INI-CET 2025 - Anesthesiology PYQs Practice Questions

Q: A 50-year-old male patient underwent lower abdominal surgery under general anaesthesia. Vecuronium was administered as a muscle relaxant during the procedure. At the end of the surgery, which of the following is the most appropriate agent to reverse the effects of vecuronium?

Neostigmine. ### **Explanation** The correct answer is **B. Neostigmine**. #### **Mechanism of Action** **Vecuronium** is a **non-depolarizing neuromuscular blocking agent (NDMR)** that works by competitively inhibiting nicotinic acetylcholine receptors at the neuromuscular junction. To reverse its effects, we must increase the concentration of acetylcholine (ACh) at the synapse. **Neostigmine** is an **acetylcholinesterase inhibitor**. By inhibiting the enzyme that breaks down ACh, it increases the availability of ACh, which then outcompetes the vecuronium molecules for the receptor sites, thereby restoring muscle power. #### **Analysis of Incorrect Options** * **A. Baclofen:** This is a **GABA-B agonist** used as a centrally acting muscle relaxant for chronic spasticity (e.g., multiple sclerosis). it has no role in reversing surgical neuromuscular blockade. * **C. Atropine:** This is an **anticholinergic (muscarinic antagonist)**. While it is almost always given *alongside* neostigmine to prevent bradycardia and secretions caused by increased ACh at muscarinic sites, it does not reverse the muscle relaxant effect itself. * **D. Drotaverine:** This is an **antispasmodic** (phosphodiesterase-4 inhibitor) used primarily for smooth muscle relaxation in cases of biliary or renal colic. #### **High-Yield Clinical Pearls for INI-CET** * **The "Gold Standard" Pair:** Neostigmine is co-administered with **Glycopyrrolate** (preferred over Atropine) to counteract the parasympathetic side effects (bradycardia, salivation, bronchospasm). * **Sugammadex:** A newer, high-yield reversal agent specifically for **Rocuronium** and **Vecuronium**. It works by **encapsulation** (chelating the drug) rather than enzyme inhibition. * **Monitoring:** Reversal should ideally be guided by **Train-of-Four (TOF)** monitoring; a TOF ratio of **>0.9** indicates adequate recovery from blockade. [Practice more Anesthesiology PYQs on OnCourse]

Question 1

A 65-year-old patient is on mechanical ventilation for acute respiratory distress syndrome (ARDS). Suddenly, the patient becomes hypotensive, tachycardic, and shows absent breath sounds on the left side with tracheal deviation to the right. What is the most common cause of this in patients receiving mechanical ventilation?

Accepted Answer

Barotrauma due to high airway pressure

Answer

Endotracheal tube malposition

Answer

Oxygen toxicity

Answer

High tidal volume

Question 2

A 50-year-old male patient underwent lower abdominal surgery under general anaesthesia. Vecuronium was administered as a muscle relaxant during the procedure. At the end of the surgery, which of the following is the most appropriate agent to reverse the effects of vecuronium?

Accepted Answer

Neostigmine

Answer

Baclofen

Answer

Atropine

Answer

Drotaverine

Question 3

According to the Muir-Barclay formula, which of the following is considered the best colloid for volume replacement?

Accepted Answer

Albumin

Answer

Fresh Frozen Plasma (FFP)

Answer

Packed Red Blood Cells (PRBC)

Answer

Dextran 40

INI-CET 2025 — Anesthesiology