NEET-PG 2020 — Anesthesiology

Q: What does the image of the Capnograph depict?

Capnograph indicating spontaneous respiration. ***Capnograph indicating spontaneous respiration*** - The characteristic dip in the **EtCO2 waveform** during the plateau phase (phaselll) is indicative of a breath taken by the individual which is a classic finding of **spontaneous respiration**. This dip is because when a patient takes a breath in, fresh gas with no CO2 is pulled into the sampling line momentarily decreasing the measured CO2. - This pattern is often referred to as a "**curare cleft**" or "**respiratory indentation**," and it signifies incomplete paralysis or return of spontaneous breathing. *Capnograph during inspiration* - During normal inspiration, there is no CO2 in the inhaled air, so the capnograph reading would theoretically drop to **zero** or near-zero, not exhibit a waveform with a plateau. - The baseline of the capnograph reflects inspiration, which should be flat (zero CO2). *Capnograph showing inspiration with cardiac oscillations* - Cardiac oscillations typically appear as **small rhythmic fluctuations** on the baseline or the expiratory plateau, synchronized with the heartbeat. - These oscillations are usually much smaller and do not present as distinct, sharp dips within the expiratory plateau as seen in the image. *Capnograph during expiration* - During a normal expiration, the capnograph waveform rises from a baseline of zero (phase I, **dead space ventilation**) to a plateau (phase III, **alveolar gas emptying**) with a peak value, before returning to baseline during inspiration. - While the image shows expiration with a plateau, the key feature of the dip during the plateau is more specific to spontaneous respiration than just general expiration. [Practice more Anesthesiology PYQs on OnCourse]

Q: Identify the airway device shown in the image.

Laryngeal Mask Airway. ***Laryngeal Mask Airway*** - The image clearly displays a **Laryngeal Mask Airway (LMA)**, characterized by its inflatable, elliptical cuff designed to seal around the laryngeal inlet. - This supraglottic device is used for airway management in anesthesia and emergencies when endotracheal intubation is not required or feasible. *Nasopharyngeal Airway* - A **nasopharyngeal airway** is a soft, flexible tube inserted through the nose into the posterior pharynx. - It does not have an inflatable cuff or the broad, mask-like structure seen in the image. *Cuffed Endotracheal Tube* - A **cuffed endotracheal tube (ETT)** is a long, narrow tube inserted directly into the trachea, featuring a balloon cuff near the distal end for tracheal sealing. - The device in the image has a much broader, mask-like structure designed to sit above the larynx, not within the trachea. *Guedel Airway* - A **Guedel airway** (or oropharyngeal airway) is a rigid, curved device inserted into the mouth to prevent the tongue from obstructing the airway. - It is typically made of plastic and lacks any inflatable components or the sophisticated design of the device shown. [Practice more Anesthesiology PYQs on OnCourse]

Q: A patient scheduled for elective inguinal hernia surgery has a history of myocardial infarction (MI) and underwent coronary artery bypass grafting (CABG). What should be included in the preoperative assessment?

History + c/e + routine labs + stress test. ***History + c/e + routine labs + stress test*** - A **stress test** is crucial in patients with a history of MI and CABG to assess **myocardial ischemia** and functional capacity, guiding perioperative management. - This evaluation helps determine the patient's **cardiac risk** for non-cardiac surgery and the need for further cardiac optimization. *History + c/e + routine labs + angiography to assess graft patency* - **Coronary angiography** is an invasive procedure and is generally not indicated as a routine preoperative assessment unless there are new, significant cardiac symptoms or signs of **graft dysfunction**. - Assessing graft patency through angiography carries risks and would only be justified if there were strong clinical indications suggesting acute or severe **cardiac ischemia**. *History + c/e + routine labs* - While critical for any preoperative assessment, **routine history, physical examination, and basic laboratory tests** are insufficient for a patient with a significant cardiac history like MI and CABG. - This approach would **underestimate the cardiac risk** and might miss undetected ischemia, leading to adverse perioperative cardiac events. *History + c/e + routine labs + V/Q scan* - A **ventilation-perfusion (V/Q) scan** is primarily used to diagnose **pulmonary embolism** or assess regional lung function. - It does not provide information about myocardial ischemia or cardiac functional capacity, making it **irrelevant** for assessing cardiac risk in this clinical scenario. [Practice more Anesthesiology PYQs on OnCourse]

3 Previous Year Questions with Answers & Explanations

Questions

What does the image of the Capnograph depict?

Identify the airway device shown in the image.

A patient scheduled for elective inguinal hernia surgery has a history of myocardial infarction (MI) and underwent coronary artery bypass grafting (CABG). What should be included in the preoperative assessment?

NEET-PG 2020 - Anesthesiology NEET-PG Practice Questions and MCQs

Question 1: What does the image of the Capnograph depict?

A. Capnograph during inspiration
B. Capnograph showing inspiration with cardiac oscillations
C. Capnograph during expiration
D. Capnograph indicating spontaneous respiration (Correct Answer)

Explanation: ***Capnograph indicating spontaneous respiration*** - The characteristic dip in the **EtCO2 waveform** during the plateau phase (phaselll) is indicative of a breath taken by the individual which is a classic finding of **spontaneous respiration**. This dip is because when a patient takes a breath in, fresh gas with no CO2 is pulled into the sampling line momentarily decreasing the measured CO2. - This pattern is often referred to as a "**curare cleft**" or "**respiratory indentation**," and it signifies incomplete paralysis or return of spontaneous breathing. *Capnograph during inspiration* - During normal inspiration, there is no CO2 in the inhaled air, so the capnograph reading would theoretically drop to **zero** or near-zero, not exhibit a waveform with a plateau. - The baseline of the capnograph reflects inspiration, which should be flat (zero CO2). *Capnograph showing inspiration with cardiac oscillations* - Cardiac oscillations typically appear as **small rhythmic fluctuations** on the baseline or the expiratory plateau, synchronized with the heartbeat. - These oscillations are usually much smaller and do not present as distinct, sharp dips within the expiratory plateau as seen in the image. *Capnograph during expiration* - During a normal expiration, the capnograph waveform rises from a baseline of zero (phase I, **dead space ventilation**) to a plateau (phase III, **alveolar gas emptying**) with a peak value, before returning to baseline during inspiration. - While the image shows expiration with a plateau, the key feature of the dip during the plateau is more specific to spontaneous respiration than just general expiration.

Question 2: Identify the airway device shown in the image.

A. Nasopharyngeal Airway
B. Cuffed Endotracheal Tube
C. Guedel Airway
D. Laryngeal Mask Airway (Correct Answer)

Explanation: ***Laryngeal Mask Airway*** - The image clearly displays a **Laryngeal Mask Airway (LMA)**, characterized by its inflatable, elliptical cuff designed to seal around the laryngeal inlet. - This supraglottic device is used for airway management in anesthesia and emergencies when endotracheal intubation is not required or feasible. *Nasopharyngeal Airway* - A **nasopharyngeal airway** is a soft, flexible tube inserted through the nose into the posterior pharynx. - It does not have an inflatable cuff or the broad, mask-like structure seen in the image. *Cuffed Endotracheal Tube* - A **cuffed endotracheal tube (ETT)** is a long, narrow tube inserted directly into the trachea, featuring a balloon cuff near the distal end for tracheal sealing. - The device in the image has a much broader, mask-like structure designed to sit above the larynx, not within the trachea. *Guedel Airway* - A **Guedel airway** (or oropharyngeal airway) is a rigid, curved device inserted into the mouth to prevent the tongue from obstructing the airway. - It is typically made of plastic and lacks any inflatable components or the sophisticated design of the device shown.

Question 3: A patient scheduled for elective inguinal hernia surgery has a history of myocardial infarction (MI) and underwent coronary artery bypass grafting (CABG). What should be included in the preoperative assessment?

A. History + c/e + routine labs + V/Q scan
B. History + c/e + routine labs
C. History + c/e + routine labs + stress test (Correct Answer)
D. History + c/e + routine labs + angiography to assess graft patency

Explanation: ***History + c/e + routine labs + stress test*** - A **stress test** is crucial in patients with a history of MI and CABG to assess **myocardial ischemia** and functional capacity, guiding perioperative management. - This evaluation helps determine the patient's **cardiac risk** for non-cardiac surgery and the need for further cardiac optimization. *History + c/e + routine labs + angiography to assess graft patency* - **Coronary angiography** is an invasive procedure and is generally not indicated as a routine preoperative assessment unless there are new, significant cardiac symptoms or signs of **graft dysfunction**. - Assessing graft patency through angiography carries risks and would only be justified if there were strong clinical indications suggesting acute or severe **cardiac ischemia**. *History + c/e + routine labs* - While critical for any preoperative assessment, **routine history, physical examination, and basic laboratory tests** are insufficient for a patient with a significant cardiac history like MI and CABG. - This approach would **underestimate the cardiac risk** and might miss undetected ischemia, leading to adverse perioperative cardiac events. *History + c/e + routine labs + V/Q scan* - A **ventilation-perfusion (V/Q) scan** is primarily used to diagnose **pulmonary embolism** or assess regional lung function. - It does not provide information about myocardial ischemia or cardiac functional capacity, making it **irrelevant** for assessing cardiac risk in this clinical scenario.