Anaesthesia RIMS Quiz

Which of the following best explains why pregnant women are more prone to gastroesophageal reflux?

• Increased gastric acid secretion during pregnancy

• Elevated progesterone levels relaxing the lower esophageal sphincter

• Displacement of the esophagus by the growing uterus

• Increased peristaltic movement of the intestines

Despite an increase in plasma volume during pregnancy, hematocrit levels decrease. What is the primary mechanism behind this change?

• Suppression of erythropoietin by estrogen

• Selective destruction of red blood cells

• Disproportionate increase in plasma volume compared to red cell mass

• Hemodilution due to reduced renal erythropoietin clearance

A 48‑year‑old with a massive multinodular goitre, stridor when supine, and limited neck extension presents for urgent tracheostomy. Which airway strategy offers the safest first‑attempt success while minimizing loss of airway tone?

• Awake flexible bronchoscopic intubation under topical anaesthesia with oxygenation maintained

• Inhalational induction maintaining spontaneous ventilation, then direct laryngoscopy

• Rapid‑sequence induction with video laryngoscopy and rocuronium

• Elective surgical tracheostomy under local without any airway instrumentation

A pregnant woman in her third trimester develops mild dyspnea. Which physiological change most likely contributes to this symptom?

• Decreased tidal volume

• Increased functional residual capacity

• Increased progesterone-mediated central respiratory drive

• Decreased oxygen demand

Cardiac output increases significantly in pregnancy. Which of the following is the most accurate explanation of this phenomenon?

• Increased systemic vascular resistance

• Increased heart rate and stroke volume

• Decreased venous return

• Increased cardiac contractility due to estrogen

A hyperthyroid patient with Graves’ disease requires urgent open reduction and internal fixation. HR 140/min (irregularly irregular), BP 150/70, T 37.5 °C. What is the most appropriate immediate pre‑operative intervention?

• Start methimazole; delay surgery 48 h

• Give saturated solution of potassium iodide immediately

• Begin esmolol infusion to control rate, then proceed with optimization as time allows

• Administer high‑dose propylthiouracil (PTU) and proceed immediately

During pregnancy, renal plasma flow and glomerular filtration rate (GFR) both increase. What clinical consequence might this have on routine lab interpretation?

• Elevated serum urea and creatinine levels

• Increased threshold for glucose reabsorption.

• Lower serum creatinine compared to non-pregnant levels

• Hyperkalemia due to aldosterone suppression

A patient with TBI is being managed conservatively. What is the best indicator of adequate cerebral perfusion in the absence of invasive ICP monitoring?

• Urine output > 0.5 mL/kg/hr

• Glasgow Coma Scale improving

• Mean arterial pressure > 65 mmHg

• Maintenance of CPP surrogate (MAP >90 mmHg and clinical signs of cerebral function)

Which of the following hormonal effects contributes to the development of physiological anemia in pregnancy?

• Increased erythropoietin production outpaced by plasma expansion

• Progesterone-mediated diuresis

• Estrogen-induced bone marrow suppression

• Decreased aldosterone levels reducing plasma volume

During maintenance anaesthesia in an inadequately controlled thyrotoxic patient, BP falls to 85/45 with HR 125/min. Which vasoactive agent is most appropriate to treat hypotension while avoiding exacerbation of tachyarrhythmia?

• Ephedrine bolus

• Phenylephrine bolus or infusion

• Dobutamine infusion

• Isoproterenol infusion