NEW
Font size
WorksheetsAnaesthesia RIMS Quiz
Total questions: 40
Worksheet time: 30mins
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
Why does pregnancy predispose to a hypercoagulable state?
Increased platelet count due to hormonal stimulation
Enhanced fibrinolytic activity
Increased levels of antithrombin III
Elevated levels of clotting factors like fibrinogen and Factor VIII
The volume of oxygen remaining in a full E-cylinder is approximately 660 L. If the flow rate is 5 L/min, how long will the cylinder last if the pressure reads 1000 psi (starting from 2000 psi full)?
66 minutes
132 minutes
100 minutes
330 minutes
A 62‑year‑old with severe hypothyroidism (myxoedema), bradycardia (HR 48), hypothermia, and low EF needs emergent laparotomy for peritonitis. Which induction plan best balances haemodynamic stability?
High‑dose propofol with fentanyl
Thiopentone induction with non‑depolariser paralysis
Ketamine‑based induction with cautious opioid use and vigilant temperature management
Midazolam–fentanyl only, avoiding any induction agent
Which change in respiratory physiology during pregnancy helps in maintaining a favorable environment for fetal oxygenation?
Decreased minute ventilation
Development of respiratory acidosis
Increased arterial CO₂ tension
Mild compensated respiratory alkalosis
Thirty minutes into a thyroidectomy, the patient develops T 39.5 °C, HR 150, and hypertension. Ventilation has been increased; end‑tidal CO₂ remains normal and there is no muscle rigidity. Which finding most supports thyroid storm over malignant hyperthermia?
Rapidly rising ETCO₂ despite increased minute ventilation
Masseter spasm after succinylcholine
Mixed respiratory–metabolic acidosis with hyperkalaemia and myoglobinuria
Warm, moist skin with tachyarrhythmia and absence of rigidity
Which cardiovascular adaptation is responsible for systolic flow murmurs commonly heard in pregnancy?
Aortic stenosis
Increased blood viscosity
Increased blood volume and flow across normal valves
Pulmonary hypertension
Which of the following is the most accurate explanation for the increased risk of urinary tract infections in pregnancy?
Increased glomerular filtration rate
Progesterone-induced relaxation of smooth muscle in ureters
Compression of the bladder by the fetus
Decreased urine output due to reduced renal perfusion
For thyroidectomy with recurrent laryngeal nerve (RLN) monitoring, which neuromuscular blocker strategy is optimal?
Use a short‑acting NMB for intubation only (or none), then avoid further NMBs and titrate anaesthesia/analgesia; confirm TOF recovery before monitoring
Avoid neuromuscular blockers entirely; intubate with deep volatile alone
Intubate with succinylcholine, then rocuronium infusion throughout
Use cisatracurium infusion at low dose throughout to prevent movement
A 55‑year‑old with long‑standing overt hypothyroidism presents for elective hernia repair. Which statement is most accurate for intra‑operative anaesthetic management compared with a euthyroid patient?
MAC requirements are increased; higher volatile concentrations are needed
Greater sensitivity to sedatives/opioids with risk of hypoventilation and delayed emergence
Faster gastric emptying reduces aspiration risk under GA
Non‑depolarising neuromuscular blocker duration is reliably shorter
A 45-year-old male with severe TBI is admitted to ICU. His ICP is persistently elevated despite head elevation and sedation. MAP is 90 mmHg, ICP is 28 mmHg. What is the most appropriate next step to improve cerebral perfusion pressure (CPP)?
Initiate hyperventilation to reduce PaCO₂ below 25 mmHg
Start vasopressors to increase MAP to 110 mmHg
Administer a bolus of hypertonic saline
Begin therapeutic hypothermia at 32°C
In the context of TBI, which of the following strategies best reflects an evidence-based approach to prevent secondary brain injury during initial ICU care?
Routine use of corticosteroids to reduce cerebral edema
Aggressive hyperventilation to PaCO₂ < 25 mmHg for all patients
Keeping serum sodium < 135 mmol/L to reduce excitotoxicity
Maintenance of normocapnia and normoxia with adequate sedation
A patient with moderate TBI is found to have frequent episodes of hypertension and tachycardia unrelated to pain. What is the most likely cause, and how should it be managed initially?
Increased ICP; start mannitol
Sympathetic storm; initiate beta-blockade or clonidine
Undiagnosed infection; start broad-spectrum antibiotics
Neurogenic shock; administer IV fluids and vasopressors
In a patient with severe TBI and no surgical lesion, which sedation strategy optimally balances ICP control and neurological assessment?
Continuous high-dose midazolam infusion
Propofol infusion titrated to ICP and sedation goals
Long-acting benzodiazepines with muscle relaxants
Intermittent boluses of opioids and paralytics
A cylinder of nitrous oxide is transported in a poorly ventilated van during summer. The temperature inside reaches 60°C. What is the most likely hazard according to gas storage principles?
Cylinder explosion due to Boyle’s Law
Rapid decomposition of nitrous oxide due to Charles’ Law
Activation of the fusible plug to release pressure
Cracking of valve due to contraction of gas
An oxygen E-cylinder is read as empty after prolonged use in the OR. Which principle best explains the inability to calculate the remaining content by pressure gauge alone in a nitrous oxide cylinder but not in an oxygen cylinder?
Boyle’s Law applies only to oxygen, not nitrous oxide
Nitrous oxide exists as a compressed gas throughout its use
Pressure gauge in nitrous oxide remains constant until all liquid vaporizes
Nitrous oxide follows Dalton’s Law and not Henry’s Law
A patient on a ventilator using compressed gases shows a sudden drop in inspired oxygen concentration. Which system component failure would most likely bypass the safety features and lead to hypoxic delivery?
Malfunction of the proportioning system (e.g., Link-25)
Activation of fail-safe system due to nitrous oxide loss
Failure of oxygen pressure sensor shut-off valve
Disconnection at the common gas outlet
During a pre-use check, an anaesthesia machine shows pipeline crossover, where nitrous oxide is being delivered through the oxygen pipeline. What is the most immediate action to ensure patient safety?
Disconnect pipeline gas supply and switch to cylinder oxygen
Administer 100% nitrous oxide briefly to avoid hypoxia
Turn off the anaesthesia machine and cancel the case
Use the oxygen flush valve to bypass the vaporizer
A desflurane vaporizer is functioning suboptimally at high altitude. Which gas law best explains why the vaporizer might overdeliver agent under these conditions?
Boyle’s Law
Dalton’s Law
Charles’ Law
Henry’s Law
A 3-year-old child requires a CT scan. He is anxious and uncooperative. Which sedation method provides optimal conditions while minimizing the risk of respiratory depression?
Oral midazolam followed by chloral hydrate
Intranasal dexmedetomidine
IV propofol bolus with oxygen supplementation
Inhalational sevoflurane with a face mask
During sedation for fracture reduction in a 4-year-old, the child develops apnea after a bolus of propofol. What is the immediate management priority?
Start IV fluids and call for help
Administer naloxone to reverse the sedation
Perform airway opening maneuvers and assist ventilation
Give flumazenil to reverse benzodiazepine effects
Which of the following reflects the most appropriate combination for procedural sedation in a child requiring painful dressing change in the emergency department?
Oral midazolam and IV paracetamol
Intramuscular ketamine alone
IV dexmedetomidine and local lignocaine
Inhaled nitrous oxide with intranasal fentanyl
A 6-year-old child undergoing dental extraction under sedation becomes unresponsive to verbal commands but maintains airway reflexes. According to sedation levels, this is classified as:
Minimal sedation
Moderate sedation
Deep sedation
General anaesthesia
A child with a history of obstructive sleep apnea requires MRI under sedation. Which agent is the safest choice with the least impact on respiratory drive?
Propofol infusion
Dexmedetomidine infusion
Midazolam bolus
Ketamine bolus
While designing a study to evaluate the effect of a new sedative agent in children, which of the following best reflects the importance of defining a primary outcome clearly?
To simplify data collection
To allow flexibility in statistical analysis
To avoid data loss during the trial
To ensure the study is adequately powered and hypothesis-driven
A postgraduate student is planning a randomized controlled trial on intraoperative fluid strategies. Which principle ensures that neither the patient nor the assessor knows the intervention being given?
Stratified randomization
Allocation concealment
Blinding
Intention-to-treat analysis
A student designing a cross-sectional study on burnout among anaesthesiologists must consider which of the following as the most significant limitation of the design?
Difficulty in obtaining ethical clearance
Inability to capture prevalence rates
Inability to establish causal relationships
Need for large sample sizes
A 60-year-old obese patient with limited neck extension is posted for elective hernia repair. The anaesthesia team plans to use video laryngoscopy for intubation. What is the primary advantage of this approach in such patients?
It provides a magnified and indirect view of the glottis
It avoids the need for muscle relaxants
It completely eliminates the risk of airway trauma
It allows faster intubation than all other methods
In which of the following situations is the use of video laryngoscopy most likely to improve first-pass intubation success compared to direct laryngoscopy?
Routine intubation in ASA I patient with full neck mobility
Pediatric patients requiring uncuffed tubes
Patients requiring nasotracheal intubation under sedation
Anticipated difficult airway due to cervical spine immobilization
A 70-year-old ICU patient on high-dose vasopressors requires percutaneous tracheostomy. Which factor most strongly supports bedside tracheostomy over OR transfer?
ICU has less risk of infection than the OR
The patient’s hemodynamic instability makes transport unsafe
Percutaneous tracheostomy cannot be performed in the OR
ICU staff are more skilled at tracheostomy than surgical teams
In a septic ICU patient with rapidly worsening abdominal distension and suspected abdominal compartment syndrome, which of the following best justifies performing decompressive laparotomy at the bedside?
Immediate access can prevent irreversible organ dysfunction
Better sterility in the ICU environment
Reduced surgical workload in the OR
Avoidance of general anesthesia in unstable patients
