Question: A patient after undergoing thoracotomy complains of severe pain. He can be managed by

Orotracheal intubation Patients with severe maxillofacial trauma and with low Sp02 even on oxygen suggests severe airway compromise or obstruction. In these cases emergency airway management is essential. The patient require immediate oxygen. - These patients needs to be intubated immediately. - But an impoant point to note is that severe maxillofacial trauma makes intubation very difficult. -Some believe that nasotracheal intubation is contraindicated in patients with severe maxillofacial injury because nasotracheal intubation in these patients can result in nasocranial intubation or severe nasal hemorrhage. - Nasotracheal intubation is absolutely contraindicated in patients with midfacial injury and C.S.F. rhinorrhoea. Orotracheal intubation in patients with severe maxillofacial injury In patients with severe maxillofacial injuries orotracheal intubation is also difficult. Presence of blood clots, .fractures make the passage of the tube quite difficult. Moreover when the surgeons perform operation for mandibular or maxillary fractures they wires both these together. If surgery is required with severe maxillofacial injury surgeons usually prefer nasotracheal intubation or tracheostomy. Tracheostomy in patient with severe maxillofacial injury : ? Tracheostomy does not have much role in "emergency airways management". - Tracheostomy is a time taking procedure compared to intubation. - If the airways of the patient is severely compromised and he requires immediate oxygenation, tracheostomy has no role. - Immediate oxygenation can only be delivered by rapid intubation. In case, intubation is impossible, cricothyroidotomy is an alternative. -In emergency management of the airway, cricothyroidotomy is done if intubation is not possible. Tracheostomy is only done when immediate oxygen requirements are taken care of and a surgical procedure is planned. In the question the Sp02 of the patient is 80% when on oxygen. He requires immediate emergency management of the airway which can be achieved through intubation, If intubation is impossible, cricothyroidotomy is an alternative. The better option of intubation in this patient is orotracheal intubation. The ideal management in this patient is cricothyroidotomy. Since that is not mentioned in the question intubation in the next best option. "Orotracheal intubation would be preferred over nasotracheal intubation in these cases"


Question: Inducing agent of choice in DIC

The cardiovascular stimulatory effects make ketamine a desirable drug for the induction of anesthesia in unstable cardiovascular patients suffering from hypovolemia, hemorrhagic shock, or cardiovascular depression in sepsis. Ketamine bronchodilation and profound analgesia allowing the use of high oxygen concentrations make ketamine an excellent choice for induction of anesthesia in patients with reactive airway disease. Patients who have sustained trauma with extensive blood loss are typical candidates for rapid-sequence anesthesia induction with ketamine. Patients with septic shock also may benefit from ketamine. The intrinsic myocardial depressant effect of ketamine may manifest in this situation if trauma or sepsis has caused depletion of catecholamine stores before the patient's arrival in the operating room. The use of ketamine in these patients does not obte the need for appropriate preoperative preparation, including restoration of intravascular blood volume. Ref: Miller's anesthesia 8th edition Ref: Morgan & Mikhail's clinical anesthesiology 6e


Question: Eutectic mixture of local anaesthetic (EMLA) cream

EMLA is eutectic mixture of local anesthetics (2.5% lidocaine and 2.5% prilocaine)


Question: Most impoant factor determining the affect of anaesthetic agent on fetus

All the given options determined the effect of anaesthetic on fetus. But, duration of pregnancy is the most impoantAlmost all anaesthetic agents can be potentially teratogenicDay 15th to day 60 is the most critical period.(Refer: Morgan and Mikhail's Clinical Anaesthesiology, 5th edition, pg no. 846)


Question: Drug of choice or differential blockade is

Ropivacaine is pure S- isomer of bupivacaine,so less cardiotoxic than bupivacaine. It is drug of choice for differential block.


Question: The substance is soda lime that acts as catalyst is

Potassium hydroxide acts as catalyst for generation of sodium carbonate.


Question: M.C. nerve used for monitoring during anaesthesia

Ans. is 'a' i.e. Ulnar nerve Most common nerve used for monitoring during anaesthesia is ulnar nerve.Ulnar nerve supplies adductor pollicis, and this muscle is most commonly observed during perioperative period.Adductor pollicis muscle is monitored for neuromuscular blockade. If adductor pollicis is showing no activity it means laryngeal muscles have already been blocked and intubation can be performed. At the reversal, if there is activity in adductor pollicis it means that diaphragmatic activity has already returned and the patient will be able to maintain tidal volume even after extubation.Also knowThe muscle to show earliest reversal is orbicularis oculi, supplied by the facial nerve.Common peroneal nerve can also be used for monitoring.


Question: Pin code index of N2O is

PIn index provides prevention of wrong attachments of cylinders . N20 - 3 ,5 O2 - 2 , 5 C02 (Gas) - 1 ,6 . ( Liquid below 88F ) 2 , 6 ; Cyclopropane 3 , 6 .


Question: 'Pityriasis Versicolor' is caused by

Pityriasis versicolor are tinea versicolor is a superficial fungal infection caused by dimorphic fungi belonging to genus Malassezia. M.globosa and M.furfur are two main species causing it. Most common site affected is upper trunk, but can also affect face and flexural areas. Clinical manifustations are in te form of hypo or hypo pigmented macules with fine, branni scales. Scrapping the surface accentuate the scarring known as scratch sign or coup d'ongle sign or besniers sign Woodslamp-golden yellow fluorescense KOH-Both yeast and hyphal forms giving Spaghetti and meat ball appearance. Ref Harrison 20th edition pg 1233


Question: Sudden decreasd end tidal CO2 in GA causes

Complications of Anaesthesia During anaesthesia: > Respiratory depression - Salivation, respiratory secretions > Cardiac arrhythmias > Fall in BP >Aspiration >Laryngospasm and >asphyxia >Awareness > Delirium and convulsion > Fire and explosion

Preoperative assessment and monitoring in anaesthesia


Question: A very high PEEP results in

Hypotension is due to diminished central venous blood return to the heart secondary to elevated intrathoracic pressures.


Question: Best antagonist of morphine is


Question: The bronchoscope is best sterilized with

A fiberoptic scope like bronchoscope, the flexible laryngoscope should be sterilized with 2% glutaraldehyde.


Question: Landmark for superior laryngeal nerve block

- Larynx is supplied by vagus- Upper larynx above vocal cord - supplied by internal branch of superior laryngeal nerve- Below vocal cord - recurrent laryngeal nerve- Feel the hyoid and try to palpate greater cornua of hyoid bone and take the needle on the side of the neck, taking the needle lateral to the greater cornua of hyoid bone, and hit in the hyoid bone, then we pass our needle just below the hyoid bone, we either give local anesthetic there, or we take needle few cms inside and pierce the membrane b/w hyoid bone and thyroid and give the drug or at superior cornua of thyroid cailage instead of caudally we give cranially 2ml of 2% lignocaine Anesthetize lower pa of vocal cord - 4ml of 2% lignocaine Injecting local anesthetic solution bilaterally, in the vicinity of the superior laryngeal nerves where they lie between the greater cornua of the hyoid bone and the superior cornua of the thyroid cailage as they traverse the thyrohyoid membrane to the submucosa of the piriform sinus, blocks the internal branch of the superior laryngeal nerve. The overlying skin is cleaned with alcohol or povidone-iodine (Betadine). The cornua of the hyoid bone or the thyroid cailage can be used as landmark


Question: In a typical blood gas analyser

Oxygen tension falls with hypothermia. The pH electrode directly measure pH. The standard bicarbonate measured in sample titrated to pCO2 of 5.3 kPa, which eliminates respiratory component.

Oxygen tension will be overstimulated in hypothermia

Standard bicarbonate can be used to indicate the respiratory component

The oxygen tension can be measured using Clarke electrode.


Question: The following is the anesthetic of choice in status asthamaticus


Question: Color of nitrous oxide cylinder is

Ans. d (Blue). (Ref. Short textbook of anesthesia by Ajay Yadav, 2nd ed., 21)Colour and pressure of cylindersSr. No.Anaesthetic gasColorPressure (bar) CyclopropaneOrange52.N2OBlue543.CO2Grey504.HalothaneAmber--5.EthyleneRed--6.HeliumBrown1377.O2Black body with white shoulder1378.Entonox (50%O2+50%N2O)Blue with white shoulder1379.AirGrey with white shoulder137Colour code for vaporizer of anaesthetic agents1. Red for /ralothane} 2. Orange for enflurane(HINT: ROPY HE-IS)3. Purple for isoflurane4. Yellow for sevoflurane


Question: The circled part of given capnograph reflects

This is phase 3 which represents only alveolar air.


Question: Pudendal nerve block

Pudendal Nerve BlockIt is a peripheral nerve block that provides local anesthesia over S2-4 dermatomes (majority of perineum and inferior quaer of vagina)It does not block the superior bih canal so the mother is able to feel the uterine contractions(Refer: Morgan and Mikhail's Clinical Anaesthesiology, 5th edition, pg no.847)


Question: The pin index code of nitrous oxide is

The Pin Index Safety System, or PISS, is a means of connecting high-pressure cylinders containing medical gases to a regulator or other utilization equipment. It uses geometric features on the valve and yoke to prevent mistaken use of the wrong gas. This system is widely used worldwide for anesthesia machines, poable oxygen administration sets, and inflation gases used in surgery. Cylinders attach to the machine hanger-yoke assemblies that utilize a pin index safety system to prevent accidental connection of a wrong gas cylinder. The yoke assembly includes index pins, a washer, a gas filter, and a check valve that prevents retrograde gas flow. PIN INDICES OF COMMONLY USED GASES: O2: 2,5 N2O: 3,5 Mixture of O2 and N2O (50% / 50%), commonly called Entonox: 7 (a single pin, located in the center) Air: 1,5 Mixtures of CO2 and O2 with more than 7% CO2: 1,6 Mixtures of CO2 and O2 with less than 7% CO2: 2,6 He: No pin Mixtures of O2 and He with less than 80% He, commonly called Heliox: 2,4 Mixtures of O2 and He with more than 80% He: 4-6 Cyclopropane: 3,6 Ethylene: 1,3 Nitrogen: 1,4 Ref: Miller's anesthesia 8th edition Ref: Morgan & Mikhail's clinical anesthesiology 6e


Question: Optimum minute ventilation is ensured by adjusting the following ventilation parameters

Minute ventilation is tidal volume multiplied by respiratory rate.so these parameters must be adjusted to maintain optimum ventilation.


Question: Local anaesthetic with maximum ionized form at physiological pH

Local anaesthetics with pKa value closest at physiological pH (7.4) will have a higher concentration of nonionized (unionized) base. Thus, the agent with pKa value away from physiological pH will have more concentration of ionized formChloroprocaine has highest pKa value, hence maximum ionized form at physiological pH.(Refer: Morgan and Mikhail's Clinical Anaesthesiology, 5th edition, pg no.268-270)


Question: Use of dexemditomidine

DexmedetomidineIt is a centrally acting a-2 adrenergic agonistIt is approved by f.D.A for sho-term (<24 hours) continuous IV sedation of adults who are tracheally intubatedIts use as an anaesthetic agent is not recommended but it is useful in patients with brain injury and ongoing sedation needs.(Refer: Morgan and Mikhail's Clinical Anaesthesiology, 5th edition, pg no. 288)

Prolong action of LA in hypeensive patients

Increases bioavailability of regional anaesthetic drug

Helps in reducing bispictral index of general anaesthetic drug with low potency


Question: A patient on atracurium develops seizures due to accumulation of

Hoffman's degradation of atracurium produces a teiary metabolite,laudanosine , which can cross blood brain barrier and produce convulsions .


Question: Epidural narcotic is preferred over epidural LA because it causes


Question: Curare notch seen in capnograph is due to

With return of spontaneous ventilation, curare notch is seen in capnograph.


Question: Intracranial pressure is increased by

(C) Ketamine # KETAMINE causes an increase in all pressure viz: intracranial pressure intraocular pressure; Blood pressure> It does not cause muscle relaxation> Ketamine induces dissociative anaesthesia profound analgesia, immobility amnesia with light sleep ad feeling of dissociation from ones own body and the surrounding.> Anaesthesia of choice in shock/hypotension: ketamine> Anaesthetic associated with increase in muscle tone: ketamine> Anaesthetic which does not abolish reflexes: ketamine> Anaesthetic of choice in bronchial asthma: Ketamine> Anaesthetic which is associated with emergence delirium and hallucinations : ketamine


Question: Inner diameter of adult male endotracheal tube is

Internal diameter of the endotracheal tube used usually for an adult male ranges from 8.0 to 9.5 ID for an adult female ranges from 6.5 to 7.5


Question: Most common local anaesthetic used for intravenous regional anesthesia (Bier block).

Lidocaine is the most - frequently selected amide local anesthetic for producing this type of regional anesthesia. Lidocaine has been the drug used most frequently for intravenous regional anesthesia. Prilocaine, mepivacaine, chloroprocaine, procaine and etidocaine have also been used successfully. Intravenous regional anesthesia or Bier's block involves the intravenous administration of a local anesthetic into a tourniquet- occluded limb. It is used to provide anesthesia for sho surgical procedures (<90 minutes) on the limbs. Note : Bupivacaine and its congeners is not used for Biers block. It is the most cardiotoxic local anesthetic. Accidental early deflation of the tourniquet can lead to massive systemic doses of bupivacaine resulting in cardiac arrhythmias and cardiovascular collapse.


Question: The following is not the differential diagnosis of an anterior mediastinal mass.

B i.e. Neurogenic tumor Neurogenic tumors (arising in posterior nerve structues) are the most common posterior mediastinal tumor but these do not occur in anterior mediastinumQ. And posterior mediastinum is the most common location for neurogenic tumors.


Question: Commonest complication of celiac plexus block is

Celiac plexus is a sympathetic ganglion thus blocking it will always cause hypotension. The celiac plexus is the largest plexus of the sympathetic nervous system. It contains preganglionic sympathetic fibers from greater and lesser splanchnic nerves (emerge from the thoracic sympathetic ganglia, T5 to T12) as well as postganglionic sympathetic and preganglionic parasympathetic fibers. It provides sensory innervation and sympathetic outflow to stomach, liver, spleen, pancreas, kidney and GI tract up to splenic flexure. Plexus is located at the level of T12-L2 (usually L1) and lies anterior to aoa in the retroperitoneal space. Indications Most common indication is treatment of pain caused by pancreatic cancer. Occasionally used in the treatment of pain from chronic pancreatitis (controversial). Can be used for pain from other GI malignancies from LES to splenic flexure, as well as liver, spleen and kidneys. Complications Ohostatic hypotension (most common, can be minimized with fluid hydration) and diarrhea (secondary to blockade of sympathetic fibers). Less common complications include paraplegia (from damage to aery of Adamkiewicz), local anesthetic toxicity, spinal or epidural injection, aoic or vena cava puncture and bleeding, retroperitoeneal hemorrhage, visceral organ injury, and pneumothorax (if needle is placed too cephalad) Anatomical Considerations: preganglionic SNS (greater/lesser splanchnic nerves), postganglionic SNS, preganglionic PNS, sensory Indications: pancreatic cancer (common); sometimes pancreatitis (controversial) Common Side Effects: ohostatic hypotension, diarrhea Rare Side Effects: paraplegia, LA toxicity, spinal/epidural injection, aoic or vena cava puncture, retroperitoeneal hemorrhage, visceral organ injury, pneumothorax


Question: Anaesthetic agent causing analgesia

"Ketamine is different from most other anaesthetic induction agents inthat it has significant analgesic action"(Refer: stoelting's pharmacology and physiology in anaesthetic practice, 5th edition, pg no.294)


Question: Primary mechanism responsible for cerebral protection effect of thiopentone is

C i.e. Decreased (lowered) cerebn metabolism Barbiturates (thiopental), primarily decreases cerebral metabolismQ resulting in a dose related depression of cevebral metabolic oxygen consumption (CMR02).Reduced CMRO2 causes progressive slowing of EEG, a reduction in rate of ATP consumption, cerebral vasoconstriction (reducing cerebral blood flow and intracranial tension) and protection from incomplete cerebral ischemiaQ. Thiopentone Sodium* Thiopentone is a yellow coloured powder used as 2.5 % solution at 5 mg/kg dose for smooth induction. It is ultrasho actingQ due to rapid redistributionQ. It is contraindicated in porphyria.Q.

GABA action, calcium channel block and free radicle removal

Reduces cerebral 02 demand by limiting CBF


Question: Stages of anaesthesia were described by Guedel with


Question: Not intravenous Anasthetic agent


Question: Anaesthesia of choice for manual removal of placenta

A i.e. GA Obstetric Anesthesia N20 can be given in Early pregnancy Anesthesia is dangerous in all three trimesters but comparatively 2" trimester is safestQ. Supine Hypotensive Syndrome : In late pregnancy (IIIrd Trim) circulatory depression occurs due to diminished venous return because of pressure of gravid uterus over inferior venacava in supine position.Q Best uterine relaxant is halothane, so uterine tetanic contractions are most rapidly treated by halothane.Q M.C. cause of death during G.A. in obstetrics is Mendelson's syndromeQ i.e. Aspiration of gastric content during anesthesia. On X-Ray, butterfly motteling in hilar area is seen. This is prevented by: - Empty stomach and H2 blockers - Esophageal Intubation - Secillik's maneuver i.e. backward pressure on cailage.Q Contraindications - Gallimanie is C/I as it crosses placenta. - Morphine is C/I until delivery as it causes respiratory depression in mother and baby. For respiratory depression of morphine or pathidine. Naloxane 0.01 mg/Kg is given through umbilical vein.


Question: The following anaesthetic drug causes pain on intravenous administration

Induction of anesthesia with propofol is often associated with pain on injection, apnea, hypotension, and, rarely, thrombophlebitis of the vein into which propofol is injected. Pain on injection is reduced by using a large vein, avoiding veins in the dorsum of the hand, and adding lidocaine to the propofol solution or changing the propofol formulation. Multiple other drugs and distraction techniques have been investigated to reduce the pain on injection of propofol. Pretreatment with a small dose of propofol, opiates, nonsteroidal antiinflammatory drugs, ketamine, esmolol or metoprolol, magnesium, a flash of light, a clonidine-ephedrine combination, dexamethasone, and metoclopramide all have been tested with variable efficacy. Ref: Millers anesthesia 8th edition.


Question: Longest acting among muscle relaxant is

Among the given options, only doxacurium is long acting(Refer: stoelting's pharmacology and physiology in anaesthetic practice ,5th edition ,pg no.139)


Question: Stage of surgical anesthesia during ether administration is

Guedel's classification is a means of assessing of depth of general anesthesia introduced by Ahur Ernest Guedel for Ether in1937. Stage I (stage of analgesia or disorientation) Stage II (stage of excitement or delirium) Stage III (stage of surgical anesthesia) plane I to IV Stage IV: from stoppage of respiration till death Stage III (stage of surgical anesthesia): from onset of automatic respiration to respiratory paralysis. It is divided into four planes: Plane I - from onset of automatic respiration to cessation of eyeball movements Plane II - from cessation of eyeball movements to beginning of paralysis of intercostal muscles Plane III - from beginning to completion of intercostal muscle paralysis. Plane IV - from complete intercostal paralysis to diaphragmatic paralysis Ref: Miller's anesthesia 8th edition Ref: Morgan & Mikhail's clinical anesthesiology 6e.

Regular respiration to cessation of breathing

Loss of Consciousness to beginning of regular respiration