Portal Chunk 13

A) General anaesthesia with rapid sequence induction

B) Spinal anaesthesia

C) Slow epidural top-up with 0.1% bupivacaine

D) Local infiltration of the surgical field

A) Hypertensive headache secondary to pre-eclampsia

B) Post-dural puncture headache

C) Meningitis following epidural insertion

D) Tension headache

A) Anaphylaxis to intrathecal bupivacaine

B) Vasovagal episode from the supine position

C) High or total spinal block

D) Local anaesthetic systemic toxicity

A) Ephedrine 6 mg IV bolus

B) Dopamine 5 mcg/kg/min infusion

C) Phenylephrine 50-100 mcg IV bolus

D) Adrenaline 100 mcg IV bolus

A) Epidural bupivacaine 0.5% plain 20 mL

B) Epidural lidocaine 2% with adrenaline and sodium bicarbonate

C) Epidural ropivacaine 0.2% 20 mL

D) Epidural bupivacaine 0.1% with fentanyl 20 mL

A) Increased plasma pseudocholinesterase activity

B) Reduced epidural space volume due to venous engorgement, and progesterone-mediated increased neural sensitivity

C) Increased cerebrospinal fluid volume

D) Reduced spinal cord perfusion pressure

A) Failed tracheal intubation leading to hypoxia

B) Pulmonary aspiration of acidic gastric contents causing chemical pneumonitis

C) Anaphylactic reaction to neuromuscular blocking agents

D) Post-dural puncture headache following inadvertent dural tap

A) Succinylcholine is absolutely contraindicated in patients receiving magnesium sulphate

B) The dose of non-depolarising neuromuscular blocking agents should be reduced and neuromuscular monitoring used

C) Magnesium sulphate accelerates recovery from rocuronium and vecuronium

D) No modification to standard neuromuscular blocking drug dosing is required

A) T10 (umbilical level)

B) T8 (costal margin)

C) T6 (xiphisternum)

D) T4 (nipple line)

A) Intrathecal fentanyl 100 mcg

B) Intrathecal diamorphine 0.3 mg

C) Intrathecal morphine 0.5 mg

D) Intrathecal pethidine 50 mg

A) High spinal block – apply left lateral tilt and give oxygen

B) Local anaesthetic systemic toxicity – stop injection, call for help, and prepare 20% lipid emulsion

C) Vasovagal syncope – lower the head of the bed and give IV fluids

D) Allergic reaction to lidocaine – give IV chlorphenamine and hydrocortisone

A) Combined spinal-epidural (CSE) using needle-through-needle technique

B) Single-shot spinal with a 27G Whitacre needle

C) Conventional epidural with loss-of-resistance to saline using a Tuohy needle

D) Continuous spinal catheter through a 17G Tuohy needle

A) Omeprazole 40 mg IV alone, given 30 minutes before induction

B) Oral sodium citrate 0.3 M 30 mL, ranitidine 150 mg orally or 50 mg IV, and metoclopramide 10 mg IV

C) Metoclopramide 10 mg IV alone, administered 15 minutes before induction

D) Antacid prophylaxis is only required for elective procedures, not emergencies

A) Immediately perform a surgical cricothyroidotomy

B) Assess maternal and fetal condition to decide whether to wake the patient or proceed with surgery via the supraglottic airway

C) Attempt a second laryngoscopy immediately with a video laryngoscope

D) Administer sugammadex and allow the patient to breathe spontaneously before reattempting intubation

A) General anaesthesia is mandatory for all patients with platelets below 100 x 10 to the 9 per litre

B) The risk-benefit of neuraxial anaesthesia should be individually assessed; most practitioners accept a threshold of 70-80 x 10 to the 9 per litre

C) Neuraxial anaesthesia is absolutely contraindicated with a platelet count below 100 x 10 to the 9 per litre

D) Epidural anaesthesia is always safer than spinal anaesthesia in thrombocytopenic patients

A) Both conditions present identically and cannot be distinguished clinically

B) High spinal block causes progressive ascending motor weakness and hypotension, whilst LAST typically begins with perioral tingling, tinnitus, and CNS excitation

C) LAST presents with bradycardia as the first sign, whilst high spinal block presents with hypertension

D) High spinal block is associated with nausea only, whilst LAST causes no gastrointestinal symptoms

A) Volatile agents cause uterine hyperstimulation and fetal distress

B) Volatile agents cross the placenta, causing neonatal respiratory depression, particularly when the uterine incision-to-delivery interval is prolonged

C) Volatile agents are contraindicated in obstetrics due to the risk of malignant hyperthermia

D) Volatile agents cause excessive blood loss by preventing uterine contraction after delivery

A) Epidural infusion of 0.5% bupivacaine at 10 mL/hour

B) Combined spinal-epidural with intrathecal low-dose bupivacaine and fentanyl, followed by low-concentration epidural infusion

C) Epidural bolus of 0.25% bupivacaine 10 mL repeated two-hourly

D) Single-shot spinal with hyperbaric bupivacaine 12.5 mg

A) Anaphylaxis to oxytocin

B) Vasodilatory side effects of a rapid IV bolus of oxytocin

C) Rebound hypertension following resolution of spinal block

D) Air embolism from the open uterine incision

A) Rapid sequence induction should proceed identically to a standard obstetric general anaesthetic

B) Awake fibreoptic intubation should be considered as the primary technique to secure the airway before induction of general anaesthesia

C) A laryngeal mask airway should be used as the primary airway device instead of tracheal intubation

D) Ketamine induction without neuromuscular blockade is the standard approach for difficult airways in obstetrics