Perioperative: post-dural puncture headache: practice question

A General Surgery 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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General Surgery · Perioperative: post-dural puncture headache

Sample item

A 28-year-old man has a spinal anaesthetic for hernia repair. On day 2 he has a severe headache that is worse sitting and relieved lying flat, with no fever. It persists after 3 days of fluids, caffeine and analgesia. What is the next treatment?

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

The answer and the reasoning

B. Epidural blood patch

Post-dural puncture headache follows leakage of cerebrospinal fluid through the dural hole, which lowers intracranial pressure and causes traction on pain-sensitive structures when upright. It is more common with larger or cutting needles and in young patients. Conservative measures work in many, and an epidural blood patch, which seals the leak, is effective for persistent cases.

Option by option

  • A. Repeat lumbar puncture to drain fluid

    Further puncture would drain more fluid and worsen the headache.

  • B. Epidural blood patch (correct)

    Autologous blood injected into the epidural space seals the dural tear.

  • C. Intrathecal antibiotics

    There is no infection to treat, as fever and meningism are absent.

  • D. Stopping oral intake

    Fasting has no effect on cerebrospinal fluid leakage.

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 General Surgery question

What is the answer to this General Surgery question?

The best answer is B, Epidural blood patch. Post-dural puncture headache follows leakage of cerebrospinal fluid through the dural hole, which lowers intracranial pressure and causes traction on pain-sensitive structures when upright.

Why is "Repeat lumbar puncture to drain fluid" not the answer?

Further puncture would drain more fluid and worsen the headache.

Why is "Intrathecal antibiotics" not the answer?

There is no infection to treat, as fever and meningism are absent.

Why is "Stopping oral intake" not the answer?

Fasting has no effect on cerebrospinal fluid leakage.

What concept does this question test?

It tests Perioperative: post-dural puncture headache in General Surgery. It is more common with larger or cutting needles and in young patients. Conservative measures work in many, and an epidural blood patch, which seals the leak, is effective for persistent cases.

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 Perioperative: post-dural puncture headache?

Learn classic signs and eponyms alongside what they diagnose. Then use the flashcards and the other General Surgery 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.