Special anaesthesia: anterior mediastinal mass: 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 · Special anaesthesia: anterior mediastinal mass

Sample item

A 25-year-old man with a large anterior mediastinal mass and orthopnoea needs a biopsy under general anaesthesia. Which induction technique is safest?

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

The answer and the reasoning

C. Inhalational induction with spontaneous ventilation, avoiding muscle relaxants

Muscle relaxation and positive pressure ventilation can allow the mass to compress the trachea, bronchi or great vessels, causing complete obstruction. Spontaneous ventilation maintains the negative pleural pressure that keeps the airways open. The patient should be positioned in the most comfortable posture, with a plan to turn lateral or prone and a rigid bronchoscope available.

Option by option

  • A. Rapid sequence induction with suxamethonium, supine

    Paralysis removes the traction that holds the airway open and can cause collapse.

  • B. Heavy sedative premedication followed by supine positioning

    Heavy sedation and supine posture can worsen obstruction and hypoventilation.

  • C. Inhalational induction with spontaneous ventilation, avoiding muscle relaxants (correct)

    Correct. Preserving spontaneous ventilation prevents loss of airway patency from the mass.

  • D. Induction with propofol and rocuronium followed by controlled ventilation

    Controlled ventilation after relaxant can lead to complete airway or vascular compression.

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.

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Questions about this Anaesthesia question

What is the answer to this Anaesthesia question?

The best answer is C, Inhalational induction with spontaneous ventilation, avoiding muscle relaxants. Muscle relaxation and positive pressure ventilation can allow the mass to compress the trachea, bronchi or great vessels, causing complete obstruction.

Why is "Rapid sequence induction with suxamethonium, supine" not the answer?

Paralysis removes the traction that holds the airway open and can cause collapse.

Why is "Heavy sedative premedication followed by supine positioning" not the answer?

Heavy sedation and supine posture can worsen obstruction and hypoventilation.

Why is "Induction with propofol and rocuronium followed by controlled ventila…" not the answer?

Controlled ventilation after relaxant can lead to complete airway or vascular compression.

What concept does this question test?

It tests Special anaesthesia: anterior mediastinal mass in Anaesthesia. Spontaneous ventilation maintains the negative pleural pressure that keeps the airways open. The patient should be positioned in the most comfortable posture, with a plan to turn lateral or prone and a rigid bronchoscope available.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. 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 Special anaesthesia: anterior mediastinal mass?

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.