Regional anaesthesia: epidural abscess: 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 · Regional anaesthesia: epidural abscess

Sample item

Five days after labour epidural analgesia, a woman has severe back pain, fever and new weakness of both legs. What is the most appropriate next step?

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

The answer and the reasoning

D. Urgent MRI, blood cultures, antibiotics and neurosurgical review

Back pain, fever and a developing neurological deficit after neuraxial instrumentation suggest an epidural abscess, a spinal emergency. Urgent MRI, cultures, antistaphylococcal antibiotics and early surgical decompression give the best chance of neurological recovery. Delay in diagnosis is the main factor in poor outcome.

Option by option

  • A. Oral analgesics and review in a week

    Delaying evaluation risks permanent paralysis.

  • B. Epidural blood patch

    A blood patch treats post-dural puncture headache and would not help, and may spread infection.

  • C. Reassure and repeat examination after discharge

    Discharge without investigation is unsafe in a patient with a progressing deficit.

  • D. Urgent MRI, blood cultures, antibiotics and neurosurgical review (correct)

    Correct. This is a time-critical diagnosis needing imaging, antibiotics and decompression.

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 D, Urgent MRI, blood cultures, antibiotics and neurosurgical review. Back pain, fever and a developing neurological deficit after neuraxial instrumentation suggest an epidural abscess, a spinal emergency.

Why is "Oral analgesics and review in a week" not the answer?

Delaying evaluation risks permanent paralysis.

Why is "Epidural blood patch" not the answer?

A blood patch treats post-dural puncture headache and would not help, and may spread infection.

Why is "Reassure and repeat examination after discharge" not the answer?

Discharge without investigation is unsafe in a patient with a progressing deficit.

What concept does this question test?

It tests Regional anaesthesia: epidural abscess in Anaesthesia. Urgent MRI, cultures, antistaphylococcal antibiotics and early surgical decompression give the best chance of neurological recovery. Delay in diagnosis is the main factor in poor outcome.

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 Regional anaesthesia: epidural abscess?

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.