AdaptLLM/med_knowledge_prob · Datasets at Hugging Face

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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.	1	Ulnar nerve	Facial nerve	Radial nerve	Median nerve	Anaesthesia	Fundamental Concepts	04684bf0-0934-40b2-b791-e4ae7fc6e4d9	single
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 .	4	1,6	2,5	2,6	3,5	Anaesthesia	Anaesthetic equipments	820d98b2-28ec-4190-821f-84f776a06648	single
'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	1	Malassezia furfur	Trichophyton rubrum	Aspergillus fumigatus	Nocardia versicolor	Anaesthesia	Anaesthesia of special situations	53b8064c-a0aa-4894-bb93-8efe061cd910	single
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	1	Cardiac arrest	Pulmonary hypeension	Malignant hypehermia	Malignant extubation	Anaesthesia	Preoperative assessment and monitoring in anaesthesia	2db1c2e5-b953-4cee-9242-a5a3d02ad2e0	single
A very high PEEP results in	Hypotension is due to diminished central venous blood return to the heart secondary to elevated intrathoracic pressures.	3	Hypertension	Hypothermia	Hypotension	Hyperthermia	Anaesthesia	null	fee5ff1b-6dbd-4a79-a223-b22fffe657c0	single
Best antagonist of morphine is	B i.e. Naloxone	2	Nalorphine	Naloxone	Buprenorphine	Pentazocine	Anaesthesia	null	090a4816-c3f1-48ca-bc32-acf9749a2022	single
The bronchoscope is best sterilized with	A fiberoptic scope like bronchoscope, the flexible laryngoscope should be sterilized with 2% glutaraldehyde.	2	Ethylene oxide	2% Glutaraldehyde	Betadine	Infrared radiation	Anaesthesia	Anaesthetic equipments	5933d065-db0a-4e2d-bc71-69df5d9290aa	single
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	4	Angle of mandible	C7 transverse process	Cricoid cailage	Great cornua hyoid bone	Anaesthesia	JIPMER 2018	53127722-9677-4ea2-9656-976b7a5c620a	single
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.	4	Oxygen tension will be overstimulated in hypothermia	pH is a derived measurement	Standard bicarbonate can be used to indicate the respiratory component	The oxygen tension can be measured using Clarke electrode.	Anaesthesia	null	b5037b8f-8b3b-4937-849b-8c0d7a509503	single
The following is the anesthetic of choice in status asthamaticus	Ketamine	3	Thiopentone	Althesin	Ketamine	Barbiturate	Anaesthesia	null	8e7c25fb-54fb-4999-8d6d-48a431192008	single
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	4	Black with white shoulders	White with black shoulders	Grey	Blue	Anaesthesia	Anaesthetic Equipments	2ac10b4f-5334-439a-a90f-39c283ec8a19	single
The circled part of given capnograph reflects	This is phase 3 which represents only alveolar air.	2	Inspiration	Alveolar air	Mixed air	Dead space air	Anaesthesia	null	afc3320f-dc16-42bc-90d4-0ba5f14e8bab	single
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)	2	S1-3	S2-4	S3-5	S4,5	Anaesthesia	All India exam	410b0c7a-c75d-4391-a224-7b3290f350b4	single
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	3	2, 5	1, 5	3, 5	2, 6	Anaesthesia	Fundamental concepts	8e02ddd3-7f83-4d2d-aa1e-4da2403c621f	single
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.	2	PEEP and FiO2	Tidal volume and respiratory rate	PEEP and respiratory rate	Tidal volume and PEEP	Anaesthesia	null	a10231ff-3aa3-4fb6-9021-bcb47e35d857	single
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)	4	Lignocaine	Etidocaine	Bupivacaine	Chloroprocaine	Anaesthesia	All India exam	c10dae90-b293-4bbd-af23-abd32cec4170	single
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)	2	Prolong action of LA in hypeensive patients	Sedative agent for intubated patients	Increases bioavailability of regional anaesthetic drug	Helps in reducing bispictral index of general anaesthetic drug with low potency	Anaesthesia	All India exam	68b69fb2-ae71-4d99-974f-ae7a13e137d9	single
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 .	2	Didanosine	Laudanosine	Methylated Atracurium	Sulfated Atracurium	Anaesthesia	Muscle relaxants	40b73a47-7f51-4376-8d64-581eda90be65	single
Epidural narcotic is preferred over epidural LA because it causes	C i.e. No motor paralysis	3	Less respiratory depression	Less dose is required	No motor paralysis	No retention of urine	Anaesthesia	null	2b9d7d5b-69d1-456d-a217-37a956b4c34c	single
Curare notch seen in capnograph is due to	With return of spontaneous ventilation, curare notch is seen in capnograph.	3	Carbon dioxide rebreathing	Bronchospasm	Spontaneous breathing	Valve malfunction	Anaesthesia	null	7cf0a407-01b8-4a50-aa7d-bf6d33c58c25	single
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	3	Ether	Halothane	Ketamine	Thiopentone	Anaesthesia	Miscellaneous	5defeaaf-45bb-44a1-b6e7-6157c19df3f9	single
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	4	2 mm	4 mm	6 mm	9 mm	Anaesthesia	Anaesthetic equipments	3e5c59bd-8c72-44d5-b2d9-3f0bdba8d9ad	single
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.	2	Bupivacaine	Lignocaine	Prilocaine	Chloroprocaine	Anaesthesia	Regional Anesthesia	02d1c019-862d-4660-9122-7c3be9fdca0c	single
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.	2	Teratoma	Neurogenic tumor	Thymoma	Lymphoma	Anaesthesia	null	853d2b37-b798-43c2-9068-b0d6af805153	single
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	2	Bradycardia	Hypotension	Seizures	Retroperitoneal hematoma	Anaesthesia	Regional Anesthesia	47c4dc77-e3a6-4a0a-bdfb-2304dda958c4	single
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)	1	Ketamine	Propofol	Etomidate	Thiopentone	Anaesthesia	All India exam	3bb97968-79d9-446d-9ee5-7db914c9b60c	single
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.	3	GABA action, calcium channel block and free radicle removal	Increased cerebral blood flow	Decreased (lowered) cerebn metabolism	Reduces cerebral 02 demand by limiting CBF	Anaesthesia	null	65e809f2-86cd-48d4-9f63-5ed398e1ddc5	single
Stages of anaesthesia were described by Guedel with	Ether	1	Ether	Chloroform	N20	Halothane	Anaesthesia	null	507230a0-5323-4180-87d7-bc57b5ab1f0a	single
Not intravenous Anasthetic agent	D i.e. Cyclopropane	4	Ketamine	Thiopantone	Etomidate	Cyclopropane	Anaesthesia	null	7f2cf9d8-4c80-4c60-a04d-a515fdbebe0c	single
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.	1	GA	Spinal	Epidural	Para Cervical	Anaesthesia	null	df8f5d0d-f1a0-44c7-beaa-2f3f58a9f420	single
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.	2	Midazolam	Propofol	Ketamine	Thiopentone sodium	Anaesthesia	General anaesthesia	8ecb2f2e-4f2e-43be-a622-52842c4fcc28	single
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)	1	Doxacurium	Rocuronium	Vecuronium	Atracurium	Anaesthesia	All India exam	fc4eb6f4-e1d1-41ff-8792-193d4fcf9e97	single
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.	3	Loss of Consciousness	failure of circulation	Regular respiration to cessation of breathing	Loss of Consciousness to beginning of regular respiration	Anaesthesia	General anaesthesia	05efacf2-26c7-4fc5-acb0-75a922638a3b	single

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.

1

Ulnar nerve

Facial nerve

Radial nerve

Median nerve

Anaesthesia

Fundamental Concepts

04684bf0-0934-40b2-b791-e4ae7fc6e4d9

single

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 .

4

1,6

2,5

2,6

3,5

Anaesthesia

Anaesthetic equipments

820d98b2-28ec-4190-821f-84f776a06648

single

'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

1

Malassezia furfur

Trichophyton rubrum

Aspergillus fumigatus

Nocardia versicolor

Anaesthesia

Anaesthesia of special situations

53b8064c-a0aa-4894-bb93-8efe061cd910

single

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

1

Cardiac arrest

Pulmonary hypeension

Malignant hypehermia

Malignant extubation

Anaesthesia

Preoperative assessment and monitoring in anaesthesia

2db1c2e5-b953-4cee-9242-a5a3d02ad2e0

single

A very high PEEP results in

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

3

Hypertension

Hypothermia

Hypotension

Hyperthermia

Anaesthesia

null

fee5ff1b-6dbd-4a79-a223-b22fffe657c0

single

Best antagonist of morphine is

B i.e. Naloxone

2

Nalorphine

Naloxone

Buprenorphine

Pentazocine

Anaesthesia

null

090a4816-c3f1-48ca-bc32-acf9749a2022

single

The bronchoscope is best sterilized with

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

2

Ethylene oxide

2% Glutaraldehyde

Betadine

Infrared radiation

Anaesthesia

Anaesthetic equipments

5933d065-db0a-4e2d-bc71-69df5d9290aa

single

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

4

Angle of mandible

C7 transverse process

Cricoid cailage

Great cornua hyoid bone

Anaesthesia

JIPMER 2018

53127722-9677-4ea2-9656-976b7a5c620a

single

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.

4

Oxygen tension will be overstimulated in hypothermia

pH is a derived measurement

Standard bicarbonate can be used to indicate the respiratory component

The oxygen tension can be measured using Clarke electrode.

Anaesthesia

null

b5037b8f-8b3b-4937-849b-8c0d7a509503

single

The following is the anesthetic of choice in status asthamaticus

Ketamine

3

Thiopentone

Althesin

Ketamine

Barbiturate

Anaesthesia

null

8e7c25fb-54fb-4999-8d6d-48a431192008

single

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

4

Black with white shoulders

White with black shoulders

Grey

Blue

Anaesthesia

Anaesthetic Equipments

2ac10b4f-5334-439a-a90f-39c283ec8a19

single

The circled part of given capnograph reflects

This is phase 3 which represents only alveolar air.

2

Inspiration

Alveolar air

Mixed air

Dead space air

Anaesthesia

null

afc3320f-dc16-42bc-90d4-0ba5f14e8bab

single

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)

2

S1-3

S2-4

S3-5

S4,5

Anaesthesia

All India exam

410b0c7a-c75d-4391-a224-7b3290f350b4

single

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

3

2, 5

1, 5

3, 5

2, 6

Anaesthesia

Fundamental concepts

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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.

2

PEEP and FiO2

Tidal volume and respiratory rate

PEEP and respiratory rate

Tidal volume and PEEP

Anaesthesia

null

a10231ff-3aa3-4fb6-9021-bcb47e35d857

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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)

4

Lignocaine

Etidocaine

Bupivacaine

Chloroprocaine

Anaesthesia

All India exam

c10dae90-b293-4bbd-af23-abd32cec4170

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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)

2

Prolong action of LA in hypeensive patients

Sedative agent for intubated patients

Increases bioavailability of regional anaesthetic drug

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

Anaesthesia

All India exam

68b69fb2-ae71-4d99-974f-ae7a13e137d9

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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 .

2

Didanosine

Laudanosine

Methylated Atracurium

Sulfated Atracurium

Anaesthesia

Muscle relaxants

40b73a47-7f51-4376-8d64-581eda90be65

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Epidural narcotic is preferred over epidural LA because it causes

C i.e. No motor paralysis

3

Less respiratory depression

Less dose is required

No motor paralysis

No retention of urine

Anaesthesia

null

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Curare notch seen in capnograph is due to

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

3

Carbon dioxide rebreathing

Bronchospasm

Spontaneous breathing

Valve malfunction

Anaesthesia

null

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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

3

Ether

Halothane

Ketamine

Thiopentone

Anaesthesia

Miscellaneous

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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

4

2 mm

4 mm

6 mm

9 mm

Anaesthesia

Anaesthetic equipments

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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.

2

Bupivacaine

Lignocaine

Prilocaine

Chloroprocaine

Anaesthesia

Regional Anesthesia

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single

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.

2

Teratoma

Neurogenic tumor

Thymoma

Lymphoma

Anaesthesia

null

853d2b37-b798-43c2-9068-b0d6af805153

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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

2

Bradycardia

Hypotension

Seizures

Retroperitoneal hematoma

Anaesthesia

Regional Anesthesia

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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)

1

Ketamine

Propofol

Etomidate

Thiopentone

Anaesthesia

All India exam

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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.

3

GABA action, calcium channel block and free radicle removal

Increased cerebral blood flow

Decreased (lowered) cerebn metabolism

Reduces cerebral 02 demand by limiting CBF

Anaesthesia

null

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Stages of anaesthesia were described by Guedel with

Ether

1

Ether

Chloroform

N20

Halothane

Anaesthesia

null

507230a0-5323-4180-87d7-bc57b5ab1f0a

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Not intravenous Anasthetic agent

D i.e. Cyclopropane

4

Ketamine

Thiopantone

Etomidate

Cyclopropane

Anaesthesia

null

7f2cf9d8-4c80-4c60-a04d-a515fdbebe0c

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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.

1

GA

Spinal

Epidural

Para Cervical

Anaesthesia

null

df8f5d0d-f1a0-44c7-beaa-2f3f58a9f420

single

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.

2

Midazolam

Propofol

Ketamine

Thiopentone sodium

Anaesthesia

General anaesthesia

8ecb2f2e-4f2e-43be-a622-52842c4fcc28

single

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)

1

Doxacurium

Rocuronium

Vecuronium

Atracurium

Anaesthesia

All India exam

fc4eb6f4-e1d1-41ff-8792-193d4fcf9e97

single

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.

3

Loss of Consciousness

failure of circulation

Regular respiration to cessation of breathing

Loss of Consciousness to beginning of regular respiration

Anaesthesia

General anaesthesia

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single