INI-CET 2026 - Anesthesiology PYQs Practice Questions

Q: A 40-year-old female is scheduled for parotid surgery and is administered general Anaesthesia. Approximately 10 minutes into the procedure, the following findings are noted: - Rise in end-tidal CO2 (EtCO2) - Temperature: 104°F (40°C) - Heart rate: 150 bpm - Blood pressure: 180/110 mmHg What is the most likely diagnosis?

Malignant hyperthermia. ***Malignant hyperthermia*** - This is a pharmacogenetic disorder triggered by volatile inhalational anesthetics or succinylcholine, characterized by a hypermetabolic state. - The rapid rise in **end-tidal CO2 (EtCO2)** is often the earliest sign, followed by **tachycardia**, severe **hyperthermia**, and **hypertension** due to muscle rigidity. *Heat stroke* - Typically caused by environmental exposure or extreme physical exertion, not triggered by anesthetic agents. - Patients often present with altered mental status and dry skin, occurring much later and not immediately following induction. *Heat cramps* - This is a mild form of heat illness characterized by painful muscle spasms caused by salt and water depletion. - It does not present with the systemic hypermetabolic crisis seen here, such as the rapid rise in **EtCO2** or life-threatening tachycardia. *Heat pyrexia* - Also known as heat exhaustion, this condition involves systemic symptoms like dizziness and fatigue due to heat stress. - It lacks the acute, life-threatening hypermetabolic surge associated with anesthesia administration. [Practice more Anesthesiology PYQs on OnCourse]

Q: During a lumbar puncture procedure, the spinal needle traverses several anatomical layers in a defined sequence before reaching the subarachnoid space. Given the structures listed below, which option correctly represents the order in which they are pierced? 1. Ligamentum flavum 2. Supraspinous ligament 3. Interspinous ligament 4. Dura mater 5. Subdural space 6. Arachnoid mater 7. Epidural space Which option correctly represents the order in which they are pierced?

2 → 3 → 1 → 7 → 4 → 5 → 6. ***2 → 3 → 1 → 7 → 4 → 5 → 6*** - The needle first penetrates the **supraspinous ligament**, followed by the **interspinous ligament**, and then the **ligamentum flavum** (the 'yellow ligament'), which provides a distinct 'pop' sensation upon entry. - After passing through the ligamentum flavum, the needle enters the **epidural space**, then pierces the **dura mater**, traverses the **subdural space**, and finally enters the **subarachnoid space** (after passing the arachnoid mater).*2 → 3 → 7 → 1 → 4 → 5 → 6* - This sequence incorrectly places the **epidural space** (7) before the **ligamentum flavum** (1). - The ligamentum flavum must be pierced to gain access from the superficial tissues into the epidural space, not vice versa.*3 → 2 → 1 → 7 → 4 → 5 → 6* - This sequence starts with the **interspinous ligament** (3), erroneously placing it before the **supraspinous ligament** (2). - The supraspinous ligament is the most superficial structure among the spinal ligaments involved in a midline lumbar puncture, thus it must be pierced first.*2 → 1 → 3 → 4 → 7 → 5 → 6* - This sequence incorrectly places the **ligamentum flavum** (1) before the **interspinous ligament** (3) and implies the dura is pierced before the epidural space. - Anatomically, the needle must pass through the interspinous ligament before reaching the deeper ligamentum flavum, and the epidural space lies between the ligamentum flavum and the dura. [Practice more Anesthesiology PYQs on OnCourse]

Q: Regarding the cardiovascular effects of halothane on blood pressure, the following statements are given: 1. A drop of 20-30 mmHg in blood pressure is commonly observed 2. The fall in blood pressure begins early and is proportional to the depth of Anaesthesia 3. The fall in blood pressure reduces as the depth of Anaesthesia 4. The baroreceptor reflex mechanism is activated in response to the fall in blood pressure Which of the above statements are correct?

1, 2, and 4 only. ***1, 2, and 4 only*** - Halothane is a potent volatile anesthetic well-known for causing a dose-dependent **decrease in systemic arterial blood pressure**, often by 20-30 mmHg, primarily due to **myocardial depression** and peripheral vasodilation. - This hypotension begins early during induction and correlates directly with the **depth of anesthesia** (concentration), while blunting or impairing the **baroreceptor reflex** that would normally compensate for the pressure drop. - *1, 2, and 3 only* - This option is incorrect because the fall in blood pressure does not decrease with increased depth of anesthesia; rather, it worsens as the **depth of anesthesia increases** due to intensified myocardial suppression. - Myocardial contractility is significantly reduced in a **concentration-dependent manner**, leading to decreased cardiac output at higher MAC (minimum alveolar concentration) values. - *2, 3, and 4 only* - This option incorrectly includes statement 3, which falsely suggests that the fall in blood pressure mitigates at deeper levels of anesthesia. - Statement 1 is factually correct as the **typical hypotensive response** observed is in the range of 20-30 mmHg, making its exclusion from this subset incorrect. - *1, 3, and 4 only* - This option incorrectly includes statement 3, which contradicts the known **dose-dependent effect** of halothane where depth directly correlates to the severity of hypotension. - It also excludes statement 2, which is a correct description of the temporal relationship between anesthesia induction and the onset of hemodynamic instability. [Practice more Anesthesiology PYQs on OnCourse]

Question 1

A 40-year-old female is scheduled for parotid surgery and is administered general Anaesthesia.
Approximately 10 minutes into the procedure, the following findings are noted:
- Rise in end-tidal CO2 (EtCO2)
- Temperature: 104°F (40°C)
- Heart rate: 150 bpm
- Blood pressure: 180/110 mmHg
What is the most likely diagnosis?

Accepted Answer

Malignant hyperthermia

Answer

Heat stroke

Answer

Heat cramps

Answer

Heat pyrexia

Question 2

During a lumbar puncture procedure, the spinal needle traverses several anatomical layers in a
defined sequence before reaching the subarachnoid space. Given the structures listed below,
which option correctly represents the order in which they are pierced?
1. Ligamentum flavum
2. Supraspinous ligament
3. Interspinous ligament
4. Dura mater
5. Subdural space
6. Arachnoid mater
7. Epidural space
Which option correctly represents the order in which they are pierced?

Accepted Answer

2 → 3 → 1 → 7 → 4 → 5 → 6

Answer

2 → 3 → 7 → 1 → 4 → 5 → 6

Answer

3 → 2 → 1 → 7 → 4 → 5 → 6

Answer

2 → 1 → 3 → 4 → 7 → 5 → 6

Question 3

Regarding the cardiovascular effects of halothane on blood pressure, the following statements
are given:
1. A drop of 20-30 mmHg in blood pressure is commonly observed
2. The fall in blood pressure begins early and is proportional to the depth of Anaesthesia
3. The fall in blood pressure reduces as the depth of Anaesthesia

4. The baroreceptor reflex mechanism is activated in response to the fall in blood pressure
Which of the above statements are correct?

Accepted Answer

1, 2, and 4 only

Answer

1, 2, and 3 only

Answer

2, 3, and 4 only

Answer

1, 3, and 4 only

INI-CET 2026 — Anesthesiology