Critical care: auto-PEEP: 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 · Critical care: auto-PEEP

Sample item

A ventilated COPD patient has expiratory flow that does not return to zero before the next breath and is hypotensive. What is the best action?

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

The answer and the reasoning

C. Reduce the respiratory rate and lengthen expiratory time, with a short disconnection if severe

Failure of flow to reach zero before the next breath signals dynamic hyperinflation (auto-PEEP), which reduces venous return and causes hypotension. Management lengthens expiratory time by lowering the rate and tidal volume, treats bronchospasm and may need brief disconnection to allow exhalation. Avoid excess sedation fixing high rates.

Option by option

  • A. Increase tidal volume

    A larger tidal volume increases trapping.

  • B. Increase the respiratory rate

    A higher rate shortens expiration and worsens trapping.

  • C. Reduce the respiratory rate and lengthen expiratory time, with a short disconnection if severe (correct)

    Correct. More time for expiration relieves trapping.

  • D. Shorten the expiratory time

    A short expiratory time worsens auto-PEEP.

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, Reduce the respiratory rate and lengthen expiratory time, with a short disconnection if severe. Failure of flow to reach zero before the next breath signals dynamic hyperinflation (auto-PEEP), which reduces venous return and causes hypotension.

Why is "Increase tidal volume" not the answer?

A larger tidal volume increases trapping.

Why is "Increase the respiratory rate" not the answer?

A higher rate shortens expiration and worsens trapping.

Why is "Shorten the expiratory time" not the answer?

A short expiratory time worsens auto-PEEP.

What concept does this question test?

It tests Critical care: auto-PEEP in Anaesthesia. Management lengthens expiratory time by lowering the rate and tidal volume, treats bronchospasm and may need brief disconnection to allow exhalation. Avoid excess sedation fixing high rates.

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 Critical care: auto-PEEP?

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.