NEET-PG 2017 Practice Questions

Q: Which of the following Mapleson system is shown below?

Mapleson D. ***Mapleson D*** - This system is characterized by the **fresh gas inlet (FG)** being close to the patient end (P) and the **reservoir bag** and **adjustable pressure-limiting (APL) valve (T)** being further away, typically near the expiratory limb. The corrugated tube separates the bag and valve from the patient. - The image clearly depicts the **fresh gas entering near a reservoir bag**, which is then connected via a corrugated tube to the patient end, with an **APL valve (T)** situated near the patient, right before the patient connection, which is characteristic of the Mapleson D system. *Mapleson A* - In a Mapleson A system, the **fresh gas inlet** is located near the **reservoir bag**, which is positioned far from the patient. The APL valve is also near the reservoir bag. - This arrangement is highly efficient for **spontaneous ventilation** but less so for controlled ventilation. The image shows a different configuration. *Mapleson B* - The Mapleson B system has both the **fresh gas inlet** and the **APL valve** close to the patient, with the reservoir bag at the end of a long expiratory limb. - This system is **not very efficient** for either spontaneous or controlled ventilation due to significant rebreathing potential, which is unlike the depicted system. *Mapleson C* - This system is similar to Mapleson B but with a **shorter expiratory limb**, making it more compact. - Both the **fresh gas inlet** and the **APL valve** are near the patient, with the reservoir bag also close to the patient. The image clearly shows a long corrugated tube, making this option incorrect.

Q: What does the following capnographic recording represent?

Asthma. ***Asthma*** - The capnographic tracing shows a characteristic **shark fin waveform**, indicative of **expiratory airflow obstruction**. - This waveform is generated due to uneven emptying of the alveoli, where CO2 continues to be exhaled at a reduced rate during the later phase of expiration. *Spontaneous extubation* - Spontaneous extubation would typically result in a **complete loss of the capnography waveform** due to disconnection from the airway. - The tracing shown still clearly depicts expired CO2, inconsistent with complete extubation. *Raised ICT* - Raised intracranial tension (ICT) can affect breathing patterns (e.g., Cheyne-Stokes, hyperventilation), but it does not directly produce a a **shark fin capnography waveform**. - Capnography reflects CO2 elimination, which can be indirectly affected by changes in ventilatory drive from raised ICT but not in this specific shape. *Air embolism* - An air embolism would cause a sudden **drop in end-tidal CO2 (EtCO2)**, often to zero, due to obstruction of pulmonary blood flow, leading to alveolar dead space. - The waveform shown does not depict a sudden drop to zero or significantly reduced EtCO2.

Q: All are complications of this anesthesia technique except: (Recent NEET Pattern 2016-17)

Paralytic ileus. **SPINAL ANESTHESIA COMPLICATIONS ANALYSIS:** ***Paralytic ileus*** - While spinal anesthesia can cause some **decreased bowel motility** due to sympathetic blockade, true **paralytic ileus** is primarily associated with **abdominal surgery**, **prolonged opioid use**, **electrolyte imbalances**, or **systemic illness**. - **Paralytic ileus** is not considered a direct complication of spinal anesthesia technique itself, making it the exception among the given options. *Bradycardia* - Direct result of **sympathetic blockade** affecting **cardiac accelerator fibers**, leading to unopposed **vagal activity**. - Common complication of spinal anesthesia due to blocked sympathetic innervation that normally maintains heart rate. *Sudden cardiac arrest* - Rare but serious complication from severe **bradycardia** and **hypotension**, especially with **high spinal blocks**. - Can occur when sympathetic blockade extends too high, affecting critical **cardiovascular control mechanisms**. *Decrease in vital capacity* - Results from **motor blockade** of **intercostal muscles** and potentially **phrenic nerve** with high spinal blocks. - Respiratory compromise can be significant, particularly in patients with pre-existing **pulmonary disease**. **Conclusion:** Paralytic ileus is the exception as it is not a direct complication of spinal anesthesia, unlike the other cardiovascular and respiratory complications listed.

Q: All are contraindications of this anesthesia technique except: (Recent NEET Pattern 2016-17)

Aortic aneurysm. ***Aortic aneurysm*** - An **aortic aneurysm** is not a contraindication for **epidural anesthesia**. In fact, epidural anesthesia can be beneficial for patients with aortic aneurysms during surgical repair as it can help stabilize hemodynamics and provide effective pain control. - The image shows a needle entering the **epidural space**, indicating this question pertains to epidural anesthesia. *Bleeding diathesis* - **Bleeding diathesis** is a **relative contraindication** for **epidural anesthesia** due to the increased risk of **epidural hematoma**, which can cause neurological damage. - The formation of an **epidural hematoma** can lead to spinal cord compression. *Severe aortic stenosis* - **Severe aortic stenosis** is a **contraindication** for **epidural anesthesia** because the associated **vasodilation** from regional anesthesia can lead to a drastic drop in blood pressure, which these patients cannot tolerate as their fixed cardiac output relies on adequate preload. - Patients with **severe aortic stenosis** are highly susceptible to **hypotension** and cardiac collapse. *Uncooperative patient* - An **uncooperative patient** is a **contraindication** for **epidural anesthesia** as proper positioning and patient cooperation are crucial for safe needle placement. - Lack of cooperation increases the risk of **neurological injury** during the procedure.

Q: Which finding indicates correct placement of needle in this nerve block? (Recent NEET Pattern 2016-17)

Increase in skin temperature of ipsilateral arm. ***Increase in skin temperature of ipsilateral arm*** - A successful **stellate ganglion block** interrupts the **sympathetic efferent fibers** that innervate the ipsilateral arm. - This interruption leads to **vasodilation** in the blood vessels of the arm, resulting in increased blood flow and thus, a rise in skin temperature. *Decrease in skin temperature of ipsilateral arm* - A decrease in skin temperature would indicate **vasoconstriction**, which is the opposite effect of a successful sympathetic block. - This would suggest either an ineffective block or stimulation of sympathetic activity. *Increase in sweating of ipsilateral arm* - The stellate ganglion also carries **sympathetic fibers** to the sweat glands. A successful block would inhibit sweat gland activity. - Increased sweating (known as **diaphoresis**) would indicate an inadequate block or irritation of the ganglion, leading to increased sympathetic outflow. *Decrease in sweating of ipsilateral arm* - While a **decrease in sweating** (anhidrosis) is indeed a sign of effective sympathetic blockade to the arm, it is typically less immediate and less clinically observable than the change in skin temperature. - The most easily and consistently observed sign of sympathetic denervation in the arm is the increase in skin temperature due to vasodilation.

Q: Which is correct about the anesthetic drugs X and Y in the image shown? (Recent NEET Pattern 2016-17)

Drug X is more fast acting than Y. ***Drug X is more fast acting than Y*** - The **oil:gas partition coefficient** for Drug X is lower than for Drug Y. A lower oil:gas partition coefficient typically correlates with a **faster onset of action** for inhaled anesthetics as it indicates lower solubility in blood and tissues, allowing for quicker equilibration in the brain. - While MAC is plotted against oil:gas partition coefficient, the question specifically asks about **onset of action**, which is primarily influenced by blood-gas solubility rather than oil-gas solubility. However, an anesthetic with lower oil-gas solubility (like X) would generally also have lower blood-gas solubility, leading to faster onset. *Drug Y is more fast acting than X* - Drug Y has a **higher oil:gas partition coefficient** compared to Drug X, indicating greater lipid solubility. - A higher oil:gas partition coefficient generally correlates with a **slower onset of action** for inhaled anesthetics, as more drug dissolves in lipids before reaching the brain. *Drug X and Y have equally fast onset of action* - The graph clearly shows that Drug X and Drug Y have different **oil:gas partition coefficients**. - Since the partition coefficients are different, their **solubility characteristics** and therefore their clinical onset of action would also be different. *Drug X and Y have equally fast onset of action but potency of X is more than Y* - Onset of action is **not equal** for X and Y due to their differing oil:gas partition coefficients. - Potency, represented by **MAC** (Minimum Alveolar Concentration), is inversely related to the oil:gas partition coefficient for many inhaled anesthetics. From the graph, Drug X has a higher MAC value than Drug Y (meaning it is **less potent** but acts faster).

Q: What ventilation modality is shown below?

Nasal CPAP. ***Nasal CPAP*** - The image shows a device applied to the nose of an infant, providing a continuous flow of air which is characteristic of **Nasal Continuous Positive Airway Pressure (nCPAP)**. - This modality helps maintain lung volume, improve oxygenation, and reduce the work of breathing in neonates with respiratory distress. *High frequency jet ventilation* - This modality involves delivering small tidal volumes at very **high frequencies** (hundreds of breaths per minute) through a specialized ventilator and endotracheal tube. - The image does not depict an **endotracheal tube** or the rapid, small tidal volume delivery characteristic of jet ventilation. *Inverse ratio ventilation* - This is a mode of **mechanical ventilation** where the inspiratory time is longer than the expiratory time (I:E ratio > 1:1), typically used in intubated patients. - The image shows a non-invasive nasal device, not an **intubated patient** on a mechanical ventilator. *Intermittent positive pressure ventilation* - This refers to delivering breaths with positive pressure, either invasively (via endotracheal tube) or non-invasively (via mask), to assist or control breathing. - While CPAP provides positive pressure, "intermittent positive pressure ventilation" implies cyclical breaths, which is not the primary defining feature shown, and CPAP (continuous pressure) is a more specific and accurate description for the depicted setup.

Q: The application of the following product can lead to development of: (Recent NEET Pattern 2016-17)

Methemoglobinemia. ***Methemoglobinemia (Correct)*** - EMLA cream contains **lidocaine** and **prilocaine**, both of which are **amide-type local anesthetics** - Prilocaine, in particular, can cause methemoglobinemia due to its metabolite, **o-toluidine**, which oxidizes hemoglobin to methemoglobin - While methemoglobinemia is rare with proper use, it is a known and serious adverse effect, especially when applied to large areas, on broken skin, or in infants - This is the most specific adverse effect associated with prilocaine in EMLA cream *Seizures (Incorrect)* - Seizures are a known systemic toxicity of local anesthetics like lidocaine and prilocaine but are usually associated with **very high systemic concentrations**, often from accidental intravenous injection or excessive application over large areas - While possible with overdose, methemoglobinemia is a more specific and direct concern linked to prilocaine's metabolic pathway - CNS toxicity typically requires systemic absorption beyond what occurs with proper topical use *Depression (Incorrect)* - Depression is **not a direct or common adverse effect** of EMLA cream or its components - Systemic absorption of local anesthetics can cause central nervous system effects, but depression is generally not among them - CNS effects more commonly involve excitation (restlessness, tremors) or sedation depending on the dose *Hypertension (Incorrect)* - Local anesthetics generally cause **vasodilation** at therapeutic doses, potentially leading to **hypotension** rather than hypertension, especially with systemic absorption - Hypertension is not a characteristic side effect associated with the topical application of EMLA cream - The cardiovascular effects of local anesthetics, when present, typically involve decreased blood pressure and myocardial depression

Question 1

Which of the following Mapleson system is shown below?

Accepted Answer

Mapleson D

Answer

Mapleson C

Answer

Mapleson A

Answer

Mapleson B

Question 2

What does the following capnographic recording represent?

Accepted Answer

Asthma

Answer

Spontaneous extubation

Answer

Raised ICT

Answer

Air embolism

Question 3

All are complications of this anesthesia technique except: (Recent NEET Pattern 2016-17)

Accepted Answer

Paralytic ileus

Answer

Bradycardia

Answer

Sudden cardiac arrest

Answer

Decrease in vital capacity

Question 4

All are contraindications of this anesthesia technique except: (Recent NEET Pattern 2016-17)

Accepted Answer

Aortic aneurysm

Answer

Bleeding diathesis

Answer

Severe aortic stenosis

Answer

Uncooperative patient

Question 5

Which finding indicates correct placement of needle in this nerve block? (Recent NEET Pattern 2016-17)

Accepted Answer

Increase in skin temperature of ipsilateral arm

Answer

Decrease in skin temperature of ipsilateral arm

Answer

Increase in sweating of ipsilateral arm

Answer

Decrease in sweating of ipsilateral arm

Question 6

Which is correct about the anesthetic drugs X and Y in the image shown? (Recent NEET Pattern 2016-17)

Accepted Answer

Drug X is more fast acting than Y

Answer

Drug X and Y have equally fast onset of action

Answer

Drug X and Y have equally fast onset of action but potency of X is more than Y

Answer

Drug Y is more fast acting than X

Question 7

What ventilation modality is shown below?

Accepted Answer

Nasal CPAP

Answer

High frequency jet ventilation

Answer

Inverse ratio ventilation

Answer

Intermittent positive pressure ventilation

Question 8

The application of the following product can lead to development of: (Recent NEET Pattern 2016-17)

Accepted Answer

Methemoglobinemia

Answer

Seizures

Answer

Depression

Answer

Hypertension

NEET-PG 2017

Anesthesiology

Pediatrics

Pharmacology