1.Etherwasfirstusedasananaestheticby? a)Priesly b)Morton c)Wells d)Simpson CorrectAnswer-BMortonREF:http://en.wikipedia.org/wiki/William_T.G_MortonWilliamThomasGreenMorton(August9,1819-July15,1868)wasanAmericandentistwhofirstpubliclydemonstratedtheuseofinhaledetherasasurgicalanaestheticin1846
2.ThefollowingincreasesIntraOcular pressure: a)Thiopentone b)Althesin c)Ketamine d)Barbiturate CorrectAnswer-CKetamine
3.Compositionofsodalimeis: NaOH-Ca(OH)2-KOH-Moisture a)4%-90%-1%-5% b)4%-80%-1%-15% c)80%-10%-5%-5% d)15%-80%-1%-4% CorrectAnswer-BSodalimeisthemorecommonabsorbentandiscapableofabsorbingupto23LofCO2per100gofabsorbent.Itconsistsprimarilyofcalciumhydroxide(80%),alongwithsodiumhydroxide(4%),water,andasmallamountofpotassiumhydroxide(1%).Commercialsodalimehasawatercontentof14%to19%.CO2absorbents(eg,sodalimeorcalciumhydroxidelime)containhydroxidesaltsthatarecapableofneutralizingcarbonicacid.Reactionendproductsincludeheat(theheatofneutralization),water,andcalciumcarbonate.Ref:ButterworthIVJ.F.,ButterworthIVJ.F.,MackeyD.C.,WasnickJ.D.,MackeyD.C.,WasnickJ.D.(2013).Chapter3.BreathingSystems.InJ.F.ButterworthIV,J.F.ButterworthIV,D.C.Mackey,J.D.Wasnick,D.C.Mackey,J.D.Wasnick(Eds),Morgan&Mikhail'sClinicalAnesthesiology,5e.
4.Allofthefollowingarecorrectaboutketamine,EXCEPT: a)Itfunctionally"dissociates"thethalamus b)Itincreasesarterialbloodpressure c)Itisapotentbronchoconstrictor d)Itinhibitspolysynapticreflexesinthespinalcord CorrectAnswer-CKetaminefunctionally"dissociates"thethalamus(whichrelayssensoryimpulsesfromthereticularactivatingsystemtothecerebralcortex)fromthelimbiccortex(whichisinvolvedwiththeawarenessofsensation).Ketamineincreasesarterialbloodpressure,heartrate,andcardiacoutput.Racemicketamineisapotentbronchodilator,makingitagoodinductionagentforasthmaticpatients.Itinhibitspolysynapticreflexesinthespinalcordaswellasexcitatoryneurotransmittereffectsinselectedareasofthebrain.Ref:ButterworthIVJ.F.,ButterworthIVJ.F.,MackeyD.C.,WasnickJ.D.,MackeyD.C.,WasnickJ.D.(2013).Chapter9.IntravenousAnesthetics.InJ.F.ButterworthIV,J.F.ButterworthIV,D.C.Mackey,J.D.Wasnick,D.C.Mackey,J.D.Wasnick(Eds),Morgan&Mikhail'sClinicalAnesthesiology,5e.
5.Apatientundergoingaminorsurgicalprocedureisgivenlignocaineinjection. Assertion:Localanaestheticsactsbyblockingnerveconduction. Reason:Smallfibersandnonmyelinatedfibersareblockedmoreeasilythanlargemyelinatedfibers. a)BothAssertionandReasonaretrue,andReasonisthecorrect explanationforAssertion b)BothAssertionandReasonaretrue,andReasonisnotthe correctexplanationforAssertion c)Assertionistrue,butReasonisfalse d)Assertionisfalse,butReasonistrue CorrectAnswer-BLocalanaestheticsblocksnerveconductionbydecreasingtheentryofsodiumionsduringupstrokeofactionpotential.Finallyitblocksdepolarizationtoreachthresholdpotentialandconductionblockoccurs.Smallfibersaremoresensitivetolocalanaestheticsthanlargefibersandnonmyelinatedfibersareblockedeasilythanmyelinatedfibers. Ref:EssentialsofMedicalPharmacologybyKDTripathi,5thEdition,Pages321-3
6.Thelaryngealmaskairwayusedforsecuringtheairwayofapatientinallofthe followingconditions,EXCEPT: a)Inadifficultintubation b)Incardiopulmonaryresuscitation c)Inachildundergoinganelective/routineeyesurgery d)Inapatientwithalargetumourintheoralcavity CorrectAnswer-DOropharyngealabscessormassisacontraindicationtotheuseoflaryngealmaskairway. Ref:ShortTextbookofAnaesthesiaByAjayYadav,2ndEdition,Page36
7.Allofthefollowingstatementsaboutneuromuscularblockageproducedby succinylcholinearetrue,except: a)NofadeonTrainoffourstimulation b)Fadeontetanicstimulation c)Noposttetanicfacilitation d)Trainoffourratio>0.4 CorrectAnswer-BSuccinylcholineisadepolarizingneuromuscularblocker.Withsuccinylcholinenofadingisobservedaftertrainoffourortetanicstimulation.AllfourstimulatoryresponsesafterTOFstimulationaresuppressedtothesameextent.Ref:NeuromuscularMonitoringinClinicalPracticeandResearchByThomasFuchs-Buder,Page16
8.Mechanismofactionoftheophyllinein BronchialasthmaincludeallofthefollowingExcept? a)Phosphodiesteraseinhibition b)Adenosinereceptorantagonism c)Increasedhistonedeacetylation d)Beta-2receptorstimulation CorrectAnswer-DAns.is'd'i.e.,Beta-2receptorstimulationProposedmechanismsofactionoftheophyllinePhosphodiesteraseinhibition(Nonselective)Adenosinereceptorantagonism(A1,A2)IncreasedhistoneDeacetylaseactivity(redefficacyofcorticosteroids)InhibitionofintracellularcalciumreleaseStimulationofcatecholaminereleaseInhibitionofNF-alphaBetatranslocationintothenucleus(nucleartranslocation)Mediatorinhibition(Prostaglandins,TNFalpha)
9.Besttomonitorintraoperativemyocardial ischemia(infarction)is a)ECG b)CVPmonitoring c)Transesophagealechocardiography d)Invasiveintracarotidarterialpressure CorrectAnswer-CCi.e.TransesophagealechocardiographyTranoesophagealechocardiographyprovidesarealtimepictureofall4cardiacchambersandvalves.Itcanidentifyanymalfunctioningvalvesinadditiontoanywallmotionabnormalitiesrelatedtomyocardiaischemia.Itisveryusefulduringanesthesia.Abnormalmotionofventricularwalldetectedinthiswayisareliableindexofmyocardialischemiaandmayguidedrugtherapy,canidentifyiftherapyhassuccessfullytreatedtheischemiaorindicatetheneedforfurthersurgicalrevascularizationCVP(catherterincentralvein)measuresrightsidedfillingpressurewhereaspulmonaryarterycathetermeasures/monitorsleftheartfillingpressure.Arterialcannulationmeasuresdirectsystemicarterialpressureandfacilitatesamplingofarterialbloodforanalysis.
10.Whichofthefollowingdrugsproduces dissociativeanesthesia a)Ketamine b)Propofol c)Thiopentone d)Enflurane CorrectAnswer-AAi.e.Ketamine
11.Ketaminecanbeusedinallofthe situationsexcept a)Statusasthamaticus b)Foranalgesia&sedation c)Obstetrichemorrhage d)Ischemicheartdisease CorrectAnswer-DDi.e.IschemicheartdiseaseKetaminecausesprofoundanalgesiaQ,disociativeanesthesiaQ,andemergencepsychomimetichallucinationsanddeliriumQ.Ketamineincreasescerebralmetabolism,02consumption,bloodflow&intracranialpressure.QKetamine*ItcausesprofoundanalgesiaQanddissociativeanesthesiaQ(i.e.patientappearsconsciouse.g.eyeopening,swallowingbutunabletoprocessorrespondtosensoryinput).KetaminecausesDissociativeAnesthesiaQbyactingoncortexandsubcorticalareas(notonRAS)l/tfeelingofdissociationfromonesownbodyandsurroundings.PostOperativeDeliriumandHallucinationQispartofthisDissociativephenomenon.Drugofchoiceforpostop.delirium&hallucinationisLorazepam.Q*Itisclosesttobeingacompleteanestheticsinceitinducesanalgesia,amnesia&unconsciousness.*Itisassociatedwithemergencepsychotomimeticsideeffects(delirium,illusions,hallucination)Q.Itislesscommoninchildrenandpretreatmentwithlorazepam(drugofchoice)Q.
12.Anestheticagent(s)safetouseinTICP a)Halothane b)Thiopentone c)Ketamine d)Ether CorrectAnswer-BBi.e.ThiopentoneAnestheticagentssafetouseinraisedintracranialpressure(ICP)arethiopentone,propofol&etomidateQ
13.Allofthefollowingcausemyocardial depressionexcept: a)Halothane b)Etomidate c)Thiopentone d)Ketamine CorrectAnswer-BBi.e.Etomidate-Etomidatecausesadreno-corticalsuppressionQbyinhibitingenzymes11/3hydroxylase(mainly)&17ahydroxylaseinvolvedincortisolandaldosterone(mineralocorticoid)productionQ.VitCsupplimentationrestorescortisollevel.-EtomidateandmidazolamprovidecardiovascularstabilityQ.ButetomidateismostcardiostableagentQthatcausestheleasthemodynamicdisturbanceofanyoftheintravenousanestheticagents.SoitisintravenousanestheticagentofchoiceforpatientswithcardiacdiseaseandaneurysmsurgeryQ.-Directmyocardialdepressioniscausedbyhalothane(severe),nitrousoxide(moderate),iso/sevo/des-flurane(mild),thiopental(marked),propofol(dosedependent)andketamineQ(butthisismaskedbycardiotonicsympatheticstimulatoryaction).Etomidate>midazolemaremostcardiostableagentsQ.
14.Attheendofanaesthesiaafter discontinuationofnitrousoxideand removalofendotrachealtube,1000/0oxygenisadministeredtothepatienttoprevent: a)DiffusionHypoxia b)Secondgaseffect c)Hyperoxia d)Bronchospasm CorrectAnswer-AAi.e.DiffusionHypoxia(Ref:Willer8/ep656,3401)OndiscontinuationofN2Oadministration,nitrousoxidegascandiffusefrombloodtothealveoli,dilutingO2inthelung.Produceaneffectcalled"Diffusionalhypoxia".Toavoidhypoxia,100%O2,ratherthanairshouldbeadministeredwhenN2Odiscontinued.
15.Stagesofanesthesiawereestablishedby a)Ether b)N20 c)Halothane d)Chloroform CorrectAnswer-AAi.e.Ether
16.Hepatotoxicagentis a)Ketamine b)Ether c)N20 d)Halothane CorrectAnswer-DDi.e.Halothane
17.Shortestactinglocalanestheticagentis a)Procaine b)Lidocaine c)Tetracaine d)Bupivacaine CorrectAnswer-AAi.e.Procaine
18.PudendalNerveBlockInvolve a)LiL2L3 b)L2L3L4 c)SiS2S3 d)S2S3S4 CorrectAnswer-DDi.e.S2S3S4
19.Whichofthefollowinganestheticagents haveanalgesicproperty: a)Ketamine b)Nitrousoxide c)Thiopentone d)aandb CorrectAnswer-DAi.e.Ketamine;Bi.e.Nitrousoxide
20.Contraindicationofbagandmask ventilationareallofthefollowingexcept:March2009 a)Tracheo-esophagealfistula b)Hiatushernia c)Pregnancy d)Emptystomach CorrectAnswer-DAns.D:EmptyStomach Bag-maskventilationcanproducegastricinflationwith complications,includingregurgitation,aspiration,andpneumonia. Conditionspredisposingtoaspirationare:FullstomachpatientsHiatushernia,pregnancyIntestinalobstructionTracheo-esophagealfistulaMeconiumaspirationsyndrome Gastricinflationcanelevatethediaphragm,restrictlungmovement, anddecreaserespiratorysystemcompliance
21.Followingistrueabouthalothaneexcept? a)Volatileliquidwithsweetodour b)Sensitiseshearttoadrenaline c)Constrictsbronchii d)Causesmalignanthyperthermia CorrectAnswer-CAns.is'c'i.e.,ConstrictsbronchiiHalothaneItisavolatileliquidwithsweetodour,nonirritatingandnoninflammable.Itisapotentanaestheticwithpooranalgesicandmusclerelaxantproperties.HalothanecausesdirectdepressionofmyocardialcontractilitybyreducingintracellularCa.ItcausesfallinBPandCO.Heartratedecreasesduetovagalstimulation.Ittendstosensitizethehearttoarrhythmogenicactionofadrenalinecontraindicatedinpheochromocytoma.Itcausesgreaterdepressionofrespirationandventilationperfusionmismatch.Itdilatesthebronchiinhalationagentofchoiceinasthmatics(intravaneousanaestheticofchoiceinasthmaticsisketamine).Itisahepatotoxicdrugandcanalsocausemalignanthyperthermia(Succinylcholineaccentuateit).Recoveryissmoothandreasonablyquick.Itcausespostanaestheticshiveringandchills.Itinhibitsintestinalanduterinecontractionsagentofchoiceforassistingexternalorinternalversionduringlatepregnancy.
Becauseitsuterinerelaxantactionitiscontraindicatedduringlabour.Itisparticularlysuitableforinductionandmaintenanceinchildrenandasmaintenanceanaestheticinadults.
22.Midazolamcausesallexcept: a)Anterogradeamnesia b)Retrogradeamnesia c)Causestachyphylaxisduringhighdoseinfusions d)Decreasedcardiovasculareffectsascomparedtopropofol CorrectAnswer-BAns.b.RetrogradeamnesiaAtthetimeofpeakconcentrationinplasma,hypnoticdosesofbenzodiazepines(midazolam)canbeexpectedtocausevaryingdegreesoflightheadedness,lassitude,increasedreactiontime,motorincoordination,impairmentofmentalandmotorfunctions,confusion,andanterogradeamnesia."Midazolam:ItcausesanterogradeamnesiaQToleranceandtachyphylaxismayoccur,particularlywithlonger-terminfusionsQ(ShaferA.Complicationsofsedationwithmidazolamintheintensivecareunitandacomparisonwithothersedativeregimens.CritCareMed.1998;26(5):947-56)Benzodiazepinewithdrawalsyndromehasalsobeenassociatedwithhighdose/long-termmidazolaminfusionsQComparedwithpropofolinfusions,midazolaminfusionshavebeenassociatedwithadecreasedoccurrenceofhypotension?butamorevariabletimecourseforrecoveryoffunctionafterthecessationoftheinfusion.
23.Whichofthefollowinginhalationalagent sensitizesmyocardiumtocatecholamine a)Sevoflurane b)Isoflurane c)Ether d)Halothane CorrectAnswer-DAns.is'd'i.e.,HalothaneSomeinhalationalagentsensitizethehearttoadrenaline-->Arrhythmiascanoccur-->ThereforetheseagentsarecontraindicatedinPheochromocytomaandalongwithadrenaline.Halothanehasmaximumpropensity.OtheragentssensitizingthehearttoadrenalineareTrilene,Cyclopropane,Chloroform,Enflurane
24.Gasusedinrapidairbaginflation a)Sodiumazide b)Nitrocellulose c)Mercuricnitrate d)Potassiumnitrate CorrectAnswer-AAns.is'a'i.e.,SodiumazideChemistryofairbagsTheinclusionofairbagsinthemodernautomobileshasledtodecreaseintheautomobileinjures.Thetermairbagisamisnomerasairisnotinvolvedintheinflationprocess.Ratheranairbaginflatesrapidly(inabout30ms)duetoexplosiveproductionofN2gas.SodiumazideisusedwhichisrapidlydecomposedtoNitrogengas.
25.Whichofthefollowingisnotprimarily usedtoanesthetizemucosa? a)Benzocaine b)Lidocaine c)Bupivacain d)Tetracaine CorrectAnswer-CAns.is'c'i.e.,Bupivacaine
26.Postspinalheadachelastsfor? a)10min b)Ihrs c)10days d)1week CorrectAnswer-CAns.is'c'i.e.,10daysPostduralpunctureheadacheisduetoCSFleak.Typicallocationisbifrontaloroccipital.Headachegetsworsenonsittingoruprightpostureandisrelievedbylyingdownpositionandabdominalpressure-->Thehallmarkofpostduralpunctureheadachei.e.,associationwithbodyposition.Theonsetofheadacheisusually12-72hoursfollowingtheprocedure,however,itmaybeseenalmostimmediately.Inmostcasesitlastsfor7-10days.PDPHisbelievedtoresultfromleakageofCSFfromaduraldefectanddecreasedICT.LossofCSFataratefasterthatitcanbeproducedcausestractiononstructuresupportingthebrain,particularlyduraandtentorium.Tractiononcranialnerve(particularly6thnerve)producesdiplopia.FactorsthatincreasetheincidenceofPDPHareyoungage,femalesex,Pregnancy,largeboreneedleandmultiplepunctures.UseofsmallboreneedlecanpreventPDPH.Intiallyconservativetreatmentisgivenwhichincludesanalgesics(NSAIDs),oralori.v.,fluids,Sumatriptan,cosyntropin,caffeineandrecumbentposition.Ifconservativetreatmentfails,epiduralbloodpatchcanbeused.Itinvolvesinjecting15-20mlofautologusbloodintotheepidural
spacewhichstopleakageofCSFbycoagulationandmasseffect
27.Laryngealmaskairwaynotusedin? a)Babyweighing<1500gms b)PregnantPatients c)OcularSurgeries d)Difficultairway CorrectAnswer-BAns.is`b'i.e.,PregnantPatientsIndicationsofLMA 1. Asanalternativetointubationwheredifficultintubationisanticipated (difficultairway). 2. Tofacilitateendo-trachealintubationinapatientwithdifficult airways. 3. Situationsinvolvingadifficultmaskfit.4. Securingairway(ascardiopulmonaryresuscitation)inemergency whereintubationandmaskventilationisnotpossible. 5. Forminorsurgeries(shortsurgeries),whereanaesthetistwantsto avoidintubation. 6. Asaconduitforbronchoscopes,smallsizetubes,gumelastic bougies. 7. Forextraandintra-ocularsurgeriesincludingretinopathysurgeryin prematureinfants--)LMAisparticularlyusefulinophthalmicsurgeryasproblemscreatedbyothertwoairwaysareeliminated:- 8. Facemaskcreatesprobleminsurgicalfieldaccessduetoitssize (LMAprovidesabetteraccess). 9. EndotrachealintubationmaycauseraisedIOT(LMAhasnoeffect). ContraindicationsofLMA 1. Conditionswithhighriskofaspirationi.e.,fullstomachpatients, hiatushernia,pregnancy.
2. Oropharyngealabscessormass(tumor).3. Massivethoracicinjury4. Massivemaxillofacialtrauma
28.Localanaestheticcausing methemoglobinuriais? a)Dibucaine b)Chlorprocaine c)Procaine d)Benzocaine CorrectAnswer-DAns.is'd'i.e.,BenzocaineImportantfactsaboutLAsChlorprocaineistheshortestactingLA.Dibucaineisthelongestacting,mostpotentandmosttoxicLA.Procaine&chlorprocaineareleastpotentLAs.BupivacaineisthemostcardiotoxicLA(Ropivacaineisanewerbupivacainecongenerwithlesscardiotoxicity).Levobupivacaine(TheS(-)enantiomerofbupivacaine)islesscardiotoxicandlesspronetocauseseizure.PrilocaineandBenzocainecancauseMethaemoglobinemiaLignocaineisthemostcommonlyusedLA.Bupivacainehasthehighestlocaltissueirritancy.Chlorprocaineiscontraindicatedinspinalanaesthesiaasitcancauseparaplegiaduetopresenceofneurotoxicpreservativesodiummetabisulphite.ProcaineistheLAofchoiceinmalignanthyperthermia
29.Whichofthefollowingarefeaturesof pulmonaryoxygentoxicity? a)Increasedcapillaryendothelialpermeability b)Decreasedmucociliarytransportinairways c)Inhibitionofphagocytosisfunctionofalveolarmacrophages d)Alltheabove CorrectAnswer-DAns.is'd'i.e.,Alltheabove 1. Prolongedinhalationofhighconcentrationof0,isknowntodamage thelungs. 2. Pulmonarytoxicityof0,isrelatedtotheoxygentensioninalveoli. ThepulmonaryoxygentoxicityhasthefollowingfeaturesIncreasedcapillaryendothelialpermeabilitycausingaccumulationoffluidintheinterstitialspace.DepressionofmucociliarytransportfunctionofairwayInhibitionofphagocytosisofalveolarmacrophagesChangesinthesurfactantactivityanditsproduction.
30.Whichofthefollowingsystemscanbe usedtoproducePEEP? a)Springsystem b)Ballvalvesystem c)Pneumaticsystem d)Alltheabove CorrectAnswer-DAns.is'd'i.e.,AlltheaboveanesthesiabyHartiganp.179]PEEPValveAPEEPValveisadevicewhichmaintainstheairwayatendexhalation.SpringvalvesystemisthesimplestPEEPvalvesystem.OthervalvesystemsforPEEPareelectronic,magnetic,pneumaticandballvale.PEEPdevicesmaybeintegratedintoventilatorormaybeseparatedevicesthatareattacheddirectlyintoanesthesiacircuit,CPAPdeviceormanualresuscitationbag.
31.Whichofthefollowingiscontraindicated inheadinjury? a)Ketamine b)Halothane c)N,0 d)Propofol CorrectAnswer-AAns.is'a'i.e.,Ketamine
32.Percentageoftetracaineusedineye surgery? a)0.5% b)1% c)2% d)4% CorrectAnswer-AAns.is'a'i.e.,0.5%Cataractsurgerycanbeperformedusingtopicalanaesthesiaalone.Tetracaine0.5%andLidocaine4%canbeused.Advantagesofthismethodisthatitavoidsthepotentialcomplicationswithretorbulbarandperibulbarinjections.Dsadvantagesincludethepotentialforeyemovementduringsurgery,increasedpatientanxiety,anddiscomfortfromthemicroscopelight
33.Whatisthepressureatwhichoxygenis stored? a)75psi b)1600psi c)760psi d)2200psi CorrectAnswer-DAns.is'd'i.e.,2200psi
34.Trueaboutpostduralheadacheisall except:? a)Orientingbevelededgeneedleparalleltolongaxispreventsit b)Thinboreneedlepreventsit c)Itismorecommoninmales d)Timingofambulationhasnoeffectoveritsincidence CorrectAnswer-CAns.is`c'i.e.,ItismorecommoninmalesFACTORSTHATINCREASETHEINCIDENCEOFHEADACHEAFTERSPINALPUNCTUREAge:Younger,morefrequent.Sex:Females>malesNeedlesize:Larger>smallerNeedlebevel:LesswhentheneedlebevelisplacedinthelongaxisoftheneuraxisPregnancy:MorewhenpregnantDuralpunctures:MorewithmultiplepuncturesFACTORSTHATDONOTINCREASETHEINCIDENCEOFHEADACHEAFTERSPINALPUNCTUREInsertionanduseofcathetersforcontinuousspinalanaesthesiaTimingofambulationAboutoptionaOrientinganeedlebevelparallelwiththeaxisofthespine,suchthatthelongitudinalfibresofthedurawouldmorelikelybeseparatedthancut,resultsinalowerincidenceofpostspinalpunctureheadache.
35.Ketaminecontraindicatedinallexcept? a)Headinjury b)Hypertension c)Asthma d)Glaucoma CorrectAnswer-CAns.is`c'i.e.,AsthmaKetamineincreasescerebralbloodflow,metabolism,oxygenconsumptionandintracranialtension,unlikethiopentone,propofol&etomidate,whichhavecerebroprotectiveeffect,thereforeketamineiscontraindicatedinheadinjury,intracranialspaceoccupyinglesionsandforneuroanaesthesia.CerebrovascularresponsivenesstoCO2ispreserved,andreducingthearterialCO2tensionbyhyperventilationattenuatestheketamineinducedriseinICT.Ketaminehasdirectmyocardialdepressant(negativeionotropic)&vasodilatoreffect.However,ketaminealsohasindirectsympathomimeticeffect.Indirectsympathomimeticeffectpredominatesoverdirectmyocardialdepressant&vasodilatoreffect;usualresponseisincreasedBP,cardiacoutputandheartrate-Cardiac02demandisincreased.Ketamineiscontraindicatedinaorticaneurysm,hypertensiveandischemicheartdisease.Ketaminealsosensitizesthehearttoadrenaline-arrhythmiasmayoccur.Asketaminecausesympatheticstimulation,itistheintravenousanaestheticofchoiceinpatientswithshockandhypovolemia.Ketamineincreasesintra-oculartension-Contraindicatedinglaucoma&openeyesurgery.
Itisapotentbronchodilatorandrelievesbronchospasm-Intravenousanestheticagentofchoiceinasthmatic(inhalationalanaestheticagentofchoiceinasthmaticsishalothane)Itincreasesuterinetoneandintensityofuterinecontraction-agentofchoiceinpatientswithobstetrichaemorrhageandflacciduterus.Injectionofketamineisnotpainful(allotheri.v.inducingagentscausepainoninjection).
36.InBier'sblockaestheticagentgivenby whichroute? a)Intravenous b)Peribulbarregion c)Retrobulbararea d)Dermal CorrectAnswer-AAns.is'a'i.e.,IntravenousIntravenousregionalanaesthesia(IVRA)isusedmostoftenforsurgeryoftheforearmandhand,butcanalsobeusedfordistallegandfoot.FirstIVcannulaisinsertedusuallyinthedorsumofhand.Thentourniquetcuffisappliedtoproximalarm.Limbiselevatedandexsanguinatedwiththehelpofanelasticbandage(Esmarch).Nowtourniquetcuffisinflatedabovesystolicpressure(sothatnobloodcanenterinthatlimbandthelimbremainsexsanguinated).Nowthelocalanaestheticsolutionisslowlyinjectedintocannula.Theveinsarefilledwithonlylocalanaestheticasthereisnoblood-->localanaestheticcannotbedrainedoutformupperlimbandcannotenterinsystemiccirculationbecauseofinflatedcuffinproximalarm.Thearmisanaesthetizedin6-8minutes.LidocainewithoutadrenalineistheDOCforthistechnique.-Goodman&GilmanIlth/ep.381Afewclinicianprefersprilocaineoverlidocainebecauseofitshighertherapeuticindex-leasttoxicLA.Torniquecuffdeflation,prematurereleaseorfailureoftorniquetcan
causereleaseofLAintocirculationandtoxicitymayoccur-->So,cardiotoxicLAslikebupivacaineandetidocainearecontraindicatedforBier'sblock.
37.Whatisthenextstepinmanagementin managingachildwithdifficultintubationwith4failedattemptsatintubation? a)UseLMA b)Abandontheprocedure c)TryETtubeintibationagain d)Cricothyrotomy CorrectAnswer-AAns.is'a'i.e.,UseLMA
38.Followinggroupofdrugsisnotthefirst lineinthemanagementofchronicpain? a)Opioids b)Antiepileptics c)Serotonergicdrugs d)Dopamineantagonist CorrectAnswer-DAns.is'd'i.e.,Dopamineantagonist
39.Anaestheticofchoicefordaycaresrgery is? a)Thiopentone b)Nitrousoxide c)Propofol d)Halothane CorrectAnswer-CAns.is'c'i.e.,Propofol
40.Macintoshindicatorisusedfor? a)ToassessdegreeofNMblockade b)Localizationofextraduralspace c)ToassesslevelofGA d)Tomonitorrespiratorydepression CorrectAnswer-BAns.is'b'i.e.,LocalizationofextraduralspaceVariousmethodshavebeenusedtolocatetheepidural(extraduralspace),mostofwhichrelyonsubatmosphericpressure.Theseare:-Lossofresistancetoairorsaline(mostcommontechnique).Gutierrez'smethod:Ahangingdropofsalineonthehubofneedleisdrawninastheepiduralspaceisentered(morereliableinthorocicthanlumbarregion).Odom'sindicator:Afine-boreglasstubefilledwithsalineandabubblethatmovesinresponsetoadropinpressure.Macintosh'sindicator:Asmallrubberballoonfilledwithairconnectedtoanadaptorcausingittodeflateonenteringtheepiduralspace.Macintosh'sspring-loadedneedle.Ultrasoniclocalization.Oxfordepidularspacedetector.
41.Atracuriumisexcretedby a)Renalexcretion b)Hepaticelimination c)Nonenzymaticdegradation d)Alloftheabove CorrectAnswer-CAns.is'c'i.e.,NonenzymaticdegradationTheuniquefeatureofatracuriumisinactivationinplasmabyspontaneousnonenzymaticdegradation(Hofmannelimination)inadditiontothatbyalkalineesterhydrolysis.Consequentlyitsdurationofactionisnotalteredinpatientswithhepatic/renalinsufficiencyorhypodynamiccirculationPreferredmusclerelaxantforsuchpatientsaswellasforneonatesandtheelderly.oAtracuriumismetabolisedtolaudanosinethatisresponsibleforseizures.ItcancausehistaminereleaseHypotension&bronchoconstriction.
42.Localanaestheticwithprolongedaction? a)Procaine b)Cocaine c)Lidocaine d)Dibucaine CorrectAnswer-DAns.is'd'i.e.,DibucaDibucaineisthelongestactinglocalanaestheticChlorprocaineistheshortestactinglocalanaestheticDecreasingorderofduration:-Dibucaine>Bupivacine=Tetracaine=Ropivacaine=Etidocaine>Prilocaine=Lignocaine=Mepivacaine=Cocaine>Procaine>Chlorprocaine.
43.DrugusedtoprolongactionofLAin Hypertensivepts? a)Clonidine b)Felypressin c)Dexmeditomidate d)Noradrenalin CorrectAnswer-BAns.is'b'.e.,Felypressin
44.Whichamongthefollowingisa depolarisingmusclerelaxant? a)Decamethonium b)Dtubocurarine c)Doxacurium d)Atracurium CorrectAnswer-AAns.is'a'i.e.,DecamethoniumMorgan4th/ep.214]Seeexplanation-4ofsession-3.
45.Whichofthefollowingisfastestacting inhalationalanaestheticagent? a)Halothane b)Desflurane c)Sevoflurane d)Isoflurane CorrectAnswer-BAns.is'b'i.e.,DesfluraneBlood:Gaspartitioncoefficient(B:Gcofflcient)Itisthemeasureofsolubilityoftheagentintheblood.Agentwithlowbloodsolubility(lowB:Gcoefficient)willhavehighconcentrationinalveolarairasitwilldiffuselessthroughthealveolarcapillarymembranebecauseoflowbloodsolubility.Sincealveolarconcentrationdeterminestheinductionandrecovery,induction&recoverywillbefastwithagentwithlessB:Gpartitioncoefficient;andinduction&recoverywillbeslowerwithagentswithhighB:Gpartitioncoefficient.DesfluranehasminimumB:Gpartitioncoefficient(leastbloodsolubility)HasFastestonsetandrecovery.oMethoxyfluranehasmaximumB:Gpartitioncoefficient(Maximumbloodsolubility)-4Hasslowestonset&recovery.Speedofonset&recoveryindecreasingorder(IncreasingorderofB:Gpartitioncoefficientandbloodsolubility):?Desflurane(0.42)>Cyclopropane(0.44)>N2O(0.47)>Sevoflurane(0.69)>Isoflurane(1.38)>Enflurane(1.8)>Halothane(2.4)>Chloroform(8)>Trilene(9)>Ether(12)>Methoxyflurane(15)
46.Currentmodeofanalgesiabestfor intrapartumpainrelief? a)Epiduralanalgesia b)Spinalanaesthesia c)Inhalational d)Localanalgesia CorrectAnswer-AAns.is'a'i.e.,EpiduralAnalgesiaContinuouslumbarepiduralanalgesiaistheprocedureofchoiceforpainreliefduringnormallabourandvaginaldelivery(Intrapartumpain).
47.Themostappropriatecircuitfor ventilatingaspontaneouslybreathinginfantduringanaesthesiais? a)jacksonReesmodificationofAyre'sTpiece b)MaplesonAorMagill'scircuit c)MaplesonCorWaterstoandfrocanister d)Bainscircuit CorrectAnswer-AAns.is'a'i.e.,JacksonReesmodification
48.CharacteristicEECpatternseenin surgicaltolerancestageofanesthesiais? a)Alpha b)Beta c)Delta d)Theta CorrectAnswer-CAns.is'c'i.e.,Delta
49.Supraclavicularblockisusedforsurgery of? a)Shoulder b)Forearm c)Arm d)All CorrectAnswer-DAns.isD.`(A)Shoulder(B)Forearm(C)Arm
50.Allofthefollowingaboutthiopentoneare trueexcept? a)ItdecreasesICT b)Ithasanticonvulsantaction c)IVinjectionispainless d)Itcancausereflextachycardia CorrectAnswer-CAns.is'c'i.e.,IVinjectionispainless
51.Thiopentoneisnotusedin? a)Inductionofanesthesia b)Medicallyinducedcoma c)Astruthserum d)Asantidepressant CorrectAnswer-DAns.is'd'i.e.,Asantidepressant
52.IVdoseof1:10000concentrationof epinephrineinpretermbabyis? a)0.1m1 b)0.2ml c)0.3ml d)0.4ml CorrectAnswer-BAns.is'b'i.e.,0-2mlEpinephrineTheIVdoseof1:10,000concentrationis0.1m1/Kg.Thusitisabout0.5mlfortermbabyand0.2mlforpretermbaby.Endotrachealtubedosingis1m1/Kg.thusitisabout3m1fortermbabyand1mlforpreterm.
53.Longestactingamongmusclerelaxantis? a)Doxacurium b)Rocuronium c)Vecuronium d)Atracurium CorrectAnswer-AAns.is'a'i.e.,DoxacuriumAmongthegivenoptions,onlydoxacuriumislongacting.Seeexplanation-4ofsession-3.
54.Warfarintobestopped____________days beforesurgery? a)2to3days b)4to5days c)6to7days d)8to9days CorrectAnswer-BAns.is'b'i.e.,4to5daysWarfarinmayincreaseperi-operativebleeding,exceptforminorproceduressuchascataractsurgerywithoutbulbarblocks.Noconsensusexistsontheoptimalperioperativemanagementofpatientsreceivingwarfarin.Theusualrecommendationistowithholdwarfarinstarting4to5dayspreoperatively(iftheINRisbetween2.0and3.0)toallowtheINRtodecreasetolessthan1.5,whichisalevelconsideredsafeforsurgicalproceduresandneuraxialblockade.IftheINRisgreaterthan3.0,itisusuallynecessarytowithholdwarfarinlongerthan4to5days.IftheINRismeasuredthedaybeforethesurgicalprocedureandremainshigherthan1.8,asmalldoseofvitaminK(1to5mgadministratedorallyorsubcutaneously)canreverseanticoagulation.VitaminKhasaneffectwithin6to10hoursafteroralorsubcutaneousadministration(morepredictablewithoraladministration),anditpeakswithin24hoursto48hours.Administrationofhigherdosesmayleadtowarfarinresistancewhentherapyisinitiatedagain.
55.Falseaboutlocalanesthetics a)Prilocaineislesstoxicthanlignocaine b)Lignocaineisusedasanantiarrhythmic c)Mixtureofligno+prilocaineisknownaseutectic d)Lidocaineisshorteractingthanbupivacaine CorrectAnswer-AAns.is'a'i.e.,Prilocaineislesstoxicthanlignocaine
56.Mostcommoncomplicationofcoeliac plexusblock? a)Hypotension b)Parasthesias c)Diarrhea d)Pneumothorax CorrectAnswer-AAns.is'a'i.e.,HypotensionCeliacplexusblockTheceliacplexusissituatedretroperitoneallyintheupperabdomen.ItisatthelevelofT12andL,vertebraeanteriortothecruraofthediaphragm.ItcontainsvisceralafferentandefferentfibersdividedfromT5toT1,bymeansofgreater,lesserandleastsplanchnicnerves.Celiacplexusinnervatesmostoftheabdominalviscera,thereforethisprocedureblocksthenerveswhichcomefromthepancreas,liver,gallbladder,stomach,intestine,spleen,kidneyandadrenalglands.Aceliacplexusblockcanbecombinedwithanintercostalblocktoprovideanesthesiaforintra-abdominalsurgery.Becauseceliacplexusblockresultsinblockadeoftheautonomicnervoussystem,thisblockmayhelptoreducestressandendocrineresponsestosurgery.Forthesamereason,themostcommoncomplicationofceliacplexusblockisposturalhypotenstionbecauseofblockadeoflumbarsympatheticchainleadingtoupperabdominalvesseldilationandvenouspooling.Celiacplexusblockcanbedonebyfollowingthreeapproaches:-Retrocrural(classic)approach,anterocruralapproachand
splanchnicnerveblock.Celiacplexusblockisgiventotreatintractablepaininchronicpancreatitis,gastric&pancreaticmalignancies.Itcanbecombinedwithanintercostalblocktoprovideanesthesiaforintra-abdomivalsurgery.PosturalhypotensionistheMostcommoncomplicationofclassicretrocruralandsplanchnicnerveblock,WhereasmostcommoncomplicationofAnterocruralapproachistransientdiarrhoea
57.Trueaboutmalignanthyperthermiaisall except a)MostcommoncauseisSch b)Dantroleneisthedrugofchoice c)EndtidalCO,isincreased d)Bradycardiaoccurs CorrectAnswer-DAns.is'd'i.e.,Bradycardia
58.Elderlypatientwithfracturerighthip anestheticofchoice a)Spinal/epidural b)General c)Localinfiltration d)Noneoftheabove CorrectAnswer-AAns.is'a'i.e.,Spinal/epidural
59.Whichisasafemusclerelaxantinrenal failure? a)Cisatracurium b)Rocuronum c)Vecuronium d)Succinylcholine CorrectAnswer-AAns.is'a'i.e.,CisatracuriumTheuniquefeatureofatracuriumandcisatracuriumisinactivationinplasmabyspontaneousnonenzymaticdegradation(Hofmanelimination)inadditiontothatbyalkalineesterhydrolysis.Thereforebothofthesedonotrequirehepaticorrenalroutesforeliminationthereforecanbeusedsafelyinhepaticandrenalfailure.Moreover,cisatracuriumdoesnotprovokehistaminerelease,thereforeitispreferredoveratracurium.
60.Onsetofpostspinalheadacheisusually athoursafterspinalanesthesia a)0-6 b)6-12 c)12-72 d)72-96 CorrectAnswer-CAns.is'c'i.e.,12-72
61.DISSisusedfor? a)Correctapplicationofcylindertoanaesthesiamachine b)Toprovideanalgesia c)TomonitorBP d)TomonitorCVP CorrectAnswer-AAns.is`a'i.e.,Correctapplicationofcylindertoanaesthesiamachine
62.Drugsusedfordaycaresurgeryareall except? a)Propofol b)Sevoflurane c)Doxacurium d)Desflurane CorrectAnswer-CAns.is'c'i.e.,Doxacurium
63.Shortestactingnondepolarizingmuscle relaxantis? a)Mivacurium b)Doxacuronium c)Pipecurium d)Vecuronium CorrectAnswer-AAns.is'a'i.e.,MivacuriumSuxamethonium(succinylcholine)istheshortestactingskeletalmusclerelaxant.oMivacuriumistheshortestactingnondepolarizingskeletalmusclerelaxant.
64.Henryslawstatesthat? a)Ataconstanttemperaturegasdissolvesinsolutionin proportiontoitspartialpressure b)AtaconstantPressuregasdissolvesinsolutioninproportionto itstemperature c)Ataconstanttemperaturegasdissolvesinsolutionin proportiontoitsfatsolubility d)Ataconstantpressuregasdissolvesinsolutioninproportionto itsfatsolubility CorrectAnswer-AAns.is'a'i.e.,Ataconstanttemperaturegasdissolvesinsolutioninproportiontoitspartialpressure
65.Propofolinfusionsyndromeallexcept? a)Occurswithinfusionofpropofolfor48hoursorlonger b)Occursincriticallyillpatients c)Featuresarenauseaandvomiting d)Featuresarecardiomyopathy,hepatomegaly CorrectAnswer-CAns.is'c'i.e.,FeaturesarenauseaandvomitingPropofolinfusionsyndromeAlethalsyndrome,associatedwithinfusionofpropofolfor48hoursorlonger.Occursinchildrenandcriticallyill.Occursasaresultoffailureoffreefattyacidmetabolismandfailureofthemitochondrialrespiratorychain.Featuresare-cardiomyopathywithacutecardiacfailure,metabolicacidosis,skeletalmyopathy,hyperkalemia,hepatomegalyandlipemia.
66.Hyperbaricoxygenisnotusefulin? a)Anemia b)Vertigo c)Gasgangrene d)CompartmentSyndrome CorrectAnswer-BAns.is'b'i.e.,Vertigo
67.Treatmentinpostoperativeshivering? a)Pethidine b)Piritramide c)Methadone d)Pentazocine CorrectAnswer-AAns.is'a'i.e.,PethidinePost-anaesthesiashivering(PAS)Postanaesthesia(postoperative)shiveringoccursin40%ofpatientsrecoveringfromgeneralanaesthesia.Sometimeitisprecededbycentralhypothermiaandperipheralvasoconstriction,indicatingthatitisathermoregulatorymechanismPethidineismosteffectivedrugfortreatmentofPAS.Otherdrugsusedare--clonidine,doxapram,ketanserin,alfentonil,butorphanol,chlorpromazine.
68.Standardmethodtodifferentiatebetween endotrachealandesophagealintubationis? a)EndtidalCO2 b)ChestX-rays c)Auscultation d)Partialpressureof02 CorrectAnswer-AAns.is'a'i.e.,EndtidalCO2
69.Anestheticagent/swhichhavetocolytic effectare? a)Halothane b)Enflurane c)Isoflurane d)Alltheabove CorrectAnswer-DAns.is'd'i.e.,AlltheaboveHalothane,enfluraneandisofluraneproduceadosedependentdecreaseinuterinetone(tocolysis).Studiesofisofluranedemonstratethathalogenatedcompoundsreduceboththefrequencyofuterinecontractionsandtheintervalbetweenthem.
70.Followingarehepatotoxicanesthetic agentsexcept? a)Halothane b)Chloroform c)Ether d)Propofol CorrectAnswer-DAns.is`d'i.e.,PropofolZimmermannp.458]Followingarethegroupsofhepatotoxicanestheticagents:GroupI:DrugswithwellknownhepatotoxicpotentialandcontainingChlorineorbromine.Eg:chloroform.GroupII:DrugswhichcontainfluorineEg:halothane,methoxyflurane.Desflurane,enflurane,sevoflurane,isoflurane,nitrousoxideandcarbontetrachloridearealsolinkedwithhepatotoxicity.
71.Actionofwhichanestheticagentis throughNMDAreceptors? a)Xenon b)NO c)Succinylcholine d)Etomidate CorrectAnswer-AAns.is'a'i.e.,XenonXenonItexertsanaestheticactionbynoncompetitiveblockadeofNMDAreceptors.Xenonhasbeenusedasageneralanesthetic.Xenoninteractswithmanydifferentreceptorsandionchannelsandlikemanytheoretically
72.AllofthefollowingareNondepolarising muscularblockersexcept a)Pancuranium b)Dexacurium c)D-Tubocurarine d)Succinylcholine CorrectAnswer-DAns.is'd'i.e.,Succinylcholine
73.Inepiduralanaesthesiadrugisinjected? a)Outsidethedura b)Insidetheduramater c)Insidearachnoidmater d)Insidepiamater CorrectAnswer-AAns.is'a'i.e.,Outsidethedura
74.Celiacplexusblockallthefollowingis trueexcept? a)Relievedpainfromgastricmalignancy b)Causehypotention c)Canbeusedtoprovideanesthesiaforintraabdominalsurgery d)Canbegivenonlybyretrocrural(classic)approach CorrectAnswer-DAns.is'd'i.e.,Canbegivenonlybyretrocrural(classic)approachCeliacplexusblockcanbedonebyfollowingthreeapproaches:Retrocrural(classic)approach,anterocruralapproachandsplanchnicnerveblock.Seeexplanation-4ofsession-8ofAnaesthesiaofAllIndia2014-15patternofthisbook.
75.Bestuterinerelaxationisseenwith? a)Chloroform b)Nitrousoxide c)Ether d)Halothane CorrectAnswer-DAns.'d'i.e.,HalothaneHalogenatedinhalationalanaestheticagentslikehalothanearepowerfultocolyticagents.Halothaneisanaestheticofchoiceforinternalversionandmanualremovalofplacenta.
76.Dibucainnumberrefersto? a)Achcholinestraseactivityderangement b)Potencyofmusclerelaxants c)Potencyofgeneralanaesthetics d)None CorrectAnswer-AAns.is'a'i.e.,AchchlinestraseactivityderangementDibucainnumber:Dibucain(alocalanaesthetic)inhibits80%ofnormalpseudocholinesteraseand20%ofatypical(non-functional)pseudocholinesterase.Thereforenormaldibucainnumberis70-80%.Dibucainnumberisusedtomeasuretheactivityofatypicalpseudocholinesterase.
77.PercentageoflidocaineinEutectic mixture- a)1% b)2.5% c)5% d)10% CorrectAnswer-BAns.is'b'i.e.,2-5%EutecticmixtureoflocalAnaestheticsThisisuniquetopicalpreparationwhichcananaesthetiseintactskin.Itisamixtureof2.5%lidocaineand2.5prilocaine.Itactsslowlyandthecreammustheldincontactwithskinforatleast1hour.EMLAisused:tomakevenepuncturepainlessespeciallyinchildren,andforprocedurelikeskingrafting&circumcision.Assystemicabsorptionofprilocainecancausemethemoglobinemia,EMLAshouldnotbeusedonmucocutaneousmembraneorinverysmallchild.
78.Longactinglocalanaesthetic? a)Procaine b)Lignocaine c)Prilocaine d)Dibucaine CorrectAnswer-DAns.is'd'i.e.,Dibucaine
79.Hepatotoxicinhalationalagent? a)Halothane b)Enflurane c)Desflurane d)Sevoflurane CorrectAnswer-AAns.is'a'i.e.,HalothaneAllinhalationalagentcausemildhepatotoxicitybydecreasinghepaticbloodflow.IsofluraneistheagentofchoiceinliverdiseaseasithasleasteffectonHepaticbloodflow.Directhepatotoxicity(Hepatitis,Hepaticnecrosis)iscausedby:-Halothane,Chloroform,trilene,methoxyflurane
80.Apatientaftergivinginhalational anaestheiadevelopedfulminanthepatitis,patientwasexposedtosamedrugpreviously.Whichisthedrug? a)Halothane b)N20 c)Enflurane d)Isoflurane CorrectAnswer-AAns.is'a'i.e.,HalothaneHalothaneItisavolatileliquidwithsweetodour,nonirritatingandnoninflammable.Itisapotentanaestheticwithpooranalgesicandmusclerelaxantproperties.HalothanecausesdirectdepressionofmyocardialcontractilitybyreducingintracellularCa+2.ItcausesfallinBPandCO.Heartratedecreasesduetovagalstimulation.Ittendstosensitizethehearttoarrhythmogenicactionofadrenaline--*contraindicatedinpheochromocytoma.Itcausesgreaterdepressionofrespirationandventilationperfusionmismatch.Itdilatesthebronchi-->inhalationagentofchoiceinasthmatics(intravaneousanaestheticofchoiceinasthmaticsisketamine).Itisahepatotoxicdrugandcanalsocausemalignanthyperthermia(Succinylcholineaccentuateit).
Recoveryissmoothandreasonablyquick.Itcausespostanaestheticshiveringandchills.Itinhibitsintestinalanduterinecontractions-->agentofchoiceforassistingexternalorinternalversionduringlatepregnancy.Becauseitsuterinerelaxantactionitiscontraindicatedduringlabour.Itisparticularlysuitableforinductionandmaintenanceinchildrenandasmaintenanceanaestheticinadults.
81.LeastMACisofwhichinhalationalagent? a)Xenon b)Halothane c)Sevoflurane d)Isoflurane CorrectAnswer-AAns.is'a'i.e.,Xenon MAC Agent (%) Ether 1.9 Halothane 0.75 Enflurane 1.68 Isoflurane 1.2 Desflurane 6.0 Sevoflurane 2.0 Nitrous 105 oxide "XenonhasMACof71%"--MorganMethoxyflurone(MAC=0.16%)>Trilene(0.2%)>Halothane(0.74%)>Chloroform(0.8%)>Isoflurane(1.15%)>Entlurane(1.68%)>Ether(1.92%)>Sevoflurane(2.0%)>Desflurane(6,0%)>Cyclopropane(9.2%)>N20(104%).
82.Inpseudocholinesterasedeficiency,drug tobeusedcautiouslyis- a)Barbiturate b)Succinylcholine c)Halothane d)Gallamine CorrectAnswer-BAns.is'b'i.e.,SuccinylcholineCholinesteraseAtcholinergicnerveendings,inerythrocytes,andgraymatterthereisanenzymethatspecficallydestroysacetylcholine,truecholinesteraseoracetylcholinestrase.Invarioustissues,especiallyinplasma,liver,whitematter&intestine,thereareotheresteraseswhicharenotspecificforacetylcholinebutwhichalsodestroyotheresters,thesearecallednonspecificorpseudocholinesteraseorbutyrylcholinesterase.Thedrugshydrolyzedbypseudocholinesteraseare(Miller5th/ep.419,420) 1. Succinylcholine2. Cocaine3. Mivacurium4. Bambuteral5. Remifentanil6. Procaine Pseudocholinesteraseismoresensitivetoorganophosphateanticholinesterase,whiletrueacetylcholinesteraseismoresensitivetocarbamateanticholinesterase(Physostigmine).Condionswherepseudocholinesteraseleveldecreases.
1. Pregnancy2. Malnutrition3. CRF4. Burns5. Collegenvasculardisease6. Hypothyroidism7. Malignancy8. Liverfailure
83.Blood:Gaspartitioncoefficientisa measureof? a)Potencyofanaestheticagent b)Speedofinductionandrecovery c)Lipidsolubilityofagent d)None CorrectAnswer-BAns.is'b'i.e.,SpeedofinductionandrecoveryMinimumalveolarconcentration(MAC)-->Measureofpotency.Blood:GaspartitioncoefficientBloodsolubilityofanaestheticagentanddeterminesthespeedofinduction&recovery.Oil:Gaspartitioncoefficient-4Lipidsolubilityofanaestheticagentandisrelatedtopotencyofanaestheticagent.
84.Inhalationalagentofchoicefor neurosurgery? a)Halothane b)Enflurane c)Isoflurane d)N20 CorrectAnswer-CAns.is'c'i.e.,IsofluraneAnaestheticagentsofchoiceforvaousconditionsDaycare: Ischemicheartdisease:Congenitalheart Propofol disease Etomidate Lefttorightshunt: Isoflurane Righttoleftshunt: Ketamine CHF: Ketamine Shock Ketamine Toproducedelibrate Isofluranehypotenion Thiopentone Epilepsy: Methohexitone Forelectroconvulsive Thiopentonetherapy: Isoflurane Thyrotoxicosis: Isoflurane Cardiacsurgery: Neurosurgery:
85.Regardingpropofol,whichoneofthe followingisfalse? a)Itisusedasanintravenousinductionagent b)Itcausesseverevomiting c)Itispainfuloninjectingintravenously d)Ithasnomusclerelaxantproperty CorrectAnswer-BAns.is'b'i.e.,ItcausesseverevomitingPropofolPropofolisamilkywhitepowderthatispreservativefree;therefore,itmustbeusedwithin6hours.Itisanoilbasedpreparation,thereforeinjectionispainful.Propofolisthemostfrequentlyusedintravenousanaesthetictoday.--Miller6thie-318Itcanbeusedforbothinductionaswellasmaintenace.Itdoesnotpossessanticonvulsiveaction(unlikethiopentone).ItcausesfallinBPandbradycardia.Likethiopentalitdoesnotpossessmusclerelaxantaction.Propofolpossesssignificantantiemeticandantipruriticaction.Miller6th/e-324Propofoldecreasespolymorphonuclearleukocytechemotoxisbutnotaherence,phagocytosisandkilling(Thiopentoneblocksallthese)--)increasedlifethreatninginfections.Propofolisparticularlysuitableforoutpatientsurgery.IntermittentinjectionorcontinuousinfusionofpropofolisfrequentlyusedfortotalLv.anaesthesia(TINA)whensupplementedbyfentanyl.
ItisanaestheticsofchoiceforintubationinICUandforpatientswithmalignanthyperthermia.Sideeffects-painoninjection,myoclonus,apnea,LBPandrarelythrombophlebitis.Propofolinfusionsyndrome 1. Alethalsyndrome,associatedwithinfusionofpropofolfor48hours orlonger. 2. Occursinchildrenandcriticallyill.3. Itoccursasaresultoffailureoffreefattyacidmetabolismand failureofthemitochondrialrespiratorychain. 4. Featuresare-cardiomyopathywithacutecardiacfailure,metabolic acidosis,skeletalmyopathy,hyperkalemia,hepatomegalyandlipemia
86.Notasignofstellateganglionblock? a)Miosis b)Exopthalomos c)Nasalcongestion d)Conjunctivalredness CorrectAnswer-BAns.is'b'i.e.,ExopthalomosThereisenophthalmos(notexophthalmos)StellateganglionblockStellateganglionisformedbyfusionoflowercervicalandfirstthoracicganglion.ItisblockedanteriortothetubercleoftransverseprocessofC6vertebrai.e.,chassaignactubercleatthelevelofcricoidcartilage.Signsofsuccessfulblockare:-Hornersyndrome(miosis,ptosis,anhydrosis,enophthalmos,absenceofciliospinalreflex),flushingofface,conjuctivalcongestion,Nasalstuffiness(Gutman'ssign),Injectionoftympanicmembrane(muller'ssyndrome),Increasedskintempratureandlacrimation.Stellateganglionblockisindicatedin:- 1. Treatmentofacuteherpeszosterinthedistributionofthetrigeminal nerve,cervicalandupperthoracicdermatomes. 2. Acutevascularinsufficiencyofupperlimbandface.3. Frostbite4. Reflexsympatheticdystrophyofface,neckandupperextremities.5. Raynaud'ssyndromeofupperextremities.
87.Theterm"balancedanaesthesia"has beengivenby? a)Simpson b)Fischer c)Lundy d)Mortan CorrectAnswer-CAns.is'c'i.e.,LundyTerm'balancedanaesthesia'wasintroducedbyLundyin1926.BalancedanaesthesiaThecardinalfeatureofgeneralanaestheticsare:? 1. Lossofallsensations,especiallypain2. Sleep(unconciousness)andamnesia3. Immobilityandmusclerelaxation4. Abolitionofreflexes Inmodernpracticeofbalancedanaesthesiathesemodalitiesareachievedbyusingcombinationofinhaledandiv.drugs.
88.Highspinalanaesthesiaisassociated with? a)DecreasedBP&decreasedheartrate b)IncreasedBP&decreasedheartrate c)DecreasedBP&increasedheartrate d)IncreasedBP&increasedheartrate CorrectAnswer-AAns.is'a'i.e.,DecreasedBP&decreasedheartrateSpinalanesthesiaascendingintothecervicallevels(highspinalanesthesia)causesseverehypotension,bradycardiaandrespiratoryinsufficiency.Complicationsofspinalanaesthesia Intraoperative PostoperativeHaedache(postduralpunctureheadach)-mostcommon Hypotension Cranialnerve (mostcommon) palsies(any Bradycardia10th cranialnerve Respiratorydepression excepttheCardiacarrest 1st,9th&most Hypothermiainelderly commonly6th nerveisinvolved)Caudaequina
equinasyndromeArachnoiditis
89.Eutecticmixtureoflocalanaesthetic (EMLA)creamis a)Bupivacaine2.0%+Prilocaine2.5% b)Lidocaine2.5%+Prilocaine2.5% c)Lidocaine2.5%+Prilocaine5% d)Bupivacaine0.5%+Lidocaine2.5% CorrectAnswer-BAns.is'b'i.e.,Lidocaine2.5%+Prilocaine2.5%Eutecticmixtureoflocalanaesthetic(EMLA)Thisisuniquetopicalpreparationwhichcananaesthetiseintactskin.Itisamixtureof2.5%lidocaineand2.5prilocaine.Itactsslowlyandthecreammustheldincontactwithskinforatleast1hour.EMLAisused:tomakevenepuncturepainlessespeciallyinchildren,andforprocedurelikeskingrafting&circumcision.Assystemicabsorptionofprilocainecancausemethemoglobinemia,EMLAshouldnotbeusedonmucocutaneousmembraneorinverysmallchild.
90. Whichanaestheticbelongstoester group? a)Procaine b)TimesNewRoman c)Lignocaine d)Propofol CorrectAnswer-AAns.is'a'i.e.,ProcaineEsters(aminoesters):-Procaine,chlorprocaine,tetracaine(amethocaine),Benzocaine,Cocaine.Amides(aminoamides)Lignocaine,Mepivacaine,Prilocaine,Bupivacaine,Etidocaine,Ropivacaine,Dibucaine.
91.ThelatestAHA2010forCPCRinbasiclife supportbytwoindividualsforcardiacexternalmassage&ventilationinadultis? a)30-2 b)15-1 c)15-2 d)30-1 CorrectAnswer-AAns.is'a'i.e.,30-2
92.Bestlocalanaestheticforophthalmic surgeryis a)Tetracaine b)Prilocaine c)Procaine d)Bupivacaine CorrectAnswer-DAns.is'd'i.e.,BupivacaineThechoiceoflocalanaestheticforocularsurgeryvaries.Butlidocaine(2%)andbupivacaine(0.5-0.75%)areusedmostcommonly.Generallytheuseof1:1mixtureof2%lidocaine(xylocaine)and0.50%bupivacainealongwithadrenalineandhyaluronidaseinfacial,retrobulbarandperibulbarblocksiscommon.
93.Percentageofadrenalinewithlignocaine forlocalinfilterationis? a)1:1000 b)1:10000 c)1:100 d)1:50000 CorrectAnswer-DAns.is'd'i.e.,1:50000Themostcommonconcentrationsofepinephrinecombinedwithlocalanaestheticsare1:50,000(0.02mg/ml),1:100,000(0.01mg/ml)and:200000(0.005mg/ml).The1:50000concentrationismanufacturedincombinationwith2%lidocaine.The1:100,000concentrationismanufacturedincombinationwith2%lidocaineand4%articaine.The1:200,000concentrationismanufactureincombinationwith4%prilocaine,4%articaineand0.5%bupivacaine
94.Localanaesthesiacausing methemoglobinemia? a)Procaine b)Prilocaine c)Etodicaine d)Ropivacaine CorrectAnswer-BAns.is'b'i.e.,PrilocainePrilocaineandbenzocainecancausemethemoglobinemia. ImportantfactsChlorprocaineistheshortestactingLA.Dibucaineisthelongestacting,mostpotentandmosttoxicLA.BupivacaineisthemostcardiotoxicLA(Ropivacaineisanewerbupivacainecongenerwithlesscardiotoxicity).oLevobupivacaine(TheS(-)enantiomerofbupivacaine)islesscardiotoxicandlesspronetocauseseizure.oPrilocainecancauseMethaemoglobinemia.LignocaineisthemostcommonlyusedLA.Bupivacainehasthehighestlocaltissueirritancy.Chlorprocaineiscontraindicatedinspinalanaesthesiaasitcancauseparaplegiaduetopresenceofneurotoxicpreservativesodiummetabisulphite.ProcaineistheLAofchoiceinmalignanthyperthermia
95.Intraocularpressureisincreasedby whichanaesthetic? a)Ketamine b)Propofol c)N20 d)Isoflurane CorrectAnswer-AAns.is'a'i.e.,Ketamine
96.A6yearoldboytakenforophthalmic examinationunderanaesthesia.Hisfathertoldthathehaslowerlimbweakness&hiselderbrotherdiedat14yearsofage.Whichanaetheticdrughastobeavoided- a)Succinylcholine b)Pancuronium c)Atracurium d)Dexacurium CorrectAnswer-AAns.is'a'i.e.,SuccinylcholineSuccinylcholineSChisadepolarisingskeletalmusclerelaxant.Itcausessustainedpartialdepolarizationofmuscleendplate-->intiallyproducetwitchingandfasciculationfollowedbyflaccidparalysis.Itistheshortestandfastestactingskeletalmusclerelaxant.Itistheonlymusclerelaxantwhichstimulateautonomicgangliaandvagus.SChisthemostcommonlyusedmusclerelaxantforpassingendotrachealtube(mivacuriumandrocuroniumarealternatives).SChisrapidlyhydrolysedbyplasmacholinesterase,somepatientshavegeneticallydeterminedabnormalityordeficiencyofpseudocholinesterase,inthem,SChcausesphaseIIblock.Itcancausemusclefasiculationsandsoreness,changeinBPandHR,arrythmia,histaminereleaseandICeffluxfrommuscles.
Dangeroushyperkalemiacanoccurinpatientswithburn,crushinjury,musculardystrophy,GB.Syndrome,paraplegiaorhemiplagia,mystheniagravisandrhabdomyolysiscontraindicatedinsuchpatients.oItcanaccentuatemalignanthyperthermiacausedbyhalothane.SChcausesincreaseinallpressures-->inraocular,intracranial,BP,andintrabdominal-->contraindicatedinglaucoma,headinjury.
97.Criticaltemperatureofoxygenis? a)20 b)118 c)36.5 d)400C CorrectAnswer-BAns.is'b'i.e.,-118
98.Disadvantageofketamineis? a)Increasedheartrate b)IncreasedICT c)Delirium d)Alloftheabove CorrectAnswer-DAns.is'd'i.e.,AlloftheaboveWhenadministeredtoadultpatientsasasoleanaestheticagent,ketaminefrequentlycauseemergencereactioncharacterizedbyanxiety,hallucination,delirium.Moreover,ketamineshowscardiovascularstimulantproperty(increasesheartrateandBP),increasessalivaryandbronchialsecretions,andmayincreaseintracranial,intraocularandpulmonarypressure.Allofthesefeatureshavebeenadvocatedaslimitationsforitsusefulness.
99.AllarefalseaboutN20except? a)Leastpotent b)Goodmusclerelaxant c)Lighterthanair d)Nodiffusionhypoxia CorrectAnswer-AAns.is'a'i.e.,LeastpotentNitrousoxideN2QItiscolourless,odourless,heavierthanair,nonirritatingandnoninflammablegas.oItisalsocalledlaughinggas.MACis105%(leastpotent)-evenpureN20at1atmosphericpressurecannotproduceadequateanaesthesia.oIthasgoodanalgesicbutpoormusclerelaxantactivity.Itissuppliedunderpressureinbluecolouredsteelcyclinders.Ithasverylowbloodsolubility-->inductionisquickandsmoothwithrapidrecovery.SecondgaseffectanddiffusionhypoxiaoccurwithN20only.N20isgenerallyusedasacarrierandadjuvanttootheranaesthetics-->Amixtureof70%N20+25-30%02+0.2-2%anotherpotentanaestheticisemployedformostofthesurgicalprocedures.Entonoxisamixtureof50%N20and50%02.Ithaslittleeffectonrespiration,heartandBP.ItcancausebonemarrowdepressionandvitB12deficiency.N20istheonlyanaestheticreportedtoproducehematologictoxicityandneurotoxicitywithlongtermadministration.BothtoxicitiesaretheresultoftheinteractionofN20withvitB12.
Completebonemarrowfailurecanbeexpectedafterseveraldaysofcontinuousexposure.Bonemarrowchangesarepreventablebypretreatingpatientswithlargedosesoffolinicacid.OthermanifestationsofvitB12deficiencyeg.megaloblasticanemia,subacutecombineddegenerationofcordmayalsooccur.Methemoglobinemiaandlaryngospasmmayoccur.Itiscontraindicatedinpatientswithaircavitieslikepneumothorax,pneumoperitoneumandvolvulus-->expansionandincreaseinpressureoccur.
100.Whichanaestheticiscontraindicatedin renalfailure? a)Isoflurane b)Desflurane c)Halothane d)Methoxyflurne CorrectAnswer-DAns.is'd'i.e.,MethoxyflurneMethoxyfluraneItwasmostpotentinhalationagent(leastMAC),butnotusednot(nowHalothaneismostpotent).oItshouldnotbeusedinclosedcircuit(reactswithrubbertubingofthelosedcircuit).Ithasslowestonset&recovery(howevernowetherhasslowestonset&recoveryasmethoxyfluraneisnotused).oBoilingpointismorethanwater(104?C).Intrarenalmetabolismofmethoxyfluraneandsubsequentintrarenalproductionoffluorideionisthesignificantcauseofmethoxyfluranerenaltoxicity.Itcancausehighoutputrenalfailureandhepatotoxicity
101.Conscioussedationis? a)CNSdepressionwithuncociousness b)Sedationwithinabilitytorespondtocommand c)Sedationwithabilitytorespondtocommand d)Anyoftheabove CorrectAnswer-CAns.is'c'i.e.,SedationwithabilitytorespondtocommandConscioussedationisatechniqueinwhichdrugsareusedtoproduceastateofCNSdepression(butnotunconsciousness),enablingsurgicalproceduretobecarriedoutwhilemaintainingcommunicationwiththepatientwhoisabletorespondpurposefullytocommandsandmaintainapatentairwaythroughout.Theprotectiveairwayreflexesarenotlost,thereforeconscioussedationissafer.However,byitself,itisnotabletosuppresspainofdentalprocedures;localanaestheticmustbeinjectedinaddition.Drugsusedforconscioussedationare- 1. N,O2. Diazepamormidazolam3. Propofol4. IMpromethazine5. IVfentanyl
102.Duringrapidinductionofanesthesia? a)Sellick'smaneuverisnotrequired b)Pre-oxygenationismandatory c)Suxamethoniumiscontraindicated d)Patientismechanicallyventilatedbeforeendotracheal intubation CorrectAnswer-BAns.is'b'i.e.,Pre-oxygenationismandatoryDuringrapidsequenceinductionpreoxygenationisdoneforfull3minutes.Schisthemusclerelaxantofchoiceforintubation.Sallieck'smaneuverisdonetopreventaspiration.Manualventilationbeforeintubationisavoidedasthisinflatesthestomachandencouragesregurgitation&aspiration.RapidsequenceanaesthesiaWhenanaesthesiaisgivenforemergencysurgery,itiscalleda"rapidsequenceanaesthesia".Thepatientshavefullstomachbecausethereisnostarvationforanaesthesia(itisanemergencysurgery)andgastricemptyingisdelayedduetotrauma,acuteabdomen.Therefore,theobjectiveofrapidsequenceanaesthesiaistosecuretheairwayrapidlyandpreventaspirationofgastriccontents.Procedureofrapidsequencehasfollowingsteps:-LiThepatientispreoxygenatedforfull3minutes.Intravenousinductionagent(thiopentoneorpropofol)isgiven.Sellick'smaneuver(cricoid/pressure)isdonetopreventaspiration.Afterensuringthecorrectpositionoftubecricoidpressureisreleasedandmaintenanceanaesthesia(NCO66%,02%33%,&inhalationalagent)isgiven.Anon-depolarizingblockerisnow
added.Suxamethenium(succinylcholine)isgivenasitquicklyrelaxesthelaryngealmusclessothatrapidintubationcanbedone.Notdoneduringrapidsequenceanaesthesia:? 1. Manualventilationbeforeintubationisavoidedasthisinflatesthe stomachandencouragesregurgitation&aspiration. 2. Premedicationsarenotgiven.
103.Whocoinedtermanaesthesia? a)Morton b)Holmes c)Morgan d)Priestly CorrectAnswer-AAns.is'a'i.e.,MortonSecondgaseffectanddiffusionhypoxiaIninitialpartofinduction,diffusiongradientfromalveolitobloodishighandlargerquantityofanaestheticisenteringblood.IftheinhaledConcentrationofanaestheticishigh(egN20),Substantiallossofalveolargasvolumewilloccuranditcreatesnegativeintralveolarpressurethatleadstoremovalofmoregasfromcylindertoalveoli-->Concentrationeffect.Ifanotherinhalationagentis(egHalothane)isbeinggivenatthesametime,italsowillbedeliveredtolungfromthecylinder(duetonegativeintraalveolarpressure)-->Secondgaseffect.Duringrecoveryreverseoccurs-N20havinglowbloodsolubility,rapidlydiffusesintoalveolianddilutesthealveolarair-->partialpressureofoxygeninalveoliisreduced.Theresultinghypoxiaisknownasdiffusionhypoxia.Diffusionhypoxiacanbepreventedbycontinuing100%02inhalationforafewminutesafterdiscontinuingN20,insteadofstraightawayswitchingovertoair.RememberConcentrationeffectandsecondarygaseffectduringinduction.Diffusionhypoxia-->duringrecovering.
AlltheseoccurwithN20only
104.Drugusedforemergencyintubationis? a)Propofol b)Ketamine c)Eomidate d)None CorrectAnswer-AAns.is'a'i.e.,PropofolEmergencyintubationinanaesthesiareferstorapidsequenceanaesthesia(orrapidsequenceintubation).Anyinducingagentcanbeused,butthiopentalandpropofolarethepreferredagent.
105.Maximumglobalwarmingisby? a)Desflurane b)Isoflurane c)Sevoflurane d)Halothane CorrectAnswer-AAns.is'a'i.e.,DesfluraneDesfluraneisagreenhousegas.Itcausesmaximumglobalwarming. Globalwarmingpotential(asanequalamountofO2)Isoflurane210timesSevoflurane510timesDesflurane1620times
106.Whichanaestheticdrugcontributesto greenhouseeffect? a)Enflurane b)Desflurane c)Sevoflurane d)Halothane CorrectAnswer-BAns.is'b'i.e.,Desflurane
107.Mostcommonlyusedapproachof brachialplexusblock? a)Interscalene b)Supraclavicular c)Infraclavicular d)Axillary CorrectAnswer-BAns.is`B'i.e.,SupraclavicularBrachialplexusblockThisisthesecondmostcommonlypractisedblockaftercentralneuraxialblock(spinal&epiduralanaesthesia).Brachialplexusblockisusedforupperlimbsurgeries.Brachialplexuscanbeblockedby4approaches:-1.InterscaleneapproachBrachialplexusisblockedbetweenanteriorandmiddlescalene.Thisapproachisnotusedroutinelyduetocloseproximityofvitalstructures.Ulnarnerveisusuallysparedbythisapproachbecauseinjectionisgivenincloseproximityofuppernerverootsandinferiornerveroots(C8-T1)maybespared.Thistechniqueprovidesexcellentanaesthesiaandanalgesiaforshoulderandupperarmprocedures.(incontrasttootherthreeapproacheswhichdonotprovideadequateshoulderanaesthesia).ComplicationsincludeHornersyndrome(duetostellateganglionblock),phrenicnerveblock,intravascularinjectionintocarotidsandepiduralorintrathecalinjections.2.SupraclavicularapproachThisisthemostcommonlyusedapproach.Itinvolvestheinjectionoflocalanaestheticincloseproximityto
thetrunksofthebrachialplexusbyinsertingtheneedlelateraltosubclavianvessels.Thesupraclavicularblockisperformedwherethebrachialplexusismostcompact,consequently,itproducesreliableandrapidonsetanaesthesiaandisparticularlyusefulinafastpacedambulatorysurgerycentre.Pneumothoraxisthemostcommoncomplication.Othercomplicationsincludephrenicnerveblock,intravascularinjectioninsubclavianarteryorvein,Hornersyndrome,hematomaformation.3.Infra-clavicularapproachInfraclavicularblockinvolvestheinjectionoflocalanaestheticincloseproximityofcordsofthebrachialplexus.Theaxillarynervemaybesparedasthisnerveexitsthebrachialplexussheathproximaltothelevelofinfraclavicularblock.4.AxillaryapproachAxillaryblockinvolvestheinjectionoflocalanaestheticincloseproximityofterminalbranchesofthebrachialplexus.Themajordisadvantageofthisapproachisthatmucocutaneousandintercostobrachialnervesarespared.Soarmsurgerycannotbeperformed.Incontrasttointerscaleneapproach,mostintenseblockoccurin(C7-T1)ulnardermatomesandleastinC5-C6dermatomes.
108.Whichofthefollowingissafeevenif injectedintraarterial? a)Thiopentone b)Propofol c)Mida7olam d)Methohexitone CorrectAnswer-BAns.is'b'i.e.,PropofolAccidentalextravasationorintra-arterialinjectionofpropofoldoesnotcauseadversereactions"PrimerofAnaesthesia"Intraartierialinjectionofpropofoldoesnotcausevascularinjury"?EssentialsofAnaesthesiaEtomidateisalsosafe.?Miller'sDrugsassociatedwithsevercomplicationsafterintraarterialinjection 1. Benzodiazepines:Diazepam,midazolam,temazepam, chlordiazapoxide 2. Phenothiazines:Promethazine,chlorpromazine,promazine3. Barbiturates:Thiopentone,methexitone,secobarbitone, pentobarbitone 4. Amphetamines5. Antibiotics:Flucloxacillin,Penicillin6. Narcotics:Heroin,mepridine,propoxyphene,cocaine7. QMiscellaneous:Tubocurarine,atracurium
109.Criticaltemperatureforliquidnitrogenis ? a)36.5?C b)-20?C c)-147?C d)-242?C CorrectAnswer-CAns.is'c'i.e.,-147?CCriticaltemperature(Tc)ofasubstanceisthetemperatureatandabovewhichvapourofthatsubstancecannotbeliquified,nomatterhowmuchpressureisapplied(Note:Belowcriticaltempratureasubstancecanexistasaliquidorgasdependingonpressure).CriticaltemperatureofN2is-146.9?C;thatmeansN2canbeliquifiedbelow-146.9?C-->So,liquidnitrogenmustbestoredbelow-146.9?C.
110.SupremeLMAcharacteristicis a)Hasnobiteblock b)Usedininfants c)Highpressure,lowvolume d)Hasbuiltindraintube CorrectAnswer-DAns.is'd'i.e.,HasbuiltindraintubeLMAsupremeisoneofthemostadvancedlaryngealmaskairway(LMA).IthasfeaturesofusualLMAwithadditionalBuilt-indraintubeandabiteblock.Ithashighvolume/lowpressurecuffwhichgenerateshighersealpressure.oItalsoprovidesaconduitforactivesuctioningofstomach.Itcanbeusedininfantsaswellasinadults.
111.Inpediatricepiduralanaestheisia, volumeoflocalanaestheticgiventocausesacraldermatomeblockis? a)0.5-1ml/kg b)2-4ml/kg c)5-10ml/kg d)None CorrectAnswer-AAns.is'a'i.e.,0.5-1ml/kgTwomostcommonlyusedlocalanaestheticsforcaudalblockinchildrenare:- 1. Bupivacaine0.25%concentrationindoseof1ml/kg.2. Ropivacaine0.2%concentrationindoseof1.2ml/kg. Foreasycalculationofvolume:- 1. 0.5mUkgforsacralblockade.2. 0.75ml/kgforlowerthoracicblockade.3. 1.25ml/kgforupperthoracicblockade.
112.Fastestinductionandrecoveryisseen with? a)Desflurane b)N,0 c)Halothane d)Enflurane CorrectAnswer-AAns.is'a'i.e.,Desfluranedecreasingorder(IncreasingorderofB:Gpartitioncoefficientandbloodsolubility):- Desflurane(0.42)Q>Cyclopropane(0.44)>N20(0.47)>Sevoflurane(0.69)Q>Isoflurane(1.38)>Enflurane(1.8)>Halothane(2.4)>Chloroform(8)>Trilene(9)>Ether(12)>Methoxyflurane(15)Q.
113.Shortestactinglocalanaesthetics? a)Lignocaine b)Bupivacaine c)Etidocaine d)Chlorprocaine CorrectAnswer-DAns.is'd'i.e.,Chlorprocaine Short Intermediateduration Longduration(>120 durationLow (30-90min) min) potency Intermediatepotency Highpotency Chloiprocaine BupivacaineoTetracaine Lignocaineo (shortest oEtodicaineo MepivacaineoPrilocaine acting) Ropivacaine aCocaine Procaine Dibucaine(longestacting)
114.Circuitofchoiceforcontrolled ventilation? a)Magillcircuit b)TypeC c)TypeD d)TypeE CorrectAnswer-CAns.is'c'i.e.,TypeD
115.Allareusedforlocalinfiltrationexcept? a)Lidocaine b)Ropivacaine c)Dibucaine d)Bupivacaine CorrectAnswer-CAns.is'c'i.e.,Dibucaine
116.DrugofchoiceforBier'sblock? a)Bupivacaine b)Etidocaine c)Ropivacaine d)Lidocaine CorrectAnswer-DAns.is'd'i.e.,LidocaineIntravenousregionalAnaesthesia(Bier'sblock)Intravenousregionalanaesthesia(IVRA)isusedmostoftenforsurgeryoftheforearmandhand,butcanalsobeusedfordistallegandfoot.FirstIVcanulaisinsertedusuallyinthedorsumofhand.Thentourniquetcuffisappliedtoproximalarm.Limbiselevatedandexsanguinatedwiththehelpofanelasticbandage(Esmarch).Nowtourniquetcuffisinflatedabovesystolicpressure(sothatnobloodcanenterinthatlimbandthelimbremainsexsanguinated).Nowthelocalanaestheticsolutionisslowlyinjectedintocannula.Theveinsarefilledwithonlylocalanaestheticasthereisnobloodocalanaestheticcannotbedrainedoutfromupperlimbandcannotenterinsystemiccirculationbecauseofinflatedcuffinproximalarm.Thearmisanaesthetizedin6-8minutes.LidocainewithoutadrenalineistheDOCforthistechnique.--Goodman&Gilmanllthie381oAfewclinicianprefersprilocaineoverlidocainebecauseofitshighertherapeuticindex-leasttoxicLA.Torniquetcuffdeflation,prematurereleaseorfailureoftorniquetcan
causereleaseofLAintocirculationandtoxicitymayoccurSo,cardiotoxicLAslikebupivacaineandetidocainearecontraindicatedforBier'sblock.
117.Smoothinductionisseenby- a)Ether b)Halothane c)Isoflurane d)Enflurane CorrectAnswer-CAns.is'c'i.e.,IsofluraneInductionbyinhalationagentsUnpleasantIntermediateSmoothEtherHalothaneIsofluraneEnfluraneDesfluraneSevofluraneNitrousoxide
118.Trueaboutconscioussedationareall except? a)CNSdepression b)Patientisconscious c)Protectivereflexesareabolished d)Patientcanobeycommands CorrectAnswer-CAns.is'c'i.e.,Protectivereflexesareabolishedconscioussedation,protectivereflexesareintact(hasbeenexplainedinprevioussessions).
119.
Longestpartofopticnerve? a)Intraocular b)Intracranial c)Intraorbital d)Intracranial CorrectAnswer-C.Ans.is'c'i.e.,IntraorbitalOpticnerveEachopticnerve(secondcranialnerve)startsfromtheopticdiscandextendsuptoopticchiasma,wherethetwonervesmeet.Itisthebackwardcontinuationofthenervefibrelayeroftheretina,whichconsistsofthesecondorderneuronsi.e.,axonoriginatingfromtheganglioncells.Italsocontainstheafferentfibresofthepapillarylightreflex.Morphologicallyandembryologically,theopticnerveiscomparabletoasensorytract.Unlikeperipheralnervesitisnotcoveredbyneurilemma(soitdoesnotregeneratewhencut).Thefibresofopticnerve,numberingaboutamillion,areveryfine(2-10mindiameterascomparedto20mmofsensorynerves).Opticnerveisabout47-50mminlengthandcanbedividedinto4parts:?Intraocularpart(1mm):-Itbeginsatopticdisc(opticnervehead)andexitsthenervethroughaholeinsclerathatisoccupiedbyameshlikestructurecalledthelaminacribrosa.Thenervefibresfromtheretinaleavetheeyethroughpores(holes)inlaminacribrosa,asieve-likestructuremadeupofcollagenmeshwork.Intraorbitalpart(30mm):-Extendsfrombackoftheeyeball(at
laminacribrosa)totheopticforamina.Intracanalicularpart(6-9mm):-Itlieswithintheopticcanalandcloselyrelatedtoophthalmicarterywhichcrossesobliquelyoverit.Intracranialpart(10mm):-Itliesabovethecavernoussinusandconvergeswithitsfellowfromcontralateralsidetoformopticchiasma.LikeotherpartsofCNS,theopticnerveiscoveredbymeningealsheaths(Pia,archnoidandduramater)assoonasthenerveleavestheeyeball.
120.Stocker'slineisseenin? a)Pterygium b)Glaucoma c)Posteriorscleritis d)Diabeticretinopathy CorrectAnswer-AAns.is'a'i.e.,Pterygiumislineofirondepositioninthecornealepitheliumseenadjacenttotheheadofthepterygium.
121.Mostcommoninfectionincontactlens usersis? a)Streptococcus b)Pseudomonas c)Staphylococcus d)Neisseria CorrectAnswer-BAns.is'b'i.e.,PseudomonasComplicationsofcontactlenswearComplicationsofcontactlenswearingare:?Intolerance:-Somepeoplefindwearingcontactlensesintolerable.Cornealcomplications:-Cornealabrasion,Cornealedema,Cornealvascularization,Microbialkeratitis(Pseudomonas,acanthamoeba),Sterilecornealinfiltrate.GiantpapillaryconjunctivitisHypoxia:-Corneaisdeprivedofoxygenfromthetearfilmbythepresenceofthecontactlens.Thecorneabecomesedematousandnewvesselsmaydevelopinthelimbalarea.Sensitivity:-Thismaydevelopinresponsetothepreservative(thiomersal)inthecleaningandsoakingsolution.Thisresultsinallergicconjunctivitis.
122.Polyopia/diplopiaisseeninwhichtype ofcataract? a)Nuclear b)Cortical c)Posteriorsubcapsular d)Anteriorpolar CorrectAnswer-BAns.is'b'i.e.,Cortical
123.Pulsatileproptosisisafeatureof? a)Orbitalvarix b)Retinoblastoma c)Cortico-cavernousfistula d)Covernoussinusthrombosis CorrectAnswer-CAns.is'c'i.e.,Cortico-cavernousfistulaProptosisProptosisisbulgingoftheeyeball(forwardbulging)beyondtheorbitalmargins.Thoughthewordexophthalmosissynonymouswithproptosis;somesourcedefinexophthalmosasaprotrusionofglobegreaterthan18mmandproptosisasaprotrusionequaltoorlessthan18mm.Proptosismaybeclassifiedasfollows:?UnilateralProptosisProptosisofoneeye.Inflammatorylesions:-Orbitalcellulitis,abscess,cavernoussinusthrombosis,etc.Vasculardisturbances:-Haemorrhage,varicoseorbitalveins,haemangioma,etc.Cystsandtumour:-Dermoidcyst,osteoma,lymphoma,lymphosarcoma,glioma,meningiomaofopticnerve,retinoblastomaandmetastaticdepositsinorbitNeuroblastoma,breast,prostate,lung,GIT,Kidney,Ewing'stumor,melanoma,wilmstumor(Nephroblastoma)].Systemicdiseases-LeukemiasandendocrinedisturbancessuchasGraves'diseaseandthyrotropicexophthalmosininitialstages.Paralysisofextraocularmusclesasincompleteophthalmoplegia.MucoceleofPNS'-Frontal(mostcommon),ethmoid,maxillary.BilateralProptosisProptosisofbotheyes.
evelopmentalanomaliesoftheskull-Oxycephaly(towerskull).Endocrineexophthalmos,boththyrotoxicandthyrotropic.Inflammatorylesions-Cavernoussinusthrombosis.Tumours-lymphosarcoma,lymphoma,pseudotumour,nephroblastoma,Ewing'ssarcoma.Systemicdisease-Histocytosis(Hand-schullerchristondisease),amyloidosis,wegner'sgranulomatosis.IntermittentproptosisProptosisdevelopingintermittentlyandrapidlyinoneeyewhenvenousstasisisinducedbyforwardbendingorloweringthehead,turningtheheadforcibly,hyperextensionoftheneck,coughing,forcedexpirationwithorwithoutcompressionofthenostrils,orpressureonjugularveins.Themostimportantcasueisorbitalvarix(varicocele).Pulsatileproptosis:-Pulsatileproptosisisseenincaroticocovernousfistula;saccularaneurysmofophthalmicartery;andduetotransmittedcerebralpulsationasseeninmeningocele,neurofibromatosisandtraumaticoroperativehiatus.
124.Photoretinitisisdueto? a)Snowreflection b)Solareclipse c)Blunttrauma d)Noneoftheabove CorrectAnswer-BAns.isbi.e.,SolareclipsePhotoretitinsPhotoretinitisreferstodamagetotheretinaresultingfromexposuretothesunlightwithoutadequateprotection.Inrecentyearsithasbecomeclearthatphotoretinitisistheresultofphotochemicalreactionfollowingexposureoftheretinatoshorterwave-lengthinthevisiblespectrum(i.e.blue/violet-bluelight)withasmallcontributionbyUV-Arays(andnotbyinfraredrayswhichwasthoughtearlier).Therefore,photoretinitisisalsocalledasblue-lightretinalinjury.Photoretinitisisassociatedwithreligioussungazing,solareclipseobserving,telescopysolarviewing,watchingbrightsunlight,orexposuretotheflashoftheshort-circuitingofastrongcurrent.Thesymptomsarepersistentoftheafterimage,progressinglaterintopositivescotoma,andmetamorphosia.Ophthalmoscopically,theremaybenosignatfirst,orapalespotisseenatthefoveawithabrownish-redringaroundit.Latertherearedepositofpigmentsandsmall,greypunctatespotsaroundthefovea,oreventheformationofretinalhole
125.Parachutelesionsareseenin? a)Eale'sdisease b)Diabetes c)Sicklecellanemia d)Alloftheabove CorrectAnswer-DAns.isdi.e.,Alloftheabove
126.FosterKennedysyndromeis a)I/LPapilloedemaCiLopticatrophy b)I/LOpticatrophyC/Lpapilloedema c)I/LOpticatrophyandpapilloedema d)ULPapilloedemaC/Lpapilitis CorrectAnswer-BAns.is'cib.,I/LOpticatrophyC/LpapilloedemaFoster-Kennedysyndrome:-Thefrontallobe,pituitaryandmiddle-eartumorsuchasmeningiomataoftheoflactorygroovearesometimesassociatedwithIpsilateralpressureatrophyoftheopticnerveandcontralateralpapilledema.Pseudo-Foster-kennedysyndrome:-ItischaracterizedbyoccurenceofunilateralpapilloedemaassociatedwithraisedICT(duetoanycause)andapre-existingopticatrophy(duetoanycause)ontheotherside.
127.Enucleationoftheeyeballis contraindicatedin? a)ndophthalmitis b)Panophthalmitis c)Intraoculartumoursd d)Painfulblindeye CorrectAnswer-BAns.is'b'i.e.,PanophthalmitisEnucleationEnucleationistheremovalofeyeballwithaportionofopticnervefromtheorbitwhilepreservingallotherorbitalstructures.IndicationsAbsolute:-Retinoblastoma,malignantmelanoma.Relative:-Painfulblindeye,mutilatingocularinjury,anteriorstaphyloma,phthisisbulbi,endophthalmitis,congenitalanophthalmiaorseveremicrophthalmia.ContraindicationsEnucleationiscontraindicated:-AftertheonsetofsympatheticophthalmiaPanophthalmitis:-Infectioncanspreadviathecutendsofopticnervesheathcausingmeningitis
128.Typeoflaserusedforiridotomy? a)Excimer b)Kryptonred c)Nd:YAG d)Diode CorrectAnswer-CAns.is'c'i.e.,Nd:YAG
129.Mostcommoncauseofptosis? a)Myastheniagravis b)Paralysisof3rdnerve c)Idiopathic d)Congenital CorrectAnswer-DAns.is'd'i.e.,CongenitalPtosisPtosisisdroopingofuppereyelid.Ptosisoccurswhenthemusclesthatraisetheeyelid(levatorpalpebraesuperiorsandmuller'snuscles)arenotstrongenoughtodosoproperly.EtiologyofPtosismaybe:?A)Congenitalmyogenicptosis:-Itisthemostcommontypeofptosisandisoftenbilateral.Itisassociatedwithmaldevelopmentorcongenitalweaknessoflevatorpalpebraesperioris.Congenitalmyogenicptosisischaracterizedbydroopingofoneorbothlidsatbirth,withadiminishedorabsentlidcreaseandlidlagondowngazeduetotetheringeffectofabnormalmuscle.ItmayoccurinfollowingformsSimplecongenitalptosis:-NotassociatedwithotheranomalyCongenitalptosiswithsuperiorrectusweaknessBlepharophimosissyndromeCongenitalptosis,blepharophimosis,telecanthusandepicanthusinversus.Congenitalsynkineticptosis(MarcusGunnjaw-winkingPtosis):-Retractionofptoticlidwithjawmovementlikechewing,i.e.,withstimulationofipsilateralpterygoidmuscle.B)Acquirdptosis:-Dependinguponthecauseacquiredptosismaybe
Neurogenic:-Itisduetoparalysisof3rdnerve,Horner'ssyndrome,ophthalmoplegicmigraine,multiplesclerosis.Neurogenicptosismayalsooccurduetolesionofsympatheticnerve)supplyingmuller'smuscle.Myogenic:-ItisduetoacquireddefectofLPSmuscleandmaybeseeninmyastheniagravis,dystrophiamyotonica,ocularmyopathy,oculopharyngealmusculardystrophy,thyrotoxicosis,Lambert-EatonmystheniasyndromeMechanical:-Itisduetoexcessiveweightontheupperlide.ginlidtumors,multiplechalazia,lidedema.Itmayalsooccurduetoscarring(cicatracialptosis)inatientswithocularpemphigoidandtrachoma.Aponeuroticptosis:-Itisduetodefectofthelevatoraponeurosisinthepresenceofnormalfunctioningmuscle,e.g.involutional(senile)ptosis,post-operativeptosis.
130.Nervecarryingmotorcomponentoflight reflex? a)1Stnerve b)2"nerve c)3'nerve d)4thnerve CorrectAnswer-CAns.is`C'i.e.,3rdnerve
131.Altitudinalvisualfielddefectisseenin? a)Papilloedema b)Retinitispigmentosa c)Anteriorischemicneuropathy d)Buphthalmos CorrectAnswer-CAns.is'c'i.e.,AnteriorischemicneuropathyAnteriorischemicopticneuropathv(AION)Itisaconditionoflocalanoxiaoftheanteriorregionoftheopticnerve.Itisduetotheinvolvementofposteriorciliaryarteryandmaybecentralretinalarterycausinginfarctoftheanteriorpartoftheopticnerveandretina.Itoccurscommonlyinneglectedacuteattackofclosedangleglaucoma,severeanemia,afteramassivehaemorrhage,andtemporalarteritis.Thereissuddenlossofvision.Onexaminationthereisswellingofthediscresultinginopticatrophy.Permanentaltitudinalvisualfielddefectsarepresent.Theseinvolvetwoquadrantsofeitherthesuperiororinferiorvisualfield.
132.UpperLidRetractorsinclude a)Mullermuscleandsuperiorrectus b)Levatorpalpabraesuperiorisandsuperioroblique c)Superiorobliqueandsuperiorrectus d)Levatorpalpabraesuperioris&mullermuscle CorrectAnswer-DAns.is'd'i.e.,Levatorpalpabraesuperioris&mullermuscleThelevatorpalpebraesuperiorisistheimportantuppereyelidretractor.Injuryorweaknesstothismuscleleadstoptosis.Thismuscleissuppliedbyocculomotor(3')nerve.DeeppartoftheelevatormuscleistheMuller'smuscle,whichissympatheticallyinnvervated.Inhyperthyroidism,sensitizationoftheMullermuscleleadstouppereyelidretractionandpseudoproptosis.Ontheotherhand,inHorner'ssyndromelossofthismuscleactionleadstoptosis.Thecapsulopalpebralfasciaassistsinlowereyelidretractionandcoordinateswitheyeballmovement.Itarisesasanextensionoftheinferiorrectusandinsertsintotheloweredgeofthelowertarsusandtheadjacentorbitalseptum.
133.Apatientwithptosis,upper4mmof corneaiscoveredbyuppereyelid.GradeofPtosisis? a)Mild b)Moderat c)Severe d)Profound CorrectAnswer-AAns.is'a'i.e.,MildInunilateralcasesofptosis,differencebetweentheverticalheightofpalpebralfissuresofthetwosidesindicatesthedegreeofptosis.Inbilateralcasesitcanbedeterminedbymeasuringtheamountofcorneacoveredbytheuppereyelidandthensubstracting2mm.Dependinguponitsamounttheptosisisgradedas-1:1Mild:2mmModerate:3mmSevere:4mmInthisquestion,4mmofcorneaiscoveredbyuppereyelid.Substracting2mmfromthismeansthereis2mmofptosis,i.e.mildgrade
134.Schwable'sringisseeninwhichlayerof cornea a)Bowmann'smembrane b)Stroma c)Descemet'smembrane d)Substantiapropria CorrectAnswer-CAns.is'c'i.e.,Descemet'smembraneHistologyofcorneaThecorneahasfivedistinctlayers(fromsuperficialtodeep):?Epithelium:-Itistheoutermostpartofcorneaandiscomposedofstratifiedsquamousnon-keratinizedepithelialcells.Bowman'smembrane:-Itisnotatruemembranebutsimplyacondensedsuperficialpartofstroma.destroyed,itdoesnotregenerate.Stroma(Substantiapropria):-Thislayerconstitutesmostofthecornea(90%ofthickness).Itconsistsofcollagenfibrils(lamellae)embeddedinhydratedmatrixofproteoglycans.Descemet'smembrane:-Thislayerboundsthestromaposteriorly.IntheperipheryitappearstoendattheanteriorlimitoftrabecularmeshworkasSchwahle'sring.Endothelium:-Itisasinglelayerofflatpolygnonalcells.Theendothelialcellscontain'active-pump'mechanismandisthemostimportantlayerinmaintainingthetransparencyofcornea.
135.PhaseIIblockisseenwith- a)SChinfusion b)SingledoseSCh c)Mivacurium d)Noneoftheabove CorrectAnswer-AAns.is'a'i.e.,SChinfusionUndercertainconditionsdepolarizingagentsproducedualmechanismofneuromuscularblockadewhichcanbedividedintotwophases:a.PhaseIblockRapidinonsetResultfrompersistantdepolarizationofmuscleendplate.b.PhaseIIblockSlowinonsetResultsfromdesensitizationofreceptortoACh.PhaseIIblockisseenwhenfluorinatedanaestheticshavebeengivenorwhenSChisinjectedinhighdoseorinfusedcontinuously.SChalsoproducesphaseIIblockinpatientswithatypicalordeficientpseudocholinesterase.
136.Anaestheticgaswithmaximum respiratoryirritation a)Halothane b)Enflurane c)Desflurane d)Sevoflurane CorrectAnswer-CAns:C.DesfluraneDesfluraneandisofuranewhenusedforinductioncauserespiratoryirritationduetotheirpungentsmellleadingtobreathholdingandcoughing.Halothaneandsevofluranedonotcausesucheffects.
137.IVadministrationofwhichanesthetic drugismostpainfulamongthefollowing? a)Methohexital b)Ketamine c)Propofol d)Etomidate CorrectAnswer-CAns:c.PropofolPropofolpreparation:Oil-basedpreparation(soybeanoil,egglecithin&glycerol).Hence,painoninjection&rarelythrombophlebitis.
138.Whichofthefollowingisnot cardiodepressive? a)Propofol b)Thiopentone c)Ketamine d)Etomidate CorrectAnswer-DAns:D.EtomidateMajoradvantageofetomidate:Cardiovascularstabilityafterinduction.Effectsofetomidateinductiondose:Negligibleincreaseinheartrate.Littledecreaseinbloodpressure/cardiacoutput.Littleeffectoncoronaryperfusionpressure,whilereducingmyocardialO2consumption.
139.Whichofthefollowingisthemost commonmethodusedtoknowdepthofanaesthesia? a)BIS b)Oesophagealcontractility c)Depressedresponses d)Hypotension CorrectAnswer-AAns:A.BISBispectralindex:*1stscientificallyvalidated&commerciallyavailablemonitortocheckdepthofanaesthesia.*Utilizesmanyparameters(EEGsignals,eyeblinks)tocalculatedepthscore.Adequatedepth:*Scoreof45-60.Fullyawakestate:*Scoreof100Completelysilentbrain:0.
140.MRP2associatedwithwhichofthe following? a)Rotorsyndrome b)Dubin-Johnsonsyndrome c)Crigler-Najjarsyndrome d)Gilbertsyndrome CorrectAnswer-BAns:B.Dubin-Johnsonsyndrome.Dubin-Johnsonsyndrome:Anautosomalrecessivedisorder.Causedbygenemutationresponsibleforhumancanalicularmultispecificorganicaniontransporter(cMOAT)protein/alsoreferred"multidrugresistanceprotein2(MRP2)"orABCC2.
141.Inophthalmologyapatientisallergicto aminoesters.Whatcanbeused? a)Cocaine b)Procaine c)Prilocaine d)Bupivacaine e)Tetracaine CorrectAnswer-C:DAns.is'c'i.e.,Prilocaine&'d'i.e.,Bupivacaine[Ref:Lee's13th/ep.486]Prilocaine&bupivacaineareamides(amcinonide).Otherthreeareaminoesters.
142.Drug(s)notgivenastransdermalpatch: a)Fentanyl b)Diclofenac c)Morphine d)Clonidine e)Buprenorphine CorrectAnswer-B:CAns.B,Diclofenac&C,Morphine[Ref:KDT7th/476Transdermalfentanyl(Durogesic)hasbecomeavailableforuseincancer/terminalillness.Butransskinpatchescontainbuprenorphineanopioidpainmedication.Clonidinetransdermaldelivery(patch)systemshavebeenavailablesincethe1980
143.Mallampatti'sclassificationisfor? a)Mobilityofcervicalspine b)Mobilityofatlantoaxialjoint c)Assessmentoffreerotationofneckbeforeintubation d)Inspectionoforalcavitybeforeintubation CorrectAnswer-DAns.D.Inspectionoforalcavitybeforeintubation[RefMorgan4thiep.113]Mallampatiscore(Mallampatioropharyngealscale):Mallampatigradingisusedtoevaluatethevisibilityoftonsilandtonsillarfossawhichinturnassesstheadequatemouthopeningdependinguponthegrade.IndicationsofMallampatiscoreareOralcavityassessmenttoruleoutdifficultintubation(Inspectionoforalcavitybeforeintubation)&Sleepapneaevaluation.
144.Anestheticagentofchoiceinasthma patientis? a)Thiopentone b)Methexitone c)Ketamine d)Propofol CorrectAnswer-CAns.C.Ketamine[RefMiller's7"lep.744-746]Ketamineisapotentbronchodilator;thereforeitistheanestheticagentofchoiceinbronchialasthmapatients.Halothaneistheinhalationalagentofchoiceinasthmatics.
145.Pinindexsystemisasafetyfeature adoptedinanesthesiamachinestoprevent? a)Incorrectattachmentofanesthesiamachines b)Incorrectattachmentofanesthesiafacemasks c)Incorrectinhalationagentdelivery d)Incorrectgascylinderattachment CorrectAnswer-DAns.D.Incorrectgascylinderattachment[RefLee13th/ep.85]Pinindexsystem:-Thisisthesafetymechanismsothatonecylindercannotbefittedattheother'sposition.
146.PropofolshowsfollowingeffectonEEG? a)Activation b)Depression c)Depressioninlowdosesandactivationinhighdoses d)Noneoftheabove CorrectAnswer-BAns.B.DepressionEEGchangesduringanesthesia:EEGDepressioncausedby,Inhalationalagents(1-2MAC)BarbituratesOpioidsEtomidatePropofolHypocapniaMarkedhypercapniaHypothermiaLatehypoxia,ischemia
147.TypeEcircuitisusedfor? a)Spontaneousventilation b)Controlledventilation c)Children d)Anusedforalloftheaboveindications CorrectAnswer-CAns.C.Children[RefAjayYadav4th/ep.29,30]Circuitofchoiceforspontaneousventilationinadult-4MaplesonACircuitofchoiceforcontrolledventilationinadultMaplesonD(Baincircuit)Circuitofchoiceforchildren-TypeF,i.e.Jackson-Rees(firstchoice)andtypeE,i.e.Ayre'sTpiece(secondchoice)
148.Anestheticagentleadingtobradycardia is? a)Pancuronium b)Vecuronium c)Atracurium d)Propofol CorrectAnswer-DAns.D.PropofolBradycardiacausinganestheticagents:SuccinylcholinePropofolOpioidsanesthetics(fentanylanditscongers)
149.SizeofLMAfora15kgchildis? a)1 b)2 c)3 d)4 CorrectAnswer-BAns.B.2LMAaccordingtopatient'sweightandage:10-20kgs,infants&children
150.Intra-arterialthiopentoneinjectionleads to? a)Ischemia b)Vasodilatation c)Vomiting d)Hypertension CorrectAnswer-AAns.A.Ischemia[RefAjayYadav4th/ep.80;Lee13thiep.155]IschemiaInadvertentintra-arterialinjectionofthiopentoneisaverydreadfulcomplication.Itproducesthrombosis,vasospasm,ischemia,necrosisandfinallygangrene.Thefirstsymptomisburningpain.Thefirstsignisblanchingofthehandduetovasospasm.
151.Inmechanicalventilation,peakpressure ininspirationdenotes? a)Complianceoflung b)Capacityofinspiratorymuscles c)Airwayresistance d)Alloftheabove CorrectAnswer-CAns.C.Airwayresistance[Ref:Essentialsofanaesthesia-786]PressuresinmechanicalventilationPeakpressurePeakpressureapplieswhenthereisairflowinthecircuit,i.e.,duringinspiration.Peakpressuredeterminesairwayresistance.
152.Hypotensionfollowingspinalanesthesia canbebestpreventedby? a)Preloadingwithcolloids b)Usingsmallsizeneedle c)Preloadingwithcrystalloids d)Alloftheabove CorrectAnswer-AAns.A.Preloadingwithcolloids[RefLee13th/ep.509,510;Morgan4th/ep.297]Hypotensionisthemostcommoncomplicationofspinalanesthesia.Itarisesduetoblockingofsympatheticrootfibersandisusuallyaccompaniedbybradycardia(PreganglionicblockofthesympatheticnervestoheartT1-T4)andnausea.Hypotensioncanbepreventedbypreloadingthepatientwithcolloids,Preloadingwithcrystalloiddoesnotpreventhypotensionbecauselargevolumesofcrystalloidsquicklyredistributefromintravasculartoextravascularspace.Beachchairpositionalsopreventshypotension.
153.Propofolvial,onceopened,shouldbe usedwithin? a)2hours b)4hours c)6hours d)8hours CorrectAnswer-CANs.C.6hours[Ref:Lee13th/ep.158-160;Morgan4thlep.200-202]Propofolisoilbasedpreparationcontainingsoybeanoil,egglecithin,andglycerol.Thecolorofsolutionismilkywhite.Solutionshouldbeusedwithin6hoursafteropeningthevialbecausetherehavebeendeathreportsfollowingtheuseofcontaminatedsolutionasegglecithinisagoodmediumforbacterialgrowth.Topreventthisproblemrecentlyavailablepropofolpreparationshavedisodiumedetateorsodiummetabisulfiteasantimicrobialagent.
154.Whichofthefollowingagentis associatedwithmaximumhistaminerelease? a)d-Tubocurarine b)Cisatracurium c)Pancronium d)Rocuronium CorrectAnswer-AAns.A.d-TubocurarineHistaminereleaseiscausedbyD-TC(maximumtendency),succinylcholine,mivacurium,doxacurium,atracurium,tubocurarinecancausebronchoconstriction.
155.Whatistheintubationdoseof pancuronium? a)0.1mg/kg b)1mg/kg c)10mg/kg d)20mg/kg CorrectAnswer-AAns.A.0.1mg/kg
156.Relativecontraindicationof neuraxial/regionalanesthesiais? a)Hypertension b)Renaldisease c)Sepsis d)Diabetes CorrectAnswer-CAns.C.Sepsis[RefMorgan4th/ep.299]Contraindicationstoneuraxialblock(spinal&epidural)Absolute:-Infectionatthesiteofinjection,patientrefusal,coagulopathyorotherbleedingdisorder,severehypovolemia,increasedICT,severeaorticormitralstenosis.Relative:-Sepsis,unto-operativepatient,pre-existingneurologicaldeficit,demyelinatinglesions,severespinaldeformity,stenoticvalvularheartdisease.
157."TriangleofPetit"isalandmarkfor whichblock? a)Spinalblock b)Bier'sblock c)TAPblock d)Epiduralblock CorrectAnswer-CAns.C.TAPblock[RefMiller'sanesthesiaE-bookp.1735]*Transverseabdominisplane(TAP)block-Itisaperipheralnerveblockdesignedtoanesthetizethenervessupplyingtheanteriorabdominalwall(T6toL1).-ThepointofentryfortheblindTAPblockisthelumbartriangleofPetit.-Thisissituatedbetweenthelowercostalmarginandiliaccrest.-Itisboundanteriorlybytheexternalobliquemuscleandposteriorlybythelatissmisdorsi.
158.CNSaffectionofalocalanestheticagent leadsto? a)Convulsion b)Perioralnumbness c)Depression d)Alloftheabove CorrectAnswer-DAns.D.Alloftheabove[RefMorgan4thlep.270]ManifestationsoflocalanesthetictoxicityEarlysymptoms(Prodrome)Circumoralnumbness,dizziness,tongueparesthesia,restlesness,tinnitus,agitation.CNSsymptoms:-Thesearebiphasici.e.excitation(convulsions,restlessness,agitation&tinnitus),followedbydepression(drowsiness,disorientation,respiratorydepression,unconciousness).Cardiovascularmanifestations:-hypotension,cardiacarrest,coma
159.Succinylcholineiscontraindicatedin? a)Hyperkalemia b)Hypokalemia c)Hypercalcemia d)Hypocalcemia CorrectAnswer-AAns.A.Hyperkalemia[RefMorganPiep.214]Schcancausedangeroushyperkalemiainandiscontraindicatedin:Burn,massivetrauma,crushinjury,Severeintraabdominalinfection(sepsis).
160.Benzocaineisusedinwhichtypeof anesthesia? a)Topical b)Spinal c)Epidural d)Alloftheabove CorrectAnswer-AAns.A.Topical[RefMorgan4th/ep.270]Benzocaineandcocaineareusedonlyintopicalanesthesia.
161.Apatientwithnormalsuccinylcholine metabolismwillhaveDibucainenumberbetween? a)20-30 b)40-45 c)50-60 d)70-80 CorrectAnswer-DAns.D.70-80Dibucainnumber:Dibucain(alocalanaesthetic)inhibits80%ofnormalpseudocholinesteraseand20%ofatypical(non-functional)pseudocholinesterase.Thereforenormaldibucainnumberis70-80%.
162.Americananestheticassociationsays thatclopidogrelshouldbewithheldhowmanydaysbeforesurgery? a)1day b)1week c)3weeks d)4weeks CorrectAnswer-BAns.B.1week[RefAjayYadav3'/ep.46]Preoperativemodificationsofpre-existingdrugs Drugswhichcanbecontinued Drugswhichcanbestopped tillthedayofsurgery Conventionaldoseaspirin& Antianginal(exceptaspirin) clopidogrel(antiplatelets)-Iweekbeforesurgery Antiepileptics Oralanticoagulants-4daysbefore&switchtoheparin, Antihypertensives(exceptAT-II whichisstopped12hoursprior antagoists)LevodopatosurgeryOralhypoglycemic(metformin) Digitalis -48hoursbeforeurgeryandswitchtoinsulin TCAs AT-IIantagonists(losartan, Lowdoseaspirin valsarton)-1daypriorLithium-48-72hoursbefore surgery
MAOinhibitors-3weeks beforesurgery Note:Antiplateletdrugslikeclopidogrelandconventionaldoseofaspirinshouldbestopped7dayspriortosurgery.Butlowdoseaspirincanbecontinuedtillthedayofsurgery.
163.Amongthefollowingagents,maximum boilingpointisassociatedwith? a)Sevoflurane b)Isofurane c)Methoxyflurane d)Desflurane CorrectAnswer-CAns.C.Methoxyflurane[RefAjayYadav4th/ep.63]Boilingpointofmethoxyfluraneismorethanwater(104?C)
164.Whichofthefollowinginhalational anestheticagentmosteasilycrossesbloodbrainbarrier? a)Methoxyflurane b)Sevoflurane c)Desflurane d)Nitrousoxide CorrectAnswer-AAns.A.Methoxyflurane[RefAjayYadav4th/ep.63]Oil:gaspartitioncoefficientmeasuresthelipidsolubilityoftheagentandthereforesolubilityinthefat-richtissuesoftheCNS(abilitytocrossBBB).Methoxyfluranehasmaximumoil:Gaspartitioncoefficient-->Mostlipidsoluble&mosteasilycrossesBBB.1120hasminimumoil:Gaspartitioncoefficient-pLeastlipidsoluble&thereforelikelytocrossBBB.
165.Whichofthefollowinganestheticagent mostislipidsoluble? a)Nitrousoxide b)Methoxyflurane c)Isoflurane d)Halothane CorrectAnswer-BAns.B.MethoxyfluraneOil:gaspartitioncoefficientmeasuresthelipidsolubilityoftheagentandthereforesolubilityinthefat-richtissuesoftheCNS(abilitytocrossBBB).Methoxyfluranehasmaximumoil:Gaspartitioncoefficient-->Mostlipidsoluble&mosteasilycrossesBBB.1120hasminimumoil:Gaspartitioncoefficient-pLeastlipidsoluble&thereforelikelytocrossBBB.
166.Etomidateisnotusedforlongterm infusionbecause? a)Resultsinadrenalsuppression b)Maycausevasospasm c)Resultsincardiacarrhythmias d)MaycauseincreaseinICT CorrectAnswer-AAns.A.Resultsinadrenalsuppression[RefMorgan4th/ep.200]Etomidatesuppressescorticosteroidsynthesisintheadrenalcortexbyreversiblyinhibiting1113-hydroxylase,whichcoverts11-deoxycortisoltocortisolandbyarelativeminoreffecton17a-hydroxylase.Usingacontinuousetomidateinfusionforsedationofcriticallyilltraumapatientsinintensivecareunitshasbeenassociatedwithincreasedmortalityduetoadrenalsuppression.Themortalityofpatientsexposedtoacontinuousinfusionofetomidateformorethan5daysincreasedfrom25%to44%,mainlyduetoinfectiouscausessuchaspneumonia.
167.Armtonguetimeis? a)13secs b)15secs c)20secs d)40secs CorrectAnswer-AAns.A.13secsArmtotonguetimeismethodforknowingthecirculationtimei.e.timetakenbyaparticleinthebloodtoflowfromonepointincirculationtoother.Itmeasuresthelinearvelocityofblood.Tocalculate-thearmtotonguetime5mlof2%ofdecholineisinjectedintocubitalvein.Assoonasdrugreachesthetongue,patientfeelsabittertaste.Thetotaltimetakenfromarmtotongueis13seconds.Similarlyarmtolungtimeiscalculatedwiththehelpofether.Itisdseconds.
168.Respiratoryfailureinapostoperative patientis? a)Type1 b)Type2 c)Type3 d)Type4 CorrectAnswer-CAns.C.Type3Type3orperioperativerespiratoryfailureIncreasedatelectasisduetolowfunctionalresidualcapacity(FRC)inthesettingofabnormalabdominalwallmechanics.OftenresultsintypeIortypeIIrespiratoryfailure.Canbeamelioratedbyanestheticoroperativetechnique,postureposture,incentivespirometry,post-operativeanalgesia,attemptstorowerintra-abdominal-pressure.
169.Laryngealmaskairway[LMA]is contraindicatedin? a)Difficultairways b)Ocularsurgeries c)Pregnantfemale d)InCPR CorrectAnswer-CAns.C.PregnantfemaleContraindicationsofLMA 1. Conditionswithhighriskofaspiration.i.e.,fullstomachpatients, hiatushernia,pregnancy. 2. Oropharyngealabscessormass(tumor).3. Massivethoracicinjury4. Massivemaxillofacialtrauma
170.Allofthefollowingareadvantagesof LMAexcept? a)Morereliablethanfacemask b)Preventaspiration c)AlternativetoEndotrachealintubation d)Doesnotrequirelaryngoscope&visualization CorrectAnswer-BAns.B.PreventaspirationLMAisintermediatebetweenthefacemaskandEndotrachealintubationintermsofreliability,invasivenessandfacilitationofgasexchange(facemaskhasminimumandendotrachealintubationhasmaximum).LMAdoesnotpreventasPiration+shouldnotbeusedinfullstomachpatients.LMAcanbeusedasanalternativetoendotrachealintubationforminorsurgeries,whereanaesthetistwantstoavoidintubation.LMAisintroducedblindly(withoutlaryngoscopy)
171.Onlyavailabledepolarizingmuscle relaxantis? a)Decamethonium b)Suxamethonium c)Mivacurium d)None CorrectAnswer-BAns.B.SuxamethoniumSuxamethonium(succinylcholine)anddecamethoniumcomeunderdepolarizingmusclerelaxants.Outoftheseonlysuxamethoniumisavalaibleforclinicaluse.
172.WhichanestheticgaswasusedbyWTG Mortoninhisexperiment? a)Nitrousoxide b)Ammonia c)Diethylether d)Trichloroethylene CorrectAnswer-CAns.C.DiethyletherWilliamThomasGreenMorton,adentistandmedicalstudentatBoston,afterexperimentingponanimals,gaveademonstrationofgeneralanesthesia,In1846.
173. Suxamethoniumactsthroughwhich channels? a)Sodiumchannels b)Potassiumchannels c)Calciumchannels d)Chloridechannels CorrectAnswer-AAns.A.SodiumchannelsSuxamethonium(succinylcholine)isadepolarizingneuromuscularblockingagentwhichactbyopeningtheNa+channelsatmuscleendPlate.
174.Mouthtomouthrespirationprovideswhatpercentageof oxygen? a)10% b)16% c)21% d)100% CorrectAnswer-BAns.B.16%Mouthtomouthbreathingprovides0.8to1.2litersofexhaledairperbreathand16%ofoxygenwhichisenoughtosustainlife.TheuseofAmbubagandroomairprovides21%O2.TheAmericanHeartAssociationrecommendstidalvolumesof700to1000mLduringmouth-to-mouthventilation,butsmallertidalvolumesof500mLmaybeofadvantagetodecreasethelikelihoodofstomachinflation,asmouth-to-mouthventilationgascontainsonly17%oxygen,but4%carbondioxide.
175.Whichofthefollowinganestheticagent isapotentbronchodilator- a)Propofol b)Ketamine c)Thiopentone d)Methoxytone CorrectAnswer-BAns.B.KetamineKetamineisapotentbronchodilator,thereforeitisthei.v.anaestheticagentofchoiceinbronchialasthmapatients.
176.Landmarkforpudendalnerveblockis? a)Ischialtuberosity b)Iliacspine c)Sacroiliacjoint d)Noneoftheabove CorrectAnswer-AAns.A.IschialtuberosityPudendalblock:Whenperformingatransvaginalpudendalnerveblock,theischialspineisthepalpatedthroughthewallofthevaginaandtheneedleisthenpassedthroughthevaginalmucousmembranetowardtheischialspine.Inaperinealpudendalnerveblock,theischialtuberosityispalpatedthroughthebuttockandtheneedleisinsertedintothepudendalcanalaboutoneinchdeepmedialtotheischialtuberosity.
177.Postduralpunctureheadacheusually presentswithin? a)0-6Hrs b)6-12Hrs c)12-72Hrs d)72-96Hrs CorrectAnswer-CAns.C.12-72HrsPostduralpunctureheadacheisduetoCSFleak.Typicallocationisbifrontaloroccipital.Headachegetsworsenonsittingoruprightpostureandisrelievedbylyingdownpositionandabdominalpressure).Thehallmarkofpostduralpunctureheadachei.e.,associationwithbodyposition.Theonsetofheadacheisusually12-72hrsfollowingtheprocedure,however,itmaybeseenalmostimmediately.Inmostcasesitlastsfor7_10days.
178.Caudaequinasyndromeisassociated with? a)Lidocaine b)Halothane c)N20 d)Ether CorrectAnswer-AAns.A.LidocaineCaudaequinasyndromemayoccurasararedevastatingcomplicationofspinalanesthesiaduetomaldistributionofinjectedlocalanesthesiaaroundcaudaequinanerverootsresultinginlossoffunctionofthelumbarplexus.Associatedwithalllocalanestheticlikelidocaine,bupivacaine,chlorprocaineetc.
179.Notincludedinneuraxialblock? a)Spinalblock b)Epiduralblock c)Bier'sblock d)Caudalblock CorrectAnswer-CAns,C.Bier'sblockCentralneuraxialblock,asthenamesuggests,isthepertainstolocalanaestheticsplacedforwaroundthenervesofthecentralnervoussystem.Examplesarespinalanaesthesia,Epiduralanaesthesiaandcaudallaesthesia.BIER'sblockorintravenousregionalanesthesia(IVRA)isaformofregionalanesthesiausedmostoftenforsurgeryoftheforearmandhand.
180.Contraindicationtoneruaxialblockis? a)Hypertension b)Renaldisease c)Clottingdisorders d)Diabetes CorrectAnswer-CAns.C.ClottingdisordersContraindicationsofcentralneuroaxialblock:Absolute:-Infectionatthesiteofinjection,patientrefusal,coagulopathyorotherbleedingdisorder,severehypovolemia,increasedICT,severeaorticormitralstenosis.Relative:-Sepsis,unco-operativepatient,pre-existingneurologicaldeficit,demyelinatinglesions,severespinaldeformity,stenoticvalvularheartdisease
181.Mostcommoncauseofmaternal mortalityinspinalanesthesiais? a)Allergytolocalanesthesia b)Nerveinjury c)Highblock d)Hypotension CorrectAnswer-CAns.C.HighblockMostcommoncauseofmaternaldeathorbraindamageinneuraxialanesthesiaclaimswashighblock"
182.Cocainewasfirstusedaslocal anaestheticby? a)Carlkollar b)Holmerwells c)Morton d)None CorrectAnswer-AAns.A.CarlkollarCocainewasthefirstlocalanestheticusedbyCarlKoller.Itwasusedforanaesthetizingcornea.
183.Levelsofetheranesthesiawere demonstratedbywhom? a)Morton b)Guedel c)Thompson d)None CorrectAnswer-BAns.B.GuedelGuedeldescribedfourstagesofetheranesthesiaknownasGuedelstages.
184.Infantcircuitforanaesthesia? a)Bainscircuit b)Magillcircuit c)Ayrestpiece d)Water'scircuit CorrectAnswer-CAns.C.Ayrestpiece
185.Ayre'sT-pieceiswhichtypeofcircuit a)TypeA b)TypeB c)TypeE d)TypeD CorrectAnswer-CAns.C.TypeE
186.Mostreliableindicatortoprevent oesophagealintubation? a)Oxygensaturationonpulseoximeter b)MeasurementofCO2inexhaledair(Etco2) c)Directvisualizationofpassingtubebeneathvocalcords d)Auscultationoverchest CorrectAnswer-BAns,B.MeasurementofCO2inexhaledair(Etco2)
187.Allarefeaturesofdifficultairwayexcept ? a)Miller'ssign b)Micrognathiawithmacroglossia c)TMJankylosis d)Increasedthyromentaldistance CorrectAnswer-DAns.D.IncreasedthyromentaldistanceDecreasedthyromentaldistancepredictsdifficultairway(notincreasedTMdistance).
188.Ratioof02:N20inEntonoxis? a)50:50 b)60:40 c)40:60 d)25:75 CorrectAnswer-AAns.A.50:50Entonoxcontainequalamount(50/50)ofN2OandO2.
189.WhichisthecriticaltemperatureofN20? a)-118?C b)-88?C c)-26?C d)-36.5?C CorrectAnswer-DAns.D.-36.5?CCriticaltemperatureofN2O-36.5CriticalpressureofN2O-214.7atm
190.Whichanaestheticagentisneither metabolisedbylivernorbykidney? a)Atracurium b)Vecuronium c)Pancuronium d)Rocuronium CorrectAnswer-AAns.A.Atracurium
191.Fastinductionandrecoveryisseenin? a)Methoxyflurane b)Ether c)Halothane d)N2O CorrectAnswer-DAns.D.N2OSpeedofonset&recoveryindecreasingorder(IncreasingorderofB:Gpartitioncoefficientandbloodsolubility).
192.MACofdesfluraneis? a)1.15 b)2 c)4 d)6 CorrectAnswer-DAns.D.6
193.WhichcanreplaceN20as02carrier? a)Argon b)Xenon c)Helium d)None CorrectAnswer-CAns.C.HeliumHeliumcanbeusedtoreplacenitrogen,asthecarriergasforoxygen(Helium)toreducetheworkofbreathing.
194.Benefitofketamine? a)CausesdecreaseinBP b)Goodanalgesicaction c)DecreaseICT d)DecreaseIOT CorrectAnswer-BAns.B.GoodanalgesicactionKetamineisdifferentfrommostotheranaestheticinductionagentsinthatithassignificantanalgesicaction
195.Whichofthefollowingisa sympathomimetic? a)Propofol b)Etomidate c)Ketamine d)N2O CorrectAnswer-CAns.C.KetamineKetaminehasanindirectsympathomimeticaction.
196.WhichcantbegivenbyEpidural anaesthesia? a)Morphine b)Remifentanil c)Alfentanil d)Fentanyl CorrectAnswer-BAns.B.RemifentanilOpioidsusedforepiduralanalgesiaaremorphine,Fentanyl,Tramadol,Buprenorphine,alfentanil,sulfentanil,pentazocine.Ramifentanilcontainsglycinewhichcancausemotorweakness--?hencenotsuitableforepiduralanalgesia.
197.Additionofepinephrinetolignocaine? a)IncreasesesdistributionofLA b)DecreasesabsorptionofLA c)DecreasesdurationofLA d)IncreasesmetabolismofLA CorrectAnswer-BAns.B.DecreasesabsorptionofLAVasoconstrictorsareusedalongwithLAwhichprolongsdurationofactionasrateofabsorptionisdecreasedduetovasoconstriction.Forthesamereason,metabolismofLAisreducedandtoxicityisdecreasedasthereislesserabsorptionofLA,
198.Maximumconcentrationforepidural block? a)Bupivacaine b)Lidocaine c)Ropivacaine d)Chlorprocaine CorrectAnswer-DAns,D.Chlorprocaine
199.VasoconstricatorL.A.is? a)Cocaine b)Procaine c)Lidocaine d)Chlorprocaine CorrectAnswer-AAns.A.CocaineAllLAsarevasodilatorexceptcocaine.Cocainecausesvasoconstriction'"Ropivacaineandbupivacainealsocausevasoconstriction"'
200. Allarecontraindicationsofspinal anaesthesiaExcept? a)Bleedingdisorder b)Raisedintracranialtension c)Hypertension d)Infectionatinjectionsite CorrectAnswer-CAns,C.Hypertension
201.Forpreventionofheadacheduringspinal anaesthesia? a)Dilutedsolutionoflocalanaestheticshouldbeused b)Preloadingwithcrystalloids c)FinerI.P.needleshouldbeused d)Headendshouldbeelevated CorrectAnswer-CAns,C.FinerI.P.needleshouldbeusedAssinglemostimPortantpredisposingfactorislargeboreneedleuseoffineneedlepreventsPDPH.
202.Innewborn,chestcompressionshould bestartedifheartrateis? a)<120/min b)<100/min c)<80/min d)<60/min CorrectAnswer-DAns,D.<60/minCompressionfornewbornshouldbestartedifHR<60/min'
203.Murphy'seyeisseenin- a)Macintoshlaryngoscope b)Endotrachealtube c)LMA d)Flexiblelaryngoscope CorrectAnswer-BAnswer:B-EndotrachealTubeThe"Murphyeye"istheeponymousnameforaholeonthesideofmostendotrachealtubes(ETTs)thatfunctionsasavent,andpreventsthecompleteobstructionofthepatient'sairway,shouldtheprimarydistalopeningofanETTbecomeoccluded
204.ModifiedMallamPatigradingisusedin assessmentof- a)Difficultintubation b)Airwayobstruction c)Deathduetoaspiration d)Intubation CorrectAnswer-AAnswer:A-DifficultyinintubationModifiedMallampaticlassificationClass0:AbilitytoseeanypartoftheepiglottisuponmouthopeningandtongueprotrusionClassI:Softpalate,fauces,uvula,pillarsvisibleClassII:Softpalate,fauces,uvulavisibleClassIII:Softpalate,baseofuvulavisibleClassIV:SoftpalatenotvisibleatallTest:Theassessmentisperformedwiththepatientsittingupstraight,mouthopenandtonguemaximallyprotruded,withoutspeakingorsaying"ahh."Difficultlaryngoscopy:Goodaccuracy(areaunderSummaryReceiverOperatingCharacteristic[SROC]curve0.89?0.05)Difficultintubation:Goodaccuracy(areaunderSROCcurve0.83?0.03)Difficultmaskventilation:PoorpredictorUsedalone,theMallampatitestshavelimitedaccuracyforpredictingthedifficultairwayandthusarenotusefulscreeningtestsMallampaticlassificationisonlyoneof11nonreassuringfindingsduringairwayexamination
205.Whichnerveistestedforadequacyof anaesthesia- a)MedianNerve b)UlnarNerve c)Radialnerve d)Mandibularnerve CorrectAnswer-AAnswer:A-MediannerveMediannerveblockcanbeevaluatedbytestingthelateralaspectoftheringfinger
206.Mosteffectivecircuitinspontaneous anaesthesiais- a)MaplesonA b)MaplesonB c)MaplesonC d)MaplesonD CorrectAnswer-AAnswer:A-MaplesonAMAPLESONA-(Magill)CIRCUITUsefulinspontaneousventilationThepatientinspireswhateverisinthetube,usingthebagasavolumereservoir.Oneatedtubeandincomingfreshgas.Whenthebagisfull,exhaledalveolargasisventedfrxpiration,thebagrefillsfromacombinationofexpiredgasgoingbackupthecorrugomtheexhalevalve,andthenduringanyexpiratorypause,FGFpushestheremainingalveolargasout.TheoreticallyFGF=0.7xValvshouldpreventsignificantrebreathingbecausedeadspacegas(fresh)isnotwasted,butFGF=VAmorereliablypreventsrebreathing.Tubevolumemustexceed(Vt-Vd)oralveolargascouldcontaminatethebag.InadequateFGFcausesrebreathing.DifficulttodetectfromtheCO2waveformalone-allthathappensisthattherapidfalloninspirationisdelayed.IfVAexceedstubingvolume,CO2entersthebagandwillbeseenoninspirationonthecapnogram.ControlledventilationIftheanaesthetistfullyclosedthevalvewhilesqueezingthebagand
didn'topenituntiljustbeforethebagfilled,thiscircuitwouldbeOK.Morecommonlythevalveispartiallyclosed-enoughtopermitadequatetidalvolumesdespiteparallellossofgasoutthevalve.FGFmustbeincreasedtocompensateforgaslostduringinspiration-typically2.5xminuteventilation.TheLacksystemAco-axialMagill,withtheexpiratoryvalvebroughtcoaxiallybacktotheFreshGasoutlet.Notpopularduetoinefficiencyduringcontrolledventilation.
207.Whatismechanismofactionof Curaniumdrugsasmusclerelaxant? a)PersistentlydepolarizingatNeuromuscularjunction b)ActcompetitivelyonAchreceptorsblockingpost-synaptically c)RepetitivestimulationofAchreceptorsonmuscleendplate d)Inhibitingthecalciumchannelonpresynapticmembrane CorrectAnswer-BAnswer:B-ActcompetitivelyonAchreceptorsblockingpost-synapticallyCandocuroniumiodideisanaminosteroidneuromuscular-blockingdrugorskeletalmusclerelaxantinthecategoryofnon-depolarizingneuromuscular-blockingdrugs.ActsonAchreceptorscompetitivelypost-synapticallyblockingthem.Potentialadjunctiveuseinanaesthesiatofacilitateendotrachealintubation&provideskeletalmusclerelaxation.Candocuroniumdemonstratedashortdurationandarapidonsetofaction,withlittleornoganglionblockingactivity,anditwasonlyslightlylesspotentthanpancuronium
208.Duringsquintsurgery,anesthesiologist seesthemachineandseethebpsuddenlydropsto40.Whatwillbebestimmediatemanagement- a)Giveatropine b)Increaselevelofanesthesia c)Askthesurgeontostopthesurgery d)Giveadrenaline CorrectAnswer-DAnswer:D.GiveadrenalineAdrenalineshouldbegiventoraisethebloodpressure.Epinephrine,alsoknownasadrenalinoradrenaline,isahormone,neurotransmitter,andmedication.Epinephrineisnormallyproducedbyboththeadrenalglandsandcertainneurons.Itplaysanimportantroleinthefight-or-flightresponsebyincreasingbloodflowtomuscles,outputoftheheart,pupildilation,andbloodsugar.Itdoesthisbybindingtoalphaandbetareceptors.Physiologicresponsestoepinephrinebyorgan Organ Effects Heart Increasesheartrate;contractility;conductionacrossAVnode Lungs Increasesrespiratoryrate;bronchodilation Systemic Vasoconstrictionandvasodilation Liver Stimulatesglycogenolysis
Systemic Triggerslipolysis Systemic Musclecontraction
209.Oxygentherapymaynotbeusefulin a)Asthma b)Pneumonia c)Subglotticstenosis d)Pulmonaryfibrosis CorrectAnswer-DAns:D.PulmonaryfibrosisManyEMSprotocolsindicatethatoxygenshouldnotbewithheldfromanypatient,whileotherprotocolsaremorespecificorcircumspect.However,therearecertainsituationsinwhichoxygentherapyisknowntohaveanegativeimpactonapatient'sconditionlikeparaquatpoisoning,pulmonaryfibrosisandlungdamageresultingfrombleomycintreatment.
210.Mouthtomouthrespirationprovides whatpercentageofoxygen? a)10% b)16% c)21% d)100% CorrectAnswer-BAns.B.16%Mouthtomouthbreathingprovides0.8to1.2litersofexhaledairperbreathand16%ofoxygenwhichisenoughtosustainlife.TheuseofAmbubagandroomairprovides21%O2.TheAmericanHeartAssociationrecommendstidalvolumesof700to1000mLduringmouth-to-mouthventilation,butsmallertidalvolumesof500mLmaybeofadvantagetodecreasethelikelihoodofstomachinflation,asmouth-to-mouthventilationgascontainsonly17%oxygen,but4%carbondioxide.
2.ThefollowingincreasesIntraOcular pressure: a)Thiopentone b)Althesin c)Ketamine d)Barbiturate CorrectAnswer-CKetamine
3.Compositionofsodalimeis: NaOH-Ca(OH)2-KOH-Moisture a)4%-90%-1%-5% b)4%-80%-1%-15% c)80%-10%-5%-5% d)15%-80%-1%-4% CorrectAnswer-BSodalimeisthemorecommonabsorbentandiscapableofabsorbingupto23LofCO2per100gofabsorbent.Itconsistsprimarilyofcalciumhydroxide(80%),alongwithsodiumhydroxide(4%),water,andasmallamountofpotassiumhydroxide(1%).Commercialsodalimehasawatercontentof14%to19%.CO2absorbents(eg,sodalimeorcalciumhydroxidelime)containhydroxidesaltsthatarecapableofneutralizingcarbonicacid.Reactionendproductsincludeheat(theheatofneutralization),water,andcalciumcarbonate.Ref:ButterworthIVJ.F.,ButterworthIVJ.F.,MackeyD.C.,WasnickJ.D.,MackeyD.C.,WasnickJ.D.(2013).Chapter3.BreathingSystems.InJ.F.ButterworthIV,J.F.ButterworthIV,D.C.Mackey,J.D.Wasnick,D.C.Mackey,J.D.Wasnick(Eds),Morgan&Mikhail'sClinicalAnesthesiology,5e.
4.Allofthefollowingarecorrectaboutketamine,EXCEPT: a)Itfunctionally"dissociates"thethalamus b)Itincreasesarterialbloodpressure c)Itisapotentbronchoconstrictor d)Itinhibitspolysynapticreflexesinthespinalcord CorrectAnswer-CKetaminefunctionally"dissociates"thethalamus(whichrelayssensoryimpulsesfromthereticularactivatingsystemtothecerebralcortex)fromthelimbiccortex(whichisinvolvedwiththeawarenessofsensation).Ketamineincreasesarterialbloodpressure,heartrate,andcardiacoutput.Racemicketamineisapotentbronchodilator,makingitagoodinductionagentforasthmaticpatients.Itinhibitspolysynapticreflexesinthespinalcordaswellasexcitatoryneurotransmittereffectsinselectedareasofthebrain.Ref:ButterworthIVJ.F.,ButterworthIVJ.F.,MackeyD.C.,WasnickJ.D.,MackeyD.C.,WasnickJ.D.(2013).Chapter9.IntravenousAnesthetics.InJ.F.ButterworthIV,J.F.ButterworthIV,D.C.Mackey,J.D.Wasnick,D.C.Mackey,J.D.Wasnick(Eds),Morgan&Mikhail'sClinicalAnesthesiology,5e.
5.Apatientundergoingaminorsurgicalprocedureisgivenlignocaineinjection. Assertion:Localanaestheticsactsbyblockingnerveconduction. Reason:Smallfibersandnonmyelinatedfibersareblockedmoreeasilythanlargemyelinatedfibers. a)BothAssertionandReasonaretrue,andReasonisthecorrect explanationforAssertion b)BothAssertionandReasonaretrue,andReasonisnotthe correctexplanationforAssertion c)Assertionistrue,butReasonisfalse d)Assertionisfalse,butReasonistrue CorrectAnswer-BLocalanaestheticsblocksnerveconductionbydecreasingtheentryofsodiumionsduringupstrokeofactionpotential.Finallyitblocksdepolarizationtoreachthresholdpotentialandconductionblockoccurs.Smallfibersaremoresensitivetolocalanaestheticsthanlargefibersandnonmyelinatedfibersareblockedeasilythanmyelinatedfibers. Ref:EssentialsofMedicalPharmacologybyKDTripathi,5thEdition,Pages321-3
6.Thelaryngealmaskairwayusedforsecuringtheairwayofapatientinallofthe followingconditions,EXCEPT: a)Inadifficultintubation b)Incardiopulmonaryresuscitation c)Inachildundergoinganelective/routineeyesurgery d)Inapatientwithalargetumourintheoralcavity CorrectAnswer-DOropharyngealabscessormassisacontraindicationtotheuseoflaryngealmaskairway. Ref:ShortTextbookofAnaesthesiaByAjayYadav,2ndEdition,Page36
7.Allofthefollowingstatementsaboutneuromuscularblockageproducedby succinylcholinearetrue,except: a)NofadeonTrainoffourstimulation b)Fadeontetanicstimulation c)Noposttetanicfacilitation d)Trainoffourratio>0.4 CorrectAnswer-BSuccinylcholineisadepolarizingneuromuscularblocker.Withsuccinylcholinenofadingisobservedaftertrainoffourortetanicstimulation.AllfourstimulatoryresponsesafterTOFstimulationaresuppressedtothesameextent.Ref:NeuromuscularMonitoringinClinicalPracticeandResearchByThomasFuchs-Buder,Page16
8.Mechanismofactionoftheophyllinein BronchialasthmaincludeallofthefollowingExcept? a)Phosphodiesteraseinhibition b)Adenosinereceptorantagonism c)Increasedhistonedeacetylation d)Beta-2receptorstimulation CorrectAnswer-DAns.is'd'i.e.,Beta-2receptorstimulationProposedmechanismsofactionoftheophyllinePhosphodiesteraseinhibition(Nonselective)Adenosinereceptorantagonism(A1,A2)IncreasedhistoneDeacetylaseactivity(redefficacyofcorticosteroids)InhibitionofintracellularcalciumreleaseStimulationofcatecholaminereleaseInhibitionofNF-alphaBetatranslocationintothenucleus(nucleartranslocation)Mediatorinhibition(Prostaglandins,TNFalpha)
9.Besttomonitorintraoperativemyocardial ischemia(infarction)is a)ECG b)CVPmonitoring c)Transesophagealechocardiography d)Invasiveintracarotidarterialpressure CorrectAnswer-CCi.e.TransesophagealechocardiographyTranoesophagealechocardiographyprovidesarealtimepictureofall4cardiacchambersandvalves.Itcanidentifyanymalfunctioningvalvesinadditiontoanywallmotionabnormalitiesrelatedtomyocardiaischemia.Itisveryusefulduringanesthesia.Abnormalmotionofventricularwalldetectedinthiswayisareliableindexofmyocardialischemiaandmayguidedrugtherapy,canidentifyiftherapyhassuccessfullytreatedtheischemiaorindicatetheneedforfurthersurgicalrevascularizationCVP(catherterincentralvein)measuresrightsidedfillingpressurewhereaspulmonaryarterycathetermeasures/monitorsleftheartfillingpressure.Arterialcannulationmeasuresdirectsystemicarterialpressureandfacilitatesamplingofarterialbloodforanalysis.
10.Whichofthefollowingdrugsproduces dissociativeanesthesia a)Ketamine b)Propofol c)Thiopentone d)Enflurane CorrectAnswer-AAi.e.Ketamine
11.Ketaminecanbeusedinallofthe situationsexcept a)Statusasthamaticus b)Foranalgesia&sedation c)Obstetrichemorrhage d)Ischemicheartdisease CorrectAnswer-DDi.e.IschemicheartdiseaseKetaminecausesprofoundanalgesiaQ,disociativeanesthesiaQ,andemergencepsychomimetichallucinationsanddeliriumQ.Ketamineincreasescerebralmetabolism,02consumption,bloodflow&intracranialpressure.QKetamine*ItcausesprofoundanalgesiaQanddissociativeanesthesiaQ(i.e.patientappearsconsciouse.g.eyeopening,swallowingbutunabletoprocessorrespondtosensoryinput).KetaminecausesDissociativeAnesthesiaQbyactingoncortexandsubcorticalareas(notonRAS)l/tfeelingofdissociationfromonesownbodyandsurroundings.PostOperativeDeliriumandHallucinationQispartofthisDissociativephenomenon.Drugofchoiceforpostop.delirium&hallucinationisLorazepam.Q*Itisclosesttobeingacompleteanestheticsinceitinducesanalgesia,amnesia&unconsciousness.*Itisassociatedwithemergencepsychotomimeticsideeffects(delirium,illusions,hallucination)Q.Itislesscommoninchildrenandpretreatmentwithlorazepam(drugofchoice)Q.
12.Anestheticagent(s)safetouseinTICP a)Halothane b)Thiopentone c)Ketamine d)Ether CorrectAnswer-BBi.e.ThiopentoneAnestheticagentssafetouseinraisedintracranialpressure(ICP)arethiopentone,propofol&etomidateQ
13.Allofthefollowingcausemyocardial depressionexcept: a)Halothane b)Etomidate c)Thiopentone d)Ketamine CorrectAnswer-BBi.e.Etomidate-Etomidatecausesadreno-corticalsuppressionQbyinhibitingenzymes11/3hydroxylase(mainly)&17ahydroxylaseinvolvedincortisolandaldosterone(mineralocorticoid)productionQ.VitCsupplimentationrestorescortisollevel.-EtomidateandmidazolamprovidecardiovascularstabilityQ.ButetomidateismostcardiostableagentQthatcausestheleasthemodynamicdisturbanceofanyoftheintravenousanestheticagents.SoitisintravenousanestheticagentofchoiceforpatientswithcardiacdiseaseandaneurysmsurgeryQ.-Directmyocardialdepressioniscausedbyhalothane(severe),nitrousoxide(moderate),iso/sevo/des-flurane(mild),thiopental(marked),propofol(dosedependent)andketamineQ(butthisismaskedbycardiotonicsympatheticstimulatoryaction).Etomidate>midazolemaremostcardiostableagentsQ.
14.Attheendofanaesthesiaafter discontinuationofnitrousoxideand removalofendotrachealtube,1000/0oxygenisadministeredtothepatienttoprevent: a)DiffusionHypoxia b)Secondgaseffect c)Hyperoxia d)Bronchospasm CorrectAnswer-AAi.e.DiffusionHypoxia(Ref:Willer8/ep656,3401)OndiscontinuationofN2Oadministration,nitrousoxidegascandiffusefrombloodtothealveoli,dilutingO2inthelung.Produceaneffectcalled"Diffusionalhypoxia".Toavoidhypoxia,100%O2,ratherthanairshouldbeadministeredwhenN2Odiscontinued.
15.Stagesofanesthesiawereestablishedby a)Ether b)N20 c)Halothane d)Chloroform CorrectAnswer-AAi.e.Ether
16.Hepatotoxicagentis a)Ketamine b)Ether c)N20 d)Halothane CorrectAnswer-DDi.e.Halothane
17.Shortestactinglocalanestheticagentis a)Procaine b)Lidocaine c)Tetracaine d)Bupivacaine CorrectAnswer-AAi.e.Procaine
18.PudendalNerveBlockInvolve a)LiL2L3 b)L2L3L4 c)SiS2S3 d)S2S3S4 CorrectAnswer-DDi.e.S2S3S4
19.Whichofthefollowinganestheticagents haveanalgesicproperty: a)Ketamine b)Nitrousoxide c)Thiopentone d)aandb CorrectAnswer-DAi.e.Ketamine;Bi.e.Nitrousoxide
20.Contraindicationofbagandmask ventilationareallofthefollowingexcept:March2009 a)Tracheo-esophagealfistula b)Hiatushernia c)Pregnancy d)Emptystomach CorrectAnswer-DAns.D:EmptyStomach Bag-maskventilationcanproducegastricinflationwith complications,includingregurgitation,aspiration,andpneumonia. Conditionspredisposingtoaspirationare:FullstomachpatientsHiatushernia,pregnancyIntestinalobstructionTracheo-esophagealfistulaMeconiumaspirationsyndrome Gastricinflationcanelevatethediaphragm,restrictlungmovement, anddecreaserespiratorysystemcompliance
21.Followingistrueabouthalothaneexcept? a)Volatileliquidwithsweetodour b)Sensitiseshearttoadrenaline c)Constrictsbronchii d)Causesmalignanthyperthermia CorrectAnswer-CAns.is'c'i.e.,ConstrictsbronchiiHalothaneItisavolatileliquidwithsweetodour,nonirritatingandnoninflammable.Itisapotentanaestheticwithpooranalgesicandmusclerelaxantproperties.HalothanecausesdirectdepressionofmyocardialcontractilitybyreducingintracellularCa.ItcausesfallinBPandCO.Heartratedecreasesduetovagalstimulation.Ittendstosensitizethehearttoarrhythmogenicactionofadrenalinecontraindicatedinpheochromocytoma.Itcausesgreaterdepressionofrespirationandventilationperfusionmismatch.Itdilatesthebronchiinhalationagentofchoiceinasthmatics(intravaneousanaestheticofchoiceinasthmaticsisketamine).Itisahepatotoxicdrugandcanalsocausemalignanthyperthermia(Succinylcholineaccentuateit).Recoveryissmoothandreasonablyquick.Itcausespostanaestheticshiveringandchills.Itinhibitsintestinalanduterinecontractionsagentofchoiceforassistingexternalorinternalversionduringlatepregnancy.
Becauseitsuterinerelaxantactionitiscontraindicatedduringlabour.Itisparticularlysuitableforinductionandmaintenanceinchildrenandasmaintenanceanaestheticinadults.
22.Midazolamcausesallexcept: a)Anterogradeamnesia b)Retrogradeamnesia c)Causestachyphylaxisduringhighdoseinfusions d)Decreasedcardiovasculareffectsascomparedtopropofol CorrectAnswer-BAns.b.RetrogradeamnesiaAtthetimeofpeakconcentrationinplasma,hypnoticdosesofbenzodiazepines(midazolam)canbeexpectedtocausevaryingdegreesoflightheadedness,lassitude,increasedreactiontime,motorincoordination,impairmentofmentalandmotorfunctions,confusion,andanterogradeamnesia."Midazolam:ItcausesanterogradeamnesiaQToleranceandtachyphylaxismayoccur,particularlywithlonger-terminfusionsQ(ShaferA.Complicationsofsedationwithmidazolamintheintensivecareunitandacomparisonwithothersedativeregimens.CritCareMed.1998;26(5):947-56)Benzodiazepinewithdrawalsyndromehasalsobeenassociatedwithhighdose/long-termmidazolaminfusionsQComparedwithpropofolinfusions,midazolaminfusionshavebeenassociatedwithadecreasedoccurrenceofhypotension?butamorevariabletimecourseforrecoveryoffunctionafterthecessationoftheinfusion.
23.Whichofthefollowinginhalationalagent sensitizesmyocardiumtocatecholamine a)Sevoflurane b)Isoflurane c)Ether d)Halothane CorrectAnswer-DAns.is'd'i.e.,HalothaneSomeinhalationalagentsensitizethehearttoadrenaline-->Arrhythmiascanoccur-->ThereforetheseagentsarecontraindicatedinPheochromocytomaandalongwithadrenaline.Halothanehasmaximumpropensity.OtheragentssensitizingthehearttoadrenalineareTrilene,Cyclopropane,Chloroform,Enflurane
24.Gasusedinrapidairbaginflation a)Sodiumazide b)Nitrocellulose c)Mercuricnitrate d)Potassiumnitrate CorrectAnswer-AAns.is'a'i.e.,SodiumazideChemistryofairbagsTheinclusionofairbagsinthemodernautomobileshasledtodecreaseintheautomobileinjures.Thetermairbagisamisnomerasairisnotinvolvedintheinflationprocess.Ratheranairbaginflatesrapidly(inabout30ms)duetoexplosiveproductionofN2gas.SodiumazideisusedwhichisrapidlydecomposedtoNitrogengas.
25.Whichofthefollowingisnotprimarily usedtoanesthetizemucosa? a)Benzocaine b)Lidocaine c)Bupivacain d)Tetracaine CorrectAnswer-CAns.is'c'i.e.,Bupivacaine
26.Postspinalheadachelastsfor? a)10min b)Ihrs c)10days d)1week CorrectAnswer-CAns.is'c'i.e.,10daysPostduralpunctureheadacheisduetoCSFleak.Typicallocationisbifrontaloroccipital.Headachegetsworsenonsittingoruprightpostureandisrelievedbylyingdownpositionandabdominalpressure-->Thehallmarkofpostduralpunctureheadachei.e.,associationwithbodyposition.Theonsetofheadacheisusually12-72hoursfollowingtheprocedure,however,itmaybeseenalmostimmediately.Inmostcasesitlastsfor7-10days.PDPHisbelievedtoresultfromleakageofCSFfromaduraldefectanddecreasedICT.LossofCSFataratefasterthatitcanbeproducedcausestractiononstructuresupportingthebrain,particularlyduraandtentorium.Tractiononcranialnerve(particularly6thnerve)producesdiplopia.FactorsthatincreasetheincidenceofPDPHareyoungage,femalesex,Pregnancy,largeboreneedleandmultiplepunctures.UseofsmallboreneedlecanpreventPDPH.Intiallyconservativetreatmentisgivenwhichincludesanalgesics(NSAIDs),oralori.v.,fluids,Sumatriptan,cosyntropin,caffeineandrecumbentposition.Ifconservativetreatmentfails,epiduralbloodpatchcanbeused.Itinvolvesinjecting15-20mlofautologusbloodintotheepidural
spacewhichstopleakageofCSFbycoagulationandmasseffect
27.Laryngealmaskairwaynotusedin? a)Babyweighing<1500gms b)PregnantPatients c)OcularSurgeries d)Difficultairway CorrectAnswer-BAns.is`b'i.e.,PregnantPatientsIndicationsofLMA 1. Asanalternativetointubationwheredifficultintubationisanticipated (difficultairway). 2. Tofacilitateendo-trachealintubationinapatientwithdifficult airways. 3. Situationsinvolvingadifficultmaskfit.4. Securingairway(ascardiopulmonaryresuscitation)inemergency whereintubationandmaskventilationisnotpossible. 5. Forminorsurgeries(shortsurgeries),whereanaesthetistwantsto avoidintubation. 6. Asaconduitforbronchoscopes,smallsizetubes,gumelastic bougies. 7. Forextraandintra-ocularsurgeriesincludingretinopathysurgeryin prematureinfants--)LMAisparticularlyusefulinophthalmicsurgeryasproblemscreatedbyothertwoairwaysareeliminated:- 8. Facemaskcreatesprobleminsurgicalfieldaccessduetoitssize (LMAprovidesabetteraccess). 9. EndotrachealintubationmaycauseraisedIOT(LMAhasnoeffect). ContraindicationsofLMA 1. Conditionswithhighriskofaspirationi.e.,fullstomachpatients, hiatushernia,pregnancy.
2. Oropharyngealabscessormass(tumor).3. Massivethoracicinjury4. Massivemaxillofacialtrauma
28.Localanaestheticcausing methemoglobinuriais? a)Dibucaine b)Chlorprocaine c)Procaine d)Benzocaine CorrectAnswer-DAns.is'd'i.e.,BenzocaineImportantfactsaboutLAsChlorprocaineistheshortestactingLA.Dibucaineisthelongestacting,mostpotentandmosttoxicLA.Procaine&chlorprocaineareleastpotentLAs.BupivacaineisthemostcardiotoxicLA(Ropivacaineisanewerbupivacainecongenerwithlesscardiotoxicity).Levobupivacaine(TheS(-)enantiomerofbupivacaine)islesscardiotoxicandlesspronetocauseseizure.PrilocaineandBenzocainecancauseMethaemoglobinemiaLignocaineisthemostcommonlyusedLA.Bupivacainehasthehighestlocaltissueirritancy.Chlorprocaineiscontraindicatedinspinalanaesthesiaasitcancauseparaplegiaduetopresenceofneurotoxicpreservativesodiummetabisulphite.ProcaineistheLAofchoiceinmalignanthyperthermia
29.Whichofthefollowingarefeaturesof pulmonaryoxygentoxicity? a)Increasedcapillaryendothelialpermeability b)Decreasedmucociliarytransportinairways c)Inhibitionofphagocytosisfunctionofalveolarmacrophages d)Alltheabove CorrectAnswer-DAns.is'd'i.e.,Alltheabove 1. Prolongedinhalationofhighconcentrationof0,isknowntodamage thelungs. 2. Pulmonarytoxicityof0,isrelatedtotheoxygentensioninalveoli. ThepulmonaryoxygentoxicityhasthefollowingfeaturesIncreasedcapillaryendothelialpermeabilitycausingaccumulationoffluidintheinterstitialspace.DepressionofmucociliarytransportfunctionofairwayInhibitionofphagocytosisofalveolarmacrophagesChangesinthesurfactantactivityanditsproduction.
30.Whichofthefollowingsystemscanbe usedtoproducePEEP? a)Springsystem b)Ballvalvesystem c)Pneumaticsystem d)Alltheabove CorrectAnswer-DAns.is'd'i.e.,AlltheaboveanesthesiabyHartiganp.179]PEEPValveAPEEPValveisadevicewhichmaintainstheairwayatendexhalation.SpringvalvesystemisthesimplestPEEPvalvesystem.OthervalvesystemsforPEEPareelectronic,magnetic,pneumaticandballvale.PEEPdevicesmaybeintegratedintoventilatorormaybeseparatedevicesthatareattacheddirectlyintoanesthesiacircuit,CPAPdeviceormanualresuscitationbag.
31.Whichofthefollowingiscontraindicated inheadinjury? a)Ketamine b)Halothane c)N,0 d)Propofol CorrectAnswer-AAns.is'a'i.e.,Ketamine
32.Percentageoftetracaineusedineye surgery? a)0.5% b)1% c)2% d)4% CorrectAnswer-AAns.is'a'i.e.,0.5%Cataractsurgerycanbeperformedusingtopicalanaesthesiaalone.Tetracaine0.5%andLidocaine4%canbeused.Advantagesofthismethodisthatitavoidsthepotentialcomplicationswithretorbulbarandperibulbarinjections.Dsadvantagesincludethepotentialforeyemovementduringsurgery,increasedpatientanxiety,anddiscomfortfromthemicroscopelight
33.Whatisthepressureatwhichoxygenis stored? a)75psi b)1600psi c)760psi d)2200psi CorrectAnswer-DAns.is'd'i.e.,2200psi
34.Trueaboutpostduralheadacheisall except:? a)Orientingbevelededgeneedleparalleltolongaxispreventsit b)Thinboreneedlepreventsit c)Itismorecommoninmales d)Timingofambulationhasnoeffectoveritsincidence CorrectAnswer-CAns.is`c'i.e.,ItismorecommoninmalesFACTORSTHATINCREASETHEINCIDENCEOFHEADACHEAFTERSPINALPUNCTUREAge:Younger,morefrequent.Sex:Females>malesNeedlesize:Larger>smallerNeedlebevel:LesswhentheneedlebevelisplacedinthelongaxisoftheneuraxisPregnancy:MorewhenpregnantDuralpunctures:MorewithmultiplepuncturesFACTORSTHATDONOTINCREASETHEINCIDENCEOFHEADACHEAFTERSPINALPUNCTUREInsertionanduseofcathetersforcontinuousspinalanaesthesiaTimingofambulationAboutoptionaOrientinganeedlebevelparallelwiththeaxisofthespine,suchthatthelongitudinalfibresofthedurawouldmorelikelybeseparatedthancut,resultsinalowerincidenceofpostspinalpunctureheadache.
35.Ketaminecontraindicatedinallexcept? a)Headinjury b)Hypertension c)Asthma d)Glaucoma CorrectAnswer-CAns.is`c'i.e.,AsthmaKetamineincreasescerebralbloodflow,metabolism,oxygenconsumptionandintracranialtension,unlikethiopentone,propofol&etomidate,whichhavecerebroprotectiveeffect,thereforeketamineiscontraindicatedinheadinjury,intracranialspaceoccupyinglesionsandforneuroanaesthesia.CerebrovascularresponsivenesstoCO2ispreserved,andreducingthearterialCO2tensionbyhyperventilationattenuatestheketamineinducedriseinICT.Ketaminehasdirectmyocardialdepressant(negativeionotropic)&vasodilatoreffect.However,ketaminealsohasindirectsympathomimeticeffect.Indirectsympathomimeticeffectpredominatesoverdirectmyocardialdepressant&vasodilatoreffect;usualresponseisincreasedBP,cardiacoutputandheartrate-Cardiac02demandisincreased.Ketamineiscontraindicatedinaorticaneurysm,hypertensiveandischemicheartdisease.Ketaminealsosensitizesthehearttoadrenaline-arrhythmiasmayoccur.Asketaminecausesympatheticstimulation,itistheintravenousanaestheticofchoiceinpatientswithshockandhypovolemia.Ketamineincreasesintra-oculartension-Contraindicatedinglaucoma&openeyesurgery.
Itisapotentbronchodilatorandrelievesbronchospasm-Intravenousanestheticagentofchoiceinasthmatic(inhalationalanaestheticagentofchoiceinasthmaticsishalothane)Itincreasesuterinetoneandintensityofuterinecontraction-agentofchoiceinpatientswithobstetrichaemorrhageandflacciduterus.Injectionofketamineisnotpainful(allotheri.v.inducingagentscausepainoninjection).
36.InBier'sblockaestheticagentgivenby whichroute? a)Intravenous b)Peribulbarregion c)Retrobulbararea d)Dermal CorrectAnswer-AAns.is'a'i.e.,IntravenousIntravenousregionalanaesthesia(IVRA)isusedmostoftenforsurgeryoftheforearmandhand,butcanalsobeusedfordistallegandfoot.FirstIVcannulaisinsertedusuallyinthedorsumofhand.Thentourniquetcuffisappliedtoproximalarm.Limbiselevatedandexsanguinatedwiththehelpofanelasticbandage(Esmarch).Nowtourniquetcuffisinflatedabovesystolicpressure(sothatnobloodcanenterinthatlimbandthelimbremainsexsanguinated).Nowthelocalanaestheticsolutionisslowlyinjectedintocannula.Theveinsarefilledwithonlylocalanaestheticasthereisnoblood-->localanaestheticcannotbedrainedoutformupperlimbandcannotenterinsystemiccirculationbecauseofinflatedcuffinproximalarm.Thearmisanaesthetizedin6-8minutes.LidocainewithoutadrenalineistheDOCforthistechnique.-Goodman&GilmanIlth/ep.381Afewclinicianprefersprilocaineoverlidocainebecauseofitshighertherapeuticindex-leasttoxicLA.Torniquecuffdeflation,prematurereleaseorfailureoftorniquetcan
causereleaseofLAintocirculationandtoxicitymayoccur-->So,cardiotoxicLAslikebupivacaineandetidocainearecontraindicatedforBier'sblock.
37.Whatisthenextstepinmanagementin managingachildwithdifficultintubationwith4failedattemptsatintubation? a)UseLMA b)Abandontheprocedure c)TryETtubeintibationagain d)Cricothyrotomy CorrectAnswer-AAns.is'a'i.e.,UseLMA
38.Followinggroupofdrugsisnotthefirst lineinthemanagementofchronicpain? a)Opioids b)Antiepileptics c)Serotonergicdrugs d)Dopamineantagonist CorrectAnswer-DAns.is'd'i.e.,Dopamineantagonist
39.Anaestheticofchoicefordaycaresrgery is? a)Thiopentone b)Nitrousoxide c)Propofol d)Halothane CorrectAnswer-CAns.is'c'i.e.,Propofol
40.Macintoshindicatorisusedfor? a)ToassessdegreeofNMblockade b)Localizationofextraduralspace c)ToassesslevelofGA d)Tomonitorrespiratorydepression CorrectAnswer-BAns.is'b'i.e.,LocalizationofextraduralspaceVariousmethodshavebeenusedtolocatetheepidural(extraduralspace),mostofwhichrelyonsubatmosphericpressure.Theseare:-Lossofresistancetoairorsaline(mostcommontechnique).Gutierrez'smethod:Ahangingdropofsalineonthehubofneedleisdrawninastheepiduralspaceisentered(morereliableinthorocicthanlumbarregion).Odom'sindicator:Afine-boreglasstubefilledwithsalineandabubblethatmovesinresponsetoadropinpressure.Macintosh'sindicator:Asmallrubberballoonfilledwithairconnectedtoanadaptorcausingittodeflateonenteringtheepiduralspace.Macintosh'sspring-loadedneedle.Ultrasoniclocalization.Oxfordepidularspacedetector.
41.Atracuriumisexcretedby a)Renalexcretion b)Hepaticelimination c)Nonenzymaticdegradation d)Alloftheabove CorrectAnswer-CAns.is'c'i.e.,NonenzymaticdegradationTheuniquefeatureofatracuriumisinactivationinplasmabyspontaneousnonenzymaticdegradation(Hofmannelimination)inadditiontothatbyalkalineesterhydrolysis.Consequentlyitsdurationofactionisnotalteredinpatientswithhepatic/renalinsufficiencyorhypodynamiccirculationPreferredmusclerelaxantforsuchpatientsaswellasforneonatesandtheelderly.oAtracuriumismetabolisedtolaudanosinethatisresponsibleforseizures.ItcancausehistaminereleaseHypotension&bronchoconstriction.
42.Localanaestheticwithprolongedaction? a)Procaine b)Cocaine c)Lidocaine d)Dibucaine CorrectAnswer-DAns.is'd'i.e.,DibucaDibucaineisthelongestactinglocalanaestheticChlorprocaineistheshortestactinglocalanaestheticDecreasingorderofduration:-Dibucaine>Bupivacine=Tetracaine=Ropivacaine=Etidocaine>Prilocaine=Lignocaine=Mepivacaine=Cocaine>Procaine>Chlorprocaine.
43.DrugusedtoprolongactionofLAin Hypertensivepts? a)Clonidine b)Felypressin c)Dexmeditomidate d)Noradrenalin CorrectAnswer-BAns.is'b'.e.,Felypressin
44.Whichamongthefollowingisa depolarisingmusclerelaxant? a)Decamethonium b)Dtubocurarine c)Doxacurium d)Atracurium CorrectAnswer-AAns.is'a'i.e.,DecamethoniumMorgan4th/ep.214]Seeexplanation-4ofsession-3.
45.Whichofthefollowingisfastestacting inhalationalanaestheticagent? a)Halothane b)Desflurane c)Sevoflurane d)Isoflurane CorrectAnswer-BAns.is'b'i.e.,DesfluraneBlood:Gaspartitioncoefficient(B:Gcofflcient)Itisthemeasureofsolubilityoftheagentintheblood.Agentwithlowbloodsolubility(lowB:Gcoefficient)willhavehighconcentrationinalveolarairasitwilldiffuselessthroughthealveolarcapillarymembranebecauseoflowbloodsolubility.Sincealveolarconcentrationdeterminestheinductionandrecovery,induction&recoverywillbefastwithagentwithlessB:Gpartitioncoefficient;andinduction&recoverywillbeslowerwithagentswithhighB:Gpartitioncoefficient.DesfluranehasminimumB:Gpartitioncoefficient(leastbloodsolubility)HasFastestonsetandrecovery.oMethoxyfluranehasmaximumB:Gpartitioncoefficient(Maximumbloodsolubility)-4Hasslowestonset&recovery.Speedofonset&recoveryindecreasingorder(IncreasingorderofB:Gpartitioncoefficientandbloodsolubility):?Desflurane(0.42)>Cyclopropane(0.44)>N2O(0.47)>Sevoflurane(0.69)>Isoflurane(1.38)>Enflurane(1.8)>Halothane(2.4)>Chloroform(8)>Trilene(9)>Ether(12)>Methoxyflurane(15)
46.Currentmodeofanalgesiabestfor intrapartumpainrelief? a)Epiduralanalgesia b)Spinalanaesthesia c)Inhalational d)Localanalgesia CorrectAnswer-AAns.is'a'i.e.,EpiduralAnalgesiaContinuouslumbarepiduralanalgesiaistheprocedureofchoiceforpainreliefduringnormallabourandvaginaldelivery(Intrapartumpain).
47.Themostappropriatecircuitfor ventilatingaspontaneouslybreathinginfantduringanaesthesiais? a)jacksonReesmodificationofAyre'sTpiece b)MaplesonAorMagill'scircuit c)MaplesonCorWaterstoandfrocanister d)Bainscircuit CorrectAnswer-AAns.is'a'i.e.,JacksonReesmodification
48.CharacteristicEECpatternseenin surgicaltolerancestageofanesthesiais? a)Alpha b)Beta c)Delta d)Theta CorrectAnswer-CAns.is'c'i.e.,Delta
49.Supraclavicularblockisusedforsurgery of? a)Shoulder b)Forearm c)Arm d)All CorrectAnswer-DAns.isD.`(A)Shoulder(B)Forearm(C)Arm
50.Allofthefollowingaboutthiopentoneare trueexcept? a)ItdecreasesICT b)Ithasanticonvulsantaction c)IVinjectionispainless d)Itcancausereflextachycardia CorrectAnswer-CAns.is'c'i.e.,IVinjectionispainless
51.Thiopentoneisnotusedin? a)Inductionofanesthesia b)Medicallyinducedcoma c)Astruthserum d)Asantidepressant CorrectAnswer-DAns.is'd'i.e.,Asantidepressant
52.IVdoseof1:10000concentrationof epinephrineinpretermbabyis? a)0.1m1 b)0.2ml c)0.3ml d)0.4ml CorrectAnswer-BAns.is'b'i.e.,0-2mlEpinephrineTheIVdoseof1:10,000concentrationis0.1m1/Kg.Thusitisabout0.5mlfortermbabyand0.2mlforpretermbaby.Endotrachealtubedosingis1m1/Kg.thusitisabout3m1fortermbabyand1mlforpreterm.
53.Longestactingamongmusclerelaxantis? a)Doxacurium b)Rocuronium c)Vecuronium d)Atracurium CorrectAnswer-AAns.is'a'i.e.,DoxacuriumAmongthegivenoptions,onlydoxacuriumislongacting.Seeexplanation-4ofsession-3.
54.Warfarintobestopped____________days beforesurgery? a)2to3days b)4to5days c)6to7days d)8to9days CorrectAnswer-BAns.is'b'i.e.,4to5daysWarfarinmayincreaseperi-operativebleeding,exceptforminorproceduressuchascataractsurgerywithoutbulbarblocks.Noconsensusexistsontheoptimalperioperativemanagementofpatientsreceivingwarfarin.Theusualrecommendationistowithholdwarfarinstarting4to5dayspreoperatively(iftheINRisbetween2.0and3.0)toallowtheINRtodecreasetolessthan1.5,whichisalevelconsideredsafeforsurgicalproceduresandneuraxialblockade.IftheINRisgreaterthan3.0,itisusuallynecessarytowithholdwarfarinlongerthan4to5days.IftheINRismeasuredthedaybeforethesurgicalprocedureandremainshigherthan1.8,asmalldoseofvitaminK(1to5mgadministratedorallyorsubcutaneously)canreverseanticoagulation.VitaminKhasaneffectwithin6to10hoursafteroralorsubcutaneousadministration(morepredictablewithoraladministration),anditpeakswithin24hoursto48hours.Administrationofhigherdosesmayleadtowarfarinresistancewhentherapyisinitiatedagain.
55.Falseaboutlocalanesthetics a)Prilocaineislesstoxicthanlignocaine b)Lignocaineisusedasanantiarrhythmic c)Mixtureofligno+prilocaineisknownaseutectic d)Lidocaineisshorteractingthanbupivacaine CorrectAnswer-AAns.is'a'i.e.,Prilocaineislesstoxicthanlignocaine
56.Mostcommoncomplicationofcoeliac plexusblock? a)Hypotension b)Parasthesias c)Diarrhea d)Pneumothorax CorrectAnswer-AAns.is'a'i.e.,HypotensionCeliacplexusblockTheceliacplexusissituatedretroperitoneallyintheupperabdomen.ItisatthelevelofT12andL,vertebraeanteriortothecruraofthediaphragm.ItcontainsvisceralafferentandefferentfibersdividedfromT5toT1,bymeansofgreater,lesserandleastsplanchnicnerves.Celiacplexusinnervatesmostoftheabdominalviscera,thereforethisprocedureblocksthenerveswhichcomefromthepancreas,liver,gallbladder,stomach,intestine,spleen,kidneyandadrenalglands.Aceliacplexusblockcanbecombinedwithanintercostalblocktoprovideanesthesiaforintra-abdominalsurgery.Becauseceliacplexusblockresultsinblockadeoftheautonomicnervoussystem,thisblockmayhelptoreducestressandendocrineresponsestosurgery.Forthesamereason,themostcommoncomplicationofceliacplexusblockisposturalhypotenstionbecauseofblockadeoflumbarsympatheticchainleadingtoupperabdominalvesseldilationandvenouspooling.Celiacplexusblockcanbedonebyfollowingthreeapproaches:-Retrocrural(classic)approach,anterocruralapproachand
splanchnicnerveblock.Celiacplexusblockisgiventotreatintractablepaininchronicpancreatitis,gastric&pancreaticmalignancies.Itcanbecombinedwithanintercostalblocktoprovideanesthesiaforintra-abdomivalsurgery.PosturalhypotensionistheMostcommoncomplicationofclassicretrocruralandsplanchnicnerveblock,WhereasmostcommoncomplicationofAnterocruralapproachistransientdiarrhoea
57.Trueaboutmalignanthyperthermiaisall except a)MostcommoncauseisSch b)Dantroleneisthedrugofchoice c)EndtidalCO,isincreased d)Bradycardiaoccurs CorrectAnswer-DAns.is'd'i.e.,Bradycardia
58.Elderlypatientwithfracturerighthip anestheticofchoice a)Spinal/epidural b)General c)Localinfiltration d)Noneoftheabove CorrectAnswer-AAns.is'a'i.e.,Spinal/epidural
59.Whichisasafemusclerelaxantinrenal failure? a)Cisatracurium b)Rocuronum c)Vecuronium d)Succinylcholine CorrectAnswer-AAns.is'a'i.e.,CisatracuriumTheuniquefeatureofatracuriumandcisatracuriumisinactivationinplasmabyspontaneousnonenzymaticdegradation(Hofmanelimination)inadditiontothatbyalkalineesterhydrolysis.Thereforebothofthesedonotrequirehepaticorrenalroutesforeliminationthereforecanbeusedsafelyinhepaticandrenalfailure.Moreover,cisatracuriumdoesnotprovokehistaminerelease,thereforeitispreferredoveratracurium.
60.Onsetofpostspinalheadacheisusually athoursafterspinalanesthesia a)0-6 b)6-12 c)12-72 d)72-96 CorrectAnswer-CAns.is'c'i.e.,12-72
61.DISSisusedfor? a)Correctapplicationofcylindertoanaesthesiamachine b)Toprovideanalgesia c)TomonitorBP d)TomonitorCVP CorrectAnswer-AAns.is`a'i.e.,Correctapplicationofcylindertoanaesthesiamachine
62.Drugsusedfordaycaresurgeryareall except? a)Propofol b)Sevoflurane c)Doxacurium d)Desflurane CorrectAnswer-CAns.is'c'i.e.,Doxacurium
63.Shortestactingnondepolarizingmuscle relaxantis? a)Mivacurium b)Doxacuronium c)Pipecurium d)Vecuronium CorrectAnswer-AAns.is'a'i.e.,MivacuriumSuxamethonium(succinylcholine)istheshortestactingskeletalmusclerelaxant.oMivacuriumistheshortestactingnondepolarizingskeletalmusclerelaxant.
64.Henryslawstatesthat? a)Ataconstanttemperaturegasdissolvesinsolutionin proportiontoitspartialpressure b)AtaconstantPressuregasdissolvesinsolutioninproportionto itstemperature c)Ataconstanttemperaturegasdissolvesinsolutionin proportiontoitsfatsolubility d)Ataconstantpressuregasdissolvesinsolutioninproportionto itsfatsolubility CorrectAnswer-AAns.is'a'i.e.,Ataconstanttemperaturegasdissolvesinsolutioninproportiontoitspartialpressure
65.Propofolinfusionsyndromeallexcept? a)Occurswithinfusionofpropofolfor48hoursorlonger b)Occursincriticallyillpatients c)Featuresarenauseaandvomiting d)Featuresarecardiomyopathy,hepatomegaly CorrectAnswer-CAns.is'c'i.e.,FeaturesarenauseaandvomitingPropofolinfusionsyndromeAlethalsyndrome,associatedwithinfusionofpropofolfor48hoursorlonger.Occursinchildrenandcriticallyill.Occursasaresultoffailureoffreefattyacidmetabolismandfailureofthemitochondrialrespiratorychain.Featuresare-cardiomyopathywithacutecardiacfailure,metabolicacidosis,skeletalmyopathy,hyperkalemia,hepatomegalyandlipemia.
66.Hyperbaricoxygenisnotusefulin? a)Anemia b)Vertigo c)Gasgangrene d)CompartmentSyndrome CorrectAnswer-BAns.is'b'i.e.,Vertigo
67.Treatmentinpostoperativeshivering? a)Pethidine b)Piritramide c)Methadone d)Pentazocine CorrectAnswer-AAns.is'a'i.e.,PethidinePost-anaesthesiashivering(PAS)Postanaesthesia(postoperative)shiveringoccursin40%ofpatientsrecoveringfromgeneralanaesthesia.Sometimeitisprecededbycentralhypothermiaandperipheralvasoconstriction,indicatingthatitisathermoregulatorymechanismPethidineismosteffectivedrugfortreatmentofPAS.Otherdrugsusedare--clonidine,doxapram,ketanserin,alfentonil,butorphanol,chlorpromazine.
68.Standardmethodtodifferentiatebetween endotrachealandesophagealintubationis? a)EndtidalCO2 b)ChestX-rays c)Auscultation d)Partialpressureof02 CorrectAnswer-AAns.is'a'i.e.,EndtidalCO2
69.Anestheticagent/swhichhavetocolytic effectare? a)Halothane b)Enflurane c)Isoflurane d)Alltheabove CorrectAnswer-DAns.is'd'i.e.,AlltheaboveHalothane,enfluraneandisofluraneproduceadosedependentdecreaseinuterinetone(tocolysis).Studiesofisofluranedemonstratethathalogenatedcompoundsreduceboththefrequencyofuterinecontractionsandtheintervalbetweenthem.
70.Followingarehepatotoxicanesthetic agentsexcept? a)Halothane b)Chloroform c)Ether d)Propofol CorrectAnswer-DAns.is`d'i.e.,PropofolZimmermannp.458]Followingarethegroupsofhepatotoxicanestheticagents:GroupI:DrugswithwellknownhepatotoxicpotentialandcontainingChlorineorbromine.Eg:chloroform.GroupII:DrugswhichcontainfluorineEg:halothane,methoxyflurane.Desflurane,enflurane,sevoflurane,isoflurane,nitrousoxideandcarbontetrachloridearealsolinkedwithhepatotoxicity.
71.Actionofwhichanestheticagentis throughNMDAreceptors? a)Xenon b)NO c)Succinylcholine d)Etomidate CorrectAnswer-AAns.is'a'i.e.,XenonXenonItexertsanaestheticactionbynoncompetitiveblockadeofNMDAreceptors.Xenonhasbeenusedasageneralanesthetic.Xenoninteractswithmanydifferentreceptorsandionchannelsandlikemanytheoretically
72.AllofthefollowingareNondepolarising muscularblockersexcept a)Pancuranium b)Dexacurium c)D-Tubocurarine d)Succinylcholine CorrectAnswer-DAns.is'd'i.e.,Succinylcholine
73.Inepiduralanaesthesiadrugisinjected? a)Outsidethedura b)Insidetheduramater c)Insidearachnoidmater d)Insidepiamater CorrectAnswer-AAns.is'a'i.e.,Outsidethedura
74.Celiacplexusblockallthefollowingis trueexcept? a)Relievedpainfromgastricmalignancy b)Causehypotention c)Canbeusedtoprovideanesthesiaforintraabdominalsurgery d)Canbegivenonlybyretrocrural(classic)approach CorrectAnswer-DAns.is'd'i.e.,Canbegivenonlybyretrocrural(classic)approachCeliacplexusblockcanbedonebyfollowingthreeapproaches:Retrocrural(classic)approach,anterocruralapproachandsplanchnicnerveblock.Seeexplanation-4ofsession-8ofAnaesthesiaofAllIndia2014-15patternofthisbook.
75.Bestuterinerelaxationisseenwith? a)Chloroform b)Nitrousoxide c)Ether d)Halothane CorrectAnswer-DAns.'d'i.e.,HalothaneHalogenatedinhalationalanaestheticagentslikehalothanearepowerfultocolyticagents.Halothaneisanaestheticofchoiceforinternalversionandmanualremovalofplacenta.
76.Dibucainnumberrefersto? a)Achcholinestraseactivityderangement b)Potencyofmusclerelaxants c)Potencyofgeneralanaesthetics d)None CorrectAnswer-AAns.is'a'i.e.,AchchlinestraseactivityderangementDibucainnumber:Dibucain(alocalanaesthetic)inhibits80%ofnormalpseudocholinesteraseand20%ofatypical(non-functional)pseudocholinesterase.Thereforenormaldibucainnumberis70-80%.Dibucainnumberisusedtomeasuretheactivityofatypicalpseudocholinesterase.
77.PercentageoflidocaineinEutectic mixture- a)1% b)2.5% c)5% d)10% CorrectAnswer-BAns.is'b'i.e.,2-5%EutecticmixtureoflocalAnaestheticsThisisuniquetopicalpreparationwhichcananaesthetiseintactskin.Itisamixtureof2.5%lidocaineand2.5prilocaine.Itactsslowlyandthecreammustheldincontactwithskinforatleast1hour.EMLAisused:tomakevenepuncturepainlessespeciallyinchildren,andforprocedurelikeskingrafting&circumcision.Assystemicabsorptionofprilocainecancausemethemoglobinemia,EMLAshouldnotbeusedonmucocutaneousmembraneorinverysmallchild.
78.Longactinglocalanaesthetic? a)Procaine b)Lignocaine c)Prilocaine d)Dibucaine CorrectAnswer-DAns.is'd'i.e.,Dibucaine
79.Hepatotoxicinhalationalagent? a)Halothane b)Enflurane c)Desflurane d)Sevoflurane CorrectAnswer-AAns.is'a'i.e.,HalothaneAllinhalationalagentcausemildhepatotoxicitybydecreasinghepaticbloodflow.IsofluraneistheagentofchoiceinliverdiseaseasithasleasteffectonHepaticbloodflow.Directhepatotoxicity(Hepatitis,Hepaticnecrosis)iscausedby:-Halothane,Chloroform,trilene,methoxyflurane
80.Apatientaftergivinginhalational anaestheiadevelopedfulminanthepatitis,patientwasexposedtosamedrugpreviously.Whichisthedrug? a)Halothane b)N20 c)Enflurane d)Isoflurane CorrectAnswer-AAns.is'a'i.e.,HalothaneHalothaneItisavolatileliquidwithsweetodour,nonirritatingandnoninflammable.Itisapotentanaestheticwithpooranalgesicandmusclerelaxantproperties.HalothanecausesdirectdepressionofmyocardialcontractilitybyreducingintracellularCa+2.ItcausesfallinBPandCO.Heartratedecreasesduetovagalstimulation.Ittendstosensitizethehearttoarrhythmogenicactionofadrenaline--*contraindicatedinpheochromocytoma.Itcausesgreaterdepressionofrespirationandventilationperfusionmismatch.Itdilatesthebronchi-->inhalationagentofchoiceinasthmatics(intravaneousanaestheticofchoiceinasthmaticsisketamine).Itisahepatotoxicdrugandcanalsocausemalignanthyperthermia(Succinylcholineaccentuateit).
Recoveryissmoothandreasonablyquick.Itcausespostanaestheticshiveringandchills.Itinhibitsintestinalanduterinecontractions-->agentofchoiceforassistingexternalorinternalversionduringlatepregnancy.Becauseitsuterinerelaxantactionitiscontraindicatedduringlabour.Itisparticularlysuitableforinductionandmaintenanceinchildrenandasmaintenanceanaestheticinadults.
81.LeastMACisofwhichinhalationalagent? a)Xenon b)Halothane c)Sevoflurane d)Isoflurane CorrectAnswer-AAns.is'a'i.e.,Xenon MAC Agent (%) Ether 1.9 Halothane 0.75 Enflurane 1.68 Isoflurane 1.2 Desflurane 6.0 Sevoflurane 2.0 Nitrous 105 oxide "XenonhasMACof71%"--MorganMethoxyflurone(MAC=0.16%)>Trilene(0.2%)>Halothane(0.74%)>Chloroform(0.8%)>Isoflurane(1.15%)>Entlurane(1.68%)>Ether(1.92%)>Sevoflurane(2.0%)>Desflurane(6,0%)>Cyclopropane(9.2%)>N20(104%).
82.Inpseudocholinesterasedeficiency,drug tobeusedcautiouslyis- a)Barbiturate b)Succinylcholine c)Halothane d)Gallamine CorrectAnswer-BAns.is'b'i.e.,SuccinylcholineCholinesteraseAtcholinergicnerveendings,inerythrocytes,andgraymatterthereisanenzymethatspecficallydestroysacetylcholine,truecholinesteraseoracetylcholinestrase.Invarioustissues,especiallyinplasma,liver,whitematter&intestine,thereareotheresteraseswhicharenotspecificforacetylcholinebutwhichalsodestroyotheresters,thesearecallednonspecificorpseudocholinesteraseorbutyrylcholinesterase.Thedrugshydrolyzedbypseudocholinesteraseare(Miller5th/ep.419,420) 1. Succinylcholine2. Cocaine3. Mivacurium4. Bambuteral5. Remifentanil6. Procaine Pseudocholinesteraseismoresensitivetoorganophosphateanticholinesterase,whiletrueacetylcholinesteraseismoresensitivetocarbamateanticholinesterase(Physostigmine).Condionswherepseudocholinesteraseleveldecreases.
1. Pregnancy2. Malnutrition3. CRF4. Burns5. Collegenvasculardisease6. Hypothyroidism7. Malignancy8. Liverfailure
83.Blood:Gaspartitioncoefficientisa measureof? a)Potencyofanaestheticagent b)Speedofinductionandrecovery c)Lipidsolubilityofagent d)None CorrectAnswer-BAns.is'b'i.e.,SpeedofinductionandrecoveryMinimumalveolarconcentration(MAC)-->Measureofpotency.Blood:GaspartitioncoefficientBloodsolubilityofanaestheticagentanddeterminesthespeedofinduction&recovery.Oil:Gaspartitioncoefficient-4Lipidsolubilityofanaestheticagentandisrelatedtopotencyofanaestheticagent.
84.Inhalationalagentofchoicefor neurosurgery? a)Halothane b)Enflurane c)Isoflurane d)N20 CorrectAnswer-CAns.is'c'i.e.,IsofluraneAnaestheticagentsofchoiceforvaousconditionsDaycare: Ischemicheartdisease:Congenitalheart Propofol disease Etomidate Lefttorightshunt: Isoflurane Righttoleftshunt: Ketamine CHF: Ketamine Shock Ketamine Toproducedelibrate Isofluranehypotenion Thiopentone Epilepsy: Methohexitone Forelectroconvulsive Thiopentonetherapy: Isoflurane Thyrotoxicosis: Isoflurane Cardiacsurgery: Neurosurgery:
85.Regardingpropofol,whichoneofthe followingisfalse? a)Itisusedasanintravenousinductionagent b)Itcausesseverevomiting c)Itispainfuloninjectingintravenously d)Ithasnomusclerelaxantproperty CorrectAnswer-BAns.is'b'i.e.,ItcausesseverevomitingPropofolPropofolisamilkywhitepowderthatispreservativefree;therefore,itmustbeusedwithin6hours.Itisanoilbasedpreparation,thereforeinjectionispainful.Propofolisthemostfrequentlyusedintravenousanaesthetictoday.--Miller6thie-318Itcanbeusedforbothinductionaswellasmaintenace.Itdoesnotpossessanticonvulsiveaction(unlikethiopentone).ItcausesfallinBPandbradycardia.Likethiopentalitdoesnotpossessmusclerelaxantaction.Propofolpossesssignificantantiemeticandantipruriticaction.Miller6th/e-324Propofoldecreasespolymorphonuclearleukocytechemotoxisbutnotaherence,phagocytosisandkilling(Thiopentoneblocksallthese)--)increasedlifethreatninginfections.Propofolisparticularlysuitableforoutpatientsurgery.IntermittentinjectionorcontinuousinfusionofpropofolisfrequentlyusedfortotalLv.anaesthesia(TINA)whensupplementedbyfentanyl.
ItisanaestheticsofchoiceforintubationinICUandforpatientswithmalignanthyperthermia.Sideeffects-painoninjection,myoclonus,apnea,LBPandrarelythrombophlebitis.Propofolinfusionsyndrome 1. Alethalsyndrome,associatedwithinfusionofpropofolfor48hours orlonger. 2. Occursinchildrenandcriticallyill.3. Itoccursasaresultoffailureoffreefattyacidmetabolismand failureofthemitochondrialrespiratorychain. 4. Featuresare-cardiomyopathywithacutecardiacfailure,metabolic acidosis,skeletalmyopathy,hyperkalemia,hepatomegalyandlipemia
86.Notasignofstellateganglionblock? a)Miosis b)Exopthalomos c)Nasalcongestion d)Conjunctivalredness CorrectAnswer-BAns.is'b'i.e.,ExopthalomosThereisenophthalmos(notexophthalmos)StellateganglionblockStellateganglionisformedbyfusionoflowercervicalandfirstthoracicganglion.ItisblockedanteriortothetubercleoftransverseprocessofC6vertebrai.e.,chassaignactubercleatthelevelofcricoidcartilage.Signsofsuccessfulblockare:-Hornersyndrome(miosis,ptosis,anhydrosis,enophthalmos,absenceofciliospinalreflex),flushingofface,conjuctivalcongestion,Nasalstuffiness(Gutman'ssign),Injectionoftympanicmembrane(muller'ssyndrome),Increasedskintempratureandlacrimation.Stellateganglionblockisindicatedin:- 1. Treatmentofacuteherpeszosterinthedistributionofthetrigeminal nerve,cervicalandupperthoracicdermatomes. 2. Acutevascularinsufficiencyofupperlimbandface.3. Frostbite4. Reflexsympatheticdystrophyofface,neckandupperextremities.5. Raynaud'ssyndromeofupperextremities.
87.Theterm"balancedanaesthesia"has beengivenby? a)Simpson b)Fischer c)Lundy d)Mortan CorrectAnswer-CAns.is'c'i.e.,LundyTerm'balancedanaesthesia'wasintroducedbyLundyin1926.BalancedanaesthesiaThecardinalfeatureofgeneralanaestheticsare:? 1. Lossofallsensations,especiallypain2. Sleep(unconciousness)andamnesia3. Immobilityandmusclerelaxation4. Abolitionofreflexes Inmodernpracticeofbalancedanaesthesiathesemodalitiesareachievedbyusingcombinationofinhaledandiv.drugs.
88.Highspinalanaesthesiaisassociated with? a)DecreasedBP&decreasedheartrate b)IncreasedBP&decreasedheartrate c)DecreasedBP&increasedheartrate d)IncreasedBP&increasedheartrate CorrectAnswer-AAns.is'a'i.e.,DecreasedBP&decreasedheartrateSpinalanesthesiaascendingintothecervicallevels(highspinalanesthesia)causesseverehypotension,bradycardiaandrespiratoryinsufficiency.Complicationsofspinalanaesthesia Intraoperative PostoperativeHaedache(postduralpunctureheadach)-mostcommon Hypotension Cranialnerve (mostcommon) palsies(any Bradycardia10th cranialnerve Respiratorydepression excepttheCardiacarrest 1st,9th&most Hypothermiainelderly commonly6th nerveisinvolved)Caudaequina
equinasyndromeArachnoiditis
89.Eutecticmixtureoflocalanaesthetic (EMLA)creamis a)Bupivacaine2.0%+Prilocaine2.5% b)Lidocaine2.5%+Prilocaine2.5% c)Lidocaine2.5%+Prilocaine5% d)Bupivacaine0.5%+Lidocaine2.5% CorrectAnswer-BAns.is'b'i.e.,Lidocaine2.5%+Prilocaine2.5%Eutecticmixtureoflocalanaesthetic(EMLA)Thisisuniquetopicalpreparationwhichcananaesthetiseintactskin.Itisamixtureof2.5%lidocaineand2.5prilocaine.Itactsslowlyandthecreammustheldincontactwithskinforatleast1hour.EMLAisused:tomakevenepuncturepainlessespeciallyinchildren,andforprocedurelikeskingrafting&circumcision.Assystemicabsorptionofprilocainecancausemethemoglobinemia,EMLAshouldnotbeusedonmucocutaneousmembraneorinverysmallchild.
90. Whichanaestheticbelongstoester group? a)Procaine b)TimesNewRoman c)Lignocaine d)Propofol CorrectAnswer-AAns.is'a'i.e.,ProcaineEsters(aminoesters):-Procaine,chlorprocaine,tetracaine(amethocaine),Benzocaine,Cocaine.Amides(aminoamides)Lignocaine,Mepivacaine,Prilocaine,Bupivacaine,Etidocaine,Ropivacaine,Dibucaine.
91.ThelatestAHA2010forCPCRinbasiclife supportbytwoindividualsforcardiacexternalmassage&ventilationinadultis? a)30-2 b)15-1 c)15-2 d)30-1 CorrectAnswer-AAns.is'a'i.e.,30-2
92.Bestlocalanaestheticforophthalmic surgeryis a)Tetracaine b)Prilocaine c)Procaine d)Bupivacaine CorrectAnswer-DAns.is'd'i.e.,BupivacaineThechoiceoflocalanaestheticforocularsurgeryvaries.Butlidocaine(2%)andbupivacaine(0.5-0.75%)areusedmostcommonly.Generallytheuseof1:1mixtureof2%lidocaine(xylocaine)and0.50%bupivacainealongwithadrenalineandhyaluronidaseinfacial,retrobulbarandperibulbarblocksiscommon.
93.Percentageofadrenalinewithlignocaine forlocalinfilterationis? a)1:1000 b)1:10000 c)1:100 d)1:50000 CorrectAnswer-DAns.is'd'i.e.,1:50000Themostcommonconcentrationsofepinephrinecombinedwithlocalanaestheticsare1:50,000(0.02mg/ml),1:100,000(0.01mg/ml)and:200000(0.005mg/ml).The1:50000concentrationismanufacturedincombinationwith2%lidocaine.The1:100,000concentrationismanufacturedincombinationwith2%lidocaineand4%articaine.The1:200,000concentrationismanufactureincombinationwith4%prilocaine,4%articaineand0.5%bupivacaine
94.Localanaesthesiacausing methemoglobinemia? a)Procaine b)Prilocaine c)Etodicaine d)Ropivacaine CorrectAnswer-BAns.is'b'i.e.,PrilocainePrilocaineandbenzocainecancausemethemoglobinemia. ImportantfactsChlorprocaineistheshortestactingLA.Dibucaineisthelongestacting,mostpotentandmosttoxicLA.BupivacaineisthemostcardiotoxicLA(Ropivacaineisanewerbupivacainecongenerwithlesscardiotoxicity).oLevobupivacaine(TheS(-)enantiomerofbupivacaine)islesscardiotoxicandlesspronetocauseseizure.oPrilocainecancauseMethaemoglobinemia.LignocaineisthemostcommonlyusedLA.Bupivacainehasthehighestlocaltissueirritancy.Chlorprocaineiscontraindicatedinspinalanaesthesiaasitcancauseparaplegiaduetopresenceofneurotoxicpreservativesodiummetabisulphite.ProcaineistheLAofchoiceinmalignanthyperthermia
95.Intraocularpressureisincreasedby whichanaesthetic? a)Ketamine b)Propofol c)N20 d)Isoflurane CorrectAnswer-AAns.is'a'i.e.,Ketamine
96.A6yearoldboytakenforophthalmic examinationunderanaesthesia.Hisfathertoldthathehaslowerlimbweakness&hiselderbrotherdiedat14yearsofage.Whichanaetheticdrughastobeavoided- a)Succinylcholine b)Pancuronium c)Atracurium d)Dexacurium CorrectAnswer-AAns.is'a'i.e.,SuccinylcholineSuccinylcholineSChisadepolarisingskeletalmusclerelaxant.Itcausessustainedpartialdepolarizationofmuscleendplate-->intiallyproducetwitchingandfasciculationfollowedbyflaccidparalysis.Itistheshortestandfastestactingskeletalmusclerelaxant.Itistheonlymusclerelaxantwhichstimulateautonomicgangliaandvagus.SChisthemostcommonlyusedmusclerelaxantforpassingendotrachealtube(mivacuriumandrocuroniumarealternatives).SChisrapidlyhydrolysedbyplasmacholinesterase,somepatientshavegeneticallydeterminedabnormalityordeficiencyofpseudocholinesterase,inthem,SChcausesphaseIIblock.Itcancausemusclefasiculationsandsoreness,changeinBPandHR,arrythmia,histaminereleaseandICeffluxfrommuscles.
Dangeroushyperkalemiacanoccurinpatientswithburn,crushinjury,musculardystrophy,GB.Syndrome,paraplegiaorhemiplagia,mystheniagravisandrhabdomyolysiscontraindicatedinsuchpatients.oItcanaccentuatemalignanthyperthermiacausedbyhalothane.SChcausesincreaseinallpressures-->inraocular,intracranial,BP,andintrabdominal-->contraindicatedinglaucoma,headinjury.
97.Criticaltemperatureofoxygenis? a)20 b)118 c)36.5 d)400C CorrectAnswer-BAns.is'b'i.e.,-118
98.Disadvantageofketamineis? a)Increasedheartrate b)IncreasedICT c)Delirium d)Alloftheabove CorrectAnswer-DAns.is'd'i.e.,AlloftheaboveWhenadministeredtoadultpatientsasasoleanaestheticagent,ketaminefrequentlycauseemergencereactioncharacterizedbyanxiety,hallucination,delirium.Moreover,ketamineshowscardiovascularstimulantproperty(increasesheartrateandBP),increasessalivaryandbronchialsecretions,andmayincreaseintracranial,intraocularandpulmonarypressure.Allofthesefeatureshavebeenadvocatedaslimitationsforitsusefulness.
99.AllarefalseaboutN20except? a)Leastpotent b)Goodmusclerelaxant c)Lighterthanair d)Nodiffusionhypoxia CorrectAnswer-AAns.is'a'i.e.,LeastpotentNitrousoxideN2QItiscolourless,odourless,heavierthanair,nonirritatingandnoninflammablegas.oItisalsocalledlaughinggas.MACis105%(leastpotent)-evenpureN20at1atmosphericpressurecannotproduceadequateanaesthesia.oIthasgoodanalgesicbutpoormusclerelaxantactivity.Itissuppliedunderpressureinbluecolouredsteelcyclinders.Ithasverylowbloodsolubility-->inductionisquickandsmoothwithrapidrecovery.SecondgaseffectanddiffusionhypoxiaoccurwithN20only.N20isgenerallyusedasacarrierandadjuvanttootheranaesthetics-->Amixtureof70%N20+25-30%02+0.2-2%anotherpotentanaestheticisemployedformostofthesurgicalprocedures.Entonoxisamixtureof50%N20and50%02.Ithaslittleeffectonrespiration,heartandBP.ItcancausebonemarrowdepressionandvitB12deficiency.N20istheonlyanaestheticreportedtoproducehematologictoxicityandneurotoxicitywithlongtermadministration.BothtoxicitiesaretheresultoftheinteractionofN20withvitB12.
Completebonemarrowfailurecanbeexpectedafterseveraldaysofcontinuousexposure.Bonemarrowchangesarepreventablebypretreatingpatientswithlargedosesoffolinicacid.OthermanifestationsofvitB12deficiencyeg.megaloblasticanemia,subacutecombineddegenerationofcordmayalsooccur.Methemoglobinemiaandlaryngospasmmayoccur.Itiscontraindicatedinpatientswithaircavitieslikepneumothorax,pneumoperitoneumandvolvulus-->expansionandincreaseinpressureoccur.
100.Whichanaestheticiscontraindicatedin renalfailure? a)Isoflurane b)Desflurane c)Halothane d)Methoxyflurne CorrectAnswer-DAns.is'd'i.e.,MethoxyflurneMethoxyfluraneItwasmostpotentinhalationagent(leastMAC),butnotusednot(nowHalothaneismostpotent).oItshouldnotbeusedinclosedcircuit(reactswithrubbertubingofthelosedcircuit).Ithasslowestonset&recovery(howevernowetherhasslowestonset&recoveryasmethoxyfluraneisnotused).oBoilingpointismorethanwater(104?C).Intrarenalmetabolismofmethoxyfluraneandsubsequentintrarenalproductionoffluorideionisthesignificantcauseofmethoxyfluranerenaltoxicity.Itcancausehighoutputrenalfailureandhepatotoxicity
101.Conscioussedationis? a)CNSdepressionwithuncociousness b)Sedationwithinabilitytorespondtocommand c)Sedationwithabilitytorespondtocommand d)Anyoftheabove CorrectAnswer-CAns.is'c'i.e.,SedationwithabilitytorespondtocommandConscioussedationisatechniqueinwhichdrugsareusedtoproduceastateofCNSdepression(butnotunconsciousness),enablingsurgicalproceduretobecarriedoutwhilemaintainingcommunicationwiththepatientwhoisabletorespondpurposefullytocommandsandmaintainapatentairwaythroughout.Theprotectiveairwayreflexesarenotlost,thereforeconscioussedationissafer.However,byitself,itisnotabletosuppresspainofdentalprocedures;localanaestheticmustbeinjectedinaddition.Drugsusedforconscioussedationare- 1. N,O2. Diazepamormidazolam3. Propofol4. IMpromethazine5. IVfentanyl
102.Duringrapidinductionofanesthesia? a)Sellick'smaneuverisnotrequired b)Pre-oxygenationismandatory c)Suxamethoniumiscontraindicated d)Patientismechanicallyventilatedbeforeendotracheal intubation CorrectAnswer-BAns.is'b'i.e.,Pre-oxygenationismandatoryDuringrapidsequenceinductionpreoxygenationisdoneforfull3minutes.Schisthemusclerelaxantofchoiceforintubation.Sallieck'smaneuverisdonetopreventaspiration.Manualventilationbeforeintubationisavoidedasthisinflatesthestomachandencouragesregurgitation&aspiration.RapidsequenceanaesthesiaWhenanaesthesiaisgivenforemergencysurgery,itiscalleda"rapidsequenceanaesthesia".Thepatientshavefullstomachbecausethereisnostarvationforanaesthesia(itisanemergencysurgery)andgastricemptyingisdelayedduetotrauma,acuteabdomen.Therefore,theobjectiveofrapidsequenceanaesthesiaistosecuretheairwayrapidlyandpreventaspirationofgastriccontents.Procedureofrapidsequencehasfollowingsteps:-LiThepatientispreoxygenatedforfull3minutes.Intravenousinductionagent(thiopentoneorpropofol)isgiven.Sellick'smaneuver(cricoid/pressure)isdonetopreventaspiration.Afterensuringthecorrectpositionoftubecricoidpressureisreleasedandmaintenanceanaesthesia(NCO66%,02%33%,&inhalationalagent)isgiven.Anon-depolarizingblockerisnow
added.Suxamethenium(succinylcholine)isgivenasitquicklyrelaxesthelaryngealmusclessothatrapidintubationcanbedone.Notdoneduringrapidsequenceanaesthesia:? 1. Manualventilationbeforeintubationisavoidedasthisinflatesthe stomachandencouragesregurgitation&aspiration. 2. Premedicationsarenotgiven.
103.Whocoinedtermanaesthesia? a)Morton b)Holmes c)Morgan d)Priestly CorrectAnswer-AAns.is'a'i.e.,MortonSecondgaseffectanddiffusionhypoxiaIninitialpartofinduction,diffusiongradientfromalveolitobloodishighandlargerquantityofanaestheticisenteringblood.IftheinhaledConcentrationofanaestheticishigh(egN20),Substantiallossofalveolargasvolumewilloccuranditcreatesnegativeintralveolarpressurethatleadstoremovalofmoregasfromcylindertoalveoli-->Concentrationeffect.Ifanotherinhalationagentis(egHalothane)isbeinggivenatthesametime,italsowillbedeliveredtolungfromthecylinder(duetonegativeintraalveolarpressure)-->Secondgaseffect.Duringrecoveryreverseoccurs-N20havinglowbloodsolubility,rapidlydiffusesintoalveolianddilutesthealveolarair-->partialpressureofoxygeninalveoliisreduced.Theresultinghypoxiaisknownasdiffusionhypoxia.Diffusionhypoxiacanbepreventedbycontinuing100%02inhalationforafewminutesafterdiscontinuingN20,insteadofstraightawayswitchingovertoair.RememberConcentrationeffectandsecondarygaseffectduringinduction.Diffusionhypoxia-->duringrecovering.
AlltheseoccurwithN20only
104.Drugusedforemergencyintubationis? a)Propofol b)Ketamine c)Eomidate d)None CorrectAnswer-AAns.is'a'i.e.,PropofolEmergencyintubationinanaesthesiareferstorapidsequenceanaesthesia(orrapidsequenceintubation).Anyinducingagentcanbeused,butthiopentalandpropofolarethepreferredagent.
105.Maximumglobalwarmingisby? a)Desflurane b)Isoflurane c)Sevoflurane d)Halothane CorrectAnswer-AAns.is'a'i.e.,DesfluraneDesfluraneisagreenhousegas.Itcausesmaximumglobalwarming. Globalwarmingpotential(asanequalamountofO2)Isoflurane210timesSevoflurane510timesDesflurane1620times
106.Whichanaestheticdrugcontributesto greenhouseeffect? a)Enflurane b)Desflurane c)Sevoflurane d)Halothane CorrectAnswer-BAns.is'b'i.e.,Desflurane
107.Mostcommonlyusedapproachof brachialplexusblock? a)Interscalene b)Supraclavicular c)Infraclavicular d)Axillary CorrectAnswer-BAns.is`B'i.e.,SupraclavicularBrachialplexusblockThisisthesecondmostcommonlypractisedblockaftercentralneuraxialblock(spinal&epiduralanaesthesia).Brachialplexusblockisusedforupperlimbsurgeries.Brachialplexuscanbeblockedby4approaches:-1.InterscaleneapproachBrachialplexusisblockedbetweenanteriorandmiddlescalene.Thisapproachisnotusedroutinelyduetocloseproximityofvitalstructures.Ulnarnerveisusuallysparedbythisapproachbecauseinjectionisgivenincloseproximityofuppernerverootsandinferiornerveroots(C8-T1)maybespared.Thistechniqueprovidesexcellentanaesthesiaandanalgesiaforshoulderandupperarmprocedures.(incontrasttootherthreeapproacheswhichdonotprovideadequateshoulderanaesthesia).ComplicationsincludeHornersyndrome(duetostellateganglionblock),phrenicnerveblock,intravascularinjectionintocarotidsandepiduralorintrathecalinjections.2.SupraclavicularapproachThisisthemostcommonlyusedapproach.Itinvolvestheinjectionoflocalanaestheticincloseproximityto
thetrunksofthebrachialplexusbyinsertingtheneedlelateraltosubclavianvessels.Thesupraclavicularblockisperformedwherethebrachialplexusismostcompact,consequently,itproducesreliableandrapidonsetanaesthesiaandisparticularlyusefulinafastpacedambulatorysurgerycentre.Pneumothoraxisthemostcommoncomplication.Othercomplicationsincludephrenicnerveblock,intravascularinjectioninsubclavianarteryorvein,Hornersyndrome,hematomaformation.3.Infra-clavicularapproachInfraclavicularblockinvolvestheinjectionoflocalanaestheticincloseproximityofcordsofthebrachialplexus.Theaxillarynervemaybesparedasthisnerveexitsthebrachialplexussheathproximaltothelevelofinfraclavicularblock.4.AxillaryapproachAxillaryblockinvolvestheinjectionoflocalanaestheticincloseproximityofterminalbranchesofthebrachialplexus.Themajordisadvantageofthisapproachisthatmucocutaneousandintercostobrachialnervesarespared.Soarmsurgerycannotbeperformed.Incontrasttointerscaleneapproach,mostintenseblockoccurin(C7-T1)ulnardermatomesandleastinC5-C6dermatomes.
108.Whichofthefollowingissafeevenif injectedintraarterial? a)Thiopentone b)Propofol c)Mida7olam d)Methohexitone CorrectAnswer-BAns.is'b'i.e.,PropofolAccidentalextravasationorintra-arterialinjectionofpropofoldoesnotcauseadversereactions"PrimerofAnaesthesia"Intraartierialinjectionofpropofoldoesnotcausevascularinjury"?EssentialsofAnaesthesiaEtomidateisalsosafe.?Miller'sDrugsassociatedwithsevercomplicationsafterintraarterialinjection 1. Benzodiazepines:Diazepam,midazolam,temazepam, chlordiazapoxide 2. Phenothiazines:Promethazine,chlorpromazine,promazine3. Barbiturates:Thiopentone,methexitone,secobarbitone, pentobarbitone 4. Amphetamines5. Antibiotics:Flucloxacillin,Penicillin6. Narcotics:Heroin,mepridine,propoxyphene,cocaine7. QMiscellaneous:Tubocurarine,atracurium
109.Criticaltemperatureforliquidnitrogenis ? a)36.5?C b)-20?C c)-147?C d)-242?C CorrectAnswer-CAns.is'c'i.e.,-147?CCriticaltemperature(Tc)ofasubstanceisthetemperatureatandabovewhichvapourofthatsubstancecannotbeliquified,nomatterhowmuchpressureisapplied(Note:Belowcriticaltempratureasubstancecanexistasaliquidorgasdependingonpressure).CriticaltemperatureofN2is-146.9?C;thatmeansN2canbeliquifiedbelow-146.9?C-->So,liquidnitrogenmustbestoredbelow-146.9?C.
110.SupremeLMAcharacteristicis a)Hasnobiteblock b)Usedininfants c)Highpressure,lowvolume d)Hasbuiltindraintube CorrectAnswer-DAns.is'd'i.e.,HasbuiltindraintubeLMAsupremeisoneofthemostadvancedlaryngealmaskairway(LMA).IthasfeaturesofusualLMAwithadditionalBuilt-indraintubeandabiteblock.Ithashighvolume/lowpressurecuffwhichgenerateshighersealpressure.oItalsoprovidesaconduitforactivesuctioningofstomach.Itcanbeusedininfantsaswellasinadults.
111.Inpediatricepiduralanaestheisia, volumeoflocalanaestheticgiventocausesacraldermatomeblockis? a)0.5-1ml/kg b)2-4ml/kg c)5-10ml/kg d)None CorrectAnswer-AAns.is'a'i.e.,0.5-1ml/kgTwomostcommonlyusedlocalanaestheticsforcaudalblockinchildrenare:- 1. Bupivacaine0.25%concentrationindoseof1ml/kg.2. Ropivacaine0.2%concentrationindoseof1.2ml/kg. Foreasycalculationofvolume:- 1. 0.5mUkgforsacralblockade.2. 0.75ml/kgforlowerthoracicblockade.3. 1.25ml/kgforupperthoracicblockade.
112.Fastestinductionandrecoveryisseen with? a)Desflurane b)N,0 c)Halothane d)Enflurane CorrectAnswer-AAns.is'a'i.e.,Desfluranedecreasingorder(IncreasingorderofB:Gpartitioncoefficientandbloodsolubility):- Desflurane(0.42)Q>Cyclopropane(0.44)>N20(0.47)>Sevoflurane(0.69)Q>Isoflurane(1.38)>Enflurane(1.8)>Halothane(2.4)>Chloroform(8)>Trilene(9)>Ether(12)>Methoxyflurane(15)Q.
113.Shortestactinglocalanaesthetics? a)Lignocaine b)Bupivacaine c)Etidocaine d)Chlorprocaine CorrectAnswer-DAns.is'd'i.e.,Chlorprocaine Short Intermediateduration Longduration(>120 durationLow (30-90min) min) potency Intermediatepotency Highpotency Chloiprocaine BupivacaineoTetracaine Lignocaineo (shortest oEtodicaineo MepivacaineoPrilocaine acting) Ropivacaine aCocaine Procaine Dibucaine(longestacting)
114.Circuitofchoiceforcontrolled ventilation? a)Magillcircuit b)TypeC c)TypeD d)TypeE CorrectAnswer-CAns.is'c'i.e.,TypeD
115.Allareusedforlocalinfiltrationexcept? a)Lidocaine b)Ropivacaine c)Dibucaine d)Bupivacaine CorrectAnswer-CAns.is'c'i.e.,Dibucaine
116.DrugofchoiceforBier'sblock? a)Bupivacaine b)Etidocaine c)Ropivacaine d)Lidocaine CorrectAnswer-DAns.is'd'i.e.,LidocaineIntravenousregionalAnaesthesia(Bier'sblock)Intravenousregionalanaesthesia(IVRA)isusedmostoftenforsurgeryoftheforearmandhand,butcanalsobeusedfordistallegandfoot.FirstIVcanulaisinsertedusuallyinthedorsumofhand.Thentourniquetcuffisappliedtoproximalarm.Limbiselevatedandexsanguinatedwiththehelpofanelasticbandage(Esmarch).Nowtourniquetcuffisinflatedabovesystolicpressure(sothatnobloodcanenterinthatlimbandthelimbremainsexsanguinated).Nowthelocalanaestheticsolutionisslowlyinjectedintocannula.Theveinsarefilledwithonlylocalanaestheticasthereisnobloodocalanaestheticcannotbedrainedoutfromupperlimbandcannotenterinsystemiccirculationbecauseofinflatedcuffinproximalarm.Thearmisanaesthetizedin6-8minutes.LidocainewithoutadrenalineistheDOCforthistechnique.--Goodman&Gilmanllthie381oAfewclinicianprefersprilocaineoverlidocainebecauseofitshighertherapeuticindex-leasttoxicLA.Torniquetcuffdeflation,prematurereleaseorfailureoftorniquetcan
causereleaseofLAintocirculationandtoxicitymayoccurSo,cardiotoxicLAslikebupivacaineandetidocainearecontraindicatedforBier'sblock.
117.Smoothinductionisseenby- a)Ether b)Halothane c)Isoflurane d)Enflurane CorrectAnswer-CAns.is'c'i.e.,IsofluraneInductionbyinhalationagentsUnpleasantIntermediateSmoothEtherHalothaneIsofluraneEnfluraneDesfluraneSevofluraneNitrousoxide
118.Trueaboutconscioussedationareall except? a)CNSdepression b)Patientisconscious c)Protectivereflexesareabolished d)Patientcanobeycommands CorrectAnswer-CAns.is'c'i.e.,Protectivereflexesareabolishedconscioussedation,protectivereflexesareintact(hasbeenexplainedinprevioussessions).
119.
Longestpartofopticnerve? a)Intraocular b)Intracranial c)Intraorbital d)Intracranial CorrectAnswer-C.Ans.is'c'i.e.,IntraorbitalOpticnerveEachopticnerve(secondcranialnerve)startsfromtheopticdiscandextendsuptoopticchiasma,wherethetwonervesmeet.Itisthebackwardcontinuationofthenervefibrelayeroftheretina,whichconsistsofthesecondorderneuronsi.e.,axonoriginatingfromtheganglioncells.Italsocontainstheafferentfibresofthepapillarylightreflex.Morphologicallyandembryologically,theopticnerveiscomparabletoasensorytract.Unlikeperipheralnervesitisnotcoveredbyneurilemma(soitdoesnotregeneratewhencut).Thefibresofopticnerve,numberingaboutamillion,areveryfine(2-10mindiameterascomparedto20mmofsensorynerves).Opticnerveisabout47-50mminlengthandcanbedividedinto4parts:?Intraocularpart(1mm):-Itbeginsatopticdisc(opticnervehead)andexitsthenervethroughaholeinsclerathatisoccupiedbyameshlikestructurecalledthelaminacribrosa.Thenervefibresfromtheretinaleavetheeyethroughpores(holes)inlaminacribrosa,asieve-likestructuremadeupofcollagenmeshwork.Intraorbitalpart(30mm):-Extendsfrombackoftheeyeball(at
laminacribrosa)totheopticforamina.Intracanalicularpart(6-9mm):-Itlieswithintheopticcanalandcloselyrelatedtoophthalmicarterywhichcrossesobliquelyoverit.Intracranialpart(10mm):-Itliesabovethecavernoussinusandconvergeswithitsfellowfromcontralateralsidetoformopticchiasma.LikeotherpartsofCNS,theopticnerveiscoveredbymeningealsheaths(Pia,archnoidandduramater)assoonasthenerveleavestheeyeball.
120.Stocker'slineisseenin? a)Pterygium b)Glaucoma c)Posteriorscleritis d)Diabeticretinopathy CorrectAnswer-AAns.is'a'i.e.,Pterygiumislineofirondepositioninthecornealepitheliumseenadjacenttotheheadofthepterygium.
121.Mostcommoninfectionincontactlens usersis? a)Streptococcus b)Pseudomonas c)Staphylococcus d)Neisseria CorrectAnswer-BAns.is'b'i.e.,PseudomonasComplicationsofcontactlenswearComplicationsofcontactlenswearingare:?Intolerance:-Somepeoplefindwearingcontactlensesintolerable.Cornealcomplications:-Cornealabrasion,Cornealedema,Cornealvascularization,Microbialkeratitis(Pseudomonas,acanthamoeba),Sterilecornealinfiltrate.GiantpapillaryconjunctivitisHypoxia:-Corneaisdeprivedofoxygenfromthetearfilmbythepresenceofthecontactlens.Thecorneabecomesedematousandnewvesselsmaydevelopinthelimbalarea.Sensitivity:-Thismaydevelopinresponsetothepreservative(thiomersal)inthecleaningandsoakingsolution.Thisresultsinallergicconjunctivitis.
122.Polyopia/diplopiaisseeninwhichtype ofcataract? a)Nuclear b)Cortical c)Posteriorsubcapsular d)Anteriorpolar CorrectAnswer-BAns.is'b'i.e.,Cortical
123.Pulsatileproptosisisafeatureof? a)Orbitalvarix b)Retinoblastoma c)Cortico-cavernousfistula d)Covernoussinusthrombosis CorrectAnswer-CAns.is'c'i.e.,Cortico-cavernousfistulaProptosisProptosisisbulgingoftheeyeball(forwardbulging)beyondtheorbitalmargins.Thoughthewordexophthalmosissynonymouswithproptosis;somesourcedefinexophthalmosasaprotrusionofglobegreaterthan18mmandproptosisasaprotrusionequaltoorlessthan18mm.Proptosismaybeclassifiedasfollows:?UnilateralProptosisProptosisofoneeye.Inflammatorylesions:-Orbitalcellulitis,abscess,cavernoussinusthrombosis,etc.Vasculardisturbances:-Haemorrhage,varicoseorbitalveins,haemangioma,etc.Cystsandtumour:-Dermoidcyst,osteoma,lymphoma,lymphosarcoma,glioma,meningiomaofopticnerve,retinoblastomaandmetastaticdepositsinorbitNeuroblastoma,breast,prostate,lung,GIT,Kidney,Ewing'stumor,melanoma,wilmstumor(Nephroblastoma)].Systemicdiseases-LeukemiasandendocrinedisturbancessuchasGraves'diseaseandthyrotropicexophthalmosininitialstages.Paralysisofextraocularmusclesasincompleteophthalmoplegia.MucoceleofPNS'-Frontal(mostcommon),ethmoid,maxillary.BilateralProptosisProptosisofbotheyes.
evelopmentalanomaliesoftheskull-Oxycephaly(towerskull).Endocrineexophthalmos,boththyrotoxicandthyrotropic.Inflammatorylesions-Cavernoussinusthrombosis.Tumours-lymphosarcoma,lymphoma,pseudotumour,nephroblastoma,Ewing'ssarcoma.Systemicdisease-Histocytosis(Hand-schullerchristondisease),amyloidosis,wegner'sgranulomatosis.IntermittentproptosisProptosisdevelopingintermittentlyandrapidlyinoneeyewhenvenousstasisisinducedbyforwardbendingorloweringthehead,turningtheheadforcibly,hyperextensionoftheneck,coughing,forcedexpirationwithorwithoutcompressionofthenostrils,orpressureonjugularveins.Themostimportantcasueisorbitalvarix(varicocele).Pulsatileproptosis:-Pulsatileproptosisisseenincaroticocovernousfistula;saccularaneurysmofophthalmicartery;andduetotransmittedcerebralpulsationasseeninmeningocele,neurofibromatosisandtraumaticoroperativehiatus.
124.Photoretinitisisdueto? a)Snowreflection b)Solareclipse c)Blunttrauma d)Noneoftheabove CorrectAnswer-BAns.isbi.e.,SolareclipsePhotoretitinsPhotoretinitisreferstodamagetotheretinaresultingfromexposuretothesunlightwithoutadequateprotection.Inrecentyearsithasbecomeclearthatphotoretinitisistheresultofphotochemicalreactionfollowingexposureoftheretinatoshorterwave-lengthinthevisiblespectrum(i.e.blue/violet-bluelight)withasmallcontributionbyUV-Arays(andnotbyinfraredrayswhichwasthoughtearlier).Therefore,photoretinitisisalsocalledasblue-lightretinalinjury.Photoretinitisisassociatedwithreligioussungazing,solareclipseobserving,telescopysolarviewing,watchingbrightsunlight,orexposuretotheflashoftheshort-circuitingofastrongcurrent.Thesymptomsarepersistentoftheafterimage,progressinglaterintopositivescotoma,andmetamorphosia.Ophthalmoscopically,theremaybenosignatfirst,orapalespotisseenatthefoveawithabrownish-redringaroundit.Latertherearedepositofpigmentsandsmall,greypunctatespotsaroundthefovea,oreventheformationofretinalhole
125.Parachutelesionsareseenin? a)Eale'sdisease b)Diabetes c)Sicklecellanemia d)Alloftheabove CorrectAnswer-DAns.isdi.e.,Alloftheabove
126.FosterKennedysyndromeis a)I/LPapilloedemaCiLopticatrophy b)I/LOpticatrophyC/Lpapilloedema c)I/LOpticatrophyandpapilloedema d)ULPapilloedemaC/Lpapilitis CorrectAnswer-BAns.is'cib.,I/LOpticatrophyC/LpapilloedemaFoster-Kennedysyndrome:-Thefrontallobe,pituitaryandmiddle-eartumorsuchasmeningiomataoftheoflactorygroovearesometimesassociatedwithIpsilateralpressureatrophyoftheopticnerveandcontralateralpapilledema.Pseudo-Foster-kennedysyndrome:-ItischaracterizedbyoccurenceofunilateralpapilloedemaassociatedwithraisedICT(duetoanycause)andapre-existingopticatrophy(duetoanycause)ontheotherside.
127.Enucleationoftheeyeballis contraindicatedin? a)ndophthalmitis b)Panophthalmitis c)Intraoculartumoursd d)Painfulblindeye CorrectAnswer-BAns.is'b'i.e.,PanophthalmitisEnucleationEnucleationistheremovalofeyeballwithaportionofopticnervefromtheorbitwhilepreservingallotherorbitalstructures.IndicationsAbsolute:-Retinoblastoma,malignantmelanoma.Relative:-Painfulblindeye,mutilatingocularinjury,anteriorstaphyloma,phthisisbulbi,endophthalmitis,congenitalanophthalmiaorseveremicrophthalmia.ContraindicationsEnucleationiscontraindicated:-AftertheonsetofsympatheticophthalmiaPanophthalmitis:-Infectioncanspreadviathecutendsofopticnervesheathcausingmeningitis
128.Typeoflaserusedforiridotomy? a)Excimer b)Kryptonred c)Nd:YAG d)Diode CorrectAnswer-CAns.is'c'i.e.,Nd:YAG
129.Mostcommoncauseofptosis? a)Myastheniagravis b)Paralysisof3rdnerve c)Idiopathic d)Congenital CorrectAnswer-DAns.is'd'i.e.,CongenitalPtosisPtosisisdroopingofuppereyelid.Ptosisoccurswhenthemusclesthatraisetheeyelid(levatorpalpebraesuperiorsandmuller'snuscles)arenotstrongenoughtodosoproperly.EtiologyofPtosismaybe:?A)Congenitalmyogenicptosis:-Itisthemostcommontypeofptosisandisoftenbilateral.Itisassociatedwithmaldevelopmentorcongenitalweaknessoflevatorpalpebraesperioris.Congenitalmyogenicptosisischaracterizedbydroopingofoneorbothlidsatbirth,withadiminishedorabsentlidcreaseandlidlagondowngazeduetotetheringeffectofabnormalmuscle.ItmayoccurinfollowingformsSimplecongenitalptosis:-NotassociatedwithotheranomalyCongenitalptosiswithsuperiorrectusweaknessBlepharophimosissyndromeCongenitalptosis,blepharophimosis,telecanthusandepicanthusinversus.Congenitalsynkineticptosis(MarcusGunnjaw-winkingPtosis):-Retractionofptoticlidwithjawmovementlikechewing,i.e.,withstimulationofipsilateralpterygoidmuscle.B)Acquirdptosis:-Dependinguponthecauseacquiredptosismaybe
Neurogenic:-Itisduetoparalysisof3rdnerve,Horner'ssyndrome,ophthalmoplegicmigraine,multiplesclerosis.Neurogenicptosismayalsooccurduetolesionofsympatheticnerve)supplyingmuller'smuscle.Myogenic:-ItisduetoacquireddefectofLPSmuscleandmaybeseeninmyastheniagravis,dystrophiamyotonica,ocularmyopathy,oculopharyngealmusculardystrophy,thyrotoxicosis,Lambert-EatonmystheniasyndromeMechanical:-Itisduetoexcessiveweightontheupperlide.ginlidtumors,multiplechalazia,lidedema.Itmayalsooccurduetoscarring(cicatracialptosis)inatientswithocularpemphigoidandtrachoma.Aponeuroticptosis:-Itisduetodefectofthelevatoraponeurosisinthepresenceofnormalfunctioningmuscle,e.g.involutional(senile)ptosis,post-operativeptosis.
130.Nervecarryingmotorcomponentoflight reflex? a)1Stnerve b)2"nerve c)3'nerve d)4thnerve CorrectAnswer-CAns.is`C'i.e.,3rdnerve
131.Altitudinalvisualfielddefectisseenin? a)Papilloedema b)Retinitispigmentosa c)Anteriorischemicneuropathy d)Buphthalmos CorrectAnswer-CAns.is'c'i.e.,AnteriorischemicneuropathyAnteriorischemicopticneuropathv(AION)Itisaconditionoflocalanoxiaoftheanteriorregionoftheopticnerve.Itisduetotheinvolvementofposteriorciliaryarteryandmaybecentralretinalarterycausinginfarctoftheanteriorpartoftheopticnerveandretina.Itoccurscommonlyinneglectedacuteattackofclosedangleglaucoma,severeanemia,afteramassivehaemorrhage,andtemporalarteritis.Thereissuddenlossofvision.Onexaminationthereisswellingofthediscresultinginopticatrophy.Permanentaltitudinalvisualfielddefectsarepresent.Theseinvolvetwoquadrantsofeitherthesuperiororinferiorvisualfield.
132.UpperLidRetractorsinclude a)Mullermuscleandsuperiorrectus b)Levatorpalpabraesuperiorisandsuperioroblique c)Superiorobliqueandsuperiorrectus d)Levatorpalpabraesuperioris&mullermuscle CorrectAnswer-DAns.is'd'i.e.,Levatorpalpabraesuperioris&mullermuscleThelevatorpalpebraesuperiorisistheimportantuppereyelidretractor.Injuryorweaknesstothismuscleleadstoptosis.Thismuscleissuppliedbyocculomotor(3')nerve.DeeppartoftheelevatormuscleistheMuller'smuscle,whichissympatheticallyinnvervated.Inhyperthyroidism,sensitizationoftheMullermuscleleadstouppereyelidretractionandpseudoproptosis.Ontheotherhand,inHorner'ssyndromelossofthismuscleactionleadstoptosis.Thecapsulopalpebralfasciaassistsinlowereyelidretractionandcoordinateswitheyeballmovement.Itarisesasanextensionoftheinferiorrectusandinsertsintotheloweredgeofthelowertarsusandtheadjacentorbitalseptum.
133.Apatientwithptosis,upper4mmof corneaiscoveredbyuppereyelid.GradeofPtosisis? a)Mild b)Moderat c)Severe d)Profound CorrectAnswer-AAns.is'a'i.e.,MildInunilateralcasesofptosis,differencebetweentheverticalheightofpalpebralfissuresofthetwosidesindicatesthedegreeofptosis.Inbilateralcasesitcanbedeterminedbymeasuringtheamountofcorneacoveredbytheuppereyelidandthensubstracting2mm.Dependinguponitsamounttheptosisisgradedas-1:1Mild:2mmModerate:3mmSevere:4mmInthisquestion,4mmofcorneaiscoveredbyuppereyelid.Substracting2mmfromthismeansthereis2mmofptosis,i.e.mildgrade
134.Schwable'sringisseeninwhichlayerof cornea a)Bowmann'smembrane b)Stroma c)Descemet'smembrane d)Substantiapropria CorrectAnswer-CAns.is'c'i.e.,Descemet'smembraneHistologyofcorneaThecorneahasfivedistinctlayers(fromsuperficialtodeep):?Epithelium:-Itistheoutermostpartofcorneaandiscomposedofstratifiedsquamousnon-keratinizedepithelialcells.Bowman'smembrane:-Itisnotatruemembranebutsimplyacondensedsuperficialpartofstroma.destroyed,itdoesnotregenerate.Stroma(Substantiapropria):-Thislayerconstitutesmostofthecornea(90%ofthickness).Itconsistsofcollagenfibrils(lamellae)embeddedinhydratedmatrixofproteoglycans.Descemet'smembrane:-Thislayerboundsthestromaposteriorly.IntheperipheryitappearstoendattheanteriorlimitoftrabecularmeshworkasSchwahle'sring.Endothelium:-Itisasinglelayerofflatpolygnonalcells.Theendothelialcellscontain'active-pump'mechanismandisthemostimportantlayerinmaintainingthetransparencyofcornea.
135.PhaseIIblockisseenwith- a)SChinfusion b)SingledoseSCh c)Mivacurium d)Noneoftheabove CorrectAnswer-AAns.is'a'i.e.,SChinfusionUndercertainconditionsdepolarizingagentsproducedualmechanismofneuromuscularblockadewhichcanbedividedintotwophases:a.PhaseIblockRapidinonsetResultfrompersistantdepolarizationofmuscleendplate.b.PhaseIIblockSlowinonsetResultsfromdesensitizationofreceptortoACh.PhaseIIblockisseenwhenfluorinatedanaestheticshavebeengivenorwhenSChisinjectedinhighdoseorinfusedcontinuously.SChalsoproducesphaseIIblockinpatientswithatypicalordeficientpseudocholinesterase.
136.Anaestheticgaswithmaximum respiratoryirritation a)Halothane b)Enflurane c)Desflurane d)Sevoflurane CorrectAnswer-CAns:C.DesfluraneDesfluraneandisofuranewhenusedforinductioncauserespiratoryirritationduetotheirpungentsmellleadingtobreathholdingandcoughing.Halothaneandsevofluranedonotcausesucheffects.
137.IVadministrationofwhichanesthetic drugismostpainfulamongthefollowing? a)Methohexital b)Ketamine c)Propofol d)Etomidate CorrectAnswer-CAns:c.PropofolPropofolpreparation:Oil-basedpreparation(soybeanoil,egglecithin&glycerol).Hence,painoninjection&rarelythrombophlebitis.
138.Whichofthefollowingisnot cardiodepressive? a)Propofol b)Thiopentone c)Ketamine d)Etomidate CorrectAnswer-DAns:D.EtomidateMajoradvantageofetomidate:Cardiovascularstabilityafterinduction.Effectsofetomidateinductiondose:Negligibleincreaseinheartrate.Littledecreaseinbloodpressure/cardiacoutput.Littleeffectoncoronaryperfusionpressure,whilereducingmyocardialO2consumption.
139.Whichofthefollowingisthemost commonmethodusedtoknowdepthofanaesthesia? a)BIS b)Oesophagealcontractility c)Depressedresponses d)Hypotension CorrectAnswer-AAns:A.BISBispectralindex:*1stscientificallyvalidated&commerciallyavailablemonitortocheckdepthofanaesthesia.*Utilizesmanyparameters(EEGsignals,eyeblinks)tocalculatedepthscore.Adequatedepth:*Scoreof45-60.Fullyawakestate:*Scoreof100Completelysilentbrain:0.
140.MRP2associatedwithwhichofthe following? a)Rotorsyndrome b)Dubin-Johnsonsyndrome c)Crigler-Najjarsyndrome d)Gilbertsyndrome CorrectAnswer-BAns:B.Dubin-Johnsonsyndrome.Dubin-Johnsonsyndrome:Anautosomalrecessivedisorder.Causedbygenemutationresponsibleforhumancanalicularmultispecificorganicaniontransporter(cMOAT)protein/alsoreferred"multidrugresistanceprotein2(MRP2)"orABCC2.
141.Inophthalmologyapatientisallergicto aminoesters.Whatcanbeused? a)Cocaine b)Procaine c)Prilocaine d)Bupivacaine e)Tetracaine CorrectAnswer-C:DAns.is'c'i.e.,Prilocaine&'d'i.e.,Bupivacaine[Ref:Lee's13th/ep.486]Prilocaine&bupivacaineareamides(amcinonide).Otherthreeareaminoesters.
142.Drug(s)notgivenastransdermalpatch: a)Fentanyl b)Diclofenac c)Morphine d)Clonidine e)Buprenorphine CorrectAnswer-B:CAns.B,Diclofenac&C,Morphine[Ref:KDT7th/476Transdermalfentanyl(Durogesic)hasbecomeavailableforuseincancer/terminalillness.Butransskinpatchescontainbuprenorphineanopioidpainmedication.Clonidinetransdermaldelivery(patch)systemshavebeenavailablesincethe1980
143.Mallampatti'sclassificationisfor? a)Mobilityofcervicalspine b)Mobilityofatlantoaxialjoint c)Assessmentoffreerotationofneckbeforeintubation d)Inspectionoforalcavitybeforeintubation CorrectAnswer-DAns.D.Inspectionoforalcavitybeforeintubation[RefMorgan4thiep.113]Mallampatiscore(Mallampatioropharyngealscale):Mallampatigradingisusedtoevaluatethevisibilityoftonsilandtonsillarfossawhichinturnassesstheadequatemouthopeningdependinguponthegrade.IndicationsofMallampatiscoreareOralcavityassessmenttoruleoutdifficultintubation(Inspectionoforalcavitybeforeintubation)&Sleepapneaevaluation.
144.Anestheticagentofchoiceinasthma patientis? a)Thiopentone b)Methexitone c)Ketamine d)Propofol CorrectAnswer-CAns.C.Ketamine[RefMiller's7"lep.744-746]Ketamineisapotentbronchodilator;thereforeitistheanestheticagentofchoiceinbronchialasthmapatients.Halothaneistheinhalationalagentofchoiceinasthmatics.
145.Pinindexsystemisasafetyfeature adoptedinanesthesiamachinestoprevent? a)Incorrectattachmentofanesthesiamachines b)Incorrectattachmentofanesthesiafacemasks c)Incorrectinhalationagentdelivery d)Incorrectgascylinderattachment CorrectAnswer-DAns.D.Incorrectgascylinderattachment[RefLee13th/ep.85]Pinindexsystem:-Thisisthesafetymechanismsothatonecylindercannotbefittedattheother'sposition.
146.PropofolshowsfollowingeffectonEEG? a)Activation b)Depression c)Depressioninlowdosesandactivationinhighdoses d)Noneoftheabove CorrectAnswer-BAns.B.DepressionEEGchangesduringanesthesia:EEGDepressioncausedby,Inhalationalagents(1-2MAC)BarbituratesOpioidsEtomidatePropofolHypocapniaMarkedhypercapniaHypothermiaLatehypoxia,ischemia
147.TypeEcircuitisusedfor? a)Spontaneousventilation b)Controlledventilation c)Children d)Anusedforalloftheaboveindications CorrectAnswer-CAns.C.Children[RefAjayYadav4th/ep.29,30]Circuitofchoiceforspontaneousventilationinadult-4MaplesonACircuitofchoiceforcontrolledventilationinadultMaplesonD(Baincircuit)Circuitofchoiceforchildren-TypeF,i.e.Jackson-Rees(firstchoice)andtypeE,i.e.Ayre'sTpiece(secondchoice)
148.Anestheticagentleadingtobradycardia is? a)Pancuronium b)Vecuronium c)Atracurium d)Propofol CorrectAnswer-DAns.D.PropofolBradycardiacausinganestheticagents:SuccinylcholinePropofolOpioidsanesthetics(fentanylanditscongers)
149.SizeofLMAfora15kgchildis? a)1 b)2 c)3 d)4 CorrectAnswer-BAns.B.2LMAaccordingtopatient'sweightandage:10-20kgs,infants&children
150.Intra-arterialthiopentoneinjectionleads to? a)Ischemia b)Vasodilatation c)Vomiting d)Hypertension CorrectAnswer-AAns.A.Ischemia[RefAjayYadav4th/ep.80;Lee13thiep.155]IschemiaInadvertentintra-arterialinjectionofthiopentoneisaverydreadfulcomplication.Itproducesthrombosis,vasospasm,ischemia,necrosisandfinallygangrene.Thefirstsymptomisburningpain.Thefirstsignisblanchingofthehandduetovasospasm.
151.Inmechanicalventilation,peakpressure ininspirationdenotes? a)Complianceoflung b)Capacityofinspiratorymuscles c)Airwayresistance d)Alloftheabove CorrectAnswer-CAns.C.Airwayresistance[Ref:Essentialsofanaesthesia-786]PressuresinmechanicalventilationPeakpressurePeakpressureapplieswhenthereisairflowinthecircuit,i.e.,duringinspiration.Peakpressuredeterminesairwayresistance.
152.Hypotensionfollowingspinalanesthesia canbebestpreventedby? a)Preloadingwithcolloids b)Usingsmallsizeneedle c)Preloadingwithcrystalloids d)Alloftheabove CorrectAnswer-AAns.A.Preloadingwithcolloids[RefLee13th/ep.509,510;Morgan4th/ep.297]Hypotensionisthemostcommoncomplicationofspinalanesthesia.Itarisesduetoblockingofsympatheticrootfibersandisusuallyaccompaniedbybradycardia(PreganglionicblockofthesympatheticnervestoheartT1-T4)andnausea.Hypotensioncanbepreventedbypreloadingthepatientwithcolloids,Preloadingwithcrystalloiddoesnotpreventhypotensionbecauselargevolumesofcrystalloidsquicklyredistributefromintravasculartoextravascularspace.Beachchairpositionalsopreventshypotension.
153.Propofolvial,onceopened,shouldbe usedwithin? a)2hours b)4hours c)6hours d)8hours CorrectAnswer-CANs.C.6hours[Ref:Lee13th/ep.158-160;Morgan4thlep.200-202]Propofolisoilbasedpreparationcontainingsoybeanoil,egglecithin,andglycerol.Thecolorofsolutionismilkywhite.Solutionshouldbeusedwithin6hoursafteropeningthevialbecausetherehavebeendeathreportsfollowingtheuseofcontaminatedsolutionasegglecithinisagoodmediumforbacterialgrowth.Topreventthisproblemrecentlyavailablepropofolpreparationshavedisodiumedetateorsodiummetabisulfiteasantimicrobialagent.
154.Whichofthefollowingagentis associatedwithmaximumhistaminerelease? a)d-Tubocurarine b)Cisatracurium c)Pancronium d)Rocuronium CorrectAnswer-AAns.A.d-TubocurarineHistaminereleaseiscausedbyD-TC(maximumtendency),succinylcholine,mivacurium,doxacurium,atracurium,tubocurarinecancausebronchoconstriction.
155.Whatistheintubationdoseof pancuronium? a)0.1mg/kg b)1mg/kg c)10mg/kg d)20mg/kg CorrectAnswer-AAns.A.0.1mg/kg
156.Relativecontraindicationof neuraxial/regionalanesthesiais? a)Hypertension b)Renaldisease c)Sepsis d)Diabetes CorrectAnswer-CAns.C.Sepsis[RefMorgan4th/ep.299]Contraindicationstoneuraxialblock(spinal&epidural)Absolute:-Infectionatthesiteofinjection,patientrefusal,coagulopathyorotherbleedingdisorder,severehypovolemia,increasedICT,severeaorticormitralstenosis.Relative:-Sepsis,unto-operativepatient,pre-existingneurologicaldeficit,demyelinatinglesions,severespinaldeformity,stenoticvalvularheartdisease.
157."TriangleofPetit"isalandmarkfor whichblock? a)Spinalblock b)Bier'sblock c)TAPblock d)Epiduralblock CorrectAnswer-CAns.C.TAPblock[RefMiller'sanesthesiaE-bookp.1735]*Transverseabdominisplane(TAP)block-Itisaperipheralnerveblockdesignedtoanesthetizethenervessupplyingtheanteriorabdominalwall(T6toL1).-ThepointofentryfortheblindTAPblockisthelumbartriangleofPetit.-Thisissituatedbetweenthelowercostalmarginandiliaccrest.-Itisboundanteriorlybytheexternalobliquemuscleandposteriorlybythelatissmisdorsi.
158.CNSaffectionofalocalanestheticagent leadsto? a)Convulsion b)Perioralnumbness c)Depression d)Alloftheabove CorrectAnswer-DAns.D.Alloftheabove[RefMorgan4thlep.270]ManifestationsoflocalanesthetictoxicityEarlysymptoms(Prodrome)Circumoralnumbness,dizziness,tongueparesthesia,restlesness,tinnitus,agitation.CNSsymptoms:-Thesearebiphasici.e.excitation(convulsions,restlessness,agitation&tinnitus),followedbydepression(drowsiness,disorientation,respiratorydepression,unconciousness).Cardiovascularmanifestations:-hypotension,cardiacarrest,coma
159.Succinylcholineiscontraindicatedin? a)Hyperkalemia b)Hypokalemia c)Hypercalcemia d)Hypocalcemia CorrectAnswer-AAns.A.Hyperkalemia[RefMorganPiep.214]Schcancausedangeroushyperkalemiainandiscontraindicatedin:Burn,massivetrauma,crushinjury,Severeintraabdominalinfection(sepsis).
160.Benzocaineisusedinwhichtypeof anesthesia? a)Topical b)Spinal c)Epidural d)Alloftheabove CorrectAnswer-AAns.A.Topical[RefMorgan4th/ep.270]Benzocaineandcocaineareusedonlyintopicalanesthesia.
161.Apatientwithnormalsuccinylcholine metabolismwillhaveDibucainenumberbetween? a)20-30 b)40-45 c)50-60 d)70-80 CorrectAnswer-DAns.D.70-80Dibucainnumber:Dibucain(alocalanaesthetic)inhibits80%ofnormalpseudocholinesteraseand20%ofatypical(non-functional)pseudocholinesterase.Thereforenormaldibucainnumberis70-80%.
162.Americananestheticassociationsays thatclopidogrelshouldbewithheldhowmanydaysbeforesurgery? a)1day b)1week c)3weeks d)4weeks CorrectAnswer-BAns.B.1week[RefAjayYadav3'/ep.46]Preoperativemodificationsofpre-existingdrugs Drugswhichcanbecontinued Drugswhichcanbestopped tillthedayofsurgery Conventionaldoseaspirin& Antianginal(exceptaspirin) clopidogrel(antiplatelets)-Iweekbeforesurgery Antiepileptics Oralanticoagulants-4daysbefore&switchtoheparin, Antihypertensives(exceptAT-II whichisstopped12hoursprior antagoists)LevodopatosurgeryOralhypoglycemic(metformin) Digitalis -48hoursbeforeurgeryandswitchtoinsulin TCAs AT-IIantagonists(losartan, Lowdoseaspirin valsarton)-1daypriorLithium-48-72hoursbefore surgery
MAOinhibitors-3weeks beforesurgery Note:Antiplateletdrugslikeclopidogrelandconventionaldoseofaspirinshouldbestopped7dayspriortosurgery.Butlowdoseaspirincanbecontinuedtillthedayofsurgery.
163.Amongthefollowingagents,maximum boilingpointisassociatedwith? a)Sevoflurane b)Isofurane c)Methoxyflurane d)Desflurane CorrectAnswer-CAns.C.Methoxyflurane[RefAjayYadav4th/ep.63]Boilingpointofmethoxyfluraneismorethanwater(104?C)
164.Whichofthefollowinginhalational anestheticagentmosteasilycrossesbloodbrainbarrier? a)Methoxyflurane b)Sevoflurane c)Desflurane d)Nitrousoxide CorrectAnswer-AAns.A.Methoxyflurane[RefAjayYadav4th/ep.63]Oil:gaspartitioncoefficientmeasuresthelipidsolubilityoftheagentandthereforesolubilityinthefat-richtissuesoftheCNS(abilitytocrossBBB).Methoxyfluranehasmaximumoil:Gaspartitioncoefficient-->Mostlipidsoluble&mosteasilycrossesBBB.1120hasminimumoil:Gaspartitioncoefficient-pLeastlipidsoluble&thereforelikelytocrossBBB.
165.Whichofthefollowinganestheticagent mostislipidsoluble? a)Nitrousoxide b)Methoxyflurane c)Isoflurane d)Halothane CorrectAnswer-BAns.B.MethoxyfluraneOil:gaspartitioncoefficientmeasuresthelipidsolubilityoftheagentandthereforesolubilityinthefat-richtissuesoftheCNS(abilitytocrossBBB).Methoxyfluranehasmaximumoil:Gaspartitioncoefficient-->Mostlipidsoluble&mosteasilycrossesBBB.1120hasminimumoil:Gaspartitioncoefficient-pLeastlipidsoluble&thereforelikelytocrossBBB.
166.Etomidateisnotusedforlongterm infusionbecause? a)Resultsinadrenalsuppression b)Maycausevasospasm c)Resultsincardiacarrhythmias d)MaycauseincreaseinICT CorrectAnswer-AAns.A.Resultsinadrenalsuppression[RefMorgan4th/ep.200]Etomidatesuppressescorticosteroidsynthesisintheadrenalcortexbyreversiblyinhibiting1113-hydroxylase,whichcoverts11-deoxycortisoltocortisolandbyarelativeminoreffecton17a-hydroxylase.Usingacontinuousetomidateinfusionforsedationofcriticallyilltraumapatientsinintensivecareunitshasbeenassociatedwithincreasedmortalityduetoadrenalsuppression.Themortalityofpatientsexposedtoacontinuousinfusionofetomidateformorethan5daysincreasedfrom25%to44%,mainlyduetoinfectiouscausessuchaspneumonia.
167.Armtonguetimeis? a)13secs b)15secs c)20secs d)40secs CorrectAnswer-AAns.A.13secsArmtotonguetimeismethodforknowingthecirculationtimei.e.timetakenbyaparticleinthebloodtoflowfromonepointincirculationtoother.Itmeasuresthelinearvelocityofblood.Tocalculate-thearmtotonguetime5mlof2%ofdecholineisinjectedintocubitalvein.Assoonasdrugreachesthetongue,patientfeelsabittertaste.Thetotaltimetakenfromarmtotongueis13seconds.Similarlyarmtolungtimeiscalculatedwiththehelpofether.Itisdseconds.
168.Respiratoryfailureinapostoperative patientis? a)Type1 b)Type2 c)Type3 d)Type4 CorrectAnswer-CAns.C.Type3Type3orperioperativerespiratoryfailureIncreasedatelectasisduetolowfunctionalresidualcapacity(FRC)inthesettingofabnormalabdominalwallmechanics.OftenresultsintypeIortypeIIrespiratoryfailure.Canbeamelioratedbyanestheticoroperativetechnique,postureposture,incentivespirometry,post-operativeanalgesia,attemptstorowerintra-abdominal-pressure.
169.Laryngealmaskairway[LMA]is contraindicatedin? a)Difficultairways b)Ocularsurgeries c)Pregnantfemale d)InCPR CorrectAnswer-CAns.C.PregnantfemaleContraindicationsofLMA 1. Conditionswithhighriskofaspiration.i.e.,fullstomachpatients, hiatushernia,pregnancy. 2. Oropharyngealabscessormass(tumor).3. Massivethoracicinjury4. Massivemaxillofacialtrauma
170.Allofthefollowingareadvantagesof LMAexcept? a)Morereliablethanfacemask b)Preventaspiration c)AlternativetoEndotrachealintubation d)Doesnotrequirelaryngoscope&visualization CorrectAnswer-BAns.B.PreventaspirationLMAisintermediatebetweenthefacemaskandEndotrachealintubationintermsofreliability,invasivenessandfacilitationofgasexchange(facemaskhasminimumandendotrachealintubationhasmaximum).LMAdoesnotpreventasPiration+shouldnotbeusedinfullstomachpatients.LMAcanbeusedasanalternativetoendotrachealintubationforminorsurgeries,whereanaesthetistwantstoavoidintubation.LMAisintroducedblindly(withoutlaryngoscopy)
171.Onlyavailabledepolarizingmuscle relaxantis? a)Decamethonium b)Suxamethonium c)Mivacurium d)None CorrectAnswer-BAns.B.SuxamethoniumSuxamethonium(succinylcholine)anddecamethoniumcomeunderdepolarizingmusclerelaxants.Outoftheseonlysuxamethoniumisavalaibleforclinicaluse.
172.WhichanestheticgaswasusedbyWTG Mortoninhisexperiment? a)Nitrousoxide b)Ammonia c)Diethylether d)Trichloroethylene CorrectAnswer-CAns.C.DiethyletherWilliamThomasGreenMorton,adentistandmedicalstudentatBoston,afterexperimentingponanimals,gaveademonstrationofgeneralanesthesia,In1846.
173. Suxamethoniumactsthroughwhich channels? a)Sodiumchannels b)Potassiumchannels c)Calciumchannels d)Chloridechannels CorrectAnswer-AAns.A.SodiumchannelsSuxamethonium(succinylcholine)isadepolarizingneuromuscularblockingagentwhichactbyopeningtheNa+channelsatmuscleendPlate.
174.Mouthtomouthrespirationprovideswhatpercentageof oxygen? a)10% b)16% c)21% d)100% CorrectAnswer-BAns.B.16%Mouthtomouthbreathingprovides0.8to1.2litersofexhaledairperbreathand16%ofoxygenwhichisenoughtosustainlife.TheuseofAmbubagandroomairprovides21%O2.TheAmericanHeartAssociationrecommendstidalvolumesof700to1000mLduringmouth-to-mouthventilation,butsmallertidalvolumesof500mLmaybeofadvantagetodecreasethelikelihoodofstomachinflation,asmouth-to-mouthventilationgascontainsonly17%oxygen,but4%carbondioxide.
175.Whichofthefollowinganestheticagent isapotentbronchodilator- a)Propofol b)Ketamine c)Thiopentone d)Methoxytone CorrectAnswer-BAns.B.KetamineKetamineisapotentbronchodilator,thereforeitisthei.v.anaestheticagentofchoiceinbronchialasthmapatients.
176.Landmarkforpudendalnerveblockis? a)Ischialtuberosity b)Iliacspine c)Sacroiliacjoint d)Noneoftheabove CorrectAnswer-AAns.A.IschialtuberosityPudendalblock:Whenperformingatransvaginalpudendalnerveblock,theischialspineisthepalpatedthroughthewallofthevaginaandtheneedleisthenpassedthroughthevaginalmucousmembranetowardtheischialspine.Inaperinealpudendalnerveblock,theischialtuberosityispalpatedthroughthebuttockandtheneedleisinsertedintothepudendalcanalaboutoneinchdeepmedialtotheischialtuberosity.
177.Postduralpunctureheadacheusually presentswithin? a)0-6Hrs b)6-12Hrs c)12-72Hrs d)72-96Hrs CorrectAnswer-CAns.C.12-72HrsPostduralpunctureheadacheisduetoCSFleak.Typicallocationisbifrontaloroccipital.Headachegetsworsenonsittingoruprightpostureandisrelievedbylyingdownpositionandabdominalpressure).Thehallmarkofpostduralpunctureheadachei.e.,associationwithbodyposition.Theonsetofheadacheisusually12-72hrsfollowingtheprocedure,however,itmaybeseenalmostimmediately.Inmostcasesitlastsfor7_10days.
178.Caudaequinasyndromeisassociated with? a)Lidocaine b)Halothane c)N20 d)Ether CorrectAnswer-AAns.A.LidocaineCaudaequinasyndromemayoccurasararedevastatingcomplicationofspinalanesthesiaduetomaldistributionofinjectedlocalanesthesiaaroundcaudaequinanerverootsresultinginlossoffunctionofthelumbarplexus.Associatedwithalllocalanestheticlikelidocaine,bupivacaine,chlorprocaineetc.
179.Notincludedinneuraxialblock? a)Spinalblock b)Epiduralblock c)Bier'sblock d)Caudalblock CorrectAnswer-CAns,C.Bier'sblockCentralneuraxialblock,asthenamesuggests,isthepertainstolocalanaestheticsplacedforwaroundthenervesofthecentralnervoussystem.Examplesarespinalanaesthesia,Epiduralanaesthesiaandcaudallaesthesia.BIER'sblockorintravenousregionalanesthesia(IVRA)isaformofregionalanesthesiausedmostoftenforsurgeryoftheforearmandhand.
180.Contraindicationtoneruaxialblockis? a)Hypertension b)Renaldisease c)Clottingdisorders d)Diabetes CorrectAnswer-CAns.C.ClottingdisordersContraindicationsofcentralneuroaxialblock:Absolute:-Infectionatthesiteofinjection,patientrefusal,coagulopathyorotherbleedingdisorder,severehypovolemia,increasedICT,severeaorticormitralstenosis.Relative:-Sepsis,unco-operativepatient,pre-existingneurologicaldeficit,demyelinatinglesions,severespinaldeformity,stenoticvalvularheartdisease
181.Mostcommoncauseofmaternal mortalityinspinalanesthesiais? a)Allergytolocalanesthesia b)Nerveinjury c)Highblock d)Hypotension CorrectAnswer-CAns.C.HighblockMostcommoncauseofmaternaldeathorbraindamageinneuraxialanesthesiaclaimswashighblock"
182.Cocainewasfirstusedaslocal anaestheticby? a)Carlkollar b)Holmerwells c)Morton d)None CorrectAnswer-AAns.A.CarlkollarCocainewasthefirstlocalanestheticusedbyCarlKoller.Itwasusedforanaesthetizingcornea.
183.Levelsofetheranesthesiawere demonstratedbywhom? a)Morton b)Guedel c)Thompson d)None CorrectAnswer-BAns.B.GuedelGuedeldescribedfourstagesofetheranesthesiaknownasGuedelstages.
184.Infantcircuitforanaesthesia? a)Bainscircuit b)Magillcircuit c)Ayrestpiece d)Water'scircuit CorrectAnswer-CAns.C.Ayrestpiece
185.Ayre'sT-pieceiswhichtypeofcircuit a)TypeA b)TypeB c)TypeE d)TypeD CorrectAnswer-CAns.C.TypeE
186.Mostreliableindicatortoprevent oesophagealintubation? a)Oxygensaturationonpulseoximeter b)MeasurementofCO2inexhaledair(Etco2) c)Directvisualizationofpassingtubebeneathvocalcords d)Auscultationoverchest CorrectAnswer-BAns,B.MeasurementofCO2inexhaledair(Etco2)
187.Allarefeaturesofdifficultairwayexcept ? a)Miller'ssign b)Micrognathiawithmacroglossia c)TMJankylosis d)Increasedthyromentaldistance CorrectAnswer-DAns.D.IncreasedthyromentaldistanceDecreasedthyromentaldistancepredictsdifficultairway(notincreasedTMdistance).
188.Ratioof02:N20inEntonoxis? a)50:50 b)60:40 c)40:60 d)25:75 CorrectAnswer-AAns.A.50:50Entonoxcontainequalamount(50/50)ofN2OandO2.
189.WhichisthecriticaltemperatureofN20? a)-118?C b)-88?C c)-26?C d)-36.5?C CorrectAnswer-DAns.D.-36.5?CCriticaltemperatureofN2O-36.5CriticalpressureofN2O-214.7atm
190.Whichanaestheticagentisneither metabolisedbylivernorbykidney? a)Atracurium b)Vecuronium c)Pancuronium d)Rocuronium CorrectAnswer-AAns.A.Atracurium
191.Fastinductionandrecoveryisseenin? a)Methoxyflurane b)Ether c)Halothane d)N2O CorrectAnswer-DAns.D.N2OSpeedofonset&recoveryindecreasingorder(IncreasingorderofB:Gpartitioncoefficientandbloodsolubility).
192.MACofdesfluraneis? a)1.15 b)2 c)4 d)6 CorrectAnswer-DAns.D.6
193.WhichcanreplaceN20as02carrier? a)Argon b)Xenon c)Helium d)None CorrectAnswer-CAns.C.HeliumHeliumcanbeusedtoreplacenitrogen,asthecarriergasforoxygen(Helium)toreducetheworkofbreathing.
194.Benefitofketamine? a)CausesdecreaseinBP b)Goodanalgesicaction c)DecreaseICT d)DecreaseIOT CorrectAnswer-BAns.B.GoodanalgesicactionKetamineisdifferentfrommostotheranaestheticinductionagentsinthatithassignificantanalgesicaction
195.Whichofthefollowingisa sympathomimetic? a)Propofol b)Etomidate c)Ketamine d)N2O CorrectAnswer-CAns.C.KetamineKetaminehasanindirectsympathomimeticaction.
196.WhichcantbegivenbyEpidural anaesthesia? a)Morphine b)Remifentanil c)Alfentanil d)Fentanyl CorrectAnswer-BAns.B.RemifentanilOpioidsusedforepiduralanalgesiaaremorphine,Fentanyl,Tramadol,Buprenorphine,alfentanil,sulfentanil,pentazocine.Ramifentanilcontainsglycinewhichcancausemotorweakness--?hencenotsuitableforepiduralanalgesia.
197.Additionofepinephrinetolignocaine? a)IncreasesesdistributionofLA b)DecreasesabsorptionofLA c)DecreasesdurationofLA d)IncreasesmetabolismofLA CorrectAnswer-BAns.B.DecreasesabsorptionofLAVasoconstrictorsareusedalongwithLAwhichprolongsdurationofactionasrateofabsorptionisdecreasedduetovasoconstriction.Forthesamereason,metabolismofLAisreducedandtoxicityisdecreasedasthereislesserabsorptionofLA,
198.Maximumconcentrationforepidural block? a)Bupivacaine b)Lidocaine c)Ropivacaine d)Chlorprocaine CorrectAnswer-DAns,D.Chlorprocaine
199.VasoconstricatorL.A.is? a)Cocaine b)Procaine c)Lidocaine d)Chlorprocaine CorrectAnswer-AAns.A.CocaineAllLAsarevasodilatorexceptcocaine.Cocainecausesvasoconstriction'"Ropivacaineandbupivacainealsocausevasoconstriction"'
200. Allarecontraindicationsofspinal anaesthesiaExcept? a)Bleedingdisorder b)Raisedintracranialtension c)Hypertension d)Infectionatinjectionsite CorrectAnswer-CAns,C.Hypertension
201.Forpreventionofheadacheduringspinal anaesthesia? a)Dilutedsolutionoflocalanaestheticshouldbeused b)Preloadingwithcrystalloids c)FinerI.P.needleshouldbeused d)Headendshouldbeelevated CorrectAnswer-CAns,C.FinerI.P.needleshouldbeusedAssinglemostimPortantpredisposingfactorislargeboreneedleuseoffineneedlepreventsPDPH.
202.Innewborn,chestcompressionshould bestartedifheartrateis? a)<120/min b)<100/min c)<80/min d)<60/min CorrectAnswer-DAns,D.<60/minCompressionfornewbornshouldbestartedifHR<60/min'
203.Murphy'seyeisseenin- a)Macintoshlaryngoscope b)Endotrachealtube c)LMA d)Flexiblelaryngoscope CorrectAnswer-BAnswer:B-EndotrachealTubeThe"Murphyeye"istheeponymousnameforaholeonthesideofmostendotrachealtubes(ETTs)thatfunctionsasavent,andpreventsthecompleteobstructionofthepatient'sairway,shouldtheprimarydistalopeningofanETTbecomeoccluded
204.ModifiedMallamPatigradingisusedin assessmentof- a)Difficultintubation b)Airwayobstruction c)Deathduetoaspiration d)Intubation CorrectAnswer-AAnswer:A-DifficultyinintubationModifiedMallampaticlassificationClass0:AbilitytoseeanypartoftheepiglottisuponmouthopeningandtongueprotrusionClassI:Softpalate,fauces,uvula,pillarsvisibleClassII:Softpalate,fauces,uvulavisibleClassIII:Softpalate,baseofuvulavisibleClassIV:SoftpalatenotvisibleatallTest:Theassessmentisperformedwiththepatientsittingupstraight,mouthopenandtonguemaximallyprotruded,withoutspeakingorsaying"ahh."Difficultlaryngoscopy:Goodaccuracy(areaunderSummaryReceiverOperatingCharacteristic[SROC]curve0.89?0.05)Difficultintubation:Goodaccuracy(areaunderSROCcurve0.83?0.03)Difficultmaskventilation:PoorpredictorUsedalone,theMallampatitestshavelimitedaccuracyforpredictingthedifficultairwayandthusarenotusefulscreeningtestsMallampaticlassificationisonlyoneof11nonreassuringfindingsduringairwayexamination
205.Whichnerveistestedforadequacyof anaesthesia- a)MedianNerve b)UlnarNerve c)Radialnerve d)Mandibularnerve CorrectAnswer-AAnswer:A-MediannerveMediannerveblockcanbeevaluatedbytestingthelateralaspectoftheringfinger
206.Mosteffectivecircuitinspontaneous anaesthesiais- a)MaplesonA b)MaplesonB c)MaplesonC d)MaplesonD CorrectAnswer-AAnswer:A-MaplesonAMAPLESONA-(Magill)CIRCUITUsefulinspontaneousventilationThepatientinspireswhateverisinthetube,usingthebagasavolumereservoir.Oneatedtubeandincomingfreshgas.Whenthebagisfull,exhaledalveolargasisventedfrxpiration,thebagrefillsfromacombinationofexpiredgasgoingbackupthecorrugomtheexhalevalve,andthenduringanyexpiratorypause,FGFpushestheremainingalveolargasout.TheoreticallyFGF=0.7xValvshouldpreventsignificantrebreathingbecausedeadspacegas(fresh)isnotwasted,butFGF=VAmorereliablypreventsrebreathing.Tubevolumemustexceed(Vt-Vd)oralveolargascouldcontaminatethebag.InadequateFGFcausesrebreathing.DifficulttodetectfromtheCO2waveformalone-allthathappensisthattherapidfalloninspirationisdelayed.IfVAexceedstubingvolume,CO2entersthebagandwillbeseenoninspirationonthecapnogram.ControlledventilationIftheanaesthetistfullyclosedthevalvewhilesqueezingthebagand
didn'topenituntiljustbeforethebagfilled,thiscircuitwouldbeOK.Morecommonlythevalveispartiallyclosed-enoughtopermitadequatetidalvolumesdespiteparallellossofgasoutthevalve.FGFmustbeincreasedtocompensateforgaslostduringinspiration-typically2.5xminuteventilation.TheLacksystemAco-axialMagill,withtheexpiratoryvalvebroughtcoaxiallybacktotheFreshGasoutlet.Notpopularduetoinefficiencyduringcontrolledventilation.
207.Whatismechanismofactionof Curaniumdrugsasmusclerelaxant? a)PersistentlydepolarizingatNeuromuscularjunction b)ActcompetitivelyonAchreceptorsblockingpost-synaptically c)RepetitivestimulationofAchreceptorsonmuscleendplate d)Inhibitingthecalciumchannelonpresynapticmembrane CorrectAnswer-BAnswer:B-ActcompetitivelyonAchreceptorsblockingpost-synapticallyCandocuroniumiodideisanaminosteroidneuromuscular-blockingdrugorskeletalmusclerelaxantinthecategoryofnon-depolarizingneuromuscular-blockingdrugs.ActsonAchreceptorscompetitivelypost-synapticallyblockingthem.Potentialadjunctiveuseinanaesthesiatofacilitateendotrachealintubation&provideskeletalmusclerelaxation.Candocuroniumdemonstratedashortdurationandarapidonsetofaction,withlittleornoganglionblockingactivity,anditwasonlyslightlylesspotentthanpancuronium
208.Duringsquintsurgery,anesthesiologist seesthemachineandseethebpsuddenlydropsto40.Whatwillbebestimmediatemanagement- a)Giveatropine b)Increaselevelofanesthesia c)Askthesurgeontostopthesurgery d)Giveadrenaline CorrectAnswer-DAnswer:D.GiveadrenalineAdrenalineshouldbegiventoraisethebloodpressure.Epinephrine,alsoknownasadrenalinoradrenaline,isahormone,neurotransmitter,andmedication.Epinephrineisnormallyproducedbyboththeadrenalglandsandcertainneurons.Itplaysanimportantroleinthefight-or-flightresponsebyincreasingbloodflowtomuscles,outputoftheheart,pupildilation,andbloodsugar.Itdoesthisbybindingtoalphaandbetareceptors.Physiologicresponsestoepinephrinebyorgan Organ Effects Heart Increasesheartrate;contractility;conductionacrossAVnode Lungs Increasesrespiratoryrate;bronchodilation Systemic Vasoconstrictionandvasodilation Liver Stimulatesglycogenolysis
Systemic Triggerslipolysis Systemic Musclecontraction
209.Oxygentherapymaynotbeusefulin a)Asthma b)Pneumonia c)Subglotticstenosis d)Pulmonaryfibrosis CorrectAnswer-DAns:D.PulmonaryfibrosisManyEMSprotocolsindicatethatoxygenshouldnotbewithheldfromanypatient,whileotherprotocolsaremorespecificorcircumspect.However,therearecertainsituationsinwhichoxygentherapyisknowntohaveanegativeimpactonapatient'sconditionlikeparaquatpoisoning,pulmonaryfibrosisandlungdamageresultingfrombleomycintreatment.
210.Mouthtomouthrespirationprovides whatpercentageofoxygen? a)10% b)16% c)21% d)100% CorrectAnswer-BAns.B.16%Mouthtomouthbreathingprovides0.8to1.2litersofexhaledairperbreathand16%ofoxygenwhichisenoughtosustainlife.TheuseofAmbubagandroomairprovides21%O2.TheAmericanHeartAssociationrecommendstidalvolumesof700to1000mLduringmouth-to-mouthventilation,butsmallertidalvolumesof500mLmaybeofadvantagetodecreasethelikelihoodofstomachinflation,asmouth-to-mouthventilationgascontainsonly17%oxygen,but4%carbondioxide.