FMGE 2025 - Anesthesiology PYQs Practice Questions

Q: A 35 y/o asthmatic patient is scheduled for a minor surgical procedure. Which induction agent and muscle relaxant combination is safest for this patient?

Ketamine and Vecuronium. ***Ketamine and Vecuronium***- **Ketamine** is strongly recommended for asthmatics as it possesses potent **bronchodilating properties** via its sympathomimetic effects, helping prevent **bronchospasm**.- **Vecuronium** is an intermediate-acting non-depolarizing muscle relaxant that causes **minimal to no histamine release**, ensuring cardiovascular stability and avoiding airway irritation.*Propofol and Succinylcholine*- While **Propofol** is often used and generally considered safe (neutral to mild bronchodilation), **Succinylcholine**, a depolarizing agent, carries a potential risk of **histamine release**, although low.- The combination is generally acceptable but less preferred than Ketamine based on the strength of Ketamine's **bronchodilating effect**.*Ketamine and d-tubocurarine*- **Ketamine** is beneficial due to its **bronchodilating effect**, but **d-tubocurarine (DTC)** is highly associated with massive **histamine release**.- DTC often causes severe **hypotension** and significant **bronchospasm**, making it extremely unsafe for an asthmatic patient.*Thiopental and Rocuronium*- **Thiopental**, a barbiturate, is associated with a risk of **histamine release** and potential exacerbation of asthma symptoms or cough upon induction.- Although **Rocuronium** is a safe, low-histamine muscle relaxant, the use of **Thiopental** makes this combination less safe than using Ketamine. [Practice more Anesthesiology PYQs on OnCourse]

Q: A patient undergoing surgery is administered succinylcholine for muscle relaxation. Shortly after administration, he develops hyperthermia, muscle rigidity, tremors, and tachycardia. What is the most appropriate treatment for this condition?

Dantrolene sodium. ***Dantrolene sodium***- This is the specific and definitive antidote for **Malignant Hyperthermia (MH)**, characterized by signs like hyperthermia, muscle rigidity, and tachycardia after succinylcholine administration.- **Dantrolene** works directly on skeletal muscle by inhibiting the release of calcium from the **sarcoplasmic reticulum**, thereby interrupting the sustained muscle contraction and hypermetabolic state.*Neostigmine*- It is an **acetylcholinesterase inhibitor** used to reverse the effects of non-depolarizing neuromuscular blocking agents (e.g., rocuronium).- It is **contraindicated** in MH as it could potentially exacerbate muscle rigidity and the hypermetabolic crisis by increasing **acetylcholine** activity at the neuromuscular junction.*Atropine*- This is an **anticholinergic** drug primarily used to treat bradycardia or to dry secretions.- Although the patient exhibits severe tachycardia, atropine does not treat the underlying pathological hypermetabolism or the excessive calcium release that defines MH.*Midazolam*- This is a **benzodiazepine** used for anxiolysis, sedation, and if necessary, managing seizures.- While supportive care for MH might involve benzodiazepines if seizures occur due to hyperthermia, it is not the crucial drug needed to counteract the life-threatening hypermetabolic crisis. [Practice more Anesthesiology PYQs on OnCourse]

Q: A patient scheduled for elective hip surgery is currently taking aspirin, enalapril, a multivitamin, and metoprolol. The surgery is planned in 5 days. What is the appropriate perioperative management for this patient?

Stop enalapril. ***Correct: Stop enalapril*** - **ACE inhibitors (enalapril) should be discontinued 24-48 hours before elective surgery** - Risk of **refractory intraoperative hypotension** during anesthesia induction, particularly with vasodilatory anesthetics - Associated with increased perioperative complications including hypotension requiring vasopressor support - Can be safely restarted postoperatively once hemodynamic stability is achieved *Incorrect: Stop aspirin to minimize perioperative bleeding risk* - **Aspirin should generally be continued** in patients with cardiovascular indications (CAD, stroke prevention) - Current guidelines recommend continuation for most surgeries except those with very high bleeding risk (neurosurgery, posterior chamber eye surgery) - **Hip surgery is NOT a contraindication** to aspirin continuation - The cardiovascular risk of stopping aspirin outweighs bleeding risk in most cases *Incorrect: Stop metoprolol to increase cardiac output* - **Beta-blockers should be continued perioperatively** in patients already taking them - Abrupt withdrawal increases risk of **rebound hypertension, tachycardia, myocardial ischemia, and MI** - Stopping beta-blockers can precipitate life-threatening cardiovascular events - Should be given on the morning of surgery with a sip of water *Incorrect: Increase aspirin dosage for additional analgesic benefit* - No indication to increase aspirin dose perioperatively - Aspirin is not used as a primary analgesic in surgical settings - Increasing dose would unnecessarily increase bleeding risk without therapeutic benefit [Practice more Anesthesiology PYQs on OnCourse]

Q: A patient undergoing general anesthesia develops left lung collapse following intubation. On auscultation, breath sounds are heard only on the right side. What is the most likely cause of this condition?

Right endobronchial intubation. ***Right endobronchial intubation***- This is the most common cause of unilateral lung collapse *immediately* following intubation, as the endotracheal tube (ETT) is usually advanced too far into the **right main bronchus (RMB)**, which is wider and less acutely angled than the left.- When the ETT is solely in the RMB, air ventilates the right lung exclusively, resulting in **absent breath sounds** and subsequent **atelectasis** (collapse) of the non-ventilated left lung.*Mucus secretions obstructing the endotracheal tube*- Significant obstruction of the ETT by mucus would typically lead to **bilateral loss of breath sounds** or severely impaired ventilation (high peak inspiratory pressures), affecting both lungs equally.- The specific finding of unilateral breath sounds (only on the right) excludes a primary blockage of the ETT itself.*Pneumothorax on the left side due to positive pressure ventilation*- While a left **pneumothorax** can cause absent breath sounds on the left, it would involve air accumulation in the pleural space, often requiring significant barotrauma, and is a less frequent and less immediate cause than mainstem intubation following successful intubation.- The clinical picture of immediate unilateral absence of breath sounds following intubation is overwhelmingly attributed to ETT malposition, which causes obstructive **atelectasis** (collapse), not tension pneumothorax.*Bronchospasm*- **Bronchospasm** is characterized by diffuse airway narrowing, typically presenting with high **peak inspiratory pressures** and **wheezing** heard over both lung fields.- It impairs air entry bilaterally and would not result in the complete unilateral absence of breath sounds and lung collapse described, which is indicative of complete airway obstruction to the non-ventilated lung. [Practice more Anesthesiology PYQs on OnCourse]

Q: According to the American Heart Association (AHA), what is the 6th link added to the chain of survival?

Recovery and rehabilitation. ***Recovery and rehabilitation*** - The American Heart Association (**AHA**) added this as the **6th link** to the chain of survival to emphasize the importance of post-event care for cardiac arrest survivors. - This link focuses on the long-term health outcomes, addressing physical, cognitive, and emotional needs to improve the survivor's **quality of life**. *Rapid defibrillation* - This is the **fourth link** in the chain of survival, often grouped with Advanced Life Support (ALS). - It is a critical intervention for shockable rhythms like **ventricular fibrillation (VF)** and **pulseless ventricular tachycardia (VT)**, but it precedes post-cardiac arrest care and recovery. *High-quality CPR* - This is the **third link** in the chain of survival, immediately following activation of the emergency response system. - Its purpose is to maintain vital organ perfusion until defibrillation or the return of spontaneous circulation is achieved. *Advanced airway management* - This is a component of **Advanced Life Support (ALS)**, which is part of the fourth link in the chain. - While crucial during the resuscitation effort, it is an acute intervention and not the distinct final step focused on long-term patient recovery. [Practice more Anesthesiology PYQs on OnCourse]

Question 1

A 35 y/o asthmatic patient is scheduled for a minor surgical procedure. Which induction agent and muscle relaxant combination is safest for this patient?

Accepted Answer

Ketamine and Vecuronium

Answer

Propofol and Succinylcholine

Answer

Ketamine and d-tubocurarine

Answer

Thiopental and Rocuronium

Question 2

A patient undergoing surgery is administered succinylcholine for muscle relaxation. Shortly after administration, he develops hyperthermia, muscle rigidity, tremors, and tachycardia. What is the most appropriate treatment for this condition?

Accepted Answer

Dantrolene sodium

Answer

Neostigmine

Answer

Midazolam

Answer

Atropine

Question 3

A patient scheduled for elective hip surgery is currently taking aspirin, enalapril, a multivitamin, and metoprolol. The surgery is planned in 5 days. What is the appropriate perioperative management for this patient?

Accepted Answer

Stop enalapril

Answer

Stop aspirin to minimize perioperative bleeding risk

Answer

Stop metoprolol to increase cardiac output

Answer

Increase aspirin dosage for additional analgesic benefit

Question 4

A patient undergoing general anesthesia develops left lung collapse following intubation. On auscultation, breath sounds are heard only on the right side. What is the most likely cause of this condition?

Accepted Answer

Right endobronchial intubation

Answer

Pneumothorax on the left side due to positive pressure ventilation

Answer

Bronchospasm

Answer

Mucus secretions obstructing the endotracheal tube

Question 5

According to the American Heart Association (AHA), what is the 6th link added to the chain of survival?

Accepted Answer

Recovery and rehabilitation

Answer

Advanced airway management

Answer

High-quality CPR

Answer

Rapid defibrillation

Question 6

An RTA patient has received 4 units of packed RBCs within a few hours. Which of the following will be seen?

Accepted Answer

Hypocalcemia

Answer

Hyperkalemia

Answer

Hypernatremia

Answer

Hyponatremia

Question 7

A known case of hyperthyroidism, who is not on medication, is scheduled for total thyroidectomy. The PAC check was not done properly. What is the leading complication that can occur during surgery?

Accepted Answer

Arrhythmia

Answer

Hypothyroidism

Answer

Hypothermia

Answer

Hyperthermia

Question 8

A patient is in ICU and there is a failed attempt of subclavian catheterization. Shortly after, BP drops and the pulse rises. What is the diagnosis?

Accepted Answer

Pneumothorax

Answer

Air embolism

Answer

Displacement of endotracheal tube (ET)

Answer

Hemothorax

Question 9

Which is the best confirmatory method to ensure the central line is in the jugular vein?

Accepted Answer

Chest x-ray

Answer

ETCO2

Answer

Blood color

Answer

Blood pH

Question 10

In the image shown, identify the function of the marked structure on the endotracheal tube.

Accepted Answer

Prevention of air leakage and aspiration

Answer

Suctioning of lower respiratory tract secretions

Answer

Monitoring airway pressure

Answer

Facilitation of vocal cord visualization

FMGE 2025 — Anesthesiology