Special anaesthesia: autonomic hyperreflexia: 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: autonomic hyperreflexia

Sample item

A man with a T4 spinal cord injury undergoes cystoscopy. During bladder distension his BP rises to 230/130 mmHg with a heart rate of 45 per minute and flushing above the lesion. What is the first step?

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

The answer and the reasoning

C. Stop the surgical stimulus and deepen the anaesthesia

Lesions above T6 can produce autonomic hyperreflexia, in which stimulation below the lesion causes uncontrolled sympathetic discharge. Removing the stimulus and deepening anaesthesia is the first step, followed by a rapid-acting vasodilator such as nitroglycerin if hypertension persists. The bradycardia is reflex and settles as the pressure falls.

Option by option

  • A. Give a rapid fluid bolus

    Fluids would add to the hypertension.

  • B. Give atropine as the first drug

    Atropine would treat the reflex bradycardia but leaves the dangerous hypertension.

  • C. Stop the surgical stimulus and deepen the anaesthesia (correct)

    Correct. Treating the trigger and the sympathetic discharge comes first.

  • D. Give a beta blocker for the bradycardia

    Beta blockade can worsen bradycardia and does not address the cause.

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, Stop the surgical stimulus and deepen the anaesthesia. Lesions above T6 can produce autonomic hyperreflexia, in which stimulation below the lesion causes uncontrolled sympathetic discharge.

Why is "Give a rapid fluid bolus" not the answer?

Fluids would add to the hypertension.

Why is "Give atropine as the first drug" not the answer?

Atropine would treat the reflex bradycardia but leaves the dangerous hypertension.

Why is "Give a beta blocker for the bradycardia" not the answer?

Beta blockade can worsen bradycardia and does not address the cause.

What concept does this question test?

It tests Special anaesthesia: autonomic hyperreflexia in Anaesthesia. Removing the stimulus and deepening anaesthesia is the first step, followed by a rapid-acting vasodilator such as nitroglycerin if hypertension persists. The bradycardia is reflex and settles as the pressure falls.

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: autonomic hyperreflexia?

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.