NEET-PG 2019 - Anesthesiology PYQs Practice Questions

Q: Which of the following intravenous agents is known to cause pain upon injection?

Propofol. ***Propofol*** - **Propofol** is notoriously known to cause significant **pain upon injection**, especially when administered into smaller veins. - This is attributed to its **lipid emulsion formulation** and activation of **TRPA1 receptors** on sensory neurons. *Methohexital* - While **methohexital** can cause localized pain and venous irritation, it is generally less pronounced and less frequent than with propofol. - It is known more for causing **hiccups** and **muscle twitching** upon induction, rather than severe injection pain. *Ketamine* - **Ketamine** typically causes minimal to no pain upon intravenous injection. - Its side effects are often related to its **dissociative anesthetic** properties, such as psychomimetic effects and increased sympathetic activity. *Etomidate* - **Etomidate** is generally considered to be low in causing injection site pain. - Its primary concern is the potential for **adrenocortical suppression** and a high incidence of **myoclonus**. [Practice more Anesthesiology PYQs on OnCourse]

Q: IV administration of which anesthetic drug is most painful among the following?

Propofol. ***Propofol*** - **Propofol** is notoriously known for causing **significant pain on injection** due to its formulation with **soybean oil emulsion** and its direct irritation of venous free nerve endings. - This pain is often described as a **burning sensation** and can be severe enough to require pre-treatment with lidocaine or administering it in a larger vein. *Methohexital* - While **methohexital** can cause localized pain and sometimes **thrombophlebitis** during intravenous administration, it is generally considered less painful than propofol. - It is a **barbiturate** and its discomfort is typically related to its alkaline pH and potential for venous irritation. *Ketamine* - **Ketamine** typically causes **minimal pain on injection** when administered intravenously. - Its mechanism of action as an **NMDA receptor antagonist** does not generally involve direct irritation of venous endothelium in the same way as propofol. *Etomidate* - **Etomidate**, like methohexital, can cause some **pain and irritation on injection**, and poses a risk of **thrombophlebitis**. - However, the severity of pain is generally **less pronounced** compared to the distinct and often intense burning sensation associated with propofol. [Practice more Anesthesiology PYQs on OnCourse]

Q: Which of the following is the most common method used to know depth of anaesthesia?

BIS. ***BIS*** - The **BIS (Bispectral Index) monitor** is the most common and widely utilized objective method for assessing the depth of anesthesia by analyzing brain electrical activity. - It provides a numerical value, typically from 0 to 100, where lower numbers indicate deeper anesthetic states, aiming for a range of 40-60 during general anesthesia. *Oesophageal contractility* - While esophageal motility can be affected by anesthetic depth, it is **not a standard or common method** for monitoring anesthesia during surgery. - Its measurement is invasive and not directly correlated with cortical brain activity, which is the primary target of most general anesthetics. *Depressed responses* - **Clinical signs of depressed responses** (e.g., lack of purposeful movement, stable vital signs) are important, but they are subjective and less reliable for accurately measuring anesthetic depth, especially in paralyzed patients. - These signs can be influenced by various factors unrelated to anesthetic depth, such as neuromuscular blockade or hypothermia. *Hypotension* - **Hypotension** is a common side effect of general anesthesia, but it is an indicator of the *hemodynamic effects* of anesthetics, not a direct or reliable measure of their depth. - Hypotension can be caused by many factors other than anesthetic depth, such as blood loss, hypovolemia, or cardiac dysfunction, making it a non-specific indicator. [Practice more Anesthesiology PYQs on OnCourse]

Q: Which IV anesthetic does not cause cardiac depression?

Etomidate. **Etomidate** - **Etomidate** is known for its **minimal cardiovascular effects**, making it a preferred choice in patients with **pre-existing cardiac disease** or hemodynamic instability. - Unlike other IV anesthetics, it causes very little change in **heart rate**, **blood pressure**, or **cardiac output**. *Propofol* - **Propofol** frequently causes **dose-dependent myocardial depression** and **vasodilation**, leading to significant decreases in blood pressure. - Its cardiovascular effects can be problematic in patients with compromised cardiac function. *Thiopentone* - **Thiopentone**, a barbiturate, typically causes **dose-dependent cardiovascular depression**, including reduced **myocardial contractility** and **vasodilation**. - This can result in a decrease in **blood pressure** and **cardiac output**. *Methohexital* - **Methohexital**, another barbiturate, also causes **cardiovascular depression** similar to thiopentone. - It can lead to decreased **blood pressure** due to both **myocardial depression** and **peripheral vasodilation**. [Practice more Anesthesiology PYQs on OnCourse]

Q: Depth of Anesthesia is best measured by:

BIS. ***BIS*** - The **BIS (Bispectral Index)** is an EEG-derived parameter that provides a quantitative measure of the patient's level of consciousness or depth of anesthesia. - A typical range for adequate surgical anesthesia is a BIS score between **40 and 60**, indicating a low probability of consciousness and recall. *TOF* - **TOF (Train-of-Four)** monitoring is used to assess the level of neuromuscular blockade, measuring the response of a muscle to a series of four electrical stimuli. - While important for managing **muscle relaxants**, it does not directly measure the depth of anesthesia or consciousness. *MAC* - **MAC (Minimum Alveolar Concentration)** is a measure of the potency of an inhaled anesthetic, defined as the concentration at which 50% of patients do not respond to a surgical stimulus. - It reflects the **ED50 of the anesthetic agent** itself rather than the patient's individual depth of anesthesia at a given moment. *Post Tetanic Potentiation* - **Post Tetanic Potentiation (PTP)** is a phenomenon observed during neuromuscular monitoring where a single twitch response is enhanced following a brief tetanus (rapid series of high-frequency stimuli). - PTP is used to assess **deep neuromuscular blockade** and recovery from paralytics, not the depth of anesthesia. [Practice more Anesthesiology PYQs on OnCourse]

Question 1

Which of the following intravenous agents is known to cause pain upon injection?

Accepted Answer

Propofol

Answer

Ketamine

Answer

Etomidate

Answer

Methohexital

Question 2

IV administration of which anesthetic drug is most painful among the following?

Accepted Answer

Propofol

Answer

Ketamine

Answer

Etomidate

Answer

Methohexital

Question 3

Which of the following is the most common method used to know depth of anaesthesia?

Accepted Answer

BIS

Answer

Oesophageal contractility

Answer

Depressed responses

Answer

Hypotension

Question 4

Which IV anesthetic does not cause cardiac depression?

Accepted Answer

Etomidate

Answer

Propofol

Answer

Thiopentone

Answer

Methohexital

Question 5

Depth of Anesthesia is best measured by:

Accepted Answer

BIS

Answer

TOF

Answer

MAC

Answer

Post Tetanic Potentiation

Question 6

Which of the following anesthetic agent is not painful on intravenous administration?

Accepted Answer

Ketamine

Answer

Propofol

Answer

Etomidate

Answer

Methohexital

Question 7

Drug that does not cause cardiac depression:

Accepted Answer

Etomidate

Answer

Thiopentone

Answer

Ketamine

Answer

Propofol

Question 8

Maximum Airway Irritation caused by:-

Accepted Answer

Desflurane

Answer

Halothane

Answer

Enflurane

Answer

Sevoflurane

Answer

Isoflurane

Question 9

Inhalational anesthetic with highest respiratory irritation is:-

Accepted Answer

Desflurane

Answer

Halothane

Answer

Nitrous oxide

Answer

Sevoflurane

NEET-PG 2019 — Anesthesiology