NEET-PG 2015 - Anesthesiology PYQs Practice Questions

Q: What is the ionized calcium (IC) content of Ringer's lactate in mmol/L, and why is it clinically significant?

4 mmol/L. ***4 mmol/L*** - Ringer's lactate contains **calcium chloride**, contributing to its ionized calcium content of **4 mmol/L**. - This calcium is a critical component for **blood clotting** and **cardiac function**, making it clinically significant, particularly in large volume resuscitation. *130 mmol/L* - This value is close to the **sodium content** of Ringer's lactate, not its ionized calcium. - Sodium is the primary determinant of **fluid balance** and **osmolarity**, distinct from calcium's roles. *109 mmol/L* - This value approximates the **chloride content** of Ringer's lactate, which is important for acid-base balance but not its ionized calcium. - Chloride's primary role is in maintaining **electrical neutrality** and fluid distribution. *0 mmol/L* - Ringer's lactate is a **balanced electrolyte solution** and definitely contains calcium. - A value of 0 would indicate the absence of calcium, which would contradict its formulation and clinical utility, especially in scenarios requiring **electrolyte repletion**. [Practice more Anesthesiology PYQs on OnCourse]

Q: All of the following drugs increase the risk of postoperative nausea and vomiting after squint surgery in children except?

Propofol. ***Propofol*** - Propofol is known to have **antiemetic properties** and is often used to reduce the incidence of postoperative nausea and vomiting (PONV). - Its mechanism involves modulating **GABA-A receptors** and potentially other pathways that suppress emetic responses. *Halothane* - **Inhalational anesthetics** like halothane are a significant risk factor for PONV, particularly in children and following surgeries like squint repair. - They tend to increase PONV by directly stimulating the **chemoreceptor trigger zone** and altering gut motility. *Opioids* - Opioids, commonly used for postoperative pain control, are a well-known cause of **nausea and vomiting**. - They activate **opioid receptors** in the chemoreceptor trigger zone and the gastrointestinal tract, leading to emesis and delayed gastric emptying. *Nitrous Oxide* - The use of **nitrous oxide** as part of a general anesthetic regimen has been consistently associated with an increased risk of PONV. - It is believed to contribute to PONV by increasing the risk of **bowel distension** and stimulating neurotransmitter release involved in emesis. [Practice more Anesthesiology PYQs on OnCourse]

Q: At the end of anaesthesia after discontinuation of nitrous oxide and removal of endotracheal tube, 100% oxygen is administered to the patient to prevent:

Diffusion Hypoxia. ***Diffusion Hypoxia*** - Post-anaesthesia administration of 100% oxygen prevents **diffusion hypoxia**, a phenomenon where **nitrous oxide** rapidly diffuses out of the blood into the alveoli, diluting alveolar oxygen and carbon dioxide. - This rapid outflow of nitrous oxide can lead to a significant drop in **partial pressure of oxygen** in the alveoli, causing hypoxemia if not counteracted with high inspired oxygen. *Second gas effect* - The **second gas effect** refers to the phenomenon where the rapid uptake of a highly soluble anesthetic (like nitrous oxide) accelerates the uptake of a co-administered less soluble anesthetic. - This is an effect related to the **induction phase** of anesthesia, not emergence, and is distinct from the issues arising from nitrous oxide washout. *Bronchospasm* - **Bronchospasm** is an acute constriction of the bronchioles, often triggered by irritants, allergens, or certain medications. - While it can occur during emergence from anesthesia, it is not directly prevented by administering 100% oxygen and is typically managed with bronchodilators. *Hyperoxia* - **Hyperoxia** is a condition of excess oxygen in the body, which can be detrimental, but it is not the primary concern immediately following the discontinuation of nitrous oxide. - Administering 100% oxygen in this context is a **controlled, short-term measure** to prevent a more immediate and severe issue (hypoxia) rather than causing chronic hyperoxia. [Practice more Anesthesiology PYQs on OnCourse]

Q: Which anesthetic agent is safe to use in patients with elevated intracranial pressure (ICP)?

Thiopentone. ***Thiopentone*** - **Thiopentone** is a barbiturate that **decreases cerebral blood flow** and **metabolic rate**, leading to a reduction in intracranial pressure (ICP). - Its rapid onset and short duration of action make it suitable for inducing anesthesia in patients with elevated ICP. *Halothane* - **Halothane** is a potent **vasodilator** that can increase cerebral blood flow and consequently **elevate intracranial pressure**, making it unsuitable. - It also has a **slow onset and offset**, which can be problematic in emergent situations involving ICP. *Ketamine* - **Ketamine** is known to significantly **increase cerebral blood flow** and **intracranial pressure**, making it generally contraindicated in patients with elevated ICP. - It can also cause **dissociative states** and **emergence delirium**, which can further complicate neurological assessment. *Ether* - **Ether** is an older anesthetic agent known to cause **significant cerebral vasodilation** and an **increase in intracranial pressure**. - It is **highly flammable** and rarely used in modern clinical practice due to its side effects and safety profile. [Practice more Anesthesiology PYQs on OnCourse]

Q: Post dural puncture headache usually presents within ?

12-72 Hrs. ***12-72 Hrs*** - The onset of a **post-dural puncture headache (PDPH)** typically occurs within **12 to 72 hours** after the dural puncture. - This delay is thought to be related to the time it takes for significant **cerebrospinal fluid (CSF) leakage** and corresponding intracranial hypotension to develop. *0-6 Hrs* - Headaches presenting within this timeframe are less likely to be true **PDPH** as the typical latency period for significant CSF leakage and its symptomatic effects hasn't usually manifested. - Such early headaches might be due to other causes like **anxiety**, **dehydration**, or mild irritation from the procedure. *6-12 Hrs* - While possible, onset within this timeframe is less common than the 12-72 hour window for **classic PDPH**. - Moderate **CSF leakage** might lead to symptoms in some individuals, but the vast majority present later. *72-96 Hrs* - Although PDPH can persist for days or even weeks, its **onset** is significantly less common in this range. - A headache beginning this late may prompt consideration of other differential diagnoses, though late-onset PDPH is not unheard of. [Practice more Anesthesiology PYQs on OnCourse]

Question 1

What is the ionized calcium (IC) content of Ringer's lactate in mmol/L, and why is it clinically significant?

Accepted Answer

4 mmol/L

Answer

0 mmol/L

Answer

130 mmol/L

Answer

109 mmol/L

Question 2

All of the following drugs increase the risk of postoperative nausea and vomiting after squint surgery in children except?

Accepted Answer

Propofol

Answer

Halothane

Answer

Nitrous Oxide

Answer

Opioids

Question 3

At the end of anaesthesia after discontinuation of nitrous oxide and removal of endotracheal tube, 100% oxygen is administered to the patient to prevent:

Accepted Answer

Diffusion Hypoxia

Answer

Second gas effect

Answer

Bronchospasm

Answer

Hyperoxia

Question 4

Which anesthetic agent is safe to use in patients with elevated intracranial pressure (ICP)?

Accepted Answer

Thiopentone

Answer

Halothane

Answer

Ketamine

Answer

Ether

Question 5

Post dural puncture headache usually presents within ?

Accepted Answer

12-72 Hrs

Answer

0-6 Hrs

Answer

6-12 Hrs

Answer

72-96 Hrs

Question 6

What is the composition of soda lime?

Accepted Answer

4% NaOH, 80% Ca(OH)2, trace elements, 15% H2O

Answer

4% NaOH, 90% Ca(OH)2, 1% KOH, 5% H2O

Answer

15% NaOH, 80% Ca(OH)2, trace elements, 4% H2O

Answer

4% NaOH, 80% Ca(OH)2, 1% KOH, 15% H2O

Question 7

Which one of the following agents sensitizes the myocardium to catecholamines?

Accepted Answer

Halothane

Answer

Isoflurane

Answer

Ether

Answer

Propofol

Question 8

Laryngeal mask airway [LMA] is contraindicated in?

Accepted Answer

Pregnant female

Answer

Ocular surgeries

Answer

Difficult airways

Answer

In CPR

Question 9

Which type of pain is characterized by unknown etiology?

Accepted Answer

Idiopathic pain

Answer

Nociceptive pain

Answer

Neuropathic pain

Answer

Inflammatory pain

NEET-PG 2015 — Anesthesiology