Intravenous and inhalational agents: ketamine in ischaemic heart disease: 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 · Intravenous and inhalational agents: ketamine in ischaemic heart disease

Sample item

A 66-year-old man with severe uncontrolled hypertension and angina needs a short procedure under intravenous anaesthesia. Why is ketamine a poor choice?

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

The answer and the reasoning

D. It raises heart rate and blood pressure, increasing myocardial oxygen demand

Ketamine's sympathomimetic effect increases heart rate, blood pressure and cardiac output, raising myocardial oxygen consumption. This is undesirable in patients with ischaemic heart disease or poorly controlled hypertension.

Option by option

  • A. It depresses myocardial contractility in all patients

    Direct depression appears only when catecholamine reserves are exhausted, not in all patients.

  • B. It causes coronary vasodilation and steal

    Coronary steal is a concern with isoflurane, not with ketamine.

  • C. It blocks beta receptors and causes bradycardia

    Ketamine does not block beta receptors.

  • D. It raises heart rate and blood pressure, increasing myocardial oxygen demand (correct)

    Correct. The rise in rate and pressure increases oxygen demand in a heart with limited supply.

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, It raises heart rate and blood pressure, increasing myocardial oxygen demand. Ketamine's sympathomimetic effect increases heart rate, blood pressure and cardiac output, raising myocardial oxygen consumption.

Why is "It depresses myocardial contractility in all patients" not the answer?

Direct depression appears only when catecholamine reserves are exhausted, not in all patients.

Why is "It causes coronary vasodilation and steal" not the answer?

Coronary steal is a concern with isoflurane, not with ketamine.

Why is "It blocks beta receptors and causes bradycardia" not the answer?

Ketamine does not block beta receptors.

What concept does this question test?

It tests Intravenous and inhalational agents: ketamine in ischaemic heart disease in Anaesthesia. This is undesirable in patients with ischaemic heart disease or poorly controlled hypertension.

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 Intravenous and inhalational agents: ketamine in ischaemic heart disease?

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.