1. Uterine Relaxant : Anaesthesia MCQ
Following drug/s reliably relax the uterus for procedures like internal podalic version, MRP, difficult breech extraction
Correct Answer: First f) NTG and then e) Halothane. Nitroglycerin is a most potent uterine relaxant. Halothane is another good alternative which can be used in such situations if anaesthesiologist is not confident with NTG and if patient is not haemodynamically stable. Efficacy and safety profile of IV-NTG give it advantages over amyl nitrate, magnesium sulphate or terbutaline.
2. CSF : Anaesthesia MCQ
The normal amount of CSF in a man is about
a) 50 cc
b) 100 cc
c) 150 cc
d) 200 cc
e) 250 cc
Correct Answer: c) 150 cc. Subarachnoid space around the brain and spinal cord can contain only 135 to 150 ml. CSF is produced at a rate of 0.2 – 0.7 ml per minute or 600-700 ml per day. Thus the CSF turns over about 3.7 times a day.
3. Lithium should b stopped how many days prior to Surgery ?
a) 2 days
b) 3 days
c) 5 days
d) 7 days
e) 14 days
Correct Answer: a) 2 days. Lithium’s direct effects cause hazardous risks in surgery. This is specifically true when haemodynamic instability occurs and renal excretion becomes impeded through interference with sodium and potassium metabolism. Therefore, lithium discontinuation is recommended. Lithium can be stopped at once because no withdrawal symptoms occur. Taking a half-life of 24–36 h into account, lithium should be discontinued 48 h before surgery. Lithium does not need to be stopped for minor surgery. If discontinued, lithium should be restarted 24 hours post-op.
4. Pulse Oximetry (Select False): Anaesthesia MCQ
a) the alarm should be set at an oxygen saturation of 85%
b) is affected by bilirubin
c) is inaccurate with an oxygen saturation less than 70%
d) is affected by incident light
e) is affected by carboxyhaemoglobin.
Correct Answer: a). Pulse oximeter alarm should not be set at an oxygen saturation of 85%.
5. Core Temperature : Anaesthesia MCQ
During a long operation, reliable monitors of core temperatures include (2 Correct Answers)
a) a temperature probe at the tympanic membrane
b) a temperature probe in the rectum
c) a quadriceps muscle temperature
d) a temperature probe in the nasopharynx
e) a temperature probe in the oesophagus at the level of the cricoid
Correct Answer: a and d. Temperature probe at the tympanic membrane and Temperature probe in the nasopharynx.
6. Cricoid pressure: Sellicks manoeuvre
The application of backward pressure on the cricoid cartilage to occlude the oesophagus. This manoeuvre prevents aspiration of gastric contents during induction of anaesthesia and in resuscitation of emergency victims when intubation is delayed or not possible.
a) Sallinger’s manoeuvre
b) Sellar’s manoeuvre
c) Sellicks manoeuvre
d) Seligman’s manoeuvre
e) Cellar’s manoeuvre
Correct Answer: c) Sellicks manoeuvre. The American Heart Association, until the 2010 science update, advocated the use of cricoid pressure during resuscitation using ambu bag, and during emergent oral endotracheal intubation; effective 2010, use of Cricoid Pressure is now discouraged; because of the lack of scientific evidence of benefit and possible complications.(AHA 2013). Application may in fact displace the esophagus laterally instead of compressing it as described by Sellick. Cricoid pressure may also compress the glottis, which can obstruct the view of the laryngoscopist and actually cause a delay in securing the airway.
7. Atropine : Anaesthesia MCQ
An elderly man given atropine becomes excited and confused; appropriate treatment is
c) Intubation and ventilation
Correct Answer: b) Physostigmine. Because it is a tertiary amine (and thus does not hydrogen bond, making it more hydrophobic), it can cross the blood–brain barrier, and is used to treat the central nervous system effects of atropine, scopolamine and other anticholinergic drug overdoses.
Physostigmine is the antidote of choice for Datura stramonium poisoning. It is also an antidote for Atropa belladonna poisoning, the same as for atropine. It can reverse undesired side effects of benzodiazepines such as diazepam, alleviating anxiety and tension.
8. Endotracheal Intubation : Anaesthesia MCQ
A medication widely used in emergency medicine and anesthesia to induce muscle relaxation, usually to make endotracheal intubation possible
Correct Answer: a) Suxamethonium. It is used to induce muscle relaxation and short-term paralysis, usually to facilitate tracheal intubation. It is sometimes used in combination with analgesics and sedatives for euthanasia and immobilization of horses. It is colloquially referred to as “sux” in hospital settings.
9. TURP syndrome : Anaesthesia MCQ
a) Associated with hypokalaemia
b) May present with convulsions
c) Prevented by spinal anaesthesia
d) Caused by blood loss
e) Requires treatment with diuretics
Correct Answer: b and e. Symptoms and signs are varied and unpredictable, and result from fluid overload and disturbed electrolyte balance and hyponatraemia. It is associated with hyperkalaemia.
10. Hysteroscopy : TURP Syndrome
A patient undergone transcervical resection of fibroids. Which particular blood tests should you be specifically worried about in postoperative period?
e) Increased serum osmolality
Correct Answer: c) Hyponatraemia. Absorption of large amounts of glycine is associated with hypervolaemia, hyponatraemia and reduced osmolality. The term was coined as TURP syndrome. The patient initially becomes restless, and complains of headache. Sodium levels below 120mEq/L cause cardiac depression. Level less than 115mEq/L is associated with bradycardia, widening of QRS complex and T inversion. Level below 105mEq/L is associated with respiratory and cardiac arrest. It is essential to log input versus output in transcervical resection of fibroid cases. A loss of more than 1.5 L is associated strongly with TURP syndrome.
11. Paraplegic : Anaesthesia MCQ
A man who is paraplegic because of a T4 injury is to undergo cystoscopy. A safe and effective management could be:
a) no anaesthesia
b) diazepam sedation
c) local analgesia to urethra
d) spinal (subarachnoid) block
e) thiopentone, nitrous oxide/oxygen, halothane general anaesthetic
Correct Answer: c or d or e. The autonomic reflexes (autonomic hyperreflexia) are of particular concern to the anaesthetist, as these are often initiated by surgical stimulation, in particular bladder distension.
Injuries above T6 are associated with special hazards including
blood pressure rises to dangerous levels, associated with bradycardia.
Spinal anaesthesia, converts the hyperreflexic spinal cord below the injury to the previous spinal shock pattern. Other methods include the use of potent intravenous hypotensive agents, or GA with volatile agent to damp down the response.
Without such a plan the patient is at risk of death from cerebral haemorrhage. It is difficult to be sure that the lesion of the cord is complete.
12. NBM : Nil by Mouth
Elective LSCS posted at 9 am. Woman was asked to be NBM overnight. She had one glass of water at 5 am in the morning.
a) Defer surgery by 2 hrs
b) Defer surgery by 4 hrs
c) Can do surgery at scheduled time with high risk of aspiration
d) Give all available aspiration prophylaxis medication and defer surgery by 1 hr.
e) Can do surgery at scheduled time without high risk of aspiration
Correct Answer: e) Allowing clear fluids upto 2hrs prior to surgery has been shown to decrease the gastric content volume so decreasing the risk of aspiration.
Even ASA ans ESA recommends encouraging to drink clear fluids up to 2h before elective surgery.
Many countries have, therefore, changed their fasting guidelines, allowing most patients take clear fluids as we have highest quality evidence (Level 1++) and recommendation (grade A).
ESA Guideline: Adults and children should be encouraged to drink clear fluids (including water, pulp-free juice and tea or coffee without milk) up to 2h before elective surgery (including caesarean section).
ASA Recommendations: It is appropriate to fast from intake of clear liquids at least 2 h before elective procedures requiring general anesthesia, regional anesthesia, orsedation/analgesia (i.e. Monitored anesthesiacare). The volume of liquid ingested is less important than the type of liquid ingested.
13. Failed Intubation : Anaesthesia MCQ
An emergency procedure only when a secure airway need to be maintained and attempts at orotracheal and nasotracheal intubation have failed.
Correct Answer: e) Cricothyroidotomy or Cricothyrotomy is usually done in an emergent situation. It is done through the cricothyroid membrane (through adam’s apple). Landmarks are easy to identify, and you avoid the vocal cords and the thyroid gland & associated vessels.
Tracheostomy is placed lower down in the trachea, between the tracheal rings. It is usually placed if someone is going to need the support of a ventillator for a long time. Cricothyrotomy is easier and quicker to perform than tracheotomy, does not require manipulation of the cervical spine, and is associated with fewer complications.
14. Post Spinal Headache : Anaesthesia MCQ
Headache after spinal anaesthesia (Select “TRUE”) (2 answers)
a) Is less likely with a 26G than with a 22G needle
b) Is due to an increase in cerebrospinal fluid pressure
c) Is unlikely to develop after 24 hours
d) May be accompanied by a 6th cranial nerve palsy
e) Is more frequent in the elderly
Correct Answer: a and d. Post-dural-puncture headache (PDPH) typically occurs hours to days after puncture. It is thought to result from a loss of cerebrospinal fluid into the epidural space. A decreased hydrostatic pressure in the subarachnoid space then leads to traction to the meninges with associated symptoms. The incidence of PDPH is higher with younger patients, and use of large diameter needles. Injuries of the fourth and sixth cranial nerves have been reported. Paralysis of the abducens nerve, which is the most commonly affected nerve. Intracranial hypotension causing traction of the cranial nerves.
15. Uterine Inversion : Anaesthesia MCQ
Immediately following normal delivery woman developed uterine inversion. Which of the following anaesthesia is best for the patient?
c) TIVA + IV-NTG
f) SA + Epidural
Correct Answer: c) TIVA + IV-NTG. NTG is highly potent uterine relaxant and short life is very short (1-3 min only). Although it causes tachycardia but the effect is very short. Halothane is less potent than IV-NTG. And sometimes one needs to intubate with Halothane. This was the actual case with 120 pulse before surgery. It was completed easily with IV-NTG and TIVA (Ketamine). 100Mcg bolus was given followed by 50 mcg twice and procedure was completed in 5 minutes.
16. When we should stop aspirin before any elective surgery ?
a) Stop 10 days before and restart 2 days after
b) Stop 7 days before and restart 2 days after
c) Stop 5 days before and restart 2 days after
d) Stop 3 days before and restart 2 days after
e) No need to stop, continue perioperatively
Correct Answer: e) Aspirin is recommended as a lifelong therapy that should never be interrupted for patients with cardiovascular disease. Because of the hypercoagulable state induced by surgery, early withdrawal of antiplatelet therapy for secondary prevention of cardiovascular disease increases the risk of postoperative myocardial infarction and death five- to 10-fold in stented patients who are on continuous dual antiplatelet therapy.
The present clinical data suggest that the risk of a cardiovascular event when stopping antiplatelet agents preoperatively is higher than the risk of surgical bleeding when continuing these drugs, except during surgery in a closed space (e.g., intracranial, posterior eye chamber) or surgeries associated with massive bleeding and difficult hemostasis.
17. Raw Opium : Anaesthesia MCQ
The following are constituents of raw opium EXCEPT
Correct Answer: a) Heroin also known as diamorphine is an opioid analgesic synthesized by adding two acetyl groups to the molecule morphine, which is found naturally in the opium poppy. Heroin itself is an inactive drug, but when inserted into the body, it converts into morphine.Prev Next
"Authored By Dr.Niraj Mahajan"
MD- Gynecologist, Laparoscopic Surgeon, Uro-gynecologist , Infertility specialist & Cosmetic Gynecologist.Read more [+]