Full Stomach Considerations — MCQs
Mendelsons syndrome is:
What is the drug of choice for drug-induced peptic ulcer?
What is the most appropriate method for administering oxygen in patients with airway burns?
Endotracheal tube in the esophagus is best assessed by:
Gastric lavage is contraindicated in which of the following?
What is the correct sequence of management in a patient who presents to the casualty with an RTA? 1. Cervical spine stabilization 2. Intubation 3. IV cannulation 4. CECT
Steps of intubation - arrange in sequence:- a. Head extension and flexion of neck b. Introduction of laryngoscope c. Inflation of cuff d. Check breath sounds with stethoscope e. fixation of the tube to prevent dislodgement
In emergency caesarian section rapid induction of anaesthesia is done to –
Gout can be precipitated by -
Nil per oral orders for an 8-year-old child posted for elective nasal polyp surgery at 8 AM include all of the following EXCEPT:
Full Stomach Considerations Indian Medical PG Practice Questions and MCQs
Question 1: Mendelsons syndrome is:
- A. Allergic reaction to inhalational anesthetics
- B. Aspiration of gastric contents (Correct Answer)
- C. Aspiration of nasal secretions
- D. Complications from improper intubation
Explanation: ***Aspiration of gastric contents*** - Mendelson's syndrome refers to a chemical pneumonitis resulting from the **aspiration of acidic gastric contents** into the respiratory tract. - This typically occurs during **anesthesia**, sedation, or altered consciousness when airway reflexes are blunted. *Allergic reaction to inhalational anesthetics* - Allergic reactions to anesthetics are distinct from Mendelson's syndrome and involve an **immunological response**, not direct chemical burn. - Symptoms would include rash, bronchospasm, and hypotension, rather than pneumonitis from aspiration. *Aspiration of nasal secretions* - While aspiration of nasal secretions can occur, it's generally less irritating and does not typically lead to the severe inflammatory lung injury characteristic of Mendelson's syndrome, which is specifically due to **acidic gastric contents**. - Nasal secretions are usually **less acidic** and contain different microbial flora. *Complications from improper intubation* - Improper intubation can lead to complications such as **esophageal intubation**, trauma to the airway, or vocal cord damage. - These are **mechanical injuries** or misplacements and are distinct from aspiration pneumonitis caused by gastric contents.
Question 2: What is the drug of choice for drug-induced peptic ulcer?
- A. Prostaglandin analogues
- B. H2-receptor antagonists
- C. Proton pump inhibitors (Correct Answer)
- D. Antacids
Explanation: ***Proton pump inhibitors*** - **PPIs** are the most effective agents for treating and preventing **NSAID-induced peptic ulcers** by profoundly suppressing gastric acid secretion. - They provide **rapid symptom relief** and promote ulcer healing by creating an environment conducive to mucosal repair. *Prostaglandin analogues* - **Misoprostol**, a prostaglandin E1 analogue, can prevent NSAID-induced ulcers, but its use is limited by **gastrointestinal side effects** such as diarrhea and abdominal cramping. - While they protect the gastric mucosa, their efficacy in healing established ulcers is generally **inferior to PPIs**. *H2-receptor antagonists* - **H2-blockers** are effective in reducing gastric acid, but they are **less potent** than PPIs and typically do not heal **gastric ulcers** as effectively, especially those induced by NSAIDs. - They are more commonly used for preventing **duodenal ulcers** and managing symptoms of GERD. *Antacids* - Antacids provide **immediate, temporary relief** of ulcer symptoms by neutralizing existing stomach acid. - They do not address the underlying pathology or promote **ulcer healing** and are therefore not considered the drug of choice for treatment.
Question 3: What is the most appropriate method for administering oxygen in patients with airway burns?
- A. Elective intubation (Correct Answer)
- B. Oxygen mask
- C. Nasal cannula
- D. Surgical airway management
Explanation: ***Elective intubation*** - **Elective intubation** is the most appropriate method because airway burns can lead to rapid **airway edema** and obstruction, making intubation extremely difficult later. - Early intubation secures the airway before swelling progresses, preventing a potentially life-threatening emergency. *Oxygen mask* - An oxygen mask can provide supplemental oxygen but does not **secure the airway** or prevent potential obstruction from developing airway edema due to the burns. - This method is insufficient for preventing **airway compromise** in patients with airway burns. *Nasal cannula* - A nasal cannula delivers low-flow oxygen but does not offer **airway protection** against swelling or provide adequate respiratory support for patients with compromised airways. - This method is inadequate for ensuring a patent airway in the face of progressive **airway edema**. *Surgical airway management* - A surgical airway (e.g., **cricothyroidotomy** or **tracheostomy**) is a rescue procedure when intubation is impossible due to severe airway obstruction. - It is a more invasive measure and not the primary method for initial airway management when **elective intubation** is still feasible.
Question 4: Endotracheal tube in the esophagus is best assessed by:
- A. Direct laryngoscopy
- B. Auscultation
- C. CO2 Exhalation (Correct Answer)
- D. Chest wall movement
Explanation: ***CO2 Exhalation*** - Measuring **CO2 exhalation** (capnography) is the most reliable method to confirm endotracheal tube placement, as CO2 is present in the trachea but not in the esophagus. - A persistent **waveform on the capnograph** indicates proper tracheal intubation. *Direct laryngoscopy* - While helpful for initial visualization during intubation, **direct laryngoscopy** cannot confirm continuous tracheal placement after the tube is advanced. - It only confirms the tube passing through the vocal cords, not its final position in the trachea versus esophagus. *Auscultation* - **Auscultation** can be misleading because stomach sounds can be transmitted to the chest, and breath sounds can be heard in the epigastrium even with esophageal intubation. - It relies on subjective interpretation and is less definitive than capnography. *Chest wall movement* - Observing **chest wall movement** is not a definitive sign, as the chest can still rise with esophageal intubation due to air entering the stomach. - This method is unreliable and can be mistaken for proper ventilation, leading to dangerous delays in correcting tube misplacement.
Question 5: Gastric lavage is contraindicated in which of the following?
- A. Organophosphorus Poisoning
- B. Dhatura poisoning
- C. Arsenic poisoning
- D. Kerosene poisoning (Correct Answer)
Explanation: ***Kerosene poisoning*** - Gastric lavage is contraindicated in **kerosene poisoning** due to the high risk of **aspiration pneumonitis**. - Kerosene is a **hydrocarbon**, and aspiration of even small amounts can cause severe lung damage. *Arsenic poisoning* - **Gastric lavage** can be performed in arsenic poisoning, especially if the ingestion occurred recently, to remove unabsorbed toxin. - Activated charcoal is less effective for arsenic, making lavage a more relevant intervention in acute settings. *Organophosphorus Poisoning* - Gastric lavage is generally recommended within an hour of ingestion for **organophosphorus poisoning** to remove the toxic substance. - This helps reduce systemic absorption and mitigate the severe **cholinergic crisis** caused by these agents. *Dhatura poisoning* - **Gastric lavage** is indicated in dhatura poisoning, particularly if presenting within a few hours of ingestion, to remove unabsorbed **atropine-like alkaloids**. - This helps in reducing the **anticholinergic effects** and improving patient outcomes.
Question 6: What is the correct sequence of management in a patient who presents to the casualty with an RTA? 1. Cervical spine stabilization 2. Intubation 3. IV cannulation 4. CECT
- A. 2,1,4,3
- B. 1,3,2,4
- C. 2,1,3,4
- D. 1,2,3,4 (Correct Answer)
Explanation: ***1,2,3,4*** - This sequence follows the **ATLS (Advanced Trauma Life Support)** protocol, prioritizing immediate life threats in order. - **Cervical spine stabilization** is the **first action upon patient contact** to prevent secondary neurological injury in any trauma patient. - **Airway management (intubation)** is then performed **with maintained in-line c-spine stabilization** - these occur nearly simultaneously but c-spine protection is instituted first. - **IV cannulation (circulation)** follows to establish vascular access for resuscitation and medications. - **CECT (imaging)** is performed last, once the patient is stabilized after addressing immediate life threats. - This follows the **ATLS Primary Survey: Airway (with c-spine protection) → Breathing → Circulation → Disability → Exposure**. *2,1,4,3* - This incorrectly places intubation **before** cervical spine stabilization is initiated. - In ATLS, **c-spine protection must be applied immediately upon patient contact** before any airway manipulation. - Delaying IV cannulation until after CECT is inappropriate as circulatory access is critical for early resuscitation. *1,3,2,4* - While this correctly starts with cervical spine stabilization, it incorrectly places **IV cannulation before intubation**. - In the ATLS primary survey, **Airway comes before Circulation** - securing the airway takes priority over establishing IV access. - This sequence could delay critical airway management in a patient with respiratory compromise. *2,1,3,4* - This sequence places **intubation before cervical spine stabilization**, which violates ATLS principles. - **C-spine stabilization must be the first action** upon approaching any trauma patient to prevent secondary spinal cord injury. - While intubation with in-line stabilization is possible, the c-spine protection must be instituted first, not after beginning airway manipulation.
Question 7: Steps of intubation - arrange in sequence:- a. Head extension and flexion of neck b. Introduction of laryngoscope c. Inflation of cuff d. Check breath sounds with stethoscope e. fixation of the tube to prevent dislodgement
- A. CBAED
- B. ACBED
- C. DBCEA
- D. ABCDE (Correct Answer)
Explanation: **ABCDE** - The correct sequence for intubation starts with proper patient positioning (**A. Head extension and flexion of neck**) followed by insertion of the laryngoscope (**B. Introduction of laryngoscope**). - After visualizing the glottis and inserting the endotracheal tube, the cuff is inflated (**C. Inflation of cuff**), tube placement is confirmed by checking breath sounds (**D. Check breath sounds with stethoscope**), and finally, the tube is secured (**E. Fixation of the tube to prevent dislodgement**). *CBAED* - This sequence is incorrect because inflating the cuff (C) and introducing the laryngoscope (B) occur before head positioning (A), and checking breath sounds (E) and fixation (D) are not in the correct order after intubation. - Proper patient positioning is the critical first step to align the oral, pharyngeal, and laryngeal axes for optimal visualization. *ACBED* - This sequence incorrectly places the inflation of the cuff (C) before the introduction of the laryngoscope (B) and confirmation steps (E and D). - The cuff is inflated only after the tube is properly placed in the trachea, and confirmation of placement always precedes fixation. *DBCEA* - This sequence is incorrect as it begins with checking breath sounds (D), which is a step for confirming tube placement, not initiating the intubation process. - Head positioning (A) is also placed last, which is contrary to the vital initial steps of airway management for intubation.
Question 8: In emergency caesarian section rapid induction of anaesthesia is done to –
- A. Prevent gastric aspiration (Correct Answer)
- B. Prevent fetal depression
- C. All of the above
- D. To decrease awareness
Explanation: ***Prevent gastric aspiration*** - Rapid sequence induction is crucial in emergency cesarean sections to minimize the risk of **pulmonary aspiration of gastric contents**. - Pregnant women are at increased risk due to **delayed gastric emptying**, increased intra-abdominal pressure, and a less competent gastroesophageal sphincter. *Prevent fetal depression* - While anesthetic agents can cross the placenta and cause fetal depression, rapid induction is primarily aimed at maternal safety through aspiration prevention, not solely preventing fetal effects. - The choice of anesthetic agents and their dosage is carefully managed to minimize fetal exposure and depression. *All of the above* - This option is incorrect because while preventing fetal depression is a concern, the primary and most immediate reason for rapid induction in an emergency C-section is to prevent **maternal gastric aspiration**. - Rapid induction techniques expedite intubation, limiting the time for regurgitation and aspiration. *To decrease awareness* - Preventing awareness during anesthesia is a goal in any surgical procedure, but standard induction methods are also effective for this. - Rapid induction's specific advantage in this context is the prevention of **aspiration**, not primarily to reduce awareness, which can be accomplished with slower inductions as well.
Question 9: Gout can be precipitated by -
- A. Digitalis
- B. Calcium channel blockers
- C. Thiazide diuretics (Correct Answer)
- D. Omeprazole
Explanation: ***Thiazide diuretics*** - **Thiazide diuretics** reduce the renal excretion of **uric acid**, leading to increased serum uric acid levels (hyperuricemia). - This elevation in uric acid can lead to the formation of **uric acid crystals** in joints, precipitating a gout attack. *Digitalis* - **Digitalis** (digoxin) is a cardiac glycoside used for heart failure and arrhythmias; it does not directly affect uric acid metabolism. - Its primary mechanism involves inhibiting the **Na+/K+-ATPase pump**, increasing intracellular calcium, and enhancing myocardial contractility. *Calcium channel blockers* - **Calcium channel blockers** primarily act by blocking calcium influx into vascular smooth muscle and cardiac cells. - They are generally considered **neutral** or even slightly beneficial for uric acid levels; some, like amlodipine, have shown potential to lower uric acid slightly. *Omeprazole* - **Omeprazole** is a proton pump inhibitor (PPI) that reduces stomach acid production. - It does not have a direct mechanism that would significantly impact **uric acid metabolism** or precipitate gout.
Question 10: Nil per oral orders for an 8-year-old child posted for elective nasal polyp surgery at 8 AM include all of the following EXCEPT:
- A. Apple juice can be taken at 10 PM previous night
- B. Milk can be taken at 7 AM in morning (Correct Answer)
- C. Can take sips of water up to 6 AM in morning
- D. Rice can be consumed at 11 PM previous night
Explanation: **Milk can be taken at 7 AM in morning** - For an 8-year-old undergoing elective surgery at 8 AM, **milk is considered a solid or heavy fluid** and should be stopped at least **6 hours pre-operatively**. - Taking milk at 7 AM, just one hour before surgery, significantly increases the risk of **pulmonary aspiration** during anesthesia. *Apple juice can be taken at 10 PM previous night* - **Clear liquids**, such as apple juice, can generally be consumed up to **2 hours before surgery** in children. - Taking apple juice at 10 PM the night before for an 8 AM surgery falls well within the safe fasting window for clear liquids. *Can take sips of water up to 6 AM in morning* - **Sips of water** are considered a clear liquid and can be consumed up to **2 hours before surgery** in children. - Allowing water until 6 AM for an 8 AM surgery is appropriate and helps prevent dehydration without increasing aspiration risk. *Rice can be consumed at 11 PM previous night* - **Solid foods**, like rice, require a longer fasting period, typically at least **6-8 hours before surgery**. - Consuming rice at 11 PM the night before, for an 8 AM surgery, allows for sufficient gastric emptying and is generally safe.
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