NEET PG Anaesthesia – Spot Diagnosis & History Clinchers

100 Q&A flashcards covering spot-diagnosis scenarios and key anaesthetic considerations for NEET PG rapid revision.

What intraoperative complication presents with high-grade fever, muscle rigidity, and rising ETCO₂ shortly after succinylcholine?

Malignant hyperthermia

Which diagnosis is suggested by sudden hypotension, bronchospasm, and urticaria immediately after induction?

Anaphylaxis

In a patient with a history of obstructive jaundice and pruritus, which type of anaesthesia should generally be avoided?

Spinal (regional) anaesthesia—general anaesthesia is preferred

Why should a nasopharyngeal airway be avoided in a patient with a ‘bull neck,’ hoarseness, and recent diphtheria infection?

Risk of bleeding and airway trauma from friable tissue

Which syndrome is suspected in a tall, slender male with pectus excavatum and prior pneumothorax, increasing the risk of bullae rupture under positive-pressure ventilation?

Marfan syndrome

What intra-operative rhythm problem is an elderly hypertensive patient on β-blockers especially prone to?

Bradycardia

Which group of drugs must be avoided in a patient with acute porphyria undergoing minor surgery?

Barbiturates

What complication is indicated by hypotension and bradycardia 15 min after spinal anaesthesia?

High spinal anaesthesia

How do patients with myasthenia gravis respond to depolarising neuromuscular blockers such as succinylcholine?

Reduced sensitivity / increased resistance

Which peri-operative problem is suggested by snoring, obesity, and daytime somnolence?

Obstructive sleep apnoea (OSA)

A smoker with chronic productive cough desaturates intra-operatively; which underlying disease increases this risk?

COPD exacerbation

What airway classification with a large tongue and receding jaw predicts a difficult airway?

Mallampati class IV

Persistent hoarseness following thyroid surgery most likely indicates injury to which nerve?

Recurrent laryngeal nerve

What is the definitive airway in a facial-trauma patient bleeding into the oropharynx?

Emergency surgical airway (cricothyrotomy)

Why is a morbidly obese patient undergoing laparoscopy at high risk of rapid desaturation?

Reduced functional residual capacity and high oxygen consumption

What common post-intubation complaint presents as sore throat and hoarseness?

Post-intubation laryngeal oedema

A sudden rise in peak airway pressure with wheeze during surgery suggests what?

Bronchospasm

An asthmatic using β-agonist nebulisers desaturates during surgery. Most likely cause?

Intra-operative bronchospasm

Severe postural headache after spinal anaesthesia indicates what complication?

Post-dural puncture headache

Hypotension with tachycardia shortly after epidural placement is due to what mechanism?

Sympathetic blockade

Why might a patient retain urine post-spinal anaesthesia?

Block of sacral autonomic fibres causing bladder atony

What genetic enzyme deficiency results in prolonged apnoea after succinylcholine?

Pseudocholinesterase deficiency

Bradycardia during traction on extra-ocular muscles is termed what reflex?

Oculocardiac reflex

What special caution is required when using regional blocks in diabetics with peripheral neuropathy?

Risk of worsening neuropathy / poor nerve localisation

Sudden cardiovascular collapse during central venous catheter insertion suggests what?

Air embolism

Preferred intubation technique for cervical-spine trauma with quadriplegia?

Awake fibre-optic intubation

What scenario is described when both intubation and ventilation fail?

Can’t-intubate-can’t-ventilate (CICV) situation

Which induction approach is used for a head-injury patient with GCS 6?

Rapid sequence intubation (RSI)

Why are benzodiazepines avoided in chronic alcoholic liver disease?

Prolonged drug effect due to impaired metabolism

Increased salivation and bradycardia after neostigmine occur when it is NOT given with what class of drug?

Anticholinergics (atropine or glycopyrrolate)

Bradycardia progressing to asystole during spinal block is due to which reflex?

Bezold–Jarisch reflex

Which induction agent is contraindicated in pheochromocytoma owing to sympathomimetic effects?

Ketamine

Initial management of laryngospasm during extubation?

Apply CPAP with 100 % O₂ and deepen anaesthesia

A ‘pink’ patient with hypoxia unresponsive to high FiO₂ likely has what poisoning?

Carbon monoxide poisoning

In pregnant patients after spinal, hypotension is often due to what compression?

Aortocaval compression

Triad of hypoxia, hypotension, and low ETCO₂ during long-bone surgery indicates what?

Fat embolism

Jaw tightness in a child after succinylcholine is an early sign of what?

Masseter muscle rigidity (early malignant hyperthermia)

Which IV induction agent should be avoided in a patient allergic to egg or soy?

Propofol

Inability to obtain BP or pulse ox readings with absent pulses means what emergency?

Cardiac arrest

A patient who is awake yet paralysed post-op with memory of events likely experienced what?

Intra-operative awareness

Sudden fall in ETCO₂ with hypotension intra-op suggests what embolic event?

Pulmonary embolism

Hypotension in a patient on ACE inhibitors refractory to fluids is treated with which vasopressors?

Vasopressin or noradrenaline

Why are neuraxial blocks avoided in raised intracranial pressure?

Risk of brain herniation

Severe back pain after multiple spinal attempts suggests what complication?

Spinal (epidural) haematoma

Which congenital abnormality makes bag-mask ventilation difficult in a child undergoing cleft-palate repair?

Cleft palate (air leak and poor seal)

Elderly patient with kyphoscoliosis scheduled for hip surgery—why might GA be preferred over regional?

Distorted anatomy and impaired respiratory mechanics

Why is recent upper-respiratory infection a concern for GA in children?

Higher risk of peri-operative respiratory complications

Post-burn neck contracture in a young male predicts what airway issue?

Difficult laryngoscopy / intubation

Which induction agent is preferred for epilepsy due to its anticonvulsant properties?

Thiopentone

In schizophrenia patients, which anaesthetic drugs should be avoided?

Agents that prolong QT interval

Intra-op hypotension, tachycardia, fever, and pink urine after transfusion indicate what reaction?

Acute haemolytic transfusion reaction

Key haemodynamic goals for mitral stenosis during anaesthesia?

Avoid tachycardia and fluid overload

What is the major anaesthetic concern in severe aortic stenosis?

Maintain afterload; avoid hypotension

Which IV fluids are avoided in chronic renal failure?

Potassium-containing solutions (e.g., Ringer’s lactate)

Limitation of neck extension with rheumatoid arthritis raises concern for what instability?

Atlanto-axial instability

Why is mask ventilation and intubation often difficult in morbidly obese, short-necked patients?

Reduced pharyngeal space and neck mobility

Hypotension and tachycardia during scoliosis surgery in teens usually indicate what?

Blood loss or neurogenic shock

Which volatile agent can precipitate seizures, especially in epileptics?

Enflurane

Why is regional anaesthesia contraindicated in patients taking warfarin?

High risk of spinal/epidural haematoma

Post-thyroidectomy hypocalcaemia can present with which airway-threatening sign?

Laryngeal stridor / spasm

Bradycardia following neostigmine indicates failure to co-administer what?

An anticholinergic (atropine/glycopyrrolate)

Why may renal failure prolong action of non-depolarising muscle relaxants?

Reduced excretion and increased sensitivity

Why should excessive O₂ be avoided in COPD patients with CO₂ retention?

May suppress hypoxic respiratory drive

What cardiovascular effect can thiopentone cause immediately after injection?

Hypotension due to myocardial depression

How does elevated carboxyhaemoglobin affect pulse oximetry in smokers?

False-normal SpO₂ readings

Long-term high-dose propofol infusion can lead to what rare syndrome?

Propofol infusion syndrome

Which antiemetics are avoided in Parkinson’s disease because they worsen symptoms?

Haloperidol or metoclopramide

Sudden rise in ETCO₂ during laparoscopy suggests what two possibilities?

CO₂ embolism or excessive pneumoperitoneum absorption

Prolonged seizure during local anaesthetic use indicates toxicity of which drug?

Lignocaine (lidocaine) toxicity

Hypotension, bradycardia, and arrest during Caesarean under spinal signify what?

High spinal block

What causes sudden hypotension if oxytocin is given as a rapid IV bolus?

Peripheral vasodilation from oxytocin

Why do chronic steroid users require peri-operative stress-dose steroids?

To prevent adrenal insufficiency

An anxious patient who faints in pre-op area likely experienced what?

Vasovagal syncope

How should an obese patient be positioned for pre-oxygenation to ease ventilation?

Head-up / reverse Trendelenburg

Why is succinylcholine contraindicated in burn patients with hyperkalaemia?

Risk of lethal potassium surge

Flaccid paralysis after accidental dural puncture suggests what injury?

Spinal cord trauma

Post-operative stridor in a child following intubation usually indicates what?

Subglottic oedema

Repeated doses of succinylcholine risk development of which block?

Phase II (desensitisation) block

Best GA plan for a short daycare procedure?

Propofol induction with LMA

Cyanosis unresponsive to 100 % oxygen points toward which condition?

Methaemoglobinaemia

Chest-wall rigidity after high-dose fentanyl is treated with what?

Naloxone or a muscle relaxant

Why is nitrous oxide avoided in intra-ocular gas procedures?

It expands trapped gas bubbles and increases pressure

Bradycardia after multiple laryngoscopy attempts is due to what reflex?

Vagal stimulation

Prolonged QT interval intra-op raises risk of which arrhythmia?

Torsades de pointes

What induction technique is mandated in polytrauma with a full stomach?

Rapid sequence induction

Triad of hyperthermia, tachycardia, and masseter spasm intra-op signifies what?

Malignant hyperthermia

Blood-tinged CSF while attempting neuraxial block suggests puncture of what?

Epidural vein—regional anaesthesia contraindicated

Paraplegia after spinal anaesthesia makes you suspect what complication?

Epidural haematoma

Why is electrocautery risky in pacemaker-dependent patients?

Electromagnetic interference with pacing

Post-operative respiratory depression after morphine requires which antidote?

Naloxone

Key clinical difference between thyroid storm and malignant hyperthermia?

MH has marked muscle rigidity

First-line management of laryngospasm in a child with recent URI under anaesthesia?

Continuous positive airway pressure and deepen anaesthesia

Which anticholinergic is avoided in narrow-angle glaucoma?

Atropine

Why avoid nitrous oxide in pneumothorax or air embolism?

It diffuses into closed air spaces, expanding them

Ideal anaesthetic choice for an elderly dementia patient with hip fracture (if no contraindication)?

Regional anaesthesia

Why are neuraxial blocks avoided in liver disease with coagulopathy?

Risk of spinal/epidural haematoma

Airway protection for Parkinson’s patient with aspiration risk includes what two measures?

Head-end elevation and rapid sequence induction

Severe bradycardia during TURP alerts you to what complication?

TURP syndrome or bladder perforation

Using high-flow oxygen during laser airway surgery increases risk of what?

Airway fire

What acid–base change from hyperventilation under GA causes carpopedal spasm?

Respiratory alkalosis