NEET-PG 2021 — Anesthesiology

Q: The procedure shown in the image is performed to maintain the airway. Which of the following techniques is being used?

Jaw thrust. ***Jaw thrust*** - The image distinctly shows a rescuer performing a **jaw thrust maneuver** by placing fingers under the angles of the patient's mandible and displacing the jaw forward. - This technique is used to open the airway by lifting the tongue off the posterior pharyngeal wall, especially in cases of suspected **cervical spine injury**. *Head stabilization* - While important in trauma, **head stabilization alone** does not open the airway; it prevents movement without actively repositioning the jaw or head. - Head stabilization is a supportive technique, often used in conjunction with airway maneuvers, but it is not the primary airway-opening technique depicted. *In line manual stabilization* - **In-line manual stabilization** is a method where a rescuer holds the patient's head and neck in a neutral, in-line position to prevent movement, particularly during transport or other interventions. - This technique is used to protect the spine from further injury and prevents any movement from the head or neck. *Head tilt chin lift* - The **head tilt-chin lift** involves tilting the head back and lifting the chin, which is a different hand placement and body movement than what is shown. - This maneuver is contraindicated in suspected cervical spine injuries due to the risk of exacerbating spinal cord damage. [Practice more Anesthesiology PYQs on OnCourse]

Q: A young male was administered regional anesthesia with 0.25% bupivacaine. The patient became unresponsive, and the pulse became unrecordable. What is the best management in this situation?

ECPR with 20% intralipid. ***ECPR with 20% intralipid*** - The scenario describes **Local Anesthetic Systemic Toxicity (LAST)**, likely due to bupivacaine, leading to cardiovascular collapse. - **Intralipid 20%** is the first-line treatment for LAST-induced cardiovascular toxicity, as it acts as a lipid sink for the lipophilic local anesthetic. *ECPR with calcium* - While calcium may be used in certain cardiac arrest scenarios, it is **not the primary treatment for bupivacaine-induced cardiovascular collapse** and LAST. - Calcium might offer some cardiac support but does not directly neutralize the local anesthetic's toxic effects. *ECPR with dobutamine* - **Dobutamine is an inotropic agent** used to improve cardiac contractility but is not indicated as a primary rescue therapy for severe LAST. - It would not address the underlying toxicity caused by bupivacaine and could potentially worsen the situation by increasing myocardial oxygen demand without reversing toxin effects. *ECPR with sodium bicarbonate* - **Sodium bicarbonate** is used to treat metabolic acidosis and can be beneficial in certain drug overdoses to enhance excretion or stabilize cardiac membranes. - However, it is **not the primary or most effective treatment for bupivacaine-induced LAST** and cardiovascular collapse compared to lipid emulsion therapy. [Practice more Anesthesiology PYQs on OnCourse]

Q: A patient is undergoing surgery where anesthesia is maintained with halothane. The patient develops hyperthermia and muscle rigidity. Which of the following agents is most likely responsible?

Suxamethonium. ***Suxamethonium*** - **Suxamethonium** (succinylcholine) is a depolarizing neuromuscular blocker that can trigger **malignant hyperthermia** in susceptible individuals, characterized by **hyperthermia** and **muscle rigidity**. - This adverse reaction occurs due to an uncontrolled release of calcium from the **sarcoplasmic reticulum** in skeletal muscle, leading to sustained muscle contraction and increased metabolism. *Cisatracurium* - **Cisatracurium** is a non-depolarizing neuromuscular blocker, which works by competing with acetylcholine at the **neuromuscular junction**. - It does not typically cause **malignant hyperthermia** and is less likely to be associated with hyperthermia or muscle rigidity as a direct side effect. *D-tubocurarine* - **D-tubocurarine** is a non-depolarizing neuromuscular blocker that causes muscle relaxation by blocking nicotinic acetylcholine receptors. - While it can cause **histamine release**, leading to hypotension and bronchospasm, it is not implicated in triggering **malignant hyperthermia**. *Rocuronium* - **Rocuronium** is a rapid-onset, intermediate-acting non-depolarizing neuromuscular blocker, used for muscle relaxation during surgery. - Like other non-depolarizing agents, it does not directly trigger **malignant hyperthermia** and is not associated with hyperthermia and muscle rigidity in this context. [Practice more Anesthesiology PYQs on OnCourse]

3 Previous Year Questions with Answers & Explanations

Questions

The procedure shown in the image is performed to maintain the airway. Which of the following techniques is being used?

A young male was administered regional anesthesia with 0.25% bupivacaine. The patient became unresponsive, and the pulse became unrecordable. What is the best management in this situation?

A patient is undergoing surgery where anesthesia is maintained with halothane. The patient develops hyperthermia and muscle rigidity. Which of the following agents is most likely responsible?

NEET-PG 2021 - Anesthesiology NEET-PG Practice Questions and MCQs

Question 1: The procedure shown in the image is performed to maintain the airway. Which of the following techniques is being used?

A. Jaw thrust (Correct Answer)
B. Head stabilization
C. In line manual stabilization
D. Head tilt chin lift

Explanation: ***Jaw thrust*** - The image distinctly shows a rescuer performing a **jaw thrust maneuver** by placing fingers under the angles of the patient's mandible and displacing the jaw forward. - This technique is used to open the airway by lifting the tongue off the posterior pharyngeal wall, especially in cases of suspected **cervical spine injury**. *Head stabilization* - While important in trauma, **head stabilization alone** does not open the airway; it prevents movement without actively repositioning the jaw or head. - Head stabilization is a supportive technique, often used in conjunction with airway maneuvers, but it is not the primary airway-opening technique depicted. *In line manual stabilization* - **In-line manual stabilization** is a method where a rescuer holds the patient's head and neck in a neutral, in-line position to prevent movement, particularly during transport or other interventions. - This technique is used to protect the spine from further injury and prevents any movement from the head or neck. *Head tilt chin lift* - The **head tilt-chin lift** involves tilting the head back and lifting the chin, which is a different hand placement and body movement than what is shown. - This maneuver is contraindicated in suspected cervical spine injuries due to the risk of exacerbating spinal cord damage.

Question 2: A young male was administered regional anesthesia with 0.25% bupivacaine. The patient became unresponsive, and the pulse became unrecordable. What is the best management in this situation?

A. ECPR with calcium
B. ECPR with dobutamine
C. ECPR with 20% intralipid (Correct Answer)
D. ECPR with sodium bicarbonate

Explanation: ***ECPR with 20% intralipid*** - The scenario describes **Local Anesthetic Systemic Toxicity (LAST)**, likely due to bupivacaine, leading to cardiovascular collapse. - **Intralipid 20%** is the first-line treatment for LAST-induced cardiovascular toxicity, as it acts as a lipid sink for the lipophilic local anesthetic. *ECPR with calcium* - While calcium may be used in certain cardiac arrest scenarios, it is **not the primary treatment for bupivacaine-induced cardiovascular collapse** and LAST. - Calcium might offer some cardiac support but does not directly neutralize the local anesthetic's toxic effects. *ECPR with dobutamine* - **Dobutamine is an inotropic agent** used to improve cardiac contractility but is not indicated as a primary rescue therapy for severe LAST. - It would not address the underlying toxicity caused by bupivacaine and could potentially worsen the situation by increasing myocardial oxygen demand without reversing toxin effects. *ECPR with sodium bicarbonate* - **Sodium bicarbonate** is used to treat metabolic acidosis and can be beneficial in certain drug overdoses to enhance excretion or stabilize cardiac membranes. - However, it is **not the primary or most effective treatment for bupivacaine-induced LAST** and cardiovascular collapse compared to lipid emulsion therapy.

Question 3: A patient is undergoing surgery where anesthesia is maintained with halothane. The patient develops hyperthermia and muscle rigidity. Which of the following agents is most likely responsible?

A. Cisatracurium
B. D-tubocurarine
C. Rocuronium
D. Suxamethonium (Correct Answer)

Explanation: ***Suxamethonium*** - **Suxamethonium** (succinylcholine) is a depolarizing neuromuscular blocker that can trigger **malignant hyperthermia** in susceptible individuals, characterized by **hyperthermia** and **muscle rigidity**. - This adverse reaction occurs due to an uncontrolled release of calcium from the **sarcoplasmic reticulum** in skeletal muscle, leading to sustained muscle contraction and increased metabolism. *Cisatracurium* - **Cisatracurium** is a non-depolarizing neuromuscular blocker, which works by competing with acetylcholine at the **neuromuscular junction**. - It does not typically cause **malignant hyperthermia** and is less likely to be associated with hyperthermia or muscle rigidity as a direct side effect. *D-tubocurarine* - **D-tubocurarine** is a non-depolarizing neuromuscular blocker that causes muscle relaxation by blocking nicotinic acetylcholine receptors. - While it can cause **histamine release**, leading to hypotension and bronchospasm, it is not implicated in triggering **malignant hyperthermia**. *Rocuronium* - **Rocuronium** is a rapid-onset, intermediate-acting non-depolarizing neuromuscular blocker, used for muscle relaxation during surgery. - Like other non-depolarizing agents, it does not directly trigger **malignant hyperthermia** and is not associated with hyperthermia and muscle rigidity in this context.