Download PGI PG 2020 May Anesthesia Solved Question Paper

Download PGIMER (Post Graduate Institute of Medical Education & Research, Chandigarh) 2020 May Anesthesia Solved Question Paper

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PGI Chandigarh Last 10 Years 2011-2021 Solved Question Papers (PGIMER Previous Papers)

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In ophthalmology a patient is allergic to aminoesters. What can be used?
1. Cocaine
2. Procaine
3. Prilocaine
4. Bupivacaine
5. Tetracaine
Correct Answer - C:D

Ans. is'c'i.e., Prilocaine &'d'i.e., Bupivacaine
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[Ref: Lee's 13th/e p. 486]

Prilocaine & bupivacaine are amides (amcinonide). Other three are aminoesters.
TRUE statement regarding inhalational anesthesia is/ are?
1. Sevoflurane is the agent of choice for children and asthma patients
2. Sevoflurane should not be used where the gas flow rate is less than 2 L/min
3. Desflurane should not be used for induction in children
4. Isoflurane is more potent than sevoflurane
5. Halothane is the agent of choice for day care surgery
Correct Answer - A:B:C:D

Ans. is'a'i.e., Sevoflurane is the agent of choice for children and asthma patients,'b'i.e., Sevoflurane should not be used where the gas flow rate is less than 2Llmin,'c' i.e., Desflurane should not be used for induction in children & 'd' i.e., Isoflurane is more potent than sevoflurane
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[Ref: Ajay Yadav Sth/e p. 70-87; Morgan Sth/e p. 163-70]

"In June 1995' the Food and Drug Administration (FDAI approved the clinical use of sevoflurane. but with a warning that not sued at fresh gas flows less than 2 l/min because sufficient data had not been presented to establish its safety in that circumstance.

The FDA was concerned that sevoflurane may cause adverse renal effects at low flows because it is degraded by the strong bases in CO2 absorbents to fluoromethyl-2,2-difluoro-1-(trifluoromethyl) vinyl ether (compound A).
If you are asked to collect 4 serial samples from lumbar puncture. What should be done with first sample?
1. Cell counts like differential counts
2. Biochemical tests [protein & glucose etc
3. Bacterial culture and gram staining
4. Mycobacterial & fungal culture and staining
5. None of the above-discard the sample
Correct Answer - A
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Ans. is'a'i.e., Cell counts like differential counts

Ref: https://emedicine.medscape.com/article/80773-technique

The classic approach is to to send the 4 CSF tubes for the following studies:
1. Tube 1 - Cell count and differential
2. Tube 2 - Glucose and protein levels
3. Tube 3 - Gram stain, culture and sensitivity (C&S)
4. Tube 4 - Cell count and differential
True regarding local anesthatics is/are?
1. Prilocaine is longer acting then bupivacaine
2. Tetracaine is more potent than lignocaine
3. Dibucaine is the longest acting local anesthetic
4. Bupivacaine can produce cardiotoxicity
5. Cocaine can produce hypotension
Correct Answer - B:C:D

Ans. is'b'i.e., Tetracaine is more potent than lignocaine,'c' i.e., Dibucaine is the longest acting local anesthetic & 'd' i.e., Bupivacaine can produce cardiotoxicity
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[Ref: Morgan 4th/e p. 266-270, Ajay Yadav 4'h/e p. 118;

Essential of anaesthesia 4th/e p. 116; Goodman & Gilman LLth/e p. 375]
- Chloroprocaine is the shortest actingLA.
- Dibucaine is the longest acting. most potent and most toxic LA.
- Procaine & chloroprocaine are least potent LAs.
- BuQivacaind is the most cardiotoxic LA (Ropivacaine is a newer bupivacaine congener with less cardiotoxicity).
- Levobupivacaine (The S (-) enantiomer of bupivacaine) is less cardiotoxic and less prone to cause seizure.
- Prilocaine and Benzocaine can cause Methemoglobinemia.
- Lignocaine is the most commonly used LA.
- Bupivacaine has the highest local tissue irritancy
- Chloroprocaine is contraindicated in spinal anaesthesia as it can cause paraplegia due to the presence of neurotoxic preservative sodium metabisulphite.
- Procaine is the LA of choice in malignant hyperthermia.
Which of the following anesthetic should not be used in a patient of chronic renal failure?
1. Methoxyflurane
2. Ketamine
3. Pancuronium
4. Succinylcholine
5. Desflurane
Correct Answer - A:B:C

Ans. is 'a' i.e., Methoxyflurane l.e., Ketamine &'c' i.e., Pancuronium
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[Ref: Morgan 4th/e p. 219

Muscle relaxants
- Atracurium/cisatracurium are the muscle relaxant of choice as there elimination is not dependent on kidney.
- Mivacurium is an alternative as its elimination is also independent of kidney.
- Gallamine and metocurine are entirely dependent on renal excretion for elimination) Contraindicated in renal disease .
- Pancuronium. pipecuranium, Alcuronium and doxacurium are Primarily dependent on r contraindicated, however neuromuscular function should be closely monitored r.f these agents are used in Patients with abnormal renal function.
- Vecuronium and Rocuronium are primarily excreted in Bile (hepatic elimination) but some amount is eliminated in urine also.
- So, only three non-depolarizing blockers have no elimination through
- kidney:- Atracurium, Cisatracurium, Mivacurium
- Succinylcholine (delnlarizing blockerl is also independent of renal excretion for elimination.
- It can be safety used in the Presence of renal failure. provided serum potassium concentration is less than 5 mg/L.
In comparison to IJV cannulation, true about subclavian vein cannulation is/are?
1. More chances of pneumothorax
2. More incidence of catheter malposition
3. More infectious complications
4. More safety in ultrasound guided technique
5. All of the above
Correct Answer - A:B

Ans. is'a'i.e., More chances of pneumothorax &'b'i.e., More incidence of catheter malposition

[Ref: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC i 27 09 25 /17]
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- Subclavian vein cannulation
- Good external landmarks
- Large radius
- Practical method of central line in cardio-respiratory arrest
- Blind procedure
- Ultrasound not much useful
- Should not be attempted in children < 2 years
- Unable to compress bleeding vessels
- More common & frequent: Catheter malposition, Pneumothorax, hemothorax, Pinch-off sy:rdrome.
- Less common & frequent: Arterial puncture, Thrombosis, infectious complications.
A patient, planned for cesarean section, develops hypotension 8 minutes after the spinal anesthesia. Drugs which can be used to treat this are?
1. Ephedrine
2. Mephenteramine
3. Adrenaline
4. Dopamine
5. Steroids
Correct Answer - A:B:C:D

Ans. is'a'i.e., Ephedrine, 'b' i.e., Mephenteramine, 'c' i.e., Phenylephrine &'d' i.e. Dopamine

[Ref: Miller Vh/e p. 1617]

Managing hypotension induced by spinal anesthesia for caesarean section:
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Treatment
- In spite of using all the prophylactic measures,400/0 to 60% of patients will still need treatment for hypotension:-
- i) Fluid loading is superior to no-fluid regimen; however, the incidence of PSH is still high with all fluid loading protocols
- ii) Vasopressors:-
- Phenylephrine(PE) is preferred vasopressor.
- Prevention and treatment of PSH because of faster onset.
- Ephedrine may be more beneficial in patients with bradycardia.
- Norepinephrine infusion was recently investigated as an alternative for prophylaxis of PSH.
- Ondansetron was reported as a prophylactic drug from PSH
- Other sympathomimetic drugs used are mephentermine. metaraminol, methoxamine, dopamine and, angiotensin II
- Atropine should be given for bradycardia
Endotracheal intubation is/are assessed by:
1. Mallampati grading
2. ASA physical status grading
3. Thyromental distance
4. Teeth arrangement
5. None
Correct Answer - A:C:D

Ans. A,Mallampati grading C,Thyromental distance & D,Teeth arrangement

[Ref: Manipal Surgery 4th/ 1072-73; Ajay Yadav 5th/53' 124; Morgan 5th/ 312-13
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- ASA physical status grading is for general health status of patient (not for assessing intubation)
- Assessment of Difficult Intubation:
- Mallampati grading: It is done to assess mouth oPening
- Thyromental distance (distance b/w thyroid notch to mental prominence with fully extended neck)
- Mentohyoid distance: normal > 5 cm
- Assessment of TM joint function: Inter incisor gap (mouth opening) should be at least 5 cm (2 fingerbreadth)
- Neck Movement
Drug(s) not given as transdermal patch:
1. Fentanyl
2. Diclofenac
3. Morphine
4. Clonidine
5. Buprenorphine
Correct Answer - B:C

Ans.B,Diclofenac & C,Morphine
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[Ref: KDT 7th/476
- Transdermal fentanyl (Durogesic) has become available for use in cancer/terminal illness.
- Butrans skin patches contain buprenorphine an opioid pain medication.
- Clonidine transdermal delivery (patch) systems have been available since the 1980

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True about desflurane:
1. Boiling point is <230C
2. Chemically it is Flourinated methyl ethylether
3. It increases the effect of muscle relaxant
4. Can be given safely to patient susceptible to malignant hyperthermia
5. More potent than isoflurane
Correct Answer - A:B:C

Ans.A, Boiling point is <230C B,Chemically it is Flourinated methyl ethylether C,It increases the effect of muscle relaxant

[Ref Ajey Yadav Sth/ 82; Morgan Sth/170 & 71)

Desflurane:
- Fluorinated methyl ethyl ether
- Boiling point is less than 20C.
- Produces maximum muscle relaxation among the agents.
- 5 times less potent than isoflurane.
- Loss of potency (the MAC of desflurane is 5 times higher than isoflurane)
- Immune mediated hepatitis a rare occurrence.
- has the lowest blood: gas solubility of the potent volatile anesthetics
True about tracheostomy:
1. Tracheostomy tube may closed by mucous secretion & crust formation
2. Copious secretion from tube is always due pulmonary infection
3. X-ray chest should be done for confirmation in every case
4. Improper positioning may lead to fatal haemorrhage
5. Displacing of tube after 2 week is medical emergency
Correct Answer - A:D

Ans. A,Tracheostomy tube may closed by mucous secretion & crust formation D,Improper positioning may lead to fatal haemorrhage

[Ref Schwartz 9th/ 59- I qhttp://www.nurses.com/ ; p L.Dhingra 6th/
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316 - 20;Ajay Yadav 5th/48-49; Millo Anaesthaia Zth/232& IBit-72
- Reintubation in the first 36 hours after tracheostomy Is on emergency.
- Tracheostomy tube should not be disturbed For the first 48-72 hr, but thereafter the tube is changed daily & cleaned at regular interval.
- Recent study do not support obtaining a routine post tracheostomy chest X-ray.
- The most dramatic complication is tracheo-innominate artery fistula (TIAF).
- Palpable tube pulsation suggest impending erosion of an artery,
- Tracheal deviation may signal abdomen bleeding
Cnrnnonent of Advanced cardiovascular life support (ACLS) in accordance to ? 2015 guideline:
1. Chest compression 100-150 per minute
2. Chest compression at least 5 cm/2 inch
3. Vasopressors is used to maintain MAP > 70 mmHg in non- responsive to fluids
4. 1 Breath every 8 seconds
5. Vasopressin is used as vasopressor
Correct Answer - B

Ans. B. Chest compression at least 5 cm/2 inch
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- Basic life support (BLS), advanced cardiovascular life support (ACLS), and post-cardiac arres arrest care all describe a set of skills and knowledge applied sequentially during the treatment of patients who have a cardiac arrest.
- ACLS comprises the level of care between BLS and post-cardiac arrest care
- Update recommendations for advanced cardiac life support 2015:
- The combined use vasopressin and epinephrine offers no advantage to using standard-dose epinephrine in cardiac arrest.
- Vasopressin has been removed from the Adult Cardiac Arrest Algorithm-2015 update.
- Advanced Cardiac Life Support:
- Continuous chest compressions at a rate of lil)/rnin to 120/min, vnthout pauses for ventilation. The provider delivering ventilation
- should provide 1 breath every 6 seconds (10 breaths per minute).
- It may be reasonable to avoid and immediate$r correct hypotension (SBp < 90 mm Hg, MAp < 65 mmHg) during post-cardiac arrest care.

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Anaesthetic agents(s) having epileptogenic potential:
1. Atracurium
2. Etomidate
3. Enflurane
4. Pethidine
5. Propofol
Correct Answer - A:C:D

Ans. (A) Atracurium (C) Enflurane Pethidine
- Etomidate: Does not have epileptogenic potential.
- Enflurane: At high doses it produces spike and wave pattern in EEG which culminates into frank tonic-clonic seizure.
- Atracurium: Its metabolic product laudanosine(Laudanosine Toxicity)- seizures precipitated.
- Ketamine can elicit seizures in patients with an epileptic diathesis.
- Propofol: Significant anticonvulsant activity.
True about xenon is are:
1. Environment friendly
2. Cheap
3. Low blood solubility
4. Inert
5. Stable
Correct Answer - A:C:D:E

Ans. (A) Environment friendly (C) Low blood solubility (D) Inert (E) Stable
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Advantages and disadvantages of xenon (Xe) anesthesia:

Advantages:
- Inert (probably nontoxic with no metabolism).
- Minimal cardiovascular effects.
- Low blood solubility.
- Rapid induction and recovery
- Does not trigger malignant hyperthermia
- Environmental friendly.
- Nonexplosive
Disadvantages:
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- High cost
- Low potency {MAC=70%)
In gas tubing, rate of turbulent flow depends upon :
1. Viscosity of gas
2. Pressure gradient
3. Length of tube
4. Radius of tube
5. Density of gas
Correct Answer - B:E

Ans. (B) Pressure gradient (E) Density of gas
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Turbulent
- Turbulent flow is produced if flow rate is very high or if gas passes through bends, constrictions
- Flow is rough.
- Reynold's number must exceed to 2000 for turbulence.
- Turbulent flow is more depend on density
Gas stored in liquid state in cylinders:
1. Nitrogen
2. Helium
3. CO2
4. Cyclopropane
5. Nitrous oxide
Correct Answer - C:D:E

Ans, (C) CO2 (D) Cyclopropane (E) Nitrous oxide
- Oxygen, nitrogen, air and helium are stored in cylinders as gases.
- Nitrous oxide, carbon dioxide and cyclopropane are stored in as liquid in equilibrium with saturated vapour.
- Colour of Cylinders:
- O2-Black body with white shoulder
- N2O- Blue
- CO2-Grey
- Cyclopropane-orange
- Helium-Brown
- Air-Grey body with black and white shoulders
- Entonox-Blue body with blue and white shoulders (50% O2. + 50% N2O).
True about caudal anesthesia in children:
1. Average distance from the skin to the anterior wall of the sacral canal is 21 mm
2. 0.5 mL/kg dose of bupivacaine is sufficient for lumber and sacral dermatomes block
3. Beyond 6-7 years of age, it is difficult to give and is less successful in comparison to younger children
4. 2-3 cm of epidural catheter is advances through epidural space in continuos infusion
5. Distance from the upper border of the sacral hiatus to the dural sac is 30±10.4mm
Correct Answer - A:C:D:E
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Ans. (A) Average distance from the skin to the anterior wall of the sacral canal is 21 mm (C) Beyond 6-7 years of age, it is difficult to give and is less successful in comparison to younger children (D) 2-3 cm of epidural catheter is advances through epidural space in continuos infusion (E) Distance from the upper border of the sacral hiatus to the dural sac is 30±10.4mm

Caudal Anesthesia
- Normal length of catheter to be introduced into the epidural space Is 2 to 3 cm, asfor any epidural block.
- Dosage prescription scheme:
- With 0.5 mL/kg, all sacral dermatomes are blocked.
- With 1.0 ml/kg all sacral and lumbar dermatomes are blocked.
- With 1.25 ml/kg, the upper limit of anesthesia is at least midthoracic.
- Drug used: The dose of 0.25% bupivacaine ts 0.5-0.75 ml/kg
- Extradural space below sacral hiatus may range from being deep to excessively shallow-its average length Is 10-15 cm.
- Its anatomy is more easily appreciated in infants and chilDren
- Indications:
- Use for pattants < 8 years old to provide intraoperative and postoperative analgesia for abdominal and lower extremity surgery.
- Technique:
- Advance needle and catheter 2 to 4 mm.

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Anaesthetic used for induction in pediatric surgery is ?
1. Propofol
2. Thiopentone
3. Ketamine
4. Diazepam
5. Etomidate
Correct Answer - A:B:E

Ans. (A) Propofol (B) Thiopentone Etomidate

Anaesthetics in Pediatric patients

Induction

Inhalational induction:
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- Inhalational agent with mask - Induction method of choice in children.
- Sevoflurane - Induction agent of choice in children.
- Used in N2O +O2 gas mixture.
- Halothane - 2nd Induction agent of choice.
- Intravenous induction:
- THiopental/propofol (Outpatient surgery).
- Ketamine - preferred in children with hypovolemia.
- Etomidate - preferred in children with unstable cardiovascular status
Atracurium is metabolized by -
1. Conjugation
2. Hoffman degradation
3. Pseudocholineaterase
4. Methylation
5. None
Correct Answer - B
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Ans. B. Hoffman degradation
- The unique feature of atracurium is inactivation in plasma by spontaneous non enzymatic degradation (Hofmann elimination).
- Consequently its duration of action is not altered in patients with hepatic/renal insufficiency or hyperdynamic circulation ---> Hence, preferred muscle relaxant for such patients as well as for neonates and the elderly.
- Atracurtum is metabolised to laudanosine that is responsible for seizures.
- Cause histamine release > Hypotension, bronchoconstriction & flushing.
Ventilator associated complication(s) is/are?
1. Barotrauma
2. Subglottic stenosis
3. Pneumoperitoneum
4. Paralytic ileus
5. Increased cardiac output
Correct Answer - A:B:C:D

Ans. (A) Barotrauma (B) Subglottic stenosis (C) Pneumoperitoneum (D) Paralytic ileus

[Ref Essentials of anesthetic emergencies p. 123]

Complications of mechanical ventilator:
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- Barotrauma - Cause pneumothorax, pneumomediastinum, bronchopleural fistula, pneumopericardium/cardiac tamponade, Pneumoperitoneum, systemic air embolism and pulmonary embolism.
- Hemodynamic complications
- Nosocomial infections: Pneumonia, UTI
- Acid-base disturbances - Respiratory alkalosis due to CO2 washout.
- Water retention.
- GIT - Mainly paralytic ileus.
Headache following dural puncture, treatment is:
1. ACTH
2. Clonidine
3. Steroids
4. Blood
5. Caffeine
Correct Answer - A:C:E

Ans. (A) ACTH (C) Steroids (E) Caffeine

Ref: Morgan's 4,h/e p. 297, Lee's 13h/e p. 509, 510; www.cochrane.org
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Post dural puncture headache:
- Due to CSF leak from a dural defect & decreased ICT.
- Most common complication of spinal anesthesia.
- Typical location is bifrontal or occipital.
- Onset
- Usually 12-72hotrs following the procedure.
- Lasts for 7-10 days.
- Management:
- Use of small bore needle can prevent pDpH.
- Conservative treatment:
- Analgesics (NSAIDs), oral or i.v. fluids.
- Drugs: Cosyntropin, caffeine, hydrocortisone, gabapentin, theophylline, sumatriptan, pregabalin and ACTH.
Pre-anaesthetic medication is given to ?
1. Reduce anxiety and fear
2. Reduction of secretion of saliva
3. To produce amnesia
4. To prevent undesirable reflexes
5. Prevent vomiting
Correct Answer - A:B:C:D

Ans. (A) Reduce anxiety and fear (B) Reduction of secretion of saliva (C) To produce amnesia (D) To prevent undesirable reflexes
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[Rel KDT 6h/e p. 378]

Preanaesthetic medication:

Aims:
1. Relief of anxiety and apprehension preoperatively and to facilitate smooth induction.
2. Amnesia for preoperative and postoperative events.
3. Supplement analgesic action of anaesthetics and potentiate them.
4. Decrease secretions and vagal stimulation (undesirable reflex).
5. Antiemetic effect extending into postoperative period.
6. Decrease acidity and volume of gastric juice so that it is less damaging if aspirated.

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Methods of regional anaesthesia is/are?
1. Bier's block
2. Spinal anaesthesia
3. Rapid sequence induction
4. Conscious sedation
5. Surface anaesthesia
Correct Answer - A:B:E

Ans. (A) Bier's block (B) Spinal anaesthesia (E) Surface anaesthesia

[Ref: Morgan 4/e p. 269-270]

Regional anaesthesia (Local anaesthesia):

Methods are:
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1. Topical anaesthesia (surface anaesthesia)
2. Infiltration anaesthesia
3. Intravenous regional anaesthesia (Bier's block)
4. Conduction block (either field block or nerve block)
5. Spinal anaesthesia
6. Epiduralanaesthesia
If we increase the depth of chest compression in CPR, it causes -
1. Decreased mortality
2. Increased brain perfusion
3. Increased aortic pressure
4. Rib fracture
5. Hemothorax
Correct Answer - A:B:C:D:E

Ans. (A) Decreased mortality (B) Increased brain perfusion (C) Increased aortic pressure (D) Rib fracture (E) Hemothorax

Increasing the depth of chest compression also carry an increased risk of complications like :
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- Rib and / or sternal fracture
- Injury to diaphragm or lung
- Pneumothorax, pneumomediastinum, pneumopericardium
- Hemothorax

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Hypotensive shock refractory to fluid, what is contraindicated?
1. Ketamine
2. Atropine
3. Fentanyl
4. Thopentone
5. Etomidate
Correct Answer - C:D

Ans. (C) Fentanyl (D) Thopentone

[Ref: Wroerlee textbook of anaesthesia p.54]
- In hypotensive patients, no sedative, hypnotic or opiate should be given.
- Fentanyl is an opiate and thioPentone is a sedative (barbiturate).
- Ketamine increases cardiac output and blood pressure - Intravenous anaesthetic of choice in shock.
- Etomidate produces little cardi-ovascular anil respiratory depression
- Agent of choice for cardiovascular surgeries (bypass aneurysms, valve surgery).
- Etomidate is most cardiostable inducing agent.
- If hypotension is due to bradycardia ---> Atropine is the drug of choice.
Drugs known to trigger malignant hyperthermia -
1. Halothane
2. Succinylcholine
3. Pancuronium
4. Fentanyl
5. Propofol
Correct Answer - A:B

Ans. (A) Halothane (B) Succinylcholine

[Ref Morgan Anaesthesia 5th/e p. 1187-9A; Aiay Yadav p. 13j- 35;

Miter p. 1187-89; Lee I3'h/e p. 353; Wylle's Aflaesthesifl Vh/c p. 165- 67]
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Drugs causing Malignant hyperthermia (MH):
- Succinylcholine
- Halothane
- Isoflurane
- Enflurane
- Sevoflurane
- Desflurane
- Methoxyflurane
- MAO inhibitors
- TCA
- Phenothiazines
- Lignocaine
When will you suspect malignant hyperthermia in post appendectomy patient shifted to ICU with high fever & -
1. Hypotonia
2. Seizure
3. Masseter spasm
4. Metabolic acidosis
5. Hypokalemia
Correct Answer - B:C:D

Ans. (B) Seizure (C) Masseter spasm (D) Metabolic acidosis
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[Ref: Morgan Anaesthesia 5'h/e ?. 1187-90; Ajay Yadav Se/e p. 133- 35; Miller Thle p, 1187-89; Lee l3'h/e p. 35i; Wylie's Anesthesia Vh/e p. j65, 367]

Malignant hyperthermia:
- The condition occurs during or immediately after anaesthesia and may be precipitated by potent inhalation agents (enflurane,
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