Anesthesiology Prometric exam questions with answers

1. Question 1Basic Sciences: Anesthetic Pharmacology, Applied Physiology, Anatomy and Physicsmedium

   A 28-year-old man remains apnoeic with no response to train-of-four stimulation 90 minutes after a single intubating dose of succinylcholine 1.5 mg/kg for a short procedure. Later testing shows a dibucaine number of 20. Which is the most likely explanation?

   1. AHeterozygosity for an atypical plasma cholinesterase gene
   2. BHomozygosity for the atypical plasma cholinesterase gene
   3. CAcquired plasma cholinesterase deficiency from liver disease
   4. DPhase II block caused by a single standard dose
   Show answer and explanation▾

   Answer: B. Homozygosity for the atypical plasma cholinesterase gene

   Dibucaine inhibits normal plasma cholinesterase by about 80 per cent but the atypical enzyme by only about 20 per cent, so a dibucaine number near 20 indicates homozygous atypical enzyme, which causes block lasting several hours. Heterozygotes have intermediate values of roughly 40 to 60 and only modestly prolonged block. Acquired deficiency reduces the amount of enzyme but leaves the dibucaine number normal. Management is continued sedation and ventilation until recovery, followed by counselling and family testing.

2. Question 2Preoperative Assessment, Risk Stratification and Anesthesia for Co-Existing Diseaseeasy

   A 58-year-old woman with type 2 diabetes taking empagliflozin and metformin is scheduled for an elective laparoscopic cholecystectomy. According to current perioperative guidance, when should empagliflozin be withheld?

   1. AOn the morning of surgery only
   2. BTwelve hours before surgery
   3. COne week before surgery
   4. DAt least 3 days before surgery
   Show answer and explanation▾

   Answer: D. At least 3 days before surgery

   SGLT2 inhibitors such as empagliflozin, dapagliflozin and canagliflozin should be withheld for at least 3 days before elective surgery (4 days for ertugliflozin) because of the risk of euglycaemic diabetic ketoacidosis, which can occur with near-normal glucose. Omitting only the morning dose does not allow adequate washout. Stopping for a full week is unnecessarily long and worsens glycaemic control without added safety benefit; the drug is restarted once the patient is eating and drinking normally.

3. Question 3Airway Managementhard

   A 22-year-old muscular man develops laryngospasm immediately after extubation following nasal surgery. It resolves after positive pressure and a small dose of propofol, but within 10 minutes he has pink frothy sputum, bilateral crackles and SpO2 88% on a face mask with FiO2 0.5. He is haemodynamically stable. Which is the most appropriate management?

   1. AOxygen with CPAP, escalating to intubation and PEEP only if gas exchange fails
   2. BIntravenous furosemide and morphine, then return to the ward on nasal oxygen
   3. CUrgent echocardiography to exclude cardiomyopathy before any respiratory support
   4. DIntravenous hydrocortisone and nebulised salbutamol for aspiration bronchospasm
   Show answer and explanation▾

   Answer: A. Oxygen with CPAP, escalating to intubation and PEEP only if gas exchange fails

   This is negative pressure (post-obstructive) pulmonary oedema, caused by forceful inspiration against a closed glottis generating very negative intrathoracic pressure, typically in young muscular patients. Treatment is supportive with oxygen and positive airway pressure, with intubation and PEEP reserved for refractory hypoxaemia, and most cases resolve within 24 to 48 hours. Diuretics are often given but have no proven role and are not a substitute for positive pressure, and returning him to the ward on nasal oxygen would be unsafe.

4. Question 4Conduct of General Anesthesia, Equipment, Monitoring and Fluid/Transfusion Managementeasy

   During a long general anaesthetic with a circle system and low fresh gas flow, the capnograph waveform keeps its normal shape but the inspiratory baseline gradually rises to 6 mmHg (0.8 kPa). End-tidal CO2 is climbing slowly despite unchanged ventilator settings. What is the most likely cause?

   1. ABronchospasm causing incomplete exhalation
   2. BA leak around the tracheal tube cuff
   3. CExhausted carbon dioxide absorbent
   4. DOnset of malignant hyperthermia
   Show answer and explanation▾

   Answer: C. Exhausted carbon dioxide absorbent

   A raised inspiratory baseline means CO2 is being rebreathed, and in a circle system the commonest causes are exhausted absorbent or an incompetent unidirectional valve; increasing fresh gas flow and checking the absorbent are the first steps. Malignant hyperthermia raises end-tidal CO2 through increased production, but the inspired baseline stays at zero while the absorbent and valves work. Bronchospasm produces a sloping shark-fin upstroke rather than baseline elevation.

5. Question 5Conduct of General Anesthesia, Equipment, Monitoring and Fluid/Transfusion Managementmedium

   Ninety minutes into a laparotomy, shortly after transfusion of a unit of plasma, a ventilated 45-year-old woman develops worsening hypoxaemia, bilateral infiltrates on chest radiograph and fever. Which additional finding most favours transfusion-related acute lung injury over transfusion-associated circulatory overload?

   1. ARaised jugular venous pressure with a new third heart sound
   2. BHypotension with a low central venous pressure
   3. CA rapid improvement after intravenous furosemide
   4. DA markedly raised B-type natriuretic peptide
   Show answer and explanation▾

   Answer: B. Hypotension with a low central venous pressure

   TRALI is a non-cardiogenic permeability pulmonary oedema occurring within 6 hours of transfusion, often with fever and hypotension and normal or low filling pressures; plasma-rich products from donors with leucocyte antibodies are the classic trigger. TACO is hydrostatic oedema from volume excess and is characterised by hypertension, raised venous pressure, elevated BNP and a response to diuretics. Treatment of TRALI is supportive with lung-protective ventilation, diuretics may worsen hypotension, and the reaction must be reported to the blood service.

6. Question 6Regional Anesthesia: Neuraxial and Peripheral Nerve Blocksmedium

   A 67-year-old man with severe COPD (FEV1 38% predicted) is scheduled for arthroscopic rotator cuff repair. The surgeon requests a regional technique for postoperative analgesia. Which block provides useful shoulder analgesia with the lowest risk of hemidiaphragmatic paresis?

   1. AStandard-volume interscalene brachial plexus block
   2. BSupraclavicular brachial plexus block
   3. CLow-volume interscalene block with 5 mL of local anaesthetic
   4. DSuprascapular nerve block with or without an axillary nerve block
   Show answer and explanation▾

   Answer: D. Suprascapular nerve block with or without an axillary nerve block

   Interscalene block at standard volumes causes ipsilateral phrenic nerve palsy in almost all patients, which can precipitate respiratory failure in severe COPD. Reducing the volume or moving to the supraclavicular level lowers but does not eliminate this risk, which remains clinically significant. Suprascapular nerve block, often combined with an axillary nerve block, supplies most of the shoulder joint while largely sparing the phrenic nerve, so it is preferred when diaphragmatic function must be preserved.

7. Question 7Regional Anesthesia: Neuraxial and Peripheral Nerve Blockshard

   A 34-year-old man had a perianal procedure in the lithotomy position under spinal anaesthesia with hyperbaric lidocaine. Eighteen hours later he reports aching pain in both buttocks radiating to the posterior thighs. Motor power, sensation, reflexes and bladder function are normal and he is afebrile. Which is the most appropriate management?

   1. AEmergency MRI of the lumbar spine to exclude an epidural haematoma
   2. BEpidural blood patch for presumed atypical post-dural puncture headache
   3. CReassurance and NSAIDs, expecting resolution within days
   4. DIntravenous antibiotics and lumbar puncture for suspected meningitis
   Show answer and explanation▾

   Answer: C. Reassurance and NSAIDs, expecting resolution within days

   This is transient neurological symptoms, characterised by bilateral buttock and leg pain beginning within 24 hours of spinal anaesthesia with a normal neurological examination; risk is highest with lidocaine, lithotomy positioning and ambulatory surgery. It resolves within about a week and NSAIDs are first-line analgesics. Epidural haematoma and abscess present with progressive motor or sensory deficits or bladder dysfunction, which are absent here, so emergency imaging is not indicated.

8. Question 8Cardiac, Thoracic and Vascular Anesthesiahard

   Twenty minutes after starting one-lung ventilation for a right upper lobectomy, SpO2 falls to 87%. FiO2 is already 1.0, fibreoptic bronchoscopy confirms correct double-lumen tube position, and a recruitment manoeuvre with 5 cmH2O PEEP to the ventilated lung has not helped. Haemodynamics are stable. Which is the most appropriate next step?

   1. AApply CPAP of about 5 cmH2O to the non-ventilated operative lung
   2. BIncrease PEEP on the ventilated lung to 15 cmH2O
   3. CIncrease the volatile agent to 1.5 MAC to deepen anaesthesia
   4. DBegin an infusion of a systemic vasodilator such as nitroglycerin
   Show answer and explanation▾

   Answer: A. Apply CPAP of about 5 cmH2O to the non-ventilated operative lung

   Once FiO2 is maximised, tube position confirmed and the dependent lung recruited, CPAP to the non-ventilated lung oxygenates blood shunting through it and is the most effective next step, after warning the surgeon that the lung will partially inflate. Excessive PEEP on the ventilated lung can raise its vascular resistance and divert blood to the non-ventilated lung, worsening shunt. Vasodilators and volatile agents above about 1 MAC inhibit hypoxic pulmonary vasoconstriction and increase shunt; intermittent two-lung ventilation is the fallback if hypoxaemia persists.

9. Question 9Neuroanesthesia and Neurocritical Caremedium

   During a posterior fossa craniotomy in the sitting position, end-tidal CO2 abruptly falls from 35 to 22 mmHg (4.7 to 2.9 kPa), a mill-wheel murmur is heard on the precordial Doppler and blood pressure drops. Which is the most appropriate immediate action?

   1. APlace the patient supine and start chest compressions
   2. BAsk the surgeon to flood the field with saline and give 100% oxygen
   3. CIncrease PEEP to 15 cmH2O to raise right atrial pressure
   4. DGive intravenous furosemide to reduce cerebral venous pressure
   Show answer and explanation▾

   Answer: B. Ask the surgeon to flood the field with saline and give 100% oxygen

   Venous air embolism is likely, and the immediate priorities are to stop further air entry by flooding the operative field and waxing bone edges, discontinue nitrous oxide and give 100% oxygen, then aspirate air via a right atrial catheter, lower the head and support the circulation. Chest compressions are indicated only if cardiac arrest occurs. High PEEP was once suggested but reduces cardiac output and can promote paradoxical embolism through a patent foramen ovale, so it is not recommended.

10. Question 10Obstetric Anesthesiaeasy

    A 29-year-old woman with severe pre-eclampsia is receiving a magnesium sulfate infusion. She has had low urine output for 6 hours and is now drowsy, with a respiratory rate of 8/min and absent patellar reflexes. After stopping the infusion, which treatment should be given?

    1. AIntravenous naloxone 0.4 mg
    2. BIntravenous furosemide 40 mg
    3. CIntravenous sodium bicarbonate 50 mmol
    4. DIntravenous calcium gluconate 10%, 10 mL
    Show answer and explanation▾

    Answer: D. Intravenous calcium gluconate 10%, 10 mL

    Loss of deep tendon reflexes followed by respiratory depression indicates magnesium toxicity, made more likely by oliguria because magnesium is renally excreted. Calcium gluconate 1 g (10 mL of 10%) given slowly intravenously antagonises magnesium at the neuromuscular junction, alongside airway and ventilatory support and a serum magnesium level. Naloxone has no effect on magnesium-induced depression, and furosemide does not act quickly enough to reverse life-threatening toxicity.

11. Question 11Pediatric and Neonatal Anesthesiamedium

    A 6-year-old boy weighing 20 kg is anaesthetised with sevoflurane for strabismus surgery. He develops masseter rigidity, tachycardia, a rising end-tidal CO2 despite doubling minute ventilation, and a temperature rise of 1 degree C over 15 minutes. Sevoflurane is discontinued and help is called. What is the correct initial dantrolene dose?

    1. A0.5 mg/kg intravenously, repeated once
    2. B1 mg/kg intravenously as a single dose
    3. C2.5 mg/kg intravenously, repeated until signs resolve
    4. D10 mg/kg intravenously as a single bolus
    Show answer and explanation▾

    Answer: C. 2.5 mg/kg intravenously, repeated until signs resolve

    The initial dantrolene dose in malignant hyperthermia is 2.5 mg/kg intravenously (50 mg here), repeated until hypercarbia, tachycardia and rigidity resolve; occasionally more than 10 mg/kg in total is needed. Lower doses are inadequate to halt uncontrolled ryanodine receptor calcium release, and 10 mg/kg is a cumulative threshold at which the diagnosis should be reconsidered, not a first bolus. Concurrent management includes hyperventilation with 100% oxygen at high fresh gas flows, active cooling and treatment of hyperkalaemia.

12. Question 12Trauma, Burns, Orthopedic and Organ-Based/Specialty Anesthesiaeasy

    A 40-year-old man with 35% total body surface area burns sustained 10 days ago is listed for excision and grafting. Which neuromuscular blocking drug should be avoided for rapid sequence induction?

    1. ASuccinylcholine
    2. BRocuronium
    3. CAtracurium
    4. DCisatracurium
    Show answer and explanation▾

    Answer: A. Succinylcholine

    From about 24 to 48 hours after a major burn, extrajunctional and immature acetylcholine receptors proliferate across the muscle membrane, so succinylcholine can cause massive potassium efflux and hyperkalaemic cardiac arrest; the risk persists until the burns have healed and may last many months. Rocuronium is suitable for rapid sequence induction, although burn patients are resistant to non-depolarising agents and may need larger doses. Atracurium and cisatracurium are safe but have slower onset.

13. Question 13Critical Care Medicine and Resuscitationmedium

    A 62-year-old man with septic shock from cholangitis has received 30 mL/kg of crystalloid and source control is planned. His mean arterial pressure is 58 mmHg on norepinephrine 0.35 micrograms/kg/min and lactate is 4.2 mmol/L. According to the Surviving Sepsis Campaign 2021 guideline, which is the most appropriate next step?

    1. AIncrease norepinephrine progressively without an upper dose limit
    2. BAdd vasopressin rather than escalating norepinephrine further
    3. CReplace norepinephrine with dopamine as the sole agent
    4. DStart hydrocortisone only after a cosyntropin stimulation test
    Show answer and explanation▾

    Answer: B. Add vasopressin rather than escalating norepinephrine further

    The guideline suggests adding vasopressin rather than escalating norepinephrine, usually when norepinephrine reaches 0.25 to 0.5 micrograms/kg/min, to restore a MAP of 65 mmHg while limiting catecholamine exposure. Dopamine causes more arrhythmias than norepinephrine and is not recommended as first-line. Intravenous hydrocortisone is suggested for patients with ongoing vasopressor requirements and does not require prior stimulation testing.

14. Question 14Acute and Chronic Pain Medicinehard

    A 38-year-old woman taking sublingual buprenorphine 16 mg daily for opioid use disorder, stable for 3 years, is scheduled for an elective open abdominal hysterectomy. Which perioperative plan is most consistent with current multisociety guidance?

    1. AStop buprenorphine 5 days before surgery and use full agonist opioids alone
    2. BSwitch to methadone 2 weeks before surgery and taper it after discharge
    3. CStop buprenorphine on the day of surgery and restart it at discharge
    4. DContinue buprenorphine and add multimodal analgesia, using full agonists if needed
    Show answer and explanation▾

    Answer: D. Continue buprenorphine and add multimodal analgesia, using full agonists if needed

    Current guidance favours continuing buprenorphine throughout the perioperative period, sometimes in divided doses, because stopping it risks relapse, overdose and a difficult re-induction. Adequate analgesia is usually achievable with regional techniques, non-opioid adjuncts and, when needed, high-affinity full agonists titrated to effect. Routine preoperative discontinuation was older practice and is no longer recommended for most patients, and switching to methadone adds complexity and risk without clear analgesic benefit.

15. Question 15Patient Safety, Complications, Quality, Professionalism and Ethicsmedium

    During a tracheostomy under general anaesthesia using electrocautery, a flash and flame are seen within the tracheal tube. Which is the most appropriate immediate action?

    1. AIncrease FiO2 to 1.0 and continue ventilation
    2. BInject saline down the tube while continuing ventilation
    3. CRemove the tube and stop the flow of all airway gases
    4. DDeflate the cuff and leave the tube in place
    Show answer and explanation▾

    Answer: C. Remove the tube and stop the flow of all airway gases

    In an airway fire the tracheal tube should be removed and all airway gas flow stopped simultaneously, flammable material removed and saline poured into the airway; ventilation by mask is then resumed, avoiding oxygen-enriched gas and nitrous oxide where possible, followed by bronchoscopy to assess injury. Continuing ventilation, especially with high oxygen, fuels the fire, and leaving a burning tube in place prolongs thermal injury. Prevention relies on minimising FiO2 and stopping oxygen before diathermy is used near the airway.

Last reviewed September 2026. Questions are original and written to the published exam blueprint; they are not taken from any real paper.