Anesthesiology Prometric exam questions

The Anesthesiology exam in every GCC country

From each regulator's own exam pages; anything a regulator does not publish says so. Assessment mode also depends on your licence title, so confirm your route on your eligibility notice.

12 worked Anesthesiology practice questions

Original exam-style questions from the bank, spread across the blueprint domains. They are not real or recalled exam questions. Try each one, then open the answer for the rationale and reference. None of them appear in the free mock exam, so reading them will not spoil it.

1. Question 1 · Airway Management

   In the DAS 2015 adult guideline, which step constitutes Plan C and must be completed before declaring 'can't intubate, can't oxygenate' and proceeding to emergency front-of-neck access?

   1. AA further attempt at supraglottic airway insertion
   2. BInsertion of a nasogastric tube to decompress the stomach
   3. CAdministration of intravenous sugammadex to reverse neuromuscular blockade
   4. DOne final attempt at facemask ventilation using a two-person technique, airway adjuncts and full neuromuscular blockade
   Show answer and explanation

   Correct answer: D. One final attempt at facemask ventilation using a two-person technique, airway adjuncts and full neuromuscular blockade

   Plan C is a final, optimised attempt at facemask ventilation: two-person technique, oral and nasal airways, and confirmation that neuromuscular blockade is complete, since residual muscle tone and laryngospasm are common reversible causes of failed ventilation. Only if this fails is CICO declared and Plan D (scalpel cricothyroidotomy) performed. Further supraglottic attempts belong to Plan B, and reversing blockade with sugammadex will not restore adequate spontaneous ventilation quickly enough to be relied upon.

   Reference: Frerk C et al. Difficult Airway Society 2015 guidelines. British Journal of Anaesthesia 2015

2. Question 2 · Basic Sciences: Anesthetic Pharmacology, Applied Physiology, Anatomy and Physics

   During resuscitation of cardiac arrest attributed to bupivacaine toxicity, which modification to standard advanced life support is recommended?

   1. AGive adrenaline in the usual 1 mg boluses and add a calcium channel blocker for arrhythmia control
   2. BUse reduced adrenaline boluses (1 microgram/kg or less) and avoid vasopressin, calcium channel blockers and further local anesthetic such as lidocaine
   3. CSubstitute vasopressin 40 units for the first adrenaline dose to improve coronary perfusion
   4. DWithhold all vasopressors until lipid emulsion has been running for 20 minutes
   Show answer and explanation

   Correct answer: B. Use reduced adrenaline boluses (1 microgram/kg or less) and avoid vasopressin, calcium channel blockers and further local anesthetic such as lidocaine

   ASRA guidance advises reducing individual adrenaline boluses to 1 microgram/kg or less because larger doses impair lipid rescue and worsen outcome in animal models, and avoiding vasopressin, calcium channel blockers, beta-blockers and additional local anesthetics such as lidocaine or procainamide. Standard 1 mg adrenaline boluses and vasopressin are therefore not recommended, and vasopressors should not be withheld altogether since perfusion must be maintained while lipid emulsion takes effect. Prolonged CPR and early consideration of cardiopulmonary bypass or ECMO are also advised.

   Reference: American Society of Regional Anesthesia and Pain Medicine (ASRA) Practice Advisory on Local Anesthetic Systemic Toxicity, 2020

3. Question 3 · Conduct of General Anesthesia, Equipment, Monitoring and Fluid/Transfusion Management

   A hypotensive patient in the operating theatre has a pulse pressure variation of 18% displayed on the arterial waveform monitor. In which of the following circumstances would this value be a valid predictor of fluid responsiveness?

   1. AFully controlled ventilation at 8 mL/kg tidal volume in sinus rhythm with a closed chest
   2. BSpontaneous breathing through a supraglottic airway with pressure support
   3. CAtrial fibrillation with a ventricular rate of 130 beats/min
   4. DDuring an open thoracotomy with the chest wall retracted
   Show answer and explanation

   Correct answer: A. Fully controlled ventilation at 8 mL/kg tidal volume in sinus rhythm with a closed chest

   Dynamic indices such as pulse pressure and stroke volume variation depend on cyclical heart-lung interaction and are only valid with regular controlled mechanical ventilation using tidal volumes of at least about 8 mL/kg, a regular cardiac rhythm and a closed chest. Spontaneous or assisted breathing produces variable intrathoracic pressure swings, arrhythmias such as atrial fibrillation create beat-to-beat stroke volume variability unrelated to preload, and an open chest abolishes the transmitted pressure swings.

   Reference: Miller's Anesthesia, 9th edition (2020), Cardiovascular Monitoring; Michard F, Anesthesiology 2005 review of dynamic preload indices

4. Question 4 · Cardiac, Thoracic and Vascular Anesthesia

   An 84-year-old with severe aortic stenosis and moderate COPD is listed for elective transfemoral TAVI. The team asks whether general anesthesia or local anesthesia with conscious sedation should be used. Which statement best reflects current evidence and practice?

   1. AGeneral anesthesia significantly reduces the incidence of paravalvular leak and permanent pacemaker implantation
   2. BGeneral anesthesia is mandatory because transesophageal echocardiography must be used in every transfemoral case
   3. CLocal anesthesia with conscious sedation is a well-established default for transfemoral access, with shorter procedure and hospital stay and no excess mortality
   4. DConscious sedation is contraindicated in COPD because of the risk of hypercapnia
   Show answer and explanation

   Correct answer: C. Local anesthesia with conscious sedation is a well-established default for transfemoral access, with shorter procedure and hospital stay and no excess mortality

   Registry and randomized data show that conscious sedation for transfemoral TAVI is associated with shorter procedure times, less vasopressor use, shorter intensive care and hospital stay and at least equivalent 30-day mortality, and it is now the default in most high-volume centres. Transesophageal echocardiography is not mandatory since transthoracic imaging and fluoroscopy with contrast aortography suffice for most transfemoral cases. Anesthetic technique does not determine paravalvular leak or pacemaker rates, which relate to annular sizing, calcification and implant depth, and COPD is in fact an argument in favour of avoiding general anesthesia.

   Reference: ESC/EACTS Guidelines for the Management of Valvular Heart Disease (2021); Herrmann et al., SOLVE-TAVI randomized trial, Circulation (2020)

5. Question 5 · Obstetric Anesthesia

   A 32-year-old woman presents 6 weeks postpartum with orthopnea and peripheral edema. Echocardiography shows a dilated left ventricle with an ejection fraction of 30 percent and no other cause is found. Which statement about her condition is most accurate?

   1. AThe diagnosis requires onset before 20 weeks gestation
   2. BAngiotensin-converting enzyme inhibitors are the first-line therapy during pregnancy
   3. CPeripartum cardiomyopathy is defined by an ejection fraction below 45 percent developing towards the end of pregnancy or in the months following delivery, with no other identifiable cause
   4. DFull recovery of ventricular function is essentially never seen
   Show answer and explanation

   Correct answer: C. Peripartum cardiomyopathy is defined by an ejection fraction below 45 percent developing towards the end of pregnancy or in the months following delivery, with no other identifiable cause

   Peripartum cardiomyopathy is an idiopathic systolic heart failure with an ejection fraction usually below 45 percent presenting in the last month of pregnancy or up to about 5 months postpartum, once other causes are excluded. Management follows heart failure principles adapted for pregnancy and lactation: ACE inhibitors and ARBs are contraindicated antenatally because of fetal toxicity (hydralazine with nitrates and beta-blockade are used instead), anticoagulation is considered at very low ejection fraction, and bromocriptine has been studied as adjunctive therapy. A substantial proportion of women recover ventricular function, though relapse in subsequent pregnancies is a real risk.

   Reference: European Society of Cardiology Guidelines for the Management of Cardiovascular Diseases during Pregnancy, 2018

6. Question 6 · Neuroanesthesia and Neurocritical Care

   During a thoracic spine deformity correction under stable TIVA, the neurophysiologist reports that cortical somatosensory evoked potentials have fallen in amplitude by 55% with a 12% increase in latency, while subcortical and peripheral responses are unchanged. What is the most appropriate interpretation and next step?

   1. AThis meets the classical alarm criteria; check the mean arterial pressure, temperature and haematocrit, exclude a technical fault, and inform the surgeon so corrective action such as reducing distraction can be taken
   2. BThis is an expected pharmacological effect of TIVA and no action is required
   3. CThis confirms an irreversible spinal cord infarct and the operation should be abandoned immediately
   4. DThis indicates peripheral nerve compression from arm positioning and only the arm position needs adjusting
   Show answer and explanation

   Correct answer: A. This meets the classical alarm criteria; check the mean arterial pressure, temperature and haematocrit, exclude a technical fault, and inform the surgeon so corrective action such as reducing distraction can be taken

   The classical alarm criteria for somatosensory evoked potentials are a reduction in amplitude of 50% or more and/or an increase in latency of 10% or more, which mandates an immediate coordinated response: confirm the signal is real, correct anaesthetic, haemodynamic, haematocrit and temperature contributors, raise the mean arterial pressure, and ask the surgeon to reverse distraction or remove implants. Stable TIVA does not itself cause an abrupt change, so this cannot be dismissed as drug effect. The change is potentially reversible rather than proof of infarction, and unchanged peripheral responses argue against a positioning-related peripheral neuropathy.

   Reference: American Clinical Neurophysiology Society guidelines on intraoperative monitoring; Miller's Anesthesia, 9th Edition (2020)

7. Question 7 · Patient Safety, Complications, Quality, Professionalism and Ethics

   An unidentified adult is brought to the emergency department after a road traffic collision. He is unconscious with a distended abdomen and a systolic blood pressure of 70 mmHg. No relatives are contactable and there is no advance directive or identification. What is the correct basis for proceeding to emergency laparotomy and general anaesthesia?

   1. AAnaesthesia should be withheld until the patient regains capacity, since valid consent is an absolute prerequisite for any intervention
   2. BConsent must be obtained from the hospital's legal department before any anaesthesia can be given
   3. CTwo consultants may sign a consent form on the patient's behalf, which is legally equivalent to the patient's own consent
   4. DTreatment may proceed under the principle of necessity, providing care that is immediately necessary and in the patient's best interests, limited to what cannot reasonably wait, with full documentation of the decision and reasoning
   Show answer and explanation

   Correct answer: D. Treatment may proceed under the principle of necessity, providing care that is immediately necessary and in the patient's best interests, limited to what cannot reasonably wait, with full documentation of the decision and reasoning

   When an adult lacks capacity in an emergency and no valid advance decision or legally authorised decision-maker is available, clinicians may lawfully provide treatment that is immediately necessary and in the patient's best interests under the doctrine of necessity, restricted to what cannot reasonably be deferred until capacity or a proxy is available, with contemporaneous documentation. No clinician or administrator can 'consent' on behalf of an adult by signing a form as a substitute for the patient's own consent (C), legal departments do not authorise emergency clinical care (B), and withholding life-saving treatment pending capacity (A) would be indefensible.

   Reference: Association of Anaesthetists 'Consent for Anaesthesia' guideline (2017); UK Mental Capacity Act 2005 (best interests, sections 4-5); GMC 'Decision Making and Consent' (2020)

8. Question 8 · Trauma, Burns, Orthopedic and Organ-Based/Specialty Anesthesia

   A 30-year-old man has a stab wound to zone II of the neck. He is haemodynamically stable but has a rapidly expanding haematoma, a hoarse voice, subcutaneous emphysema and early inspiratory stridor. The larynx is deviated and surface anatomy is distorted. What is the safest airway plan?

   1. ARapid sequence induction with cricoid pressure and direct laryngoscopy on the trauma trolley
   2. BInsert a second-generation supraglottic airway and transfer immediately to CT angiography
   3. CBlind nasotracheal intubation with the patient sitting up
   4. DAwake tracheostomy under local anaesthesia in the operating theatre with the surgeon scrubbed
   Show answer and explanation

   Correct answer: D. Awake tracheostomy under local anaesthesia in the operating theatre with the surgeon scrubbed

   With an expanding neck haematoma, distorted anatomy and impending obstruction, induction of anaesthesia may cause irretrievable loss of the airway, and a securely placed surgical airway below the injury under local anaesthesia is the safest option. Cricoid pressure risks disrupting the haematoma and worsening the view. A supraglottic airway will not bypass an obstructing haematoma or a disrupted larynx, and blind nasal intubation may create a false passage in an injured airway.

   Reference: Difficult Airway Society 2015 adult unanticipated difficult intubation guidelines; Miller's Anesthesia, 9th edition (2020), trauma anaesthesia chapter

9. Question 9 · Preoperative Assessment, Risk Stratification and Anesthesia for Co-Existing Disease

   A 71-year-old man with stable ischaemic heart disease and previous stroke is listed for elective open infrarenal aortic aneurysm repair. His RCRI is 2, he cannot climb one flight of stairs because of knee osteoarthritis, and he is on optimal medical therapy with no angina at rest. Which management is most consistent with current perioperative guidelines?

   1. AProceed with surgery, reserving pharmacological stress testing for the situation where the result would change perioperative management
   2. BOrder coronary angiography for all patients with an RCRI of 2 or more before vascular surgery
   3. CCancel surgery until prophylactic coronary revascularisation has been performed
   4. DStart high-dose metoprolol on the morning of surgery to reduce myocardial oxygen demand
   Show answer and explanation

   Correct answer: A. Proceed with surgery, reserving pharmacological stress testing for the situation where the result would change perioperative management

   Both the ACC/AHA and ESC algorithms state that non-invasive stress testing before elevated-risk surgery is reasonable only when the result will alter management, such as prompting revascularisation for a clear standalone indication or a change in the surgical plan. The CARP trial showed that prophylactic coronary revascularisation before vascular surgery does not improve outcome, so routine angiography or revascularisation is not indicated. High-dose beta-blockade started on the day of surgery increases stroke and death, as shown in POISE, and is explicitly discouraged.

   Reference: 2024 ACC/AHA Perioperative Guideline for Noncardiac Surgery; McFalls et al., CARP trial, NEJM 2004; POISE Study Group, Lancet 2008

10. Question 10 · Regional Anesthesia: Neuraxial and Peripheral Nerve Blocks

    A 78-year-old woman had a lumbar epidural catheter removed 12 hours after a dose of prophylactic enoxaparin following bowel surgery. Eight hours later she develops severe interscapular and lumbar back pain, progressive weakness of both legs and urinary retention. What is the most appropriate immediate management?

    1. AUrgent MRI of the spine and immediate neurosurgical referral for decompression
    2. BObservation with hourly neurological observations and reassessment in 12 hours
    3. CPlain radiographs of the lumbar spine followed by non-contrast CT
    4. DWithhold further enoxaparin, give vitamin K and review on the morning ward round
    Show answer and explanation

    Correct answer: A. Urgent MRI of the spine and immediate neurosurgical referral for decompression

    Progressive lower limb weakness with back pain and sphincter disturbance after neuraxial instrumentation is a spinal epidural hematoma until proven otherwise, and neurological recovery depends on decompression within about 8 hours of symptom onset, so imaging and surgical referral must be simultaneous and immediate. Watchful waiting or a next-morning review wastes the therapeutic window, CT and plain films are insensitive for epidural hematoma compared with MRI, and vitamin K does not reverse low molecular weight heparin.

    Reference: ASRA Regional Anesthesia in the Patient Receiving Antithrombotic or Thrombolytic Therapy, 4th edition (Reg Anesth Pain Med, 2018); NAP3 Royal College of Anaesthetists (2009)

11. Question 11 · Critical Care Medicine and Resuscitation

    Forty-eight hours after ROSC a post-arrest patient remains comatose off sedation for 6 hours, with an absent pupillary light reflex on one side and a motor score of 2. The family requests a definitive statement on prognosis. What is the most appropriate response?

    1. AA single absent pupillary reflex at 48 hours reliably predicts a poor outcome and treatment can be limited now
    2. BMultimodal prognostication should be deferred until at least 72 hours after ROSC, with confounders excluded and at least two concordant predictors required
    3. CA motor score of 2 alone is sufficient evidence of irreversible hypoxic brain injury
    4. DNeuroprognostication should be based on a CT brain performed within 6 hours of ROSC
    Show answer and explanation

    Correct answer: B. Multimodal prognostication should be deferred until at least 72 hours after ROSC, with confounders excluded and at least two concordant predictors required

    Guidelines require that prognostication in comatose post-arrest patients be delayed until at least 72 hours after ROSC, performed only after excluding confounders such as residual sedation, neuromuscular blockade, hypothermia, hypotension and metabolic derangement, and be multimodal with at least two concordant unfavourable predictors. Clinical signs in isolation, particularly the motor score, have unacceptably high false-positive rates. Early CT brain may show loss of grey-white differentiation but is one component of a multimodal algorithm rather than a stand-alone determinant.

    Reference: ERC-ESICM Guidelines 2021: Post-Resuscitation Care - prognostication algorithm

12. Question 12 · Obstetric Anesthesia

    NAP5 identified obstetric general anesthesia as a high-risk setting for accidental awareness. Which practice most directly reduces this risk during cesarean section under general anesthesia?

    1. AWithholding volatile agent until the umbilical cord is clamped to avoid uterine atony
    2. BSubstituting nitrous oxide 70 percent alone until delivery
    3. CMaintaining an end-tidal volatile concentration of at least 0.7 to 1.0 age-adjusted MAC from induction, with an adequate induction dose and monitoring of end-tidal agent
    4. DDeepening anesthesia only after neuromuscular blockade has been reversed
    Show answer and explanation

    Correct answer: C. Maintaining an end-tidal volatile concentration of at least 0.7 to 1.0 age-adjusted MAC from induction, with an adequate induction dose and monitoring of end-tidal agent

    Awareness in obstetric general anesthesia is driven by deliberately light anesthesia, an under-dosed induction agent relative to a raised cardiac output, and the interval between induction and establishing adequate volatile concentration, so an adequate induction dose plus a rapidly established end-tidal volatile of at least 0.7 to 1.0 age-adjusted MAC (supplemented by processed EEG where available) is the key measure. Volatile agents at these concentrations cause little clinically significant atony, and withholding them until cord clamping is precisely the practice that generates awareness. Nitrous oxide alone is insufficient, and delaying depth until reversal is nonsensical.

    Reference: NAP5: 5th National Audit Project of the Royal College of Anaesthetists and AAGBI on Accidental Awareness during General Anaesthesia, 2014

Anesthesiology reference books and guidelines

Every question in this bank names the textbook or guideline its answer rests on. These are the sources our Anesthesiology questions cite most often - the reading list to revise from alongside the bank.

Where your regulator publishes a reading list, use the editions it names. Exam questions are not taken from any one book.