Special anaesthesia: hypertrophic cardiomyopathy: 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: hypertrophic cardiomyopathy

Sample item

A patient with hypertrophic obstructive cardiomyopathy becomes hypotensive after induction of anaesthesia. Which drug is the most appropriate?

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

The answer and the reasoning

C. Phenylephrine

Outflow obstruction worsens with a fast, forceful contraction, reduced preload and reduced afterload. Phenylephrine raises afterload and does not increase contractility, which lessens the gradient. Inotropes and vasodilators increase obstruction.

Option by option

  • A. Isoprenaline

    Isoprenaline is a beta agonist that increases contractility and tachycardia, worsening obstruction.

  • B. Dobutamine

    Dobutamine increases contractility and heart rate, worsening obstruction.

  • C. Phenylephrine (correct)

    Correct. A pure alpha agonist raises afterload and reduces the outflow gradient.

  • D. Glyceryl trinitrate

    Glyceryl trinitrate reduces preload and afterload, which increases the gradient.

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, Phenylephrine. Outflow obstruction worsens with a fast, forceful contraction, reduced preload and reduced afterload.

Why is "Isoprenaline" not the answer?

Isoprenaline is a beta agonist that increases contractility and tachycardia, worsening obstruction.

Why is "Dobutamine" not the answer?

Dobutamine increases contractility and heart rate, worsening obstruction.

Why is "Glyceryl trinitrate" not the answer?

Glyceryl trinitrate reduces preload and afterload, which increases the gradient.

What concept does this question test?

It tests Special anaesthesia: hypertrophic cardiomyopathy in Anaesthesia. Phenylephrine raises afterload and does not increase contractility, which lessens the gradient. Inotropes and vasodilators increase obstruction.

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: hypertrophic cardiomyopathy?

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.