Perioperative care: laparoscopic pneumoperitoneum: practice question

A General Surgery 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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General Surgery · Perioperative care: laparoscopic pneumoperitoneum

Sample item

During laparoscopic cholecystectomy, the anaesthetist notes a sudden drop in end-tidal CO2, hypotension and a mill-wheel murmur. What is the complication and immediate action?

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

The answer and the reasoning

C. Carbon dioxide gas embolism; stop insufflation, left lateral head-down position and aspirate via central line

CO2 pneumoperitoneum at 12 to 15 mmHg can rarely cause venous gas embolism, producing a mill-wheel murmur and collapse. Treatment is to stop insufflation, desufflate, 100 percent oxygen, and position left lateral head-down (Durant). Shoulder-tip pain is from diaphragmatic irritation.

Option by option

  • A. Subcutaneous emphysema; continue

    Emphysema does not cause this pattern.

  • B. Pneumothorax; increase insufflation

    Increasing insufflation worsens embolism.

  • C. Carbon dioxide gas embolism; stop insufflation, left lateral head-down position and aspirate via central line (correct)

    Correct. This is gas embolism management.

  • D. Shoulder-tip pain; analgesia

    Shoulder pain is benign.

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 General Surgery questions

Questions about this General Surgery question

What is the answer to this General Surgery question?

The best answer is C, Carbon dioxide gas embolism; stop insufflation, left lateral head-down position and aspirate via central line. CO2 pneumoperitoneum at 12 to 15 mmHg can rarely cause venous gas embolism, producing a mill-wheel murmur and collapse.

Why is "Subcutaneous emphysema; continue" not the answer?

Emphysema does not cause this pattern.

Why is "Pneumothorax; increase insufflation" not the answer?

Increasing insufflation worsens embolism.

Why is "Shoulder-tip pain; analgesia" not the answer?

Shoulder pain is benign.

What concept does this question test?

It tests Perioperative care: laparoscopic pneumoperitoneum in General Surgery. Treatment is to stop insufflation, desufflate, 100 percent oxygen, and position left lateral head-down (Durant). Shoulder-tip pain is from diaphragmatic irritation.

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 Perioperative care: laparoscopic pneumoperitoneum?

Learn classic signs and eponyms alongside what they diagnose. Then use the flashcards and the other General Surgery 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.