Local and regional anaesthesia: bladder perforation under spinal: 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 and regional anaesthesia: bladder perforation under spinal

Sample item

A man having transurethral prostate resection under spinal anaesthesia to T10 suddenly complains of pain in the shoulder tip, and his abdomen becomes distended and he is pale. The sodium is normal and he is oriented. What is the most likely cause?

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

The answer and the reasoning

C. Bladder perforation with leakage of irrigating fluid

Perforation lets irrigating fluid collect around the bladder, and a T10 block still allows referred shoulder pain from diaphragmatic irritation, together with abdominal distension and signs of shock. TURP syndrome from absorbed fluid presents with confusion, nausea and low sodium rather than abdominal signs.

Option by option

  • A. A high spinal block from cephalad spread

    A high block would cause breathing difficulty and arm weakness, not shoulder pain with distension.

  • B. Pulmonary embolism

    Pulmonary embolism would cause dyspnoea and hypoxia without abdominal distension.

  • C. Bladder perforation with leakage of irrigating fluid (correct)

    Correct. Shoulder tip pain with distension and a normal sodium suggests fluid in the abdomen from perforation.

  • D. Hyponatraemia from absorbed irrigating fluid

    Hyponatraemia would give confusion and visual change, and sodium here is normal.

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, Bladder perforation with leakage of irrigating fluid. Perforation lets irrigating fluid collect around the bladder, and a T10 block still allows referred shoulder pain from diaphragmatic irritation, together with abdominal distension and signs of shock.

Why is "A high spinal block from cephalad spread" not the answer?

A high block would cause breathing difficulty and arm weakness, not shoulder pain with distension.

Why is "Pulmonary embolism" not the answer?

Pulmonary embolism would cause dyspnoea and hypoxia without abdominal distension.

Why is "Hyponatraemia from absorbed irrigating fluid" not the answer?

Hyponatraemia would give confusion and visual change, and sodium here is normal.

What concept does this question test?

It tests Local and regional anaesthesia: bladder perforation under spinal in Anaesthesia. TURP syndrome from absorbed fluid presents with confusion, nausea and low sodium rather than abdominal signs.

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 Local and regional anaesthesia: bladder perforation under spinal?

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.