INI-CET 2017 — Anesthesiology

Q: The position of the patient as shown below is favored for which of the following conditions?

Raised ICP. ***Raised ICT*** - The image depicts the patient in a **reverse Trendelenburg position** (head elevated). This position is often used to reduce **intracranial pressure (ICP)** by promoting venous drainage from the brain. - Elevating the head above the trunk aids in gravity-assisted drainage of cerebral venous blood and cerebrospinal fluid, thereby lowering ICP and preventing complications like brain herniation. *CHF* - Patients with **congestive heart failure (CHF)** often prefer a **Fowler's position** (sitting upright) to ease breathing and reduce pulmonary congestion, not the reverse Trendelenburg as shown. - Lying flat or with feet elevated in CHF can worsen dyspnea and increase cardiac workload due to increased venous return. *Air embolism* - For suspected **air embolism**, the patient is typically placed in the **Trendelenburg position** (head down, feet up) with a left lateral tilt to trap air in the right ventricle and prevent it from entering the pulmonary circulation. - This position helps prevent air from crossing into the left side of the heart thereby reducing the risk of systemic arterial air embolization. *Neurosurgery* - While neurosurgery often involves specific patient positioning, the depicted position isn't uniquely favored for neurosurgery in general. Positioning depends on the surgical site. - The **reverse Trendelenburg** is specifically used when reducing ICP is a primary goal during or after neurosurgical procedures, but not all neurosurgeries. [Practice more Anesthesiology PYQs on OnCourse]

Q: Which is not true regarding the procedure done with the needle shown below?

Breath holding is not necessary. ***Breath holding is not necessary*** - This statement is **FALSE** - breath holding **IS necessary** during lumbar puncture to maximize **opening pressure** measurement and reduce **CSF pressure variations**. - Patients are typically instructed to hold their breath in **expiration** to minimize movement artifacts and obtain accurate pressure readings. *Coagulopathy is not an absolute contraindication* - This statement is **TRUE** - coagulopathy is considered a **relative contraindication**, not an absolute one for lumbar puncture. - The procedure can often be performed safely after **correcting clotting abnormalities** or with careful risk-benefit assessment and meticulous technique. *Bevel should be facing upwards while inserting the needle* - This statement is **TRUE** - the needle should be inserted with the **bevel facing upwards** (or laterally in lateral position) to minimize **dural trauma**. - This orientation allows dural fibers to **spread rather than cut**, reducing the risk of **post-dural puncture headache (PDPH)**. *To be done in lateral recumbent position* - This statement is **TRUE** - **lateral recumbent position** is one of the standard positions for lumbar puncture, especially for measuring **opening pressure** accurately. - Alternative **sitting position** may be used for obese patients or those with difficult anatomical landmarks, but lateral recumbent remains a correct approach. [Practice more Anesthesiology PYQs on OnCourse]

2 Previous Year Questions with Answers & Explanations

Questions

The position of the patient as shown below is favored for which of the following conditions?

Which is not true regarding the procedure done with the needle shown below?