Breast and endocrine surgery: hypotension after adrenal vein ligation: 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 · Breast and endocrine surgery: hypotension after adrenal vein ligation

Sample item

During laparoscopic adrenalectomy for a phaeochromocytoma in a patient prepared with phenoxybenzamine, blood pressure falls to 70/40 mmHg within minutes of ligating the adrenal vein. What is the best immediate management?

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

The answer and the reasoning

A. Intravenous fluid loading with vasopressors if needed

After the tumour venous drainage is controlled, circulating catecholamines fall abruptly while alpha blockade and chronic volume contraction persist, causing profound vasodilatation and hypotension. Treatment is rapid volume expansion, with vasopressors if required, and preparation includes adequate preoperative fluids.

Option by option

  • A. Intravenous fluid loading with vasopressors if needed (correct)

    Correct. Volume replacement and vasopressors counter the vasodilatation after the catecholamine surge ends.

  • B. Beta blocker infusion

    Beta blockade lowers cardiac output and would worsen the hypotension.

  • C. More alpha blockade

    Further alpha blockade would cause more vasodilatation.

  • D. Phentolamine bolus

    Phentolamine is an alpha blocker used for hypertensive surges, not for hypotension.

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 A, Intravenous fluid loading with vasopressors if needed. After the tumour venous drainage is controlled, circulating catecholamines fall abruptly while alpha blockade and chronic volume contraction persist, causing profound vasodilatation and hypotension.

Why is "Beta blocker infusion" not the answer?

Beta blockade lowers cardiac output and would worsen the hypotension.

Why is "More alpha blockade" not the answer?

Further alpha blockade would cause more vasodilatation.

Why is "Phentolamine bolus" not the answer?

Phentolamine is an alpha blocker used for hypertensive surges, not for hypotension.

What concept does this question test?

It tests Breast and endocrine surgery: hypotension after adrenal vein ligation in General Surgery. Treatment is rapid volume expansion, with vasopressors if required, and preparation includes adequate preoperative fluids.

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 Breast and endocrine surgery: hypotension after adrenal vein ligation?

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.