Local and regional anaesthesia: Horner syndrome after interscalene block: 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: Horner syndrome after interscalene block

Sample item

After an interscalene block for shoulder surgery, the patient has ptosis, miosis and anhidrosis on the same side of the face. What is the cause?

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

The answer and the reasoning

C. Spread of local anaesthetic to the cervical sympathetic chain

Local anaesthetic spreading to the cervical sympathetic chain or stellate ganglion produces Horner syndrome, which is harmless and resolves as the block wears off. Phrenic block causes dyspnoea, recurrent laryngeal block causes hoarseness and vertebral artery injection causes seizures.

Option by option

  • A. Block of the recurrent laryngeal nerve

    Recurrent laryngeal block gives hoarseness.

  • B. Injection into the vertebral artery

    Vertebral artery injection causes sudden seizures and collapse.

  • C. Spread of local anaesthetic to the cervical sympathetic chain (correct)

    Correct. Sympathetic chain block gives ptosis, miosis and anhidrosis.

  • D. Block of the phrenic nerve

    Phrenic block gives hemidiaphragm paralysis and breathlessness.

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, Spread of local anaesthetic to the cervical sympathetic chain. Local anaesthetic spreading to the cervical sympathetic chain or stellate ganglion produces Horner syndrome, which is harmless and resolves as the block wears off.

Why is "Block of the recurrent laryngeal nerve" not the answer?

Recurrent laryngeal block gives hoarseness.

Why is "Injection into the vertebral artery" not the answer?

Vertebral artery injection causes sudden seizures and collapse.

Why is "Block of the phrenic nerve" not the answer?

Phrenic block gives hemidiaphragm paralysis and breathlessness.

What concept does this question test?

It tests Local and regional anaesthesia: Horner syndrome after interscalene block in Anaesthesia. Phrenic block causes dyspnoea, recurrent laryngeal block causes hoarseness and vertebral artery injection causes seizures.

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 and regional anaesthesia: Horner syndrome after interscalene block?

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.