answer.
  3. Increased FEV1/FVC ratio with reduced total lung capacity
  4. Restrictive pattern with normal FEV1/FVC ratio

Explanation

Asthma produces an obstructive pattern with a reduced FEV1 and reduced FEV1/FVC ratio, and reversibility after a bronchodilator supports the diagnosis. Restrictive disease preserves or raises the ratio, and an increased ratio with reduced lung volumes suggests restriction rather than obstruction.

Question 10Anaesthesiology and intensive care (official content domains not enumerated in source)

Which preoperative finding is most strongly associated with an increased risk of postoperative pulmonary complications after major abdominal surgery?

  1. Mildly elevated liver enzymes
  2. Body mass index of 26 kg/m2
  3. Current smoking with a productive cough Correct answer.
  4. Well-controlled hypothyroidism

Explanation

Current smoking, particularly with chronic sputum production, is a well-established risk factor for postoperative pulmonary complications and should prompt cessation advice and physiotherapy planning. Mild obesity, isolated liver enzyme elevation and treated hypothyroidism carry much weaker associations.

Question 11Anaesthesiology and intensive care (official content domains not enumerated in source)

Which is the most appropriate first-line vasopressor for a septic patient in the intensive care unit who remains hypotensive despite adequate fluid resuscitation?

  1. Vasopressin as a single agent
  2. Noradrenaline Correct answer.
  3. Dobutamine
  4. Adrenaline

Explanation

Noradrenaline is recommended as the first-line vasopressor in septic shock because it raises mean arterial pressure with relatively little tachyarrhythmia. Dobutamine is an inotrope, adrenaline is usually reserved for refractory shock, and vasopressin is added as a second agent rather than used alone initially.

Question 12Anaesthesiology and intensive care (official content domains not enumerated in source)

A patient in the intensive care unit has a serum potassium of 6.9 mmol/L with peaked T waves on the ECG. Which intervention most rapidly protects the myocardium from arrhythmia?

  1. Intravenous furosemide
  2. Intravenous insulin with glucose
  3. Intravenous calcium gluconate Correct answer.
  4. Oral sodium polystyrene sulfonate

Explanation

Intravenous calcium stabilises the myocardial membrane within minutes and is the immediate priority when hyperkalaemia produces ECG changes. Insulin with glucose and furosemide shift or remove potassium but act more slowly, and a potassium binder has a delayed onset unsuitable for an emergency.

Question 13Anaesthesiology and intensive care (official content domains not enumerated in source)

Which statement about the pharmacology of sugammadex is correct?

  1. It reverses vecuronium more effectively than rocuronium
  2. It acts as an acetylcholinesterase inhibitor at the neuromuscular junction
  3. It encapsulates rocuronium and can reverse profound blockade Correct answer.
  4. It is ineffective when given at the end of surgery

Explanation

Sugammadex is a modified gamma-cyclodextrin that encapsulates rocuronium (and to a lesser extent vecuronium), removing it from the neuromuscular junction and allowing reversal even of deep blockade. It does not act through cholinesterase inhibition and is specifically licensed for aminosteroid blockers.

Question 14Anaesthesiology and intensive care (official content domains not enumerated in source)

Which technique is most appropriate for confirming correct placement of a nasogastric tube in an intubated intensive care patient?

  1. Aspiration of gastric contents with pH testing
  2. Chest radiograph showing the tube below the diaphragm Correct answer.
  3. Auscultation of an injected air bolus over the epigastrium
  4. Measurement of tube length at the nostril

Explanation

A chest radiograph demonstrating the tube passing below the diaphragm and curving into the stomach is the most reliable confirmation. Auscultation of injected air is unreliable, tube length marking is only a guide, and aspiration may fail or be misleading, especially with small-bore tubes.

Question 15Anaesthesiology and intensive care (official content domains not enumerated in source)

Which describes the correct use of the Mallampati classification during airway assessment?

  1. It measures the thyromental distance in centimetres
  2. It grades the pharyngeal structures visible with the patient seated, mouth open and tongue protruded Correct answer.
  3. It is scored with the patient supine and the tongue protruded
  4. It records the degree of mouth opening in finger breadths

Explanation

The Mallampati score is assessed with the patient seated, the mouth fully open and the tongue protruded without phonation, grading visible pharyngeal structures from I to IV. It is not a measurement of distance or mouth opening, and the supine position is not used for the standard assessment.

Question 16Anaesthesiology and intensive care (official content domains not enumerated in source)

In a patient with a predicted difficult airway, which preoxygenation strategy best prolongs the safe apnoea time before desaturation?

  1. Three minutes of tidal volume breathing with 100% oxygen via a tight-fitting mask Correct answer.
  2. Nasal cannula at 2 L/min for 2 minutes
  3. Breathing room air while the equipment is prepared
  4. Four vital capacity breaths of 100% oxygen over 30 seconds

Explanation

Three minutes of tidal-volume breathing with 100% oxygen through a well-sealed mask replaces alveolar nitrogen and maximises the functional residual capacity oxygen store, extending the apnoea time. Low-flow nasal oxygen and brief vital-capacity breaths provide less reliable denitrogenation, and room air provides none.

Question 17Anaesthesiology and intensive care (official content domains not enumerated in source)

Which agent is most appropriate for induction of anaesthesia in a haemodynamically unstable trauma patient with suspected hypovolaemia?

  1. Ketamine 1 to 2 mg/kg Correct answer.
  2. Propofol 2.5 mg/kg
  3. Sevoflurane at 8% for 5 minutes
  4. Thiopentone 5 mg/kg

Explanation

Ketamine preserves sympathetic tone and blood pressure, making it preferable in hypovolaemic shock, although reduced doses are still advised. Propofol, thiopentone and high concentrations of volatile agents all cause significant vasodilation and myocardial depression that can precipitate collapse.

Question 18Anaesthesiology and intensive care (official content domains not enumerated in source)

Which statement about the physiological changes of pregnancy relevant to anaesthesia is correct?

  1. Functional residual capacity increases by about 20%
  2. Gastric emptying is reliably delayed throughout pregnancy
  3. Maternal arterial PaCO2 is normally lower than in non-pregnant women Correct answer.
  4. Minimum alveolar concentration is unchanged

Explanation

Progesterone-driven hyperventilation lowers maternal PaCO2 to around 4.0 kPa with a compensatory fall in bicarbonate. Functional residual capacity falls by roughly 20%, gastric emptying is not consistently delayed, and MAC is reduced by approximately 30% in pregnancy.

Question 19Anaesthesiology and intensive care (official content domains not enumerated in source)

A patient with severe pre-eclampsia requires anaesthesia for caesarean section. Which statement about spinal anaesthesia is most accurate?

  1. A reduced dose combined with vasopressor support is commonly used Correct answer.
  2. It reliably produces hypertension and must be avoided
  3. It is absolutely contraindicated in pre-eclampsia
  4. It requires a higher than usual intrathecal dose

Explanation

Spinal anaesthesia is widely used in pre-eclampsia, often with a reduced local anaesthetic dose and proactive vasopressor support to limit hypotension. It is not contraindicated, does not cause hypertension, and does not require an increased dose.

Question 20Anaesthesiology and intensive care (official content domains not enumerated in source)

Which parameter is the most sensitive early indicator of inadequate tissue perfusion in a patient with septic shock?

  1. Central venous pressure
  2. Haemoglobin concentration
  3. Arterial lactate concentration Correct answer.
  4. Body temperature

Explanation

Rising or persistently elevated lactate reflects anaerobic metabolism and impaired tissue perfusion and is used to guide resuscitation. Central venous pressure correlates poorly with volume status, and haemoglobin and temperature are not markers of perfusion adequacy.

Question 21Anaesthesiology and intensive care (official content domains not enumerated in source)

Which is the most appropriate initial treatment for severe anaphylaxis during anaesthesia?

  1. Intramuscular adrenaline 0.5 mg into the deltoid Correct answer.
  2. Nebulised salbutamol
  3. Intravenous hydrocortisone 200 mg
  4. Intravenous chlorphenamine 10 mg

Explanation

Intramuscular adrenaline is the first-line treatment for anaphylaxis, given as 0.5 mg of the 1:1000 solution into the anterolateral thigh or deltoid, repeated as needed. Antihistamines, bronchodilators and steroids are adjuncts and do not reverse the acute reaction.

Question 22Anaesthesiology and intensive care (official content domains not enumerated in source)

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

  1. It always increases cardiac output by reducing afterload
  2. It abolishes the need for fluid resuscitation
  3. It has no effect on intrathoracic pressure
  4. It may reduce venous return and cardiac output at high levels Correct answer.

Explanation

Positive end-expiratory pressure raises intrathoracic pressure, which can impede venous return and reduce cardiac output, particularly in hypovolaemic patients. It does not always improve output and does not eliminate the need for volume assessment.

Question 23Anaesthesiology and intensive care (official content domains not enumerated in source)

Which is the most appropriate management of a patient with a suspected tension pneumothorax who becomes profoundly hypotensive during positive pressure ventilation?

  1. Urgent CT scan to confirm the diagnosis
  2. Increasing the peak inspiratory pressure
  3. Awaiting a portable chest radiograph before acting
  4. Immediate needle decompression followed by chest drain insertion Correct answer.

Explanation

Tension pneumothorax is a clinical diagnosis requiring immediate needle decompression followed by definitive chest drain insertion. Imaging delays treatment and may precipitate cardiac arrest, and increasing airway pressure would worsen the intrathoracic tension.

Question 24Anaesthesiology and intensive care (official content domains not enumerated in source)

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

  1. Non-invasive blood pressure
  2. Capnography
  3. Processed EEG depth-of-anaesthesia monitoring Correct answer.
  4. Pulse oximetry

Explanation

Processed EEG monitors such as the bispectral index estimate depth of hypnosis and can help detect light anaesthesia when clinical signs are masked by paralysis. Capnography, oximetry and blood pressure reflect ventilation and haemodynamics but not depth of consciousness.

Question 25Anaesthesiology and intensive care (official content domains not enumerated in source)

A patient on long-term amiodarone requires emergency anaesthesia. Which perioperative concern is most relevant?

  1. Risk of bradycardia and hypotension with anaesthetic agents Correct answer.
  2. Need to double the dose of neuromuscular blockers
  3. Increased risk of malignant hyperthermia
  4. Enhanced metabolism of volatile agents requiring higher concentrations

Explanation

Amiodarone slows cardiac conduction and can cause bradycardia, hypotension and QT prolongation, which may be exacerbated by anaesthetic drugs. It does not increase MAC requirements, does not trigger malignant hyperthermia, and does not require doubling neuromuscular blocker doses.

Question 26Anaesthesiology and intensive care (official content domains not enumerated in source)

A 68-year-old man with stable angina is scheduled for elective hemicolectomy. His regular medication includes bisoprolol, which he has taken for three years. How should this beta-blocker be managed in the perioperative period?

  1. Continue it throughout, including on the morning of surgery Correct answer.
  2. Stop it 48 hours before surgery to reduce the risk of bradycardia
  3. Stop it on the morning of surgery and restart once oral intake resumes
  4. Replace it with a short-acting agent such as esmolol infused from the night before

Explanation

Abrupt withdrawal of chronic beta-blockade unmasks up-regulated receptors and can precipitate tachycardia, hypertension, and perioperative myocardial ischaemia, so continuation is the safest strategy. The agent should be given on the morning of surgery, with an intravenous alternative if oral intake is interrupted. Routine initiation or substitution of beta-blockers purely for surgery is not indicated.

Question 27Anaesthesiology and intensive care (official content domains not enumerated in source)

A 42-year-old woman receives a spinal anaesthetic for caesarean delivery and becomes hypotensive with a sensory block to T4. Which physiological mechanism best explains the hypotension?

  1. Arteriolar and venous dilatation from sympathetic blockade Correct answer.
  2. Direct myocardial depression from the local anaesthetic
  3. Increased vagal tone from blockade of the stellate ganglion
  4. Blockade of cardiac accelerator fibres causing bradycardia

Explanation

Spinal anaesthesia blocks preganglionic sympathetic fibres, producing both arteriolar dilatation that lowers systemic vascular resistance and venous pooling that reduces preload and cardiac output. The result is the characteristic fall in blood pressure, usually treated with vasopressors and fluid. Cardiac accelerator fibres may be affected at high blocks, but this is not the primary mechanism of the hypotension seen at a T4 level.

Question 28Anaesthesiology and intensive care (official content domains not enumerated in source)

A 55-year-old man is being ventilated in the intensive care unit after laparotomy. Which ventilator variable is defined as the airway pressure measured at end-expiration during a brief end-inspiratory and end-expiratory occlusion?

  1. Auto-positive end-expiratory pressure Correct answer.
  2. Plateau airway pressure
  3. Peak airway pressure
  4. Mean airway pressure

Explanation

Auto-PEEP, or intrinsic PEEP, is the pressure trapped in the alveoli at end-expiration and is revealed by an end-expiratory occlusion manoeuvre in a passive patient. It reflects incomplete emptying, typically from airflow obstruction or a short expiratory time. Peak and plateau pressures are measured during inspiration and describe different mechanical properties.

Question 29Anaesthesiology and intensive care (official content domains not enumerated in source)

A 30-year-old man is scheduled for open reduction of a wrist fracture under general anaesthesia. He has no comorbidities and a body mass index of 24. Which preoxygenation endpoint is most appropriate before induction?

  1. Arterial oxygen saturation above 94%
  2. End-tidal oxygen fraction above 0.9 Correct answer.
  3. End-tidal carbon dioxide below 5.5 kPa
  4. Respiratory rate below 12 breaths per minute

Explanation

Denitrogenation is best confirmed by an end-tidal oxygen fraction approaching 0.9, which indicates that alveolar nitrogen has been largely replaced and prolongs the safe apnoea time. Pulse oximetry cannot exceed 100% and is a poor guide to the adequacy of preoxygenation. End-tidal carbon dioxide and respiratory rate do not measure oxygen reserve.

Question 30Anaesthesiology and intensive care (official content domains not enumerated in source)

A 70-year-old woman with chronic kidney disease is given a neuromuscular blocking drug and later requires reversal. Which statement about neostigmine is correct?

  1. Its effect is independent of the depth of neuromuscular block
  2. It is contraindicated in patients with renal impairment
  3. It must be given with an antimuscarinic to prevent bradycardia Correct answer.
  4. It directly binds and encapsulates aminosteroid molecules

Explanation

Neostigmine inhibits acetylcholinesterase, increasing acetylcholine at both nicotinic and muscarinic receptors; the muscarinic effects include bradycardia and increased secretions, so an antimuscarinic such as glycopyrronium is co-administered. Reversal is only reliable once there is some spontaneous recovery. Neostigmine does not bind the relaxant itself.

Question 31Anaesthesiology and intensive care (official content domains not enumerated in source)

A 24-year-old man is brought to the emergency department after a motorcycle crash. He is confused, with a blood pressure of 82/50 mmHg and a heart rate of 130 beats per minute. Which fluid strategy is most consistent with a damage-control resuscitation approach?

  1. Hypertonic saline to normalise the base deficit
  2. Balanced transfusion of packed cells, plasma, and platelets in a 1:1:1 ratio Correct answer.
  3. Rapid infusion of 3 litres of crystalloid before any blood products
  4. Colloid infusion until the systolic pressure exceeds 110 mmHg

Explanation

Damage-control resuscitation emphasises early balanced transfusion of red cells, plasma, and platelets, permissive hypotension until haemorrhage is controlled, and avoidance of large crystalloid volumes that worsen dilutional coagulopathy and oedema. The aim is to restore perfusion while minimising further bleeding. Large crystalloid boluses and colloids are not the preferred initial strategy in haemorrhagic shock.

Question 32Anaesthesiology and intensive care (official content domains not enumerated in source)

A 60-year-old man with severe aortic stenosis is undergoing general anaesthesia. Which haemodynamic change is least well tolerated in this condition?

  1. A small increase in preload
  2. A rise in systemic vascular resistance
  3. A fall in systemic vascular resistance Correct answer.
  4. A modest increase in heart rate with maintained preload

Explanation

In severe aortic stenosis the fixed obstruction limits stroke volume, so cardiac output depends heavily on preload, sinus rhythm, and adequate afterload. A fall in systemic vascular resistance causes a reflex tachycardia and reduced coronary perfusion pressure, precipitating ischaemia and hypotension. Vasodilatation is therefore the least well tolerated change.

Question 33Anaesthesiology and intensive care (official content domains not enumerated in source)

A 35-year-old woman is recovering from general anaesthesia and develops stridor, urticaria, and hypotension shortly after a dose of intravenous antibiotic. Which drug should be given first?

  1. Intramuscular adrenaline 0.5 mg Correct answer.
  2. Intravenous hydrocortisone 200 mg
  3. Nebulised salbutamol 5 mg
  4. Intravenous chlorphenamine 10 mg

Explanation

Adrenaline is the first-line treatment for anaphylaxis because alpha-agonism reverses vasodilatation and mucosal oedema while beta-agonism relieves bronchospasm. Intramuscular injection into the anterolateral thigh gives the most reliable absorption. Steroids, antihistamines, and bronchodilators are adjuncts that do not reverse the acute distributive shock.

Question 34Anaesthesiology and intensive care (official content domains not enumerated in source)

A patient in the intensive care unit has a rising plasma creatinine and a falling urine output. Which finding best supports a diagnosis of acute kidney injury due to acute tubular necrosis rather than a pre-renal cause?

  1. Urine osmolality of 700 mOsm/kg
  2. Urine sodium of 12 mmol/L and fractional excretion of sodium below 1%
  3. Urine sodium above 40 mmol/L with a fractional excretion of sodium above 2% Correct answer.
  4. A positive response to a 250 mL fluid challenge

Explanation

Intact tubular function in pre-renal states avidly reabsorbs sodium and water, producing low urine sodium and a fractional excretion below 1%. When tubular cells are injured in acute tubular necrosis, reabsorptive capacity is lost, so urine sodium and fractional excretion rise. Concentrated urine and a response to fluid also point towards a pre-renal cause.

Question 35Anaesthesiology and intensive care (official content domains not enumerated in source)

A 45-year-old woman with a body mass index of 42 is undergoing laparoscopic cholecystectomy. Which strategy best reduces the risk of postoperative pulmonary complications in this patient?

  1. Routine postoperative admission to the intensive care unit
  2. Prophylactic broad-spectrum antibiotics for 72 hours
  3. Intraoperative lung-protective ventilation with recruitment and early mobilisation Correct answer.
  4. Prolonged bed rest for the first 24 postoperative hours

Explanation

Obese patients are at risk of atelectasis from reduced functional residual capacity and abdominal insufflation. Protective ventilation with low tidal volumes, appropriate PEEP, recruitment manoeuvres, and early mobilisation and physiotherapy reduce atelectrauma and improve outcomes. Prolonged immobilisation and unnecessary intensive care admission increase risk rather than reduce it.

Question 36Anaesthesiology and intensive care (official content domains not enumerated in source)

A 72-year-old man is receiving mechanical ventilation for pneumonia. His plateau pressure is 32 cmH2O, tidal volume 6 mL/kg predicted body weight, and PEEP 12 cmH2O. Which change is most appropriate to limit ventilator-induced lung injury?

  1. Increase PEEP to 20 cmH2O to maximise recruitment
  2. Increase tidal volume to improve carbon dioxide clearance
  3. Reduce tidal volume and consider further PEEP titration to lower driving pressure Correct answer.
  4. Increase respiratory rate to 35 breaths per minute regardless of auto-PEEP

Explanation

Driving pressure (plateau pressure minus PEEP) is the mechanical variable most strongly linked to mortality in acute respiratory distress syndrome, and a plateau above 30 cmH2O signals overdistension. Reducing tidal volume and carefully titrating PEEP to lower driving pressure while accepting permissive hypercapnia is the standard approach. Aggressive recruitment with very high PEEP risks haemodynamic compromise and barotrauma.

Question 37Anaesthesiology and intensive care (official content domains not enumerated in source)

A 58-year-old woman with type 2 diabetes is scheduled for major abdominal surgery. Her HbA1c is 9.2% and she takes metformin and gliclazide. Which perioperative plan is most appropriate?

  1. Withhold the sulfonylurea on the day of surgery and use a variable-rate insulin infusion if glucose is poorly controlled Correct answer.
  2. Stop all glucose-lowering therapy for 48 hours before surgery
  3. Continue both drugs unchanged through the fasting period
  4. Give an extra dose of gliclazide on the morning of surgery to cover stress hyperglycaemia

Explanation

Sulfonylureas can cause prolonged hypoglycaemia during fasting and should be withheld on the day of surgery, while metformin is generally continued unless there is a contraindication such as contrast administration or renal impairment. Poorly controlled diabetes is best managed with a variable-rate intravenous insulin infusion to maintain glucose roughly between 6 and 10 mmol/L. Continuing a sulfonylurea while fasting risks severe hypoglycaemia.

Question 38Anaesthesiology and intensive care (official content domains not enumerated in source)

A 66-year-old man with chronic obstructive pulmonary disease is breathing spontaneously through a tracheostomy in the intensive care unit. Which finding is the most reliable indicator that he is ready for a spontaneous breathing trial?

  1. Arterial oxygen tension above 8 kPa on 60% inspired oxygen
  2. Positive end-expiratory pressure of 10 cmH2O required to maintain oxygenation
  3. A haemoglobin concentration of 90 g/L
  4. Rapid shallow breathing index below 105 with adequate cough and minimal secretions Correct answer.

Explanation

The rapid shallow breathing index, the ratio of respiratory rate to tidal volume in litres, predicts success when below about 105, and a strong cough with manageable secretions is essential for extubation or decannulation. Readiness also requires resolving the underlying cause, stable cardiovascular status, and modest oxygen requirements. High oxygen needs, high PEEP, and anaemia argue against immediate weaning.

Question 39Anaesthesiology and intensive care (official content domains not enumerated in source)

A 28-year-old woman at 34 weeks' gestation requires emergency caesarean delivery for fetal distress. She is awake with a blood pressure of 118/70 mmHg and no symptoms. Which statement about rapid sequence induction in this patient is correct?

  1. Cricoid pressure is no longer recommended under any circumstances
  2. Rocuronium can be used at a standard intubating dose and reversed with sugammadex if needed Correct answer.
  3. Succinylcholine is contraindicated in all pregnant patients
  4. A smaller induction dose of thiopentone is required because of increased cardiac output

Explanation

Rocuronium at an intubating dose of about 1.2 mg/kg provides rapid intubating conditions in pregnancy and can be reliably reversed with sugammadex, which is useful if intubation fails. Pregnancy increases cardiac output and plasma volume, so induction doses of agents such as thiopentone may need to be higher rather than lower. Succinylcholine remains an option in most pregnant patients.

Question 40Anaesthesiology and intensive care (official content domains not enumerated in source)

A 74-year-old man is admitted with a hip fracture. He takes apixaban for atrial fibrillation, with the last dose 20 hours ago. Which statement about neuraxial anaesthesia is most appropriate?

  1. Neuraxial blockade should be delayed according to the recommended interval and renal function, or an alternative technique used Correct answer.
  2. Spinal anaesthesia can proceed immediately because apixaban has a short half-life
  3. A platelet transfusion will reliably reverse the anticoagulant effect
  4. Neuraxial blockade is safe once the activated partial thromboplastin time is normal

Explanation

Apixaban is a direct factor Xa inhibitor, and guidelines specify a minimum interval between the last dose and neuraxial puncture, lengthened in renal impairment because the drug accumulates. If the interval cannot be respected, an alternative such as general anaesthesia or peripheral nerve blocks should be considered. Standard coagulation tests do not reliably reflect the anticoagulant effect of direct oral anticoagulants.

Question 41Anaesthesiology and intensive care (official content domains not enumerated in source)

A 50-year-old man with cirrhosis and ascites is undergoing emergency surgery. Which combination of changes is most typical of his altered drug handling?

  1. Reduced volume of distribution for water-soluble drugs
  2. Reduced plasma protein binding with increased free fraction of highly bound drugs Correct answer.
  3. Increased plasma protein binding and increased first-pass metabolism
  4. Increased hepatic clearance of high-extraction drugs

Explanation

Cirrhosis reduces albumin and alpha-1-acid glycoprotein, so the bound fraction of highly protein-bound drugs falls and the free, pharmacologically active fraction rises. Hepatic clearance of high-extraction drugs is impaired by reduced hepatic blood flow and shunting. Ascites and oedema increase the volume of distribution of water-soluble drugs.

Question 42Anaesthesiology and intensive care (official content domains not enumerated in source)

A 62-year-old woman is undergoing craniotomy for a frontal tumour. Which ventilation strategy best supports cerebral perfusion while limiting brain relaxation problems?

  1. Normocapnia with modest hyperventilation only for acute herniation, plus adequate depth of anaesthesia and head elevation Correct answer.
  2. Hypercapnia to improve cerebral blood flow
  3. Hyperventilation to a carbon dioxide tension of 3.0 kPa throughout the case
  4. Hypocapnia maintained for 24 hours postoperatively

Explanation

Carbon dioxide is a potent cerebral vasodilator, so normocapnia is the routine target; brief hyperventilation to about 4 to 4.5 kPa can be used to reduce intracranial pressure during acute herniation but prolonged hypocapnia risks cerebral ischaemia. Adequate anaesthetic depth, head-up positioning, and avoidance of venous obstruction aid brain relaxation. Hypercapnia raises intracranial pressure and should be avoided.

Question 43Anaesthesiology and intensive care (official content domains not enumerated in source)

A 38-year-old woman with a history of asthma undergoes laparoscopy. During insufflation her peak airway pressure rises and she becomes difficult to ventilate. Which action should be taken first?

  1. Administer intravenous fentanyl for presumed light anaesthesia
  2. Disconnect the circuit and exclude a circuit or tube problem before assuming bronchospasm Correct answer.
  3. Increase the fresh gas flow and continue the procedure
  4. Increase the inspired oxygen concentration and give intravenous salbutamol

Explanation

A sudden rise in airway pressure requires a systematic check: disconnection, obstruction, pneumothorax, and equipment failure must be excluded before attributing the problem to bronchospasm. If the circuit and tube are clear, bronchodilator therapy and deepening anaesthesia are appropriate. Simply increasing oxygen or analgesia may delay recognition of a life-threatening mechanical cause.

Question 44Anaesthesiology and intensive care (official content domains not enumerated in source)

A 55-year-old man is scheduled for elective coronary artery bypass grafting. He takes aspirin 100 mg daily. Which statement about perioperative aspirin management is most appropriate?

  1. Aspirin is generally continued because the bleeding risk is modest compared with the thrombotic risk Correct answer.
  2. Aspirin should be stopped only if the platelet count is below 150 x 10^9/L
  3. Aspirin should be replaced by a therapeutic dose of low molecular weight heparin
  4. Aspirin should be stopped 10 days before surgery in all patients

Explanation

Continuing aspirin modestly increases bleeding but reduces thrombotic complications, and current practice generally favours continuation through cardiac and most major non-cardiac surgery. Decisions are individualised according to bleeding risk and the indication for the drug. Routine bridging with heparin is not a substitute for antiplatelet therapy.

Question 45Anaesthesiology and intensive care (official content domains not enumerated in source)

A 19-year-old man with Duchenne muscular dystrophy requires anaesthesia for a minor procedure. Which anaesthetic concern is most important?

  1. Enhanced metabolism of propofol necessitating larger induction doses
  2. Increased sensitivity to non-depolarising muscle relaxants requiring higher doses
  3. Reduced risk of aspiration because of preserved pharyngeal tone
  4. Risk of hyperkalaemic cardiac arrest with succinylcholine and of rhabdomyolysis with volatile agents Correct answer.

Explanation

Duchenne dystrophy involves up-regulation of extrajunctional acetylcholine receptors, so succinylcholine can cause massive potassium efflux and cardiac arrest. Volatile anaesthetics can trigger rhabdomyolysis or a malignant hyperthermia-like reaction, so total intravenous anaesthesia is often preferred. These patients are also sensitive to non-depolarising relaxants and have impaired respiratory and cardiac function.

Question 46Anaesthesiology and intensive care (official content domains not enumerated in source)

A 64-year-old woman with end-stage renal disease on haemodialysis presents for urgent surgery with a serum potassium of 6.2 mmol/L and no ECG changes. Which intervention lowers total body potassium rather than merely shifting it intracellularly?

  1. Intravenous calcium gluconate
  2. Intravenous insulin with glucose
  3. Nebulised salbutamol
  4. Sodium zirconium cyclosilicate Correct answer.

Explanation

Potassium binders such as sodium zirconium cyclosilicate remove potassium from the body through the gut, lowering total body stores over hours. Insulin with glucose, salbutamol, and sodium bicarbonate shift potassium into cells without removing it. Calcium stabilises the myocardium but has no effect on potassium concentration.

Question 47Anaesthesiology and intensive care (official content domains not enumerated in source)

A 70-year-old man is admitted to the intensive care unit with septic shock. He remains hypotensive despite 30 mL/kg of crystalloid. Which parameter best guides the decision to start a vasopressor rather than continue fluid loading?

  1. Serum lactate of 3 mmol/L
  2. Urine output of 0.4 mL/kg/h
  3. Central venous pressure of 12 mmHg
  4. Dynamic assessment such as passive leg raise or stroke volume variation suggesting fluid responsiveness Correct answer.

Explanation

Dynamic measures of fluid responsiveness, such as passive leg raise or stroke volume variation in a ventilated patient, identify those who will increase cardiac output with more fluid and help avoid harmful overload. Static pressures like central venous pressure correlate poorly with volume status. Lactate and urine output reflect perfusion but do not by themselves indicate whether more fluid will help.

Question 48Anaesthesiology and intensive care (official content domains not enumerated in source)

A 48-year-old man is undergoing resection of a phaeochromocytoma. During tumour manipulation his blood pressure rises to 210/120 mmHg and the heart rate to 125 beats per minute. Which agent is most appropriate for immediate control?

  1. Intravenous phentolamine Correct answer.
  2. Intravenous metoprolol
  3. Intravenous furosemide
  4. Intravenous hydralazine

Explanation

Phaeochromocytoma manipulation releases catecholamines, causing severe alpha-mediated vasoconstriction. Phentolamine, a short-acting alpha-blocker, directly counteracts this and is the preferred agent for intraoperative hypertensive crises. Beta-blockade must never precede alpha-blockade because unopposed alpha stimulation can precipitate a further hypertensive surge and pulmonary oedema.

Question 49Anaesthesiology and intensive care (official content domains not enumerated in source)

A 33-year-old woman at 36 weeks' gestation develops sudden hypotension, hypoxaemia, and fetal bradycardia during labour after spontaneous rupture of membranes. Which diagnosis should be considered first?

  1. Placental abruption
  2. Amniotic fluid embolism Correct answer.
  3. Uterine rupture
  4. Pulmonary embolism from deep vein thrombosis

Explanation

Amniotic fluid embolism classically presents with sudden cardiovascular collapse, hypoxaemia, and coagulopathy during labour or immediately postpartum, often after membrane rupture. Management is supportive, with early airway control, vasopressors, and aggressive treatment of disseminated intravascular coagulation. The other conditions can cause hypotension but have different characteristic features.

Question 50Anaesthesiology and intensive care (official content domains not enumerated in source)

A 58-year-old woman with a history of myasthenia gravis is receiving mechanical ventilation in the intensive care unit for a respiratory infection. Which finding best suggests that her respiratory muscle strength is improving?

  1. A vital capacity of 8 mL/kg
  2. A maximum expiratory pressure of 25 cmH2O Correct answer.
  3. A negative inspiratory force of -20 cmH2O
  4. A rising arterial carbon dioxide tension

Explanation

Respiratory muscle strength is assessed by maximum inspiratory and expiratory pressures and vital capacity; a maximum expiratory pressure of 25 cmH2O is within the normal range and suggests improving strength. A negative inspiratory force of -20 cmH2O is weak, as is a vital capacity of 8 mL/kg, both indicating persisting weakness. A rising carbon dioxide tension suggests ventilatory failure rather than recovery.