Neuromuscular blockers: 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.

Try it

Anaesthesia · Neuromuscular blockers

Sample item

At the end of surgery, residual neuromuscular block from atracurium is reversed with neostigmine. Why is glycopyrrolate given with it?

ATo prevent malignant hyperthermiaBTo counter the muscarinic effects such as bradycardia and salivationCTo increase acetylcholine release at the motor end plateDTo deepen the neuromuscular block

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

The answer and the reasoning

B. To counter the muscarinic effects such as bradycardia and salivation

Neostigmine inhibits acetylcholinesterase, raising acetylcholine at both nicotinic and muscarinic sites. An antimuscarinic such as glycopyrrolate or atropine is given with it to prevent bradycardia, bronchospasm, increased secretions and intestinal hypermotility.

Option by option

A. To prevent malignant hyperthermia
Glycopyrrolate has no role in prevention or treatment of malignant hyperthermia.
B. To counter the muscarinic effects such as bradycardia and salivation (correct)
Correct. Antimuscarinic cover blocks the unwanted parasympathetic effects of neostigmine.
C. To increase acetylcholine release at the motor end plate
Glycopyrrolate does not increase acetylcholine release.
D. To deepen the neuromuscular block
Glycopyrrolate has no effect on neuromuscular block depth.

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.

Questions about this Anaesthesia question

What is the answer to this Anaesthesia question?

The best answer is B, To counter the muscarinic effects such as bradycardia and salivation. Neostigmine inhibits acetylcholinesterase, raising acetylcholine at both nicotinic and muscarinic sites.

Why is "To prevent malignant hyperthermia" not the answer?

Glycopyrrolate has no role in prevention or treatment of malignant hyperthermia.

Why is "To increase acetylcholine release at the motor end plate" not the answer?

Glycopyrrolate does not increase acetylcholine release.

Why is "To deepen the neuromuscular block" not the answer?

Glycopyrrolate has no effect on neuromuscular block depth.

What concept does this question test?

It tests Neuromuscular blockers in Anaesthesia. An antimuscarinic such as glycopyrrolate or atropine is given with it to prevent bradycardia, bronchospasm, increased secretions and intestinal hypermotility.

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 blockers?

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.