Prometric Exam Questions for Anaesthesiology Specialists 2026: 15 Practice MCQs with Answers and Rationale for the ANA5781 Paper

The anaesthesiology specialist paper (ANA5781) is written for the anaesthesia registrar: assessing the patient the night before, managing the airway, choosing and dosing drugs, running a regional block, handling the emergency on the table, and looking after the patient in recovery and intensive care. It is usually 100 to 150 single-best-answer questions in 2.5 to 3 hours, with a pass mark of about 65%.

The fifteen questions below follow that blueprint. Allow about 70 seconds each and read every rationale. The paper rewards exact doses, exact numbers and the correct order of actions in a crisis.

For titles and the route, read the anaesthesiologist guide. For timed papers use the Anaesthesia specialist bank, about 2,600 questions. Anaesthesia technicians sit a separate paper (technician sample questions).

Preoperative assessment

Question 1

A 68-year-old with stable angina on medication, controlled hypertension and an exercise tolerance of more than four metabolic equivalents is scheduled for an inguinal hernia repair. His ASA class and the appropriate cardiac work-up are:

1. ASA I; no tests
2. ASA III; proceed with no further cardiac testing, since functional capacity is good and the surgery is low risk
3. ASA IV; cancel surgery
4. ASA II; coronary angiography first

Answer: B. Severe systemic disease that is not life-threatening is ASA III. Good functional capacity before low-risk surgery does not warrant further cardiac testing; continue beta blockers and statins perioperatively.

Question 2

The standard fasting guidance for an adult before elective general anaesthesia is:

1. Nothing by mouth from midnight regardless of the time of surgery
2. Clear fluids up to 2 hours, breast milk 4 hours, light meal and non-human milk 6 hours before induction
3. Clear fluids up to 30 minutes
4. Solid food up to 2 hours

Answer: B. The 2-4-6 rule reduces aspiration risk without unnecessary dehydration. Many units now encourage clear carbohydrate drinks until two hours before surgery.

Question 3

Which finding on airway assessment most strongly predicts difficult laryngoscopy?

1. Mallampati class I
2. Mallampati class III or IV, thyromental distance under 6 cm, reduced mouth opening and limited neck extension, especially in combination
3. Loose dentures
4. Thin neck

Answer: B. No single test is reliable; combinations of Mallampati, thyromental distance, inter-incisor gap, neck mobility and a history of difficult intubation predict difficulty and trigger a plan with videolaryngoscopy and awake techniques available.

Airway and induction

Question 4

During rapid sequence induction for a patient with bowel obstruction, which drug combination and technique is standard?

1. Slow titrated propofol with a laryngeal mask
2. Pre-oxygenation, a predetermined induction dose (for example propofol or ketamine), a rapid-onset relaxant such as suxamethonium 1 to 1.5 mg/kg or rocuronium 1.2 mg/kg, and intubation without mask ventilation unless hypoxia develops
3. Inhalational induction with sevoflurane
4. Midazolam alone

Answer: B. RSI minimises the time between loss of airway reflexes and a secured airway. Rocuronium with sugammadex available is an increasingly common alternative to suxamethonium.

Question 5

After intubation, the capnography trace is absent despite chest movement and a passing view at laryngoscopy. The correct action is:

1. Assume the capnograph is faulty and proceed
2. Treat as oesophageal intubation until proven otherwise: remove the tube and ventilate by mask, or confirm immediately by repeat laryngoscopy, with "no trace, wrong place" as the rule
3. Give adrenaline
4. Increase the ventilator rate

Answer: B. Unrecognised oesophageal intubation kills. Sustained exhaled CO₂ is the only reliable confirmation; even in cardiac arrest a low trace is present with correct placement.

Question 6

In the "cannot intubate, cannot oxygenate" situation after failed supraglottic airway rescue, the next step is:

1. Further attempts at laryngoscopy
2. Declare the emergency and perform front-of-neck access, usually scalpel-bougie-tube cricothyroidotomy, while continuing oxygenation attempts
3. Wake the patient slowly
4. Nasal intubation

Answer: B. The difficult airway algorithm ends in emergency front-of-neck access. Repeated laryngoscopy wastes the oxygen reserve. Declaring the emergency aloud is part of the algorithm.

Pharmacology and regional anaesthesia

Question 7

The maximum recommended dose of bupivacaine for a regional block in a 70 kg adult is approximately:

1. 7 mg/kg, about 490 mg
2. 2 mg/kg, about 140 mg (2.5 to 3 mg/kg with adrenaline in some guidelines)
3. 0.5 mg/kg, about 35 mg
4. No maximum

Answer: B. Bupivacaine is cardiotoxic; levobupivacaine and ropivacaine are safer alternatives. Toxicity is treated with 20% lipid emulsion (1.5 mL/kg bolus then infusion) and prolonged resuscitation.

Question 8

Ten minutes after a spinal anaesthetic for caesarean section, the patient's blood pressure falls to 75/40 mmHg with nausea. The first-line vasopressor is:

1. Adrenaline bolus
2. Phenylephrine, with left lateral tilt and fluid co-loading, titrated to maintain blood pressure near baseline
3. Dopamine infusion
4. No treatment; it will resolve

Answer: B. Phenylephrine maintains uteroplacental perfusion with a better fetal acid-base profile than ephedrine, which is reserved for maternal bradycardia. Prophylactic infusion is now common practice.

Question 9

Which patient has an absolute contraindication to neuraxial anaesthesia?

1. A patient on aspirin 75 mg alone
2. A patient with uncorrected coagulopathy, therapeutic anticoagulation within the timing window, infection at the puncture site, raised intracranial pressure or patient refusal
3. A patient with controlled hypertension
4. A patient with mild scoliosis

Answer: B. Timing rules for LMWH (12 hours after prophylactic, 24 hours after therapeutic doses) and DOACs are tested; aspirin alone is not a contraindication.

Intraoperative emergencies

Question 10

Thirty minutes into a sevoflurane anaesthetic, end-tidal CO₂ rises steadily despite increased ventilation, with tachycardia, rigidity and a rising temperature. Management includes:

1. Deepen the volatile anaesthetic
2. Stop volatile agents and suxamethonium, hyperventilate with 100% oxygen on a clean circuit, give dantrolene 2.5 mg/kg IV repeated as needed, actively cool, and treat hyperkalaemia and acidosis
3. Give more neostigmine
4. Beta blockers only

Answer: B. Malignant hyperthermia is a pharmacogenetic emergency; a rising end-tidal CO₂ is the earliest sign. Dantrolene must be available in every theatre, and the patient and family are referred for testing afterwards.

Question 11

A patient develops sudden bronchospasm, hypotension to 60/30 mmHg and a widespread rash after antibiotic administration under anaesthesia. The treatment is:

1. Antihistamine and observation
2. Stop the likely trigger, call for help, 100% oxygen, intravenous adrenaline in 50 microgram boluses titrated to response (or 0.5 mg intramuscularly if no IV access), large-volume crystalloid, and an adrenaline infusion if refractory; send tryptase samples
3. Steroids first
4. Terminate surgery immediately without treatment

Answer: B. Perioperative anaphylaxis is treated with titrated IV adrenaline by the anaesthetist, unlike the intramuscular route outside theatre. Antibiotics, neuromuscular blockers and chlorhexidine are the commonest triggers.

Question 12

At the end of surgery, train-of-four monitoring shows a ratio of 0.6 after rocuronium. The appropriate reversal is:

1. No reversal needed
2. Sugammadex 2 mg/kg (or neostigmine 50 micrograms/kg with glycopyrrolate), extubating only once the TOF ratio reaches 0.9 or more
3. Sugammadex 16 mg/kg
4. Extubate now

Answer: B. Residual block below 0.9 causes airway obstruction and aspiration. Sugammadex 2 mg/kg reverses moderate block; 4 mg/kg deep block; 16 mg/kg is for immediate reversal after an RSI dose.

Paediatric, pain and critical care

Question 13

For a 4-year-old weighing 16 kg, the appropriate uncuffed endotracheal tube size and the hourly maintenance fluid rate are approximately:

1. 3.5 mm tube; 100 mL/h
2. 5.0 mm tube (4.5 mm if cuffed); about 52 mL/h by the 4-2-1 rule
3. 7.0 mm tube; 20 mL/h
4. 6.0 mm tube; 150 mL/h

Answer: B. Uncuffed size is age/4 + 4; cuffed is half a size smaller. Maintenance is 4 mL/kg for the first 10 kg plus 2 mL/kg for the next 10, giving 40 + 12 = 52 mL/h.

Question 14

A patient after major abdominal surgery has a thoracic epidural infusion and develops progressive bilateral leg weakness with back pain 20 hours later. The action is:

1. Reduce the infusion rate and reassess tomorrow
2. Stop the infusion, examine immediately, and arrange urgent MRI for suspected epidural haematoma or abscess, with neurosurgical decompression within hours if confirmed
3. Increase the infusion to improve analgesia
4. Give naloxone

Answer: B. New motor block that does not resolve within an hour of stopping the infusion is a neurosurgical emergency; outcome depends on decompression within about 8 hours.

Question 15

A ventilated patient in intensive care with septic shock remains hypotensive after 30 mL/kg of crystalloid. The first-line vasopressor and target are:

1. Dopamine, to a systolic of 90 mmHg
2. Noradrenaline, titrated to a mean arterial pressure of at least 65 mmHg, with vasopressin added if the dose escalates and hydrocortisone for refractory shock
3. Phenylephrine alone
4. Adrenaline as first line

Answer: B. Current sepsis guidance names noradrenaline first line with vasopressin as the second agent; dopamine increases arrhythmias and mortality.

How to use these questions

• Memorise doses and numbers: local anaesthetic maxima, reversal doses, paediatric sizes and fluids, fasting times, anticoagulant timing.
• Rehearse the crisis algorithms: cannot intubate cannot oxygenate, malignant hyperthermia, anaphylaxis, local anaesthetic toxicity, high spinal.
• Cover obstetrics, paediatrics and pain, where general-list anaesthetists lose marks.
• Practise under time in the Anaesthesia bank with the error-log method.

Other specialty banks are listed in specialty question banks for doctors, and intensivists have their own guide (critical care guide). When you hold eligibility, join the doctor talent pool; anaesthetists are among the most requested specialists in the Gulf.

Frequently asked questions

How many questions are in the anaesthesiology Prometric exam?

Usually 100 to 150 in 2.5 to 3 hours. Your eligibility notice states the exact format.

What is the pass mark?

About 65% for the specialist paper, scaled at some authorities, and higher for consultant titles.

Does the paper include intensive care and pain medicine?

Yes, at the level of initial management, sepsis and ventilation basics, and acute pain and epidural care.

Can an FCPS or MD in anaesthesia skip the exam?

Sometimes, depending on the authority's recognition list; see the exemptions guide.

Are these real exam questions?

No. They are original practice questions written to the published blueprint. Real exam content is confidential.