Cardiovascular physiology, fluids, and blood management: curriculum recognition: 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 · Cardiovascular physiology, fluids, and blood management: curriculum recognition

Sample item

An anaesthetised, ventilated patient is tilted from supine to a 60-degree head-up sitting position for shoulder surgery, and the blood pressure falls. Which change best explains this?

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

The answer and the reasoning

A. Gravitational pooling of blood in dependent veins reduces venous return and cardiac output

Sitting upright shifts blood to the lower body, reducing preload and cardiac output, an effect worsened by vasodilating anaesthetics. Pressure at brain level is also lower than at the arm. Fluids, vasopressors and gradual positioning mitigate this.

Option by option

  • A. Gravitational pooling of blood in dependent veins reduces venous return and cardiac output (correct)

    Correct. Venous pooling reduces preload and output.

  • B. Reflex bradycardia from carotid sinus stimulation alone

    Baroreflex activity would raise heart rate in response to falling pressure.

  • C. Rise in pulmonary vascular resistance from hypoxic vasoconstriction

    Pulmonary resistance changes are not the main cause of hypotension.

  • D. Increased venous return from the lower limbs raising stroke volume

    Venous return falls rather than rises in the upright position.

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 A, Gravitational pooling of blood in dependent veins reduces venous return and cardiac output. Sitting upright shifts blood to the lower body, reducing preload and cardiac output, an effect worsened by vasodilating anaesthetics.

Why is "Reflex bradycardia from carotid sinus stimulation alone" not the answer?

Baroreflex activity would raise heart rate in response to falling pressure.

Why is "Rise in pulmonary vascular resistance from hypoxic vasoconstriction" not the answer?

Pulmonary resistance changes are not the main cause of hypotension.

Why is "Increased venous return from the lower limbs raising stroke volume" not the answer?

Venous return falls rather than rises in the upright position.

What concept does this question test?

It tests Cardiovascular physiology, fluids, and blood management: curriculum recognition in Anaesthesia. Pressure at brain level is also lower than at the arm. Fluids, vasopressors and gradual positioning mitigate this.

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 Cardiovascular physiology, fluids, and blood management: curriculum recognition?

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.