Neuromuscular monitoring: practice question

A Anaesthesia question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Anaesthesia · Neuromuscular monitoring

Sample item

During surgery, train-of-four stimulation of the ulnar nerve shows four twitches that progressively fade, with an enhanced response after tetanic stimulation. Which block does this indicate?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

A. Non-depolarising block

A non-depolarising agent competes with acetylcholine and produces fade on train-of-four and post-tetanic potentiation. A phase I depolarising block reduces all twitches equally without fade. Neostigmine with glycopyrrolate, or sugammadex for aminosteroid agents, reverses the block.

Option by option

  • A. Non-depolarising block (correct)

    Correct. Fade with post-tetanic potentiation is characteristic of non-depolarising block.

  • B. Central depression from the volatile agent alone

    Volatile agents do not produce train-of-four fade by acting centrally.

  • C. Normal neuromuscular function

    Normal transmission gives four equal twitches without fade.

  • D. Phase I depolarising block

    Phase I depolarising block shows no fade and no post-tetanic potentiation.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

More Anaesthesia questions

Questions about this Anaesthesia question

What is the answer to this Anaesthesia question?

The best answer is A, Non-depolarising block. A non-depolarising agent competes with acetylcholine and produces fade on train-of-four and post-tetanic potentiation.

Why is "Central depression from the volatile agent alone" not the answer?

Volatile agents do not produce train-of-four fade by acting centrally.

Why is "Normal neuromuscular function" not the answer?

Normal transmission gives four equal twitches without fade.

Why is "Phase I depolarising block" not the answer?

Phase I depolarising block shows no fade and no post-tetanic potentiation.

What concept does this question test?

It tests Neuromuscular monitoring in Anaesthesia. A phase I depolarising block reduces all twitches equally without fade. Neostigmine with glycopyrrolate, or sugammadex for aminosteroid agents, reverses the block.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Neuromuscular monitoring?

Make a table of each agent, its key advantage and its main side effect. Then use the flashcards and the other Anaesthesia questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.