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A) Negative inotropic effect of bupivacaine on the myocardium

B) Sympathetic blockade causing vasodilation and reduced venous return

C) Vagally mediated bradycardia from peritoneal traction

D) Aortocaval compression by the gravid uterus alone

A) Quincke 22G (cutting bevel)

B) Quincke 25G (cutting bevel)

C) Whitacre 25G (pencil-point)

D) Tuohy 16G (epidural needle)

A) Anxiety-related sinus tachycardia

B) Intrathecal placement of the epidural catheter

C) Intravascular injection of the adrenaline-containing test dose

D) Pain from needle advancement through the ligamentum flavum

A) Inject additional hyperbaric bupivacaine intrathecally via the same needle

B) Place the patient head-down and wait 5 minutes for the block to rise

C) Convert to general anaesthesia

D) Administer intravenous ketamine 1 mg/kg to supplement the block

A) Subdural space

B) Intravascular placement within an epidural vein

C) Paravertebral space via an intervertebral foramen

D) Intrathecal space

A) Hyperbaric bupivacaine 0.5%

B) Isobaric ropivacaine 0.75%

C) Lignocaine 5% (hyperbaric)

D) Levobupivacaine 0.5%

A) 4 hours

B) 8 hours

C) 12 hours

D) 24 hours

A) A spinal needle is inserted first, then the Tuohy needle is advanced alongside it

B) The epidural Tuohy needle identifies the epidural space, then the spinal needle is passed through its lumen into the subarachnoid space

C) Two separate interspaces are used for the spinal and epidural components

D) The epidural catheter is advanced into the subarachnoid space for the spinal component

A) Total spinal block with cerebral hypoperfusion

B) TURP syndrome (hypo-osmolar fluid absorption)

C) Local anaesthetic systemic toxicity

D) Hyperglycaemic hyperosmolar state

A) T6 bilaterally

B) T8 bilaterally

C) T4 bilaterally

D) T10 bilaterally

A) The anticoagulant agent used

B) The level at which the catheter was sited

C) The time from symptom onset to surgical decompression

D) The total volume of local anaesthetic administered

A) Full blood count and C-reactive protein

B) Blood cultures and urine culture

C) Urgent MRI of the spine

D) Plain X-ray of the thoracic and lumbar spine

A) Lignocaine 2%

B) Prilocaine 2%

C) Bupivacaine 0.5% (heavy)

D) Ropivacaine 0.75%

A) They increase the dermatomal spread of the local anaesthetic block

B) They prolong and intensify analgesia by acting on spinal opioid receptors without affecting motor block height

C) They reduce the risk of post-dural puncture headache

D) They prevent the cardiovascular depression associated with high spinal block

A) Proceed with spinal anaesthesia using the smallest available needle

B) Reverse anticoagulation with vitamin K and FFP, delay until INR ≤1.5, then perform spinal anaesthesia

C) Use peripheral nerve blocks (femoral and obturator) that avoid the neuraxis

D) Administer protamine and proceed with epidural anaesthesia

A) Prophylactic intravenous crystalloid preload of 1,000 mL before the block

B) Combined left lateral tilt with prophylactic phenylephrine infusion

C) Elevation of the legs to 45 degrees immediately after block placement

D) Administration of intramuscular ephedrine 15 mg at the time of spinal injection

A) T10–L1 dermatomes; hysterectomy

B) S1–S5 and coccyx (perineal dermatomes); perianal, perineal, or obstetric procedures

C) L1–L4 dermatomes; knee replacement

D) T6–T12 dermatomes; appendicectomy

A) Single-shot hyperbaric bupivacaine 0.5% via a 25G Whitacre needle

B) Repeated doses of hyperbaric lignocaine 5% through a microcatheter

C) Intrathecal morphine 400 mcg for postoperative analgesia

D) High spinal block reaching the cervical segments

A) Administer intravenous ketamine 0.5 mg/kg and proceed

B) Test the block height and, if inadequate, convert to general anaesthesia

C) Inject a further 10 mL of epidural lignocaine 2%

D) Add intrathecal fentanyl via a fresh spinal needle

A) Supraspinous ligament

B) Interspinous ligament

C) Ligamentum flavum

D) Posterior longitudinal ligament