PGIM MD Anaesthesiology common mistakes
PGIM MD Anaesthesiology · Understand the traps and how to avoid them.
When an airway question describes a cannot-intubate/cannot-oxygenate scenario, the candidate lists supraglottic airway insertion, fibreoptic intubation, and surgical airway as an undifferentiated bundle rather than sequencing them by the stage at which oxygenation is failing.
Airway algorithms are memorised as a flat list of rescue options, so the candidate never anchors each step to the physiological trigger (SpO2 falling despite mask ventilation versus failure to place a supraglottic device) that determines which option comes next.
What to do instead
Rehearse the sequence as decision nodes: optimise mask ventilation and positioning, then supraglottic rescue with a limited attempt count, then final options including surgical airway, stating the explicit trigger and a time or attempt limit at each node. For every practice stem, write the trigger before writing the intervention.
On rapid sequence induction questions the candidate names the drugs but omits the pre-oxygenation endpoint, the rocuronium dose relative to suxamethonium, and the plan for a failed first attempt.
The pharmacology of induction agents is over-learned relative to the procedural choreography of RSI, so dosing and contingency planning are treated as assumed rather than stated.
What to do instead
Answer RSI stems with a fixed template: pre-oxygenation to a stated endpoint, positioning, pre-calculated doses with mg/kg figures, cricoid pressure policy, and a named rescue plan with a repeat-attempt limit. Practise writing the template from memory until it takes under two minutes.
For a peripheral nerve block question the candidate describes the block but cannot state the local anaesthetic volume, concentration, maximum safe dose, and the early signs of LAST with the lipid emulsion regimen.
Block technique and surface anatomy are studied visually, while dose arithmetic and toxicity management are skipped as 'basic', leaving a gap precisely where examiners probe.
What to do instead
For each commonly examined block, build a one-page card with target nerve, landmark or ultrasound endpoint, volume and concentration, cumulative mg dose against the weight-based maximum, and the LAST response including lipid emulsion dosing. Test yourself by reciting the card before reading the answer key.
When asked to manage acute postoperative pain in a patient on chronic opioids or with renal impairment, the candidate gives a standard multimodal regimen without adjusting for tolerance, active metabolites, or the ceiling of non-opioid adjuvants.
Multimodal analgesia is taught as a fixed package, so the candidate does not interrogate the patient factors that make individual components unsafe or ineffective.
What to do instead
Before prescribing, run three checks: current opioid intake and tolerance, organ function affecting drug accumulation, and contraindications to each adjuvant. Then justify each agent by mechanism and state what you would titrate and monitor. Practise rewriting standard regimens for a defined comorbidity.
In critical care stems the candidate describes fluid and vasopressor therapy but never states the resuscitation target, the reassessment interval, or the criteria for escalation, and does not differentiate the type of shock before treating it.
Management is recalled as a drug list rather than as a goal-directed loop, and shock categories blur together under time pressure.
What to do instead
Structure every shock answer as: classify the shock with the supporting measurements, state the target for the chosen endpoint, give the intervention with dose, then state the reassessment time and the escalation trigger. Rehearse with mixed shock vignettes so classification is forced first.
On ventilation questions the candidate adjusts the ventilator without linking the setting to the underlying lung mechanics, and cannot explain the difference between pressure- and volume-targeted modes or the meaning of a rising peak versus plateau pressure.
Ventilator parameters are memorised as numbers for named conditions instead of as consequences of compliance and resistance, so the candidate cannot reason when the scenario is atypical.
What to do instead
For each stem, derive the expected compliance and resistance from the diagnosis, predict the pressure trace, then choose settings and state the acceptable limits. Practise distinguishing peak from plateau pressure with a worked example of each cause of elevation.
When interpreting an arterial blood gas the candidate reports the primary disorder but omits compensation, the anion gap, and the delta ratio, and does not reconcile the numbers with the clinical picture.
The steps are known individually but are not executed in a fixed order under time pressure, so the answer stops at the first abnormality found.
What to do instead
Use a rigid five-step sequence every time: pH, primary disorder, expected compensation, anion gap with albumin correction, then delta-delta. Write the sequence at the top of your rough work and follow it mechanically on every practice gas.
Physics questions are answered by quoting a formula without identifying the clinical situation it governs, so the candidate misapplies relationships such as laminar versus turbulent flow, the solubility effect on uptake, or the behaviour of a plenum vaporiser.
Physics is revised as isolated equations, and the link between the equation and the equipment or patient scenario is never rehearsed.
What to do instead
For each principle, write the equation, the clinical context where it matters, and one worked numerical example with units. Practise explaining the same principle in one sentence to a colleague without using the formula.
In obstetric stems the candidate manages the mother and fetus as separate problems, missing the aortocaval compression, aspiration prophylaxis, and the altered response to vasopressors and local anaesthetics that pregnancy imposes.
Obstetric anaesthesia is revised as a list of scenarios rather than as a set of physiological changes that modify every intervention.
What to do instead
Before answering, list the pregnancy-induced changes relevant to the stem and apply each one explicitly to your plan. Include left uterine displacement, aspiration risk, reduced local anaesthetic requirement, and the choice of vasopressor with justification.
Paediatric stems are answered with adult doses, fluid volumes, and equipment sizes, or with a weight-based calculation that ignores the different pharmacokinetics and the narrower margin before bradycardia and desaturation.
Adult patterns are over-rehearsed and paediatric formulae are recalled without the physiological reasoning that tells the candidate when the formula is unsafe.
What to do instead
For every paediatric answer, state weight, then derive dose, fluid bolus, tube size, and blade from weight-based rules, and add the paediatric-specific caveats on drug handling and monitoring. Memorise the emergency drug doses for a 10 kg child as a fixed anchor and check every other calculation against it.