Local anaesthetics: 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 · Local anaesthetics

Sample item

For a Bier block (intravenous regional anaesthesia) of the forearm, which local anaesthetic is contraindicated because of the risk of cardiac arrest if the cuff fails?

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

The answer and the reasoning

D. Bupivacaine

In intravenous regional anaesthesia, a large dose of local anaesthetic is injected into an exsanguinated limb under a tourniquet. If the cuff leaks or is released early, the agent reaches the circulation. Bupivacaine is highly cardiotoxic and has caused refractory cardiac arrest, so it must not be used, and lignocaine or prilocaine are chosen.

Option by option

  • A. Prilocaine

    Prilocaine is the preferred agent because of low systemic toxicity.

  • B. Lignocaine

    Lignocaine is the commonly used agent for Bier block.

  • C. Chloroprocaine

    Chloroprocaine is rapidly metabolised and is not the agent that is contraindicated.

  • D. Bupivacaine (correct)

    Correct. Its cardiotoxicity makes accidental systemic release dangerous.

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.

More Anaesthesia questions

Questions about this Anaesthesia question

What is the answer to this Anaesthesia question?

The best answer is D, Bupivacaine. In intravenous regional anaesthesia, a large dose of local anaesthetic is injected into an exsanguinated limb under a tourniquet.

Why is "Prilocaine" not the answer?

Prilocaine is the preferred agent because of low systemic toxicity.

Why is "Lignocaine" not the answer?

Lignocaine is the commonly used agent for Bier block.

Why is "Chloroprocaine" not the answer?

Chloroprocaine is rapidly metabolised and is not the agent that is contraindicated.

What concept does this question test?

It tests Local anaesthetics in Anaesthesia. If the cuff leaks or is released early, the agent reaches the circulation. Bupivacaine is highly cardiotoxic and has caused refractory cardiac arrest, so it must not be used, and lignocaine or prilocaine are chosen.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. 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 Local anaesthetics?

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.