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Laughing gas is | Humphry Davy coined the name "laughing gas" for nitrous oxide. Nitrous oxide, commonly known as laughing gas or nitrous, is a chemical compound, an oxide of nitrogen with the formula N2O. At room temperature, it is a colourless, non-flammable gas, with a slight metallic scent and taste. At elevated temperatures, nitrous oxide is a powerful oxidiser similar to molecular oxygen. It is soluble in water. Nitrous oxide is a weak general anaesthetic, and so is generally not used alone in general anaesthesia, but used as a carrier gas (mixed with oxygen) for more powerful general anaesthetic drugs such as sevoflurane or desflurane. It has a minimum alveolar concentration of 105% and a blood/gas paition coefficient of 0.46. The use of nitrous oxide in anaesthesia, however, can increase the risk of postoperative nausea and vomiting. Recreational inhalation of nitrous oxide, with the purpose of causing euphoria and/or slight hallucinations, began as a phenomenon for the British upper class in 1799, known as "laughing gas paies". In rats, N2O stimulates the mesolimbic reward pathway by inducing dopamine release and activating dopaminergic neurons in the ventral tegmental area and nucleus accumbens, presumably through antagonistic of NMDA receptors localised in the system. This action has been implicated in its euphoric effects and, notably, appears to augment its analgesic propeies as well. It is remarkable, however, that in mice, N2O blocks amphetamine-induced carrier-mediated dopamine release in the nucleus accumbens and behavioural sensitisation, abolishes the conditioned place preference (CPP) of cocaine and morphine, and does not produce reinforcing (or aversive) effects of its own. Effects of CPP of N2O in rats are mixed, consisting of reinforcement, aversion and no change. In contrast, it is a positive reinforcer in squirrel monkeys, and is well known as a drug of abuse in humans. These discrepancies in response to N2O may reflect species variation or methodological differences. In human clinical studies, N2O was found to produce mixed responses, similarly to rats, reflecting high subjective individual variability. | 1 | Nitrous oxide | Halothane | Chloroform | Diethylether | Anaesthesia | General anaesthesia | 37d49c49-8b4d-4d46-9c9b-a3233fa32ea5 | single |
Anaesthetic circuit that prevents rebreathing of CO2 | Different anaesthetic breathing circuits are Mapleson circuits and circle system. Circle system is a closed circuit, so called because it has inbuilt CO2 absorbers. It prevents rebreathing of exhaled air | 4 | Magil's circuit | Mapleson D circuit | Ayre's piece | Circle system | Anaesthesia | Anaesthetic equipments | 978accf4-8843-4840-82cd-69818910d389 | single |
Drug contraindicated in renal failure is | B i.e. Pethidine Meperidine (pethidine, demerol), a phenylpiperidine is metabolized chiefly in liver to nonmeperidine, which is eliminated by the kidney and liver. In patients or addicts who are tolerant to the depressant effects of meperidine, large doses repeated at sho interval may produce an excitatory syndrome including hallncination, tremors, muscle twitches, dilated pupils, hyperactive reflexes and convulsions. These excitatory symptoms are d/t accumulation of normeperidine, which has a half life of 15-20 hours, compared to 3 hours for meperidine. In patients with cirrhosis, the bioavailability of meperidine is --80% increased and t1/2 of both meperidine and normeperidine are prolonged. Since normeperidine is eleminated by kidney and liver, decreased renal or hepatic function predispose to neurotoxic effects of nor-meperidineQ. Meperidine is also not recommended for the treatment of chronic pain b/o concerns of metabolite toxicity. It should not be used for longer than 48 hours or in doses > 600 mg/day. Major pathway for morphine metabolism is conjugation with glucuronic acid forming morphine -6- glucuronide and morphine -3- glucuronide. Morphine-6-glucuronide is twice as potent as morphine with somewhat longer t1/2. (t1/2 of morphine is 2 hours) and pharmacological actions indistinguishable from those of morphine. With chronic morphine administration, the 6-glucuronide accounts for most of analgesia and its blood levels exceed those of morphine. Morphine-6-glucuronide is excreted by kidney, so its levels increase in renal failure, perhaps explaining morphine's potency and long action in compromised renal function. So in patients with renal failure decreased protein binding of morphine (resulting in higher plasma free drug level) and accumulation of morphine -6- glucuronide predispose them to respiratory depression. So morphine is given cautiously in low doses in renal failure. Respiratory depression is also repoed in patients with CRF receiving sufentanyl. Except for slightly decreased protein binding, the free drug volume of distribution and clearance of alfentanil appears to be unaffected by renal failure. Fentanyl, has sho half life and its metabolites are inactive. Therefore, it is a good choice in patients with renal diseaseQ. In renal disease (renal failure) remifentanil > fentanyl > alfentanil > sufentanil are safe. Whereas morphine (d/t morphine 6 glucoronide) 1/t respiratory depression is used very cautiously in low dose and meperidine (pethidine) is contraindicated d/t very long acting metabolite nor-meperidine causing neurotoxic excitatory syndrome. | 2 | Morphine | Pethidine | Fentanyl | Alfentanil | Anaesthesia | null | f5fac5f4-1023-4ba1-a8cd-80625f86d2dd | single |
Lumbar puncture was done in a patient with raised intracranial tension. The patient died suddenly on the table. The cause of the death is most likely to be | (B) Tentorial herniation # Lumbar puncture was done in a patient with raised intracranial tension. The patient died suddenly on the table. The cause of the death is most likely to be:- Tentorial herniation | 2 | Middle cerebral artery hemorrhage | Tentorial herniation | Rupture of an aneurysm | Loss of CSF | Anaesthesia | Miscellaneous | 9cfd5ca4-6af8-4235-ab10-3455e93e345b | single |
During induction of general anesthesia, administration of oxygen with high concentration of nitrous oxide and halothane hastens the uptake of halothane, this is known as | During induction ofgeneral anesthesia, when a large volume of a gas (nitrous oxide) is taken up from alveoli into pulmonary capillary blood, the concentration of gases remaining in the alveoli is increased. This results in effects known as the second gas effect. These effects occur because of the contraction of alveolar volume associated with the uptake of the nitrous oxide. this effect makes speed of induction fast | 3 | Fink effect | Concentration effect | Second gas effect | Third gas effect | Anaesthesia | Inhalational Anesthetic Agents | 40d4a2bf-0dd6-4978-85ec-81bcafa94b0f | single |
During G.A. shivering is abolished by suppression of | A i.e. Hypothalmus Temperature regulation during G.A. OWI Normally hypothalmus maintain core body temperatureQ (central blood temperature) within very narrow range (intehreshold range). Temperature of patient undergoing G.A. should be monitored (except for < 15 minutes procedure) by thermistor or thermocouple with a probe placed over tympanic membrane, rectum, nasopharynx, esophagus, bladder & skin. Hypothermia (ie body temperatureprotective during times of cerebral or cardiac ischemiaQ Raising body temperature induces vasodialation & sweating while hypothermia triggers vasoconstriction & shivering as compensatory mechanism. During G.A. body cannot compensate for hypothermia because anesthetics inhibit central thermoregulation by interfering with hypothalamic function.Q Spinal & epidural anesthesia also lead to hypothermia by vasodialation & internal redistribution of heat. The accompanying thermoregulatory impairment from regional anesthesia is due to an altered perception of temperature in bloacked dermatomes by hypothalmus as opposed to central effect of G.A. Postanesthetic shivering or shaking that is not related to hypehermia can be abolished by ceain opioids e.g. meperidine, butrophanol & tramadol (but not morphine). | 1 | Hypothalmus | Thalmus | Cerebral Coex | Medulla | Anaesthesia | null | 7b975b29-6a00-47c0-922f-52691d26da57 | single |
Shoest acting skeletal muscle relaxant is | Suxamethonium (succinylcholine) is the shoest acting skeletal muscle relaxantMivacurium is the shoest acting nondepolarizing skeletal muscle relaxant.(Refer: Morgan and Mikhail's Clinical Anaesthesiology, 5th edition, pg no.205-211) | 1 | Suxamethonium | Mivacurium | Pancuronium | Vecuronium | Anaesthesia | All India exam | 41503c68-c34f-4ea0-b58a-6f023a0264ed | single |
Most commonly used local anaesthetics | BupivacaineBupivacaine is 2nd most commonly used local anaesthetic (after lidocaine)Bupivacaine has the highest local tissue irritancy amongst local anaestheticsIt is the most cardiotoxic local anaestheticLevobupivacaine (The S(-) enantiomer of bupivacaine) is less cardiotoxic and less prone to cause seizureConcentrations used for bupivacaine are:- Nerve block :0.5%, epidural: 0.25-0.5% and spinal: 0.5% Maximum safe dose is 2mg/kg without adrenaline and 3mg/kg with epinephrine(Refer: stoelting's pharmacology and physiology in anaesthetic practice, 5th edition, pg no.294) | 2 | Dibucaine | Bupivacaine | Prilocaine | Tetracaine | Anaesthesia | All India exam | b030f822-ba34-43cc-98c2-f250975541c7 | single |
Nephrotoxic agent is | A i.e. Methoxy flurane | 1 | Methoxy flurone | Isoflurone | Halothane | N20 | Anaesthesia | null | ae0c08d1-8f64-49a0-8928-e03d32c53b3a | single |
Gas cylinder with single pin index | Entonox has an pin index number of 7 . Air - 1 , 5 ; Oxygen- 2 , 5 ; N20 - 3 , 5 . CO2 - 1 ,6 ; Cyclopropane - 3 , 6 ; Heliox - 4 , 6 . PIN index number is developed to prevent incorect cylinder attachment . | 4 | Oxygen | Air | Titrogen | Entonox | Anaesthesia | Anaesthetic equipments | cbea2c66-a701-499a-86c1-13a055a062f8 | single |
Levosimendan is approved in | Levosimendan is a calcium sensitizer -- it increases the sensitivity of the hea to calcium, thus increasing cardiac contractility without a rise in intracellular calcium.Has been approved for use in acute cardiac failure in EuropeKatzung 13e pg: 220 | 1 | Hea failure | Kidney failure | Liver failure | Endocrine crisis | Anaesthesia | Muscle relaxants | e2456f9a-7470-4e13-99fe-3176866d0a57 | single |
Malignant hyperthermia is | Malignant hyperthermia is autosomal dominant disease. It is characterized by metabolic acidosis and hyperkalemia.
i.v dantrolene infusion is used for treatment. | 2 | Autosomal recessive pharamacogenetic disease | Succinylcholine is a triggering agent | Metabolic alkalosis and hypokalemia | Calcium infusion is used for treatment. | Anaesthesia | null | 00d9efd9-cc33-4f14-8e6c-76eefaa1f408 | single |
Commonly used route of administration for general anaesthesia is | Ans. b (Intravenous). (Ref: Anesthesia by Ajay Yadav 2nd/pg. 71; KD Tripathi, 5th/pg. 342)INTRAVENOUS ANAESTHESIA# The most commonly used route of administration used for general anesthesia is IV for induction of anesthesia and inhalational agents are preferred for maintenance.# The most commonly used IV anesthetic agent for induction is thiopentone,# Ideal characteristics of IV anesthetics are- Compatible with other dugs- High therapeutic index- Inexpensive- Independent of liver/kidneys for metabolism/excretion- No toxic metabolites- Long shelf life and resistance to microbial contamination- Non-cumulative- Non-allergenic- No cardiopulmonary depression- No effect on cerebral blood flow- No endocrinologic effect- No pain on injection- Quick and smooth induction-recovery- Reversible with specific antagonist- Potent, so small volume is required for anesthetic induction/maintenanceIV Anesthetic agents:BarbituratesNon-barbituratesDissociatives- Oxybarbiturate - pentobarbital and methohexital- Thiobarbiturates - thiopental and thiamylal- Propofol- Etomidate- Alphaxalone- PropanididKetamineTiletamine | 2 | Inhalational | Intravenous | Intraarterial | Subcutaneous | Anaesthesia | General Anesthesia | d5c6d1c1-f794-4e57-9417-1be5128111aa | single |
Duration of action of Lidocaine with adrenaline | Duration of action of lidocaine with adrenaline is 2-3 hours. Adrenaline enhances both speed and quality of block, It also prolong effect of lignocaine and reduce the peak blood level and toxicity by reducing the local blood supply duration of action of lidocaine whithout adrenaline is 30-90min | 3 | 15-30 minutes | 30-60 minutes | 2-3 hours | 3-6 hours | Anaesthesia | Regional anaesthesia | 8d960f53-4590-43f8-835a-6f776efc76fa | single |
Percentage of hepatitis after halothane use | The first modern halogenated volatile anesthetic, halothane, was introduced in 1955. Clinical exposure to halothane is associated with two distinct types of hepatic injury. Subclinical hepatotoxicity occurs in 20% of adults who receive halothane. It is characterized by mild postoperative elevations in alanine aminotransferase and aspaate aminotransferase, but is reversible and innocuous. Anaerobic halothane reduction by CYP2A6 to a 2-chloro-1,1,1-trifluoroethyl radical is thought to mediate this mild hepatic injury. The fulminant form of hepatotoxicity, commonly known as halothane hepatitis, It is characterized by elevated alanine aminotransferase, aspaate aminotransferase, bilirubin, and alkaline phosphatase levels, and massive hepatic necrosis following the administration of halothane. Halothane hepatitis is rare (1 in 5000 to 35,000 administrations in adults), but is fatal in 50% to 75% of these cases. Because of the potential for fatal hepatitis, halothane is no longer used in adult patients in many countries. Halothane hepatitis is caused by a hypersensitivity reaction associated with the oxidative metabolism of halothane. The highly reactive trifluoroacetyl chloride metabolite of halothane oxidation can react with nearby liver proteins. In most patients who developed hepatic necrosis after halothane anesthesia, antibodies against TFA-modified proteins were detected, suggesting that the hepatic damage is linked to an immune response against the modified protein, which acts as a neoantigen. Accordingly, patients who develop halothane hepatitis often have a history of prior exposures to halothane or other volatile anesthetics, together with symptoms suggestive of immune reactivity, such as fever, rash, ahralgia, and eosinophilia. A current hypothesis is that TFA-protein adducts induce a cytotoxic T cell reaction in sensitized individuals, which leads to liver damage. However, the immune responses observed in halothane hepatitis might not mediate liver injury. Ref: Miller's anesthesia 8th edition Ref: Morgan & Mikhail's clinical anesthesiology 6e | 3 | 20% | 40% | 1 in 30000 | 1 in 3000 | Anaesthesia | General anaesthesia | f39377ef-8c1e-40b6-b421-ce9075dd95b6 | single |
Dissociative anaesthesia is produced by | Dissociative anaesthesia is characterized by profound analgesia, immobility, amnesia with light sleep and feeling of dissociation from once own body and the surroundings - Cataleptic stateKetamine (phencyclidine) induces dissociative anaesthesia.(Refer: stoelting's pharmacology and physiology in anaesthetic practice, 5th edition, pg no.294) | 1 | Ketamine | Etomidate | Propofol | Thiopentone | Anaesthesia | All India exam | 8e5d7def-3e49-47b7-83ca-bc1d5aff248c | single |
Maximum global warming is by | Desflurane is a greenhouse gasIt causes maximum global warmingGlobal warming potential (as an equal amount of CO2)Isoflurane210 timesSevoflurane510 timesDesflurane 1620 times (Refer: Morgan and Mikhail's Clinical Anaesthesiology, 5th edition, pg no. 170) | 1 | Desflurane | Isoflurane | Sevoflurane | Halothane | Anaesthesia | All India exam | 667a7c0d-40f9-4a33-81ee-6a03148ee24b | single |
Maximum safe dose of bupivacaine | Maximum safe dose of bupivacaine is 2 mg/kg with or without adrenaline. | 2 | 1 mg/kg | 2 mg/kg | 3 mg/kg | 5 mg/kg | Anaesthesia | All India exam | 082767e6-e33b-471e-b8df-1446467a032f | single |
Anaesthetic agent of choice in congenital heart disease with right to left shunt is | Ketamine being sympathomimetic causes raised left sided pressures, which obstructs shunt flow. | 4 | Thiopentone | Propofol | Etomidate | Ketamine | Anaesthesia | null | a701f10b-ba4f-4512-8fa2-92629238a880 | single |
Best antagonist of Morphine | Ans. is 'c' Naloxone T/t of choice for morphine poisoning is Naloxone (6 mg. IV) repeated every 3 min till respiration picks up) It is preferred due to no agonistic action and no respiratory depression. Nalorphine is given only when Naloxone not available | 3 | Pentazocine | Buprenorphine | Naloxone | Nalorphine | Anaesthesia | Miscellaneous General Anesthesia | 00f2a2ee-23ec-40d6-a80a-c6059c3292dc | single |
Least Cardiotoxic anaesthetic agent | B i.e. Isoflurane Isoflurane increases ICT but less than halothane & enflurane; which can be reversed by hyperventilation. So isoflurane is a preferable agent in raised ICT. Isoflurane is anaesthesia of choice (AOC) for neurosurgical procedureQ as it does not increase cerebral blood flow & CSF pressure. Of various inhalation agents available, isoflurane has the advantage of providing stability of cardiac rhythm & lack of sensitizention of the hea to exogenous & endogenous adrenalineQ. In coronary aery disease isoflurane should be avoided Wt coronary steel phenomenonQ. In ischemia of cardiac muscle selective vasodialation of vessels of Ischemic zone and maintained tone of non ischemic zone //t selective increase of blood supply to ischemic areas. But in coronary steal phenomenon (Isoflurane & Dipyridomole) there is dialation of vessels of non ischemic zone also so there is decrease of flow in ischemic zone.Q That is why isoflurane is avoided in ischemic hea disease. In Myocardial Infarction operation should be with held for 6 monthsQ. Goldman Index is for cardiac risk factor and when it is > 13 it is associated with poor prognosis. In hypeension, halothane is AOC (for hypotensive surgery) In hypovolumia, Light G.A. (preferably Ether and Cyclopropane) with IPPV is method of choice Isoflurane increases ICT but less than halothane & enflurane; which can be reversed by hyperventilation. So isoflurane is a preferable agent in raised ICT. Isoflurane is anaesthesia of choice (AOC) for neurosurgical procedureQ as it does not increase cerebral blood flow & CSF pressure. Of various inhalation agents available, isoflurane has the advantage of providing stability of cardiac rhythm & lack of sensitizention of the hea to exogenous & endogenous adrenalineQ. In coronary aery disease isoflurane should be avoided Wt coronary steel phenomenonQ. In ischemia of cardiac muscle selective vasodialation of vessels of Ischemic zone and maintained tone of non ischemic zone //t selective increase of blood supply to ischemic areas. But in coronary steal phenomenon (Isoflurane & Dipyridomole) there is dialation of vessels of non ischemic zone also so there is decrease of flow in ischemic zone.Q That is why isoflurane is avoided in ischemic hea disease. In Myocardial Infarction operation should be with held for 6 monthsQ. Goldman Index is for cardiac risk factor and when it is > 13 it is associated with poor prognosis. In hypeension, halothane is AOC (for hypotensive surgery) In hypovolumia, Light G.A. (preferably Ether and Cyclopropane) with IPPV is method of choice | 2 | Enflurane | Isoflurane | Sevoflurane | Halothane, Trilene, ketamine | Anaesthesia | null | 78604203-d384-446d-826c-e701bd41c001 | single |
Longest acting L.A | B i.e. Tetracaine | 2 | Bupivacaine | Tetracaine | Xylocaine | Procaine | Anaesthesia | null | 7c1db26f-e677-442a-95f1-f872ded8cfc4 | single |
Local anaesthetic acts by inhibition of | The nerve resting membrane potential is little affected by local anesthetics. As the concentration of local anesthetic applied to the nerve is increased, a decrease in the rate of depolarization and in the peak amplitude of the action potential occurs until the impulse is abolished. It is not possible, however, to derive data on the binding of local anesthetics to Na+ channels from measurement of the changes in nerve impulses. By using a "voltage-clamp" procedure, Na+ currents and their inhibition by local anesthetics can be directly assayed. When the membrane of isolated neurons is rapidly depolarized to a constant value, the time course of ionic currents is observed. Sodium currents during one initial depolarization are reduced by subclinical doses of local anesthetic (e.g., 0.2mM lidocaine) and totally abolished by clinical doses (e.g., 1% lidocaine, [?]40mM). If the test depolarization is applied repeatedly, for example, at frequencies higher than 5Hz (five pulses per second), the paially depressed (tonically inhibited) Na+ current is fuher reduced incrementally for each pulse until a new steady-state level of inhibition is reached. This frequency-dependent inhibition, also called phasic inhibition. Local anesthetics bind in the inner vestibule of the closed Na+ channel. Amino acid mutations in the S6 segments of D-1, D-3, and D-4 all modify local anesthetic action, thus suggesting either that these regions form a pharmacophore small enough to simultaneously contact the drug at three surfaces or that the local anesthetic molecule moves rapidly among these three segments. X - binding site of LA. Ref: Miller's anesthesia 8th edition Ref: Morgan & Mikhail's clinical anesthesiology 6e | 1 | Na channels | Mg channels | Ca channels | K channels | Anaesthesia | Fundamental concepts | 5e72fa22-530d-45a1-bc4b-b73c7cc1353e | single |
The inhalational agent of choice in children is | An inhaled induction of anesthesia with sevoflurane in oxygen with or without nitrous oxide is a common method used in children because it does not require IV access. IV induction is selected in children who already have IV access, who request an IV induction, or for whom an IV induction is indicated (full stomach, persistent gastroesophageal reflux disease, significant potential for cardiopulmonary compromise). The most common induction anesthetic in children is propofol 2 to 3 mg/kg Basics of Anaesthesia 7e pg: 603 | 2 | Methoxyflurane | Sevoflurane | Desflurane | Isoflurane | Anaesthesia | General anaesthesia | 379287f7-a871-4ca6-98d1-8e8d14649b9a | single |
Colour coding of halothane , isoflurane, sevoflurane and desflurane is respectively | null | 2 | red, purple, blue , yellow | red , purple, yellow , blue | red , yellow, purple, blue | red, blue , purple, yellow | Anaesthesia | Anesthesia Machine | 625228a2-8b47-4a48-8f37-5c6de40bde78 | single |
For anesthesiology mild Systemic disease Included in ASA grade | null | 4 | 1 | 3 | 4 | 2 | Anaesthesia | null | 90f31f42-a9bb-4c39-9328-c527ed333b26 | single |
Maximum dose of lignocaine with adrenaline is (in mg/ kg) | Ans. c (7). (Ref. Harrisons Medicine, 18th/735)LIGNOCAINE# Maximum safest dose 3 mg/kg or 200 mg and with adrenaline 7 mg/kg or 500 mg.# Duration of effect 45 to 60 min and with adrenaline it is 2-3 hours.# Should not be given in patients with history of malignant hyperthermia.# Concentration usedo Surface topical analgesia- 4%o As jelly, for urethra- 2%o Nerve blocks/epidural/infiltration block-- 1-2%o Spinal- 5%# Lignocaine is an amide# It is 4 times less potent than bupivacaine# Drug of choice for lignocaine-induced arrhythmia is bretylium tosylate (SGPGI 2002)# Repeated doses of 4-5 mL of 0.5% bupivacaine or 1% lignocaine are used to maintain epidural analgesia.# 'Transient neurological symptoms' is an disntinct side-effect of LignocaineEducational point:The baricity of the local anesthetic solution. Baricity is defined by the ratio of the density of the local anesthetic solution to the density of CSF. A solution with a ratio > 1 is hyperbaric and tends to sink with gravity within the CSF. An isobaric solution has a baricity of 1 and tends to remain in the immediate area of injection. A ratio < 1 is a hypobaric solution, which rises in the CSF. | 3 | 4 | 2 | 7 | 10 | Anaesthesia | Local and Regional Anesthesia | d86b98eb-c7ef-4052-ab4e-2b0c78dcdd58 | single |
Second gas effect is seen with | The second gas effect is a distinct phenomenon that occurs independently of the concentration effect. The ability of the large-volume uptake of one gas (first gas) to accelerate the rate of increase of the Pa of a concurrently administered companion gas (second gas) is known as the second gas effect. For example, the initial large volume uptake of nitrous oxide accelerates the uptake of companion gases such as volatile anesthetics and oxygen. Basics of Anaesthesia 7e pg: 99 | 2 | Ether | Nitrous oxide | Halothane | Isoflurane | Anaesthesia | General anaesthesia | 63e96e4e-910a-4a9c-aee3-fda2dbd05ac0 | single |
Concentration of adrenaline used with lignocaine | local anaesthetic + adrenaline (1:200000)
Fast onset
Less systemic toxicity
Prolonged duration | 4 | 0.180555556 | 1.430555556 | 1:20000 | 1:200000 | Anaesthesia | null | 20f8fae9-b3ad-4c99-9253-accfbff91537 | single |
For reduction of shoulder one of the following technique is appropriate | Interscalene approach: most intense at C5-C7 dermatomes and least intense at C8-T1(ulnar nerve area), most optimal for procedures on shoulderAxillary approach: most optimal for a procedure from elbow to hand | 2 | Spinal anesthesia | Interscalene block | Axillary brachial block | Bier block | Anaesthesia | Regional anaesthesia | 997217e9-3ce6-4588-a4a3-37abbb5c7249 | single |
Anesthetic agent (s) safe to use in TICP | B i.e. Thiopentone Anesthetic agents safe to use in raised intracranial pressure (ICP) are thiopentone, propofol & etomidateQ | 2 | Halothane | Thiopentone | Ketamine | Ether | Anaesthesia | null | 270e8637-7e7e-4078-a65a-6138e5e5bcdc | single |
Eutectic mixture of local anaesthetic (EMLA) cream is | Eutectic mixture of local anaesthetic (EMLA)This is unique topical preparation which can anaesthetize the intact skinIt is a mixture of 2.5% lidocaine and 2.5 prilocaineIt acts slowly and the cream must head in contact with the skin for at least 1 hourEMLA is used: to make venepuncture painless especially for children, and for the procedure like skin grafting & circumcisionAs systemic absorption of prilocaine can cause methemoglobinemia, EMLA should not be used on the mucocutaneous membrane or in very small child.(Refer: Morgan and Mikhail's Clinical Anaesthesiology, 5th edition, pg no. 754, 856) | 2 | Bupivacaine 2.0 + Prilocaine 2.5% | Lidocaine 2.5%+Prilocaine 2.5% | Lidocaine 2.5% + Prilocaine 5% | Bupivacaifne 0.5% + Lidocaine 2.55 | Anaesthesia | All India exam | 64967f5d-1d02-44f5-84cd-db884b4c49f0 | single |
The most impoant constituent in soda lime for reabsorption of CO2 in a closed circuit | Sodalime is most common Co2 absorbant . Indicators added to sodalime changes the color of sodalime . It contains 94% Ca(OH)2 , 5%NaOH,1% KOH. | 3 | Sodium hydroxide | Barium hydroxide | Calcium hydroxide | Potassium hydroxide | Anaesthesia | Anaesthetic equipments | 88e2cf55-87a1-4d8f-ad51-97f3be6759e3 | single |
Commonest complication of subclan venous puncture is | Pleura being in close proximity subclan cannulation has high incidence of pneumothorax other common problem is malposition of catheter due to its touous course. | 2 | Infection | Pneumothorax | Carotid aery puncture | Atrial perforation | Anaesthesia | Monitoring in Anesthesia | 492867fe-ec5c-46ee-84ac-ba1c389e5060 | single |
Cis atracurium is prefferd over atracurium due to advantage of aEUR' | No histamine release Cisatracurium is a stereoisomer of Atracurium Unlike atracurium cisatracurium does not produce a consistent dose dependent increase in plasma histamine -Atracurium triggers dose dependent histamine release that becomes significant at dose above 5mg/kg. - The release is dose dependent such that with increasing dose administered at the same rate there is greater propensity for eliciting histamine release. The histamine release resulted in:- - Flushing - Hypotension - Reflex tachycardia These effects are transient and the extent of hypotensive effect and reflex tachycardia were rarely of clinical significance. - Cisatracurium does not cause increase in histamine secretion, does not affect hea rate or blood pressure nor does it produce autonomic effects. Cisatracurium does not cause bronchospasmQ Atracurium use has been associated with bronchospasm and it should be avoided in patients with Asthma. To date cisatracurium has not been repoed to elicit bronchospasm at doses that are clinically prescribed Cisatracurium produces less laudanosineQ Laudanosine results from Hoffman elimination of Atracurium and cisatracurium Laudanosine may cause C.N.S. toxicity Cisatracurium produces less laudanosine Cisatracurium is 4 times as potent as Atracurium and produces less Laudanosine and has longer duration of intubation dose | 3 | >Rapid onset | >Sho duration of action | >No histamine release | Less cardiodepressant | Anaesthesia | null | 35c85a06-2289-4a6e-81fa-57d0605ffa19 | single |
Dexmedetomidine is | Dexmedetomidine is alpha 2 agonist, more sensitive than clonidine. It is used to produce conscious sedation. | 2 | Selective alpha 2 blocker | Agent of choice for conscious sedation | Less sensitive to alpha 2 receptors than clonidine | Good analgesic | Anaesthesia | null | 79e99245-a83c-4586-ad85-9503956afc34 | single |
Percentage of tetracaine used in eye surgery | Cataract surgery can be performed using topical anaesthesia alone. Tetracaine 0.5% and Lidocaine 4% can be used. Advantages of this method are that it avoids the potential complications with retrobulbar and peribulbar injections. Disadvantages include the potential for eye movement during surgery, increased patient anxiety, and discomfo from the microscope light.(Refer: stoelting's pharmacology and physiology in anaesthetic practice ,5th edition ,pg no.282-283) | 1 | 0.50% | 1% | 2% | 4% | Anaesthesia | All India exam | 5ef243be-ae7a-4771-b3f9-d0fdf12e3f22 | single |
In spinal anaesthesia the needle pierced upto | Ans. d (Subarachnoid space). (Ref. Harrisons, Medicine, 18th/735)SPINAL ANESTHESIA# The term "spinal anesthesia" was coined in 1885 by Leonard Corning.Technique of spinal anesthesia:# In spinal anaesthesia the spinal needle is pierced upto subarachnoid space where the anaesthetic agent is injected to produce the anaesthesia.# The selected level should be below LI in an adult and L3 in a child to avoid needle trauma to the spinal cord. As an anatomic landmark, the L3-L4 interspace is located at the line intersecting the top of the iliac crests. Either a midline or paramedian approach can be used.# The anatomic layers passed through include skin, subcutaneous structures, supraspinous ligament, interspinous ligament, ligamentum flavum, dura mater, and arachnoid membrane.# Once the needle tip is believed to be in the subarachnoid space, the stylet is removed to see if CSF appears at the needle hub. With small diameter needles (26 to 29 gauge) this generally requires 5 to 10 seconds, but may require >1 minute in some patients. Gentle aspiration may speed the appearance of CSF. If CSF does not appear, the needle orifice may be obstructed by a nerve root and rotating the needle 90 degrees may result in CSF flow. Alternatively, the needle orifice may not be completely in the subarachnoid space and advancing an additional 1 to 2 mm may result in brisk CSF flow. This is particularly true of pencil-point needles, which have their orifice on the side of the needle shaft proximal to the needle tip.# Finally, failure to obtain CSF suggests that the needle orifice is not in the subarachnoid space and the needle should be reinserted.# Common complications include hypotension, bradycardia, increased sensitivity to sedative medications, nausea and vomiting (possibly secondary to hypotension), postdural puncture headache, nerve injury, total spinal, and hematoma/abscess formation at the site of puncture.# Total spinal anesthesia results from local anesthetic depression of the cervical spinal cord and brain stem. Signs and symptoms include dysphonia, dyspnea, upper extremity weakness, loss of consciousness, pupillary dilation, hypotension, bradycardia, and cardiopulmonary arrest. Eaily recognition is the key to management. Treatment includes securing the airway, mechanical ventilation, volume infusion, and pressor support.# Absolute contraindications include local infection at the puncture site, bacteremia, severe hypovolemia, coagulopathy, severe stenotic valvular disease, infection at the site of the procedure, and intracranial hypertension. Relative contraindications include progressive degenerative (demyelinating) neurologic disease (multiple sclerosis), low back pain, and sepsis.# Intrathecal opioids:- Opioids produce intense visceral analgesia and may prolong sensory blockade without affecting motor or sympathetic function.- Fentanyl and sufentanil have a rapid onset of action and an effective duration greater than 6 hours.- Morphine lasts 6-24 hours.- Side effects include respiratory depression (which may occur late with hydrophilic agents), nausea, vomiting, pruritus, and urinary retention. | 4 | Subdural space | Extradural space | Epidural space | Subrachnoid space | Anaesthesia | Local and Regional Anesthesia | 5c230271-f1c6-4a71-9ccf-2955c8d5456c | single |
Total cerebral metabolic failure occurs at blood flow of | A i.e. 10 ml/100 gm/min | 1 | 10 m1/100 gm/min | 20 m1/100 gm/m1 | 30 m1/100 gm/min | 40 m1/100 gm/ml | Anaesthesia | null | a1ad0acf-01b2-4a86-8f0e-384d9355fb38 | single |
Anaesthetic agent that predisposes to maximum arrhhmias | Halothane-catecholamine sensitization also promotes abnormal automaticity of dominant and latent atrial pacemakers. These effects may produce premature ventricular contractions and arrhythmias originating from the His bundle. Intact sinoatrial node function reduces the incidence of epinephrine induced ventricular escape during halothane anesthesia and is protective against His bundle arrhythmias. Halothane and, to a lesser extent, other volatile anesthetics sensitize the myocardium to the arrhythmogenic effects of epinephrine. Sensitization is the interaction between volatile anesthetics and catecholamines that leads to reductions in the threshold for both atrial and ventricular arrhythmias. Halothane and, to a lesser extent, isoflurane may be arrhythmogenic in Purkinje fibers in experimental myocardial infarction by facilitating reentrant activity or increasing temporal dispersion of the refractory period recovery. Ref: Miller's anesthesia 8th edition Ref: Morgan & Mikhail's clinical anesthesiology 6e | 3 | Isoflurance | Enflurane | Halothane | Ether | Anaesthesia | General anaesthesia | f9f0eabb-d2a5-4f24-b509-93ecc05371e4 | single |
Least analgesic | C i.e. Halothane | 3 | N20 | Ether | Halothane | Cyclopropane | Anaesthesia | null | ca7d52c7-5259-4683-ba35-62d39247dcf8 | single |
Thiopentone is contraindicated in | Being an enzyme inducer (ALA synthetase) thiopentone precipitates porphyria. | 3 | Narcoanalysis | Neurosurgery | Acute intermittent porphyria | Induction of anaesthesia | Anaesthesia | null | cb504581-4769-4188-90b0-8a4b2e20f95f | single |
A 30 yr old man with paraplegia, the muscle relaxant should be avoided for tracheal intubation will be | Succinylcholine can cause hyperkalemia in paraplegic patients due to proliferation of extrajunctional receptor. Conditions causing susceptibility to succinylcholine-induced hyperkalemia in an order. Myopathies (eg, Duchenne's dystrophy) Spinal cord injury Encephalitis Stroke Guillain-Barre syndrome Severe Parkinson's disease Burn injury Massive trauma Severe intraabdominal infection Tetanus Hence the use of succinyl choline is avoided in all the above conditions. | 1 | Suxamethonium | Vecuronium | Rocuronium | Mivacurium | Anaesthesia | Neuromuscular Blocker | c59f9f2f-6101-419e-b6b4-9e466d96255e | single |
site of action of vecuronium is | Vecuronium is the non-depolarising neuromuscular blocker, acts on nicotinic receptors(Nm) at myoneural junction. | 4 | Cerebrum | Reticular formation | Motor neuron | Myoneural junction | Anaesthesia | Muscle relaxants | 877c0db2-dba0-4d41-aec4-ea0984853b96 | single |
Depth of anaesthesia can be best assessed by | Monitors used to assess depth of anesthesia: Electroencephalography (EEG) Bispectral index (BIS) Entropy Evoked responses (EP) - Motor EP, sensory EP (Auditory, visual, brain stem evoked potential) Patient safety index Narcotrend | 4 | Pulse oximeter | End tidal Pco2 | ABG analysis | Bispectral index | Anaesthesia | Monitoring in Anesthesia | 25a3189a-14ec-4748-89e1-68cfcdf35325 | single |
Anti pruritic property is seen with | Propofol has anti pruritic property. | 2 | Thiopentone | Propofol | Etomidate | Ketamine | Anaesthesia | null | 108e5590-53b9-4d43-83b3-6d06e55ab312 | single |
Safe inducing agent in malignant hyperpyrexia is | Propofol | 4 | Thiopentone | Etomidate | Halothane | Propofol | Anaesthesia | null | 8e07e0a0-cb16-46cc-aea9-c870878b84ca | single |
Local Anesthetic first used | Cocaine was the earliest used local anaesthesia(1st time used by Carl Koller in 1884 for occular surgery) cocaine is a naturaly occuring ester linked local anesthetic | 4 | Procaine | Lignocaine | Bupivacaine | Cocaine | Anaesthesia | Regional anaesthesia | 7b1edff7-f9d7-419a-8052-8445d99304f8 | single |
Aschners reflex is seen in | Aschners reflex is also called occulocardiac reflex. Aschners reflex is called oculocardiac reflex. The Oculocardiac reflex, also known as Aschner phenomenon, Aschner reflex, or Aschner-Dagnini reflex, is a decrease in pulse rate associated with traction applied to extraocular muscles and/or compression of the eyeball. The reflex is mediated by nerve connections between the ophthalmic branch of the trigeminal cranial nerve the ciliary ganglion, and the vagus nerve of the parasympathetic nervous system. Nerve fibres from the maxillary and mandibular divisionsof the trigeminal nerve have also been documented. These afferents synapse with the visceral motor nucleus of the vagus nerve, located in the reticular formation of the brain stem. The efferent poion is carried by the vagus nerve from the cardiovascular centerof the medulla to the hea, of which increased stimulation leads to decreased output of the sinoatrial node. This reflex is especially seen children, paicularly during strabismus correction surgery.However, this reflex may also occur with adults. Bradycardia,junctional rhythm and asystole, all of which may be life-threatening, can be induced through this reflex. This reflex has been seen to occur during many pan facial trauma surgeries due to stimulation of any of the three branches of trigeminal nerve. | 4 | Cardiac surgery | Neurosurgery | Spinal anesthesia | Squint surgery | Anaesthesia | Monitoring in Anesthesia | e8e28138-0885-45ad-9bab-b6af859623d0 | single |
Maximum duration of action is seen with | Non-depolarising blockers : Long acting (>50mins) : d-Tubocurare, Pancuronium, Doxacurium, Pipecuronium. Intermediate acting (20-50mins) : Vecuronium, Atracurium ,Cisatracurium, Rocuronium . Sho acting (<20mins) : Mivacurium,Rapacuronium. | 3 | Atracurium | Rocurium | Pancuronium | Rapacurium | Anaesthesia | Muscle relaxants | bb0ab310-66e7-4641-8d8c-07a572432390 | single |
Colour of O2 cylinder | D i.e. Black & White | 4 | Gray | Orange | Blue | Black & White | Anaesthesia | null | dd0513da-29b8-4054-8749-637bcf06e81a | single |
High air flow oxygen enriched devices | High air flow oxygen enriched devices are fixed performance devices and deliver constant concentration of oxygen. They require face masks with holes to enable high volumes of air to entrained. | 2 | Are variable performance devices | Deliver constant concentrations of oxygen | Require oxygen entrainment | Require closed face masks. | Anaesthesia | null | 070645fa-2c6c-456c-9850-3712cff82c17 | single |
Afferent nerve fibre affected by local anesthesia first | C i.e. Type C | 3 | Type A | Type Il - B | Type C | Type II | Anaesthesia | null | fa402eca-0d02-4396-b307-0d32ea825c70 | single |
Bone marrow depression is seen with chronic administration of | (Refer: Morgan and Mikhail's Clinical Anaesthesiology, 5th edition, pg no.163-168) | 2 | Isoflurane | N2O | Ether | Halothane | Anaesthesia | All India exam | a223166e-c26f-480b-9450-980a9395053f | single |
The most appropriate circuit for ventilating a spontaneously breathing infant during anaesthersia is | (Refer: Morgan and Mikhail's Clinical Anaesthesiology, 5th edition, pg no.33) | 1 | Jackson rees modification of Ayre's t piece | Mapleson a or magill'scircuint | Mapleson c or Waters to and fro canister | Bains circuit | Anaesthesia | All India exam | 8ae22f97-2d54-405a-a8a3-90574798f1a1 | single |
Anaesthesia breathing circuit recommended for spontaneous breathing is | TypeA or Magills circuit is used in Spontaneous ventilation. Type D is used in controlled ventilation. TypeB and Type C are obselete nowadays | 1 | Mapleson A | Mapleson B | Mapleson C | Mapleson D | Anaesthesia | Anaesthetic equipments | c403aa56-c462-44e1-af85-3a42285d2252 | single |
Hoffman's elimination is feature of | Ans. d (Atracurium) (Ref KDT 6th !345; Anaesthesia by Ajay yadav, 2nd ed., p. 90)The unique feature of atracurium is inactivation in plasma by spontaneous nonenzymatic degradation (Hofmann elimination) in addition to that by cholinesterases. Consequently its duration of action is not altered in patients with hepatic/renal insufficiency or hypodynamic circulation. It is the preferred muscle relaxant for such patients as well as for neonates and the elderly. Hypotension may occur due to histamine release.Cisatracurium, R-Cis, R-Cis enantiomer of atracurium is nearly 4 times more potent, slower in onset, but similar in duration of action. Like atracurium it undergoes Hofmann elimination, but in contrast it is not hydrolysed by plasma cholinesterase. Most importantly, it does not provoke histamine release.ATRACURIUM BESYLATE# Long acting and non-depolarising muscle relaxant.# Muscle relaxant of choice in renal failure or anephric patients.# pH of solution is 3.5.; Stored at 4degC.; Duration of action doubled at 25degC.# Metabolism mainly by Hofmann elimination (chemical degradation) and hydrolysis in plasma and elsewhere in body.# Major metabolite is laudanosine, which is CNS stimulant.# Cisatracurium is one of the ten isomers of atracurium and its active metabolites contain less laudanosine which causeless hypotension, central nervous system excitement, and seizures than that of atracurium.# It is considered an intermediate-acting agent in terms of duration of action.Notable features of Few muscle relaxantsPropertyMuscle relaxant (MR)Rapid onset of ActionShortest ActingLongest ActingSch (overall); Rocuronium (non-depolarising)Sch (overall); Mivacurium (non-depolarising)DoxacuriumExcreted in LiverRocuronium; VecuroniumNo placenta crossingd -TCHistamine released-TC (maximum) Atracuronium Mivacuronium SchLeast Histamine releaseVecuroniumMost CardiostableVecuroniumM.R. used to decrease BPd -TCM.R. Used to maintain BPPancuroniumM.R. Safe in asthmaVecronium; CisatracuroniumM.R. Causing epilepsyAtracurium; secondary LaunodocinM.R. Causing epilepsyCisatracurium; Atracurium | 4 | Pancuronium | Thiopentone | Vecuronium | Atracurium | Anaesthesia | Muscle Relaxant | 38b3a4c3-97cf-4503-a241-f0097fd5dbd5 | single |
Dose of Thiopentone used for induction is | C i.e. 5 mg/kg | 3 | 1 mg/kg | 2 mg/ kg | 5 mg/ kg | 10 mg/kg | Anaesthesia | null | 5629f0a7-e6ea-415f-9e9a-6cd2a0c236bf | single |
The most common cranial nerve involved in spinal anesthesia | cranial nerve VI is most commonly affected during spinal Anaesthesia. Dural puncture - a critical step in performing spinal anesthesia - was first introduced by Quinke in 1891, and sholy thereafter, Bier repoed the first case of post-dural puncture headache (PDPH). Bier proposed that ongoing leakage of cerebrospinal fluid (CSF) causes the headache, ie, leakage of CSF through the dural puncture site exceeds the rate of CSF production and results in low CSF pressure. Magnetic resonance imaging has confirmed that this leads to intracranial hypotension with descent of the brain, thereby causing traction of the sixth cranial nerve and pain-sensitive structures. The stretching of the nerve is thought to cause local ischemia as well as nerve dysfunction and can be seen in association with other signs of intracranial hypotension such as veigo, nausea, and vomiting. | 2 | 1 | 6 | 9 | 10 | Anaesthesia | Central Neuraxial Blockade | 1b45fcfd-7056-477e-a298-1c8da0d20d30 | single |
Foleys catheter 16 F means | 16 mm outer diameter | 2 | 16 mm inner diameter | 16 mm outer diameter | 16 mm circumference | 16 mm for 16 years old | Anaesthesia | null | d53beb4c-aa5d-4a52-b85f-7a5c6c1c2bbe | single |
Maternal supine hypotension syndrome can be minimized by | Removal of aortocaval compression with left-uterine displacement in patients undergoing general or regional anaesthesia, can minimize maternal supine hypotension. | 2 | Left-Hip elevation | Left-Uterine displacement | Regional anaesthesia | General anaesthesia | Anaesthesia | null | 84bb066b-b824-4fef-a5af-f95c54b93d40 | single |
An 8 year old child is brought to the emergency room with testicular torsion. The parents tell you that he ate sandwich 6 hours ago. Surgeon wants to operate immediately. Your response should be | Testicular torsion requires immediate investigation and possible surgery to preserve viable testis. | 2 | Wait for 2 more hours, deem it urgent, do rapid-sequence intubation | Take him to the OT, deem it emergent, do rapid-sequence intubation | He is adequately fasting, consider elective intubation | Wait for 2 hours, consider elective intubation | Anaesthesia | null | 27556f28-cce3-45a1-b569-d9e8a4c0c76b | single |
Shoest acting local anesthetic agent is | Classification Amide type Long acting * Bupivacaine * Levo-Bupivacaine * Ropivacaine * Dibucaine Intermediate acting * Lidocaine (lignocaine) * Mepivacaine * Prilocaine * Aicaine Ester type Long acting * Tetracaine (amethocaine) Intermediate acting * Cocaine Sho acting * Procaine * Chloroprocaine * Benzocaine * Proparacaine i.e. Procaine Ref: willer 10th ed. | 1 | Procaine | Lidocaine | Tetracaine | Bupivacaine | Anaesthesia | null | 1e2cea51-869e-40d5-a7d3-0c3e7af948d1 | single |
Arrange following structures as pierced by spinal needle during spinal block (from outside to inside) i) Interspinous ligaments ii) Ligamentum flavum iii) Supra spinous ligament iv) Epidural space | Structures as pierced by spinal needle during spinal block (from outside to inside): iii)Supra spinous ligament i) Interspinous ligaments ii) Ligamentum flavum iv) Epidural space | 3 | (i), (ii), (iii), (iv) | (ii), (iv), (i), (iii) | (iii), (i), (ii), (iv) | (ii), (iii), (i), (iv) | Anaesthesia | Regional Anesthesia | 46a54b7e-55b6-45f1-a18a-4643f96b2c28 | single |
A five year old is scheduled for strabismus surgery. As the surgeon grasps medial rectus muscle anesthesiologist carefully monitors the pulse. This is for | Aschners reflex is called oculocardiac reflex. TheOculocardiac reflex, also known asAschner phenomenon, Aschner reflex, or Aschner-Dagnini reflex, is a decrease in pulse rate associated with traction applied to extraocular muscles and/or compression of the eyeball. The reflex is mediated by nerve connections between the ophthalmic branch of the trigeminal cranial nerve the ciliary ganglion, and the vagus nerve of the parasympathetic nervous system. Nerve fibres from the maxillary and mandibular divisions of the trigeminal nerve have also been documented. These afferents synapse with the visceral motor nucleus of the vagus nerve, located in the reticular formation of the brain stem. The efferent poion is carried by the vagus nerve from the cardiovascular centerof the medulla to the hea, of which increased stimulation leads to decreased output of the sinoatrial node. This reflex is especially sensitive in neonates and children, paicularly during strabismus correction surgery.However, this reflex may also occur with adults. Bradycardia, junctional rhythm and asystole all of which may be life-threatening,can be induced through this reflex. This reflex has been seen to occur during many pan facial trauma surgeries due to stimulation of any of the three branches of trigeminal nerve. | 2 | Assessing the depth of anesthesia | Detecting Aschners reflex | Rule out ventricular dysrrhythmias | Detecting hypotension | Anaesthesia | Monitoring in Anesthesia | 90c2a5df-b166-41ef-a06a-b765b35389ae | single |
Indication for nasotracheal intubation is | It is the most common method used for giving anaesthesia in oral surgeries as it provides a good field for surgeons to operate.Other options are contraindications. | 1 | Oral surgeries | Coagulopathy | Basilar skull fractures | Maxillary fractures | Anaesthesia | Anaesthetic equipments | 112e2061-52cc-40aa-9f4b-e0d66f9ad086 | single |
Site of action of epidural analgesia | C i.e. Substantia gelatinosa Opoid receptors are maximum in Lamina 2 (substantia gelatinosa) Lamina 5 of spinal cord. So Epidural Narcotics acts mainly on substantia gelatinosa Common side effects of intraspinal/ epidural opioids are pruritis (itching), nausea - vomiting; urinary retention, sedation, ileus and dose dependent respiratory depression (most serious)Q | 3 | Sensory nerve endings | Ventral horn | Substantia gelatinosa | Coex | Anaesthesia | null | 11d019a4-5f67-45b1-9aba-7fe494a0991e | single |
The following combination of agents are the most preferred for short day care surgeries | Ans. is 'a' i.e. Propofol, fentanyl, isoflurane For day care surgery patients are sent back home the same day. Therefore you need agents which are rapidly eliminated so that no after effects are left. The agents used are-PropofolAlfentanilRemifentanilN2OIsofluraneSevofluraneDesflurane | 1 | Propofol, fentanyl, isoflurane | Thiopentone sodium, morphine, halothane | Ketamine, pethidine, halothane | Propofol, morphine, halothane | Anaesthesia | Miscellaneous General Anesthesia | a1cf6329-0e6c-43ef-8e03-1e63b7d04dfd | single |
Respiratory irritation is seen with | Trichloroethlyene | 3 | Ether | Halothane | Trichloroethlyene | Cyclopropane | Anaesthesia | null | f458a077-8a1d-4cd1-ad2c-350d39d2c25d | single |
Seen after tracheostomy | Tracheostomy decreases all three :- V/P ratio, dead space, resistance to air flow. | 3 | Inversion of V/P ratio | Increased V/P ratio | Decreased in dead space | Increased resistance of air flow | Anaesthesia | null | 9454c825-0c6d-4b01-93ef-982a74e433b2 | single |
Circuit of choice for controlled ventilation | Bains co-axial system is used in controlled ventilation.Fresh gas flow required to prevent rebreathing is 1.6MV. | 3 | Magill circuit | Type C | Type D | Type E | Anaesthesia | Anaesthetic equipments | 33f8abac-ca6f-4216-b76a-648faa231a2c | single |
Emergency tracheostomy is not indicated in | Emergency tracheostomy is not indicated in asthma. | 4 | Foreign body larynx | Bilateral vocal cord paralysis | Stridor due to laryngeal growth | Acute severe asthma | Anaesthesia | Preoperative assessment and monitoring in anaesthesia | 49c16a5a-0cb3-48cb-877c-b1fbe84f0298 | single |
The penaz technique | Penaz technique is a continuous non-invasive method of BP monitoring. Infra-red plethysmograph is mounted on the pneumatic cuff. | 2 | Is invasive | Uses plethysmography | Does not require a pneumatic cuff | Is suitable in presence of peripheral vascular disease | Anaesthesia | null | 2502c9b0-89d1-4bd3-be38-eded5311e5ed | single |
Gas stored in liquid form is | N20 is stored in blue steel cylinders as a colorless liquid under 745 psi pressure and is in equilibrium with the gas phase (approximately 50 atmospheres at room temperature). The tank maintains that pressure until it is empty. | 2 | Carbon dioxide | Nitrous oxide | Cyclopropane | Oxygen | Anaesthesia | General anaesthesia | f9699360-8d93-45e2-9bcf-5328f354190d | single |
Person with RYR1 receptor mutation should avoid | (A) Succinylcholine# Malignant Hyperthermia (MH) or Malignant Hyperpyrexia is a rare life-threatening condition that is usually triggered by exposure to certain drugs used for general anesthesia -- specifically the volatile anesthetic agents and succinylcholine, a neuromuscular blocking agent.> In susceptible individuals, these drugs can induce a drastic and uncontrolled increase in oxidative metabolism in skeletal muscle, which overwhelms the body's capacity to supply oxygen, remove carbon dioxide, and regulate body temperature, eventually leading to circulatory collapse and death if not immediately treated.> Susceptibility to MH is often inherited as an autosomal dominant disorder, for which there are at least 6 genetic loci of interest, most prominently the ryanodine receptor gene (RYR1).> MH susceptibility is phenotypically and genetically related to central core disease (CCD), an autosomal dominant disorder characterized both by MH signs and myopathy.> MH is usually revealed upon or shortly after exposure to certain general anesthetic agents.> There is no simple, straightforward test to diagnose the condition.> Treatment with Dantrolene and other drugs is usually initiated when MH is strongly suspected.> Dantrolene and the avoidance of triggering agents in susceptible people have markedly reduced the mortality from this condition. | 1 | Succinylcholine | Nitrous oxide | Lidocaine | Propofol | Anaesthesia | Miscellaneous | 8c875261-3ba6-43ab-9d74-c26a3a7cbb47 | single |
Pain Assessment Tool is best done by | (B) TachycardiaPAT - Pain Assessment ToolParameters012Posture/tone ExtendedDigits widespreadShoulders raised off bedFlexed and/or tenseFists clenchedTrunk guardingLimbs drawn to midlineHead and shoulder resist posturingCryNo YesWhen disturbedDoesn't settle after handlingLoudWhimperingWhiningSleep patternRelaxed Agirated or withdrawnWakes with startleEasily wokenRestlessSquirmingNo clear sleep/wake patternEye aversion "shut out"Expression FrownShallow furrowsEyes lightly closedGrimaceDeep furrowsEyes tightly closedPupils dilatedColorPink, well perfused Pale/dusky/flushed, Palmar swearingRespirations TachypneaArt restApneaAt rest or with handlingHeart rate TachycardiaAt restFluctuatingSpontaneous or at restOxygen saturationNormal Desaturation with or without handlingBlood pressureNormal Hypo-/hypertension at restNurse's perceptionNo pain perceived by me I think the baby is in painNote: Infants are assessed and scores obtained every 2 to 4 hours. An infant with a score > 5 requires comfort measures; >10 requires analgesia dose adjustment# Pain causes stress. The endocrine system reacts by releasing an excessive amount of hormones, ultimately resulting in carbohydrate, protein, and fat catabolism (destruction); poor glucose use; and other harmful effects. This reaction combined with inflammatory processes can produce weight loss, tachycardia, increased respiratory rate, fever, shock, and death. Unrelieved pain prolongs the stress response, adversely affecting the patient's recovery.> Cardiovascular system responds to stress of pain by activating the sympathetic nervous system, which produces a variety of unwanted effects.> In the postoperative period, these include hypercoagulation and increased heart rate, blood pressure, cardiac work load, and oxygen demand.> Aggressive pain control is required to reduce these effects and prevent thromboembolic complications.> Cardiac morbidity is the primary cause of death after anesthesia and surgery | 2 | Ask patient | Tachycardia | Tachypnea | Bradypnea | Anaesthesia | Miscellaneous | abe79175-df99-4942-98bc-9a5532ee3f70 | single |
Hepatitis can be a complication of ...... | Metabolic byproduct of halothane can cause autoimmune hepatitis. Halothane hepatitisis rare with an incidence of 1 per 35,000 cases but very fatal, with amoality of 50-75%. It is an immune mediated due to antibodies against highly reactive trifluoroacetyl chloride which is a metabolite of halothane. Risk factors for halothane hepatitis: Multiple exposures to halothane at sho intervals middle-aged obese women - because halothane undergo extensive metabolism in obese patients familial predisposition to halothane Another theory for halothane hepatitis is that it is caused by a hypersensitivity reaction associated with oxidative metabolism of halothane. The liver in halothane hepatitis shows centrilobular necrosis. In a patient with prior history of halothane hepatitis, inhalational induction agent of choice is Sevoflurane. Other points related to effect of halothane on hepatic system : Disrupts dual blood supply of liver ( Among all volatile anesthetic agent , it cause max decrease in hepatic flow) Contraindicated in Pre-existing liver days function C/I in hepatic surgery | 1 | Halothane | Enflurane | Methoxyflurane | Enflurane | Anaesthesia | Inhalational Anesthetic Agents | 1f2fbb5b-80d2-4437-a44e-c794a8681a78 | single |
Intraocular Pressure is lowered by A/E (or increased by) | A i.e. Ketamine | 1 | Ketamine | Morphine | Halothane | Thiopentane | Anaesthesia | null | d967e9ec-9d24-4638-bca4-a17d84cc4b21 | single |
The given device is used for | The device shown is a peripheral nerve stimulator, which delivers train of four stimulus to peripheral nerve (ulnar nerve) to assess adequacy of muscle relaxation. | 2 | To monitor depth of anaesthesia | To monitor adequacy of paralysis | To monitor temperature | To monitor expired carbon dioxide | Anaesthesia | null | 9fef8245-8333-4e66-8fe0-4478a2781bea | single |
Vasoconstriction is seen with | Ans. is 'b' i.e. cocaine All local anaesthetic cause vasodilation except for cocaine which causes vasoconstriction. | 2 | Lignocaine | Cocaine | Idiotocaine | Bupivacaine | Anaesthesia | Miscellaneous (Local and Regional Anesthesia) | 0f8cf124-90af-4008-ac1a-fc46ac08894a | single |
The anaesthetic agent that causes maximum increase in intracranial pressure is | By dilating cerebral vessels, halothane lowers cerebral vascular resistance and increases cerebral blood volume and CBF. Autoregulation, the maintenance of constant CBF during changes in aerial blood pressure, is blunted. Concomitant rises in intracranial pressure can be prevented by establishing hyperventilation before the administration of halothane. Cerebral activity is decreased, leading to electroencephalographic slowing and modest reductions in metabolic oxygen requirements. Ref: Miller's anesthesia 8th edition Ref: Morgan & Mikhail's clinical anesthesiology 6e | 2 | Isoflurane | Halothane | Enflurane | Desflurane | Anaesthesia | General anaesthesia | 6e5f7d29-7193-4fcb-b145-9ab9f453760e | single |
Best anaesthesia for status asthamaticus | B i.e. Ketamine | 2 | Thiopentone | Ketamine | Ether | N20 | Anaesthesia | null | c2d56954-1df3-4740-b92b-b33da9fd9707 | single |
Arrange the following the anticoagulant drug's last dose to be stopped before surgery in ascending order{time} 1)Clopidogrel 2)Ticlopidine 3)low molecular wt heparin 4)Warfarin | The following drugs has tobe continued on the day of surgery: Antihypeensive medications Cardiac medications (e.g.,b-blockers, digoxin) Antidepressants, anxiolytics, and other psychiatric medications Thyroid medications Anticonvulsantmedications Asthma medications. Steroids (oral and inhaled) Drugs that should be discontinued on the day of surgery Oral hypoglycemic agents NSAIDs - Discontinue 48 hours before the day of surgery Warfarin - Discontinue 4 days before surgery, except for patients having cataract surgery without a bulbar block. Sho acting Insulins except when given by a continuous pump Thienopyridines (e.g., clopidogrel, ticlopidine) except in cataract surgery, patients with metallic/drug eluting stents Aspirin in selected cases where reversal of platelet inhibition is necessary MAO Inhibitors - 2 weeks prior (MAO Inhibitors are usually continued.They should be discontinued if the patient and anesthesiologist factors are not orable to continue them) | 2 | 2>1>3>4 | 3>4>1>2 | 4>3>2>1 | 3>4>2>1 | Anaesthesia | Anaesthesia Q Bank | 2ce1c9e1-5bb9-426a-b350-bbc28cf9e02e | single |
The pulse oximetry reading is affected in | Pulse oximetry values can be erroneous in dark skin. But in all other cases it is normal. | 4 | Anemia | Jaundice | Red nail polish | Dark skin | Anaesthesia | null | 2770f161-919a-43df-bee9-e2132123e79c | single |
Malignant hypehermia is caused by | Ans. is 'a' i.e., Succinylcholine + halothane | 1 | Succinylcholine + halothane | Propranolol | Lidocaine | Bupivacaine | Anaesthesia | null | 86d28be8-e596-467b-ad3b-f9fd9a4d4496 | single |
Fulminant hepatic failure can be caused by | The first modern halogenated volatile anesthetic, halothane, was introduced in 1955. Clinical exposure to halothane is associated with two distinct types of hepatic injury. Subclinical hepatotoxicity occurs in 20% of adults who receive halothane. It is characterized by mild postoperative elevations in alanine aminotransferase and aspaate aminotransferase, but is reversible and innocuous. Anaerobic halothane reduction by CYP2A6 to a 2-chloro-1,1,1-trifluoroethyl radical is thought to mediate this mild hepatic injury. The fulminant form of hepatotoxicity, commonly known as halothane hepatitis, is characterized by elevated alanine aminotransferase, aspaate aminotransferase, bilirubin, and alkaline phosphatase levels, massive hepatic necrosis following the administration of halothane. Halothane hepatitis is rare (1 in 5000 to 35,000 administrations in adults), but is fatal in 50% to 75% of these cases. Because of the potential for fatal hepatitis, halothane is no longer used in adult patients in many countries. Halothane hepatitis is caused by a hypersensitivity reaction associated with the oxidative metabolism of halothane. The highly reactive trifluoroacetyl chloride metabolite of halothane oxidation can react with nearby liver proteins. In most patients who developed hepatic necrosis after halothane anesthesia, antibodies against TFA-modified proteins were detected, suggesting that the hepatic damage is linked to an immune response against the modified protein, which acts as a neoantigen. Accordingly, patients who develop halothane hepatitis often have a history of prior exposures to halothane or other volatile anesthetics, together with symptoms suggestive of immune reactivity, such as fever, rash, ahralgia, and eosinophilia. A current hypothesis is that TFA-protein adducts induce a cytotoxic T cell reaction in sensitized individuals, which leads to liver damage. However, the immune responses observed in halothane hepatitis might not mediate liver injury. Ref: Miller's anesthesia 8th edition Ref: Morgan & Mikhail's clinical anesthesiology 6e | 1 | Halothane | Isoflurane | Nitrous oxide | Phenobarbitone | Anaesthesia | Fundamental concepts | 8ca00678-1009-45dd-8419-a32a0735505c | single |
Absolute contraindication for Thiopentone sodium is\ | (B) Acute intermittent porphyria # ThiOPENTONE SODIUM - Contraindications: Thiopentone sodium is contraindicated in history of Barbiturate hypersensitivity.> Acute intermittent porphyria (cause LMN paralysis or CVS collapse); Anticipated airway obstruction.> Fixed cardiac output states> Shock, Hepatic/Renal dysfunction> Asthmatic/Myxoedema> Adrenocortical failure> Myotonia dystrophia> Extremes of age | 2 | Respiratory depression | Acute intermittent porphyria | Liver failure | Pregnancy | Anaesthesia | Miscellaneous | ec888df2-00b3-4843-bc06-eca2b21861e7 | single |
Ketamine is safe in | D i.e. Severe Shock | 4 | Raised ICT | Open eye injury | Ischemic hea disease | Severe shock | Anaesthesia | null | 5246fb47-b7f8-42d5-9c97-58816b386352 | single |
Position for orotracheal intubation | Flexing of cervical joint at neck approx. 25-30degrees and extension of atlanto -occipital joint (head) approx. 85-110degrees enables oropharyngeal, pharyngolaryngeal and laryngotracheal axis in one line that allows easy intubation -This position is called as SNIFFING POSITION. | 4 | Extension of neck and atlanto-occipital joint | Extension of only neck | Flexion of neck only | Flexion of neck and extension of atlanto-occipital joint | Anaesthesia | Anaesthetic equipments | 9d2d70b3-9ef0-43f9-9d09-005ff279d8fd | single |
Helium is used along with oxygen instead of plain oxygen because | Helium is used because it decreases the turbulence. | 2 | It increases the absorption of oxygen | It decreases turbulence | It decreases the dead space | For analgesia | Anaesthesia | Preoperative assessment and monitoring in anaesthesia | d574d9f6-903f-458c-a310-5d611f7a98cf | single |
Local anaesthetics act by | Effecting the Na+ channel | 2 | Effecting the spinal level | Effecting the Na+ channel | Effecting the K+ channel | Blocking axonal transpo | Anaesthesia | null | bf8a8361-42f1-4670-935b-e4bc39c2c2d5 | single |
A severely ill patient was maintained on an infusional anaesthetic agent. On the 2nd day he staed detiorating. The probable culprit may be | A i.e. Etomidate; B i.e. Propofol Increased infection and moality in a group of patients sedated with etomidate infusion in an ICU was associated with low coisol levelsQ and is attributed to etomidate induced supression of adrenal coisal synthesisQ. Etomidate is a dose dependent but reversible inhibitor of 11 - hydroxylase in the adrenal coex and is more potent than metyrapone. This enzyme is required for both mineralocoicoid and coicosteroid production. Minor adrenocoical supressive effects (i.e. impaired response to ACTH) follow induction doses or sho infusion doses. Propofol is not recommended for sedation of critically ill pediatric patients in ICU. The drug has been associated with higher moality d/t propofol infusion syndrome. Its essential features are metabolic acidosis, multiple organ failure, hemodynamic instability, hepatomegaly, and rhabdomyolysis. Very rarely, it may occur in adults, and in patients undergoing long term propofol infusion (> 48 hours) for sedation at high doses (>5 mg/ kg/ hr). | 1 | Etiomidate | Propofol | Opioid | Barbiturate | Anaesthesia | null | e962ef84-10de-4473-a0b5-8f0f013f6408 | single |
Plan C of anesthetic airway management is | C i.e. Inseion of laryngeal mask airway& fibrotic bronchoscopy American Society of Anesthsiologist (ASA) developed practice guidelines & an algorithm that involves four plans: Plans A, B, C, and D, which go in sequence. | 3 | Standard laryngoscopy & intubation | Intubation catheter guided intubation | Inseion of laryngeal mask airway & fiberoptic bronchoscopy | Cancel the surgery or perform tracheostony | Anaesthesia | null | 238970c8-609d-42bb-a37b-45b2b9c6be81 | single |
Not an intravenous anaesthetic | Ans. is 'd' i.e., Cyclopropane | 4 | Etomidate | Thiopentone | Ketamine | Cyclopropane | Anaesthesia | null | 33bda780-b06c-4af4-b00a-8960c9ac3535 | single |
Shoest acting muscle relaxant | MivacuriumMivacurium is the shoest acting competitive blockersIt does not need reversal -can be used as an alternative to SCh for endotracheal intubationIt is metabolized rapidly by plasma cholinesterases -prolonged paralysis can occur in pseudocholinesterase deficiency Mivacurium is the only nondepolarising (competitive) blocker that is metabolized by plasma cholinesterase (pseudocholinesterase).(Refer: stoelting's pharmacology and physiology in anaesthetic practice, 5th edition, pg no.328) | 3 | Pancuronium | Atracurium | Mivacurium | Vecuronium | Anaesthesia | All India exam | a4470496-0877-4c50-8993-0ab8233a80fd | single |
Depth of anesthesia can be best assessed by | Ans. d (Bispectral Index) (Ref. CSDT 12th/pg. Chapter 11 & Anaesthesia by Ajay Yadav, 2nd/pg. 45)MONITORING THE DEPTH OF ANESTHESIA# The Bispectral Index is a monitor that can be used in many cases to assess anesthetic depth.# It is measured from superficial scalp electrodes and is a processed electroencephalogram.# It is possible that this type of monitoring approach will be increasingly used to assess anesthetic depth.# A Bispectral index (BIS) monitor is a modern neurophysiological monitoring device which continually analyses a patient's electroencephalogram during general anesthesia to assess the level of consciousness during anesthesia.# The "depth of anesthesia" is commonly used as a surrogate for "the likelihood of forming experiences or memory."# BIS is therefore best described as a monitor of the depth of the hypnotic component of anesthesia or sedation.# BIS demonstrates a dose-response relationship with inhalational and hypnotic intravenous agents, such as propofol and midazolam, which is independent of the agent(s) being used and correlates with clinical assessments of the level of consciousness.# Ketamine, however, causes EEG activation, complicating BIS interpretation. | 4 | Pulse oximeter | End-tidal PCO2 | Acid blood gas analysis | Bispectral index | Anaesthesia | Fundamental Concepts | e8cf3e05-02fd-4219-8f2a-71fed5681eed | single |
Pin index for Air is | PIN index number prevents wrong fitting of the cylinders . AIR - 1 ,5 02 - 2 ,5 N20 - 3 ,5 CO2 - 1 ,6 ; 2,6(Liquid) Cyclopropane 3 ,6 Entonox 7 | 4 | 1,4 | 2,5 | 5 | 1,5 | Anaesthesia | Anaesthetic equipments | 2478f7b6-12f0-4611-90fe-e6a94f7c6995 | single |
Best to monitor intraoperative myocardial ischemia (infarction) is | C i.e. Transesophageal echocardiography Tranoesophageal echocardiography provides a real time picture of all 4 cardiac chambers and valves. It can identify any malfunctioning valves in addition to any wall motion abnormalities related to myocardia ischemia. It is very useful during anesthesia. Abnormal motion of ventricular wall detected in this way is a reliable index of myocardial ischemia and may guide drug therapy, can identify if therapy has successfully treated the ischemia or indicate the need for fuher surgical revascularization CVP (catheer in central vein) measures right sided filling pressure whereas pulmonary aery catheter measures/monitors left hea filling pressure. Aerial cannulation measures direct systemic aerial pressure and facilitate sampling of aerial blood for analysis. | 3 | ECG | CVP monitoring | Transesophageal echocardiography | Invasive intracarotid aerial pressure | Anaesthesia | null | 2dad33e6-9207-4b2d-9b86-9aeff829c381 | single |
Administration of scoline (Sch) produces dangerous hyperkalemia in | Sch can cause dangerous hyperkalemia in burn, massive trauma, Crush injury ,Severe intraabdominal infection(sepsis),spinal cord injury, hemiplegia / paraplegia, muscular dystrophy ,GB syndrome, Rhabdomyolysis, Myasthenia Gracia, tetanus, severe parkinsonism,polyneuropathy,closed head injury, stroke ,encephalitis. Ref: Morgan 4th/e p214. | 4 | Acute renal failure (ARF) | Raised ICT | Fracture femur | Paraplegia | Anaesthesia | Muscle relaxants | 1ff2de69-e66e-481c-9df0-96595855c010 | single |
Fasciculations are caused by | Ans. a (Scoline). (Ref. KD Tripathi, Pharamacology, 6th ed., 150)SUXAMETHONIUM CHLORIDE OR SUCCINYL CHOLINE (SCOLINE)Introduction- It is a short acting muscle relaxant.- It is a phase II blocker.- Depolarising muscle i.e. depolarising block at motor end-plate.- It is dichlor ester of succinic acid.- The action lasts for 3-5 minutes.- Action is prolonged in liver disease.- Metabolised by pseudocholinesterase.- It gives good intubating condition in shortest time (less than one minute).Uses- Endotracheal intubation in dose of 1 to 2 mg/kg body weight.- To modify electroconvulsive therapy.- For procedures requiring short duration relaxation.- Excellent for operative abet and caesaerian section.Side effects(Mnemonic=ABRHAM on FTV)- Apnoea (Prolonged),- Bradycardia,- Raised intraocular pressure- Hyperkalemia- Ache (Myalgia/ Post-operative muscle ache)- Malignant hyperpyrexia- Fasciculation,- Tachyphylaxis- Ventricular fibrillationIts S/E can be prevented by- Self-taming with 10 mg suxamethonium given a minute before induction of an anaesthesia.PrecurarizationAlso remember:# Malignant hyperpyrexia:- It is due to release of Ca++ from sarcoplasmic reticulum in sensitive person- It can be caused also bya) Halothane,b) Methoxyflurane andc) Isoflurane- Rx- dantrolene.- Dantrolene is muscle relaxant acting directly on muscle. {MH 2006) | 1 | Scoline | Ketamine | Halothane | Atracurium | Anaesthesia | Muscle Relaxant | 889d7522-a081-4024-ad90-38873c42d2c8 | single |