Anesthesia for Bronchoscopy — MCQs
Which of the following medications should be avoided in a patient with asthma?
Which of the following structures is not seen on bronchoscopy?
During rapid sequence intubation in a child after taking brief history and clinical examination next step is:
Procedure of choice for control of massive hemoptysis?
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
Early and reliable indication of air embolism during anaesthesia can be obtained by continuous monitoring of:
Which of the following statements about the esophagoscope is correct?
Why 100% oxygen has to be given to a patient after recovering from N2O anesthesia?
Subarachnoid block as anaesthesia is contraindicated in –
During induction of anesthesia, after thiopentone injection patient develops discoloration of hand. All are true about this condition and its management except:
Anesthesia for Bronchoscopy Indian Medical PG Practice Questions and MCQs
Question 1: Which of the following medications should be avoided in a patient with asthma?
- A. theophylline
- B. corticosteroids
- C. sympathomimetic amines
- D. beta-blockers (Correct Answer)
Explanation: ***Correct Answer: beta-blockers*** - **Non-selective beta-blockers** can block beta-2 adrenergic receptors in the lungs, leading to **bronchoconstriction** and worsening asthma symptoms. - Even **cardioselective beta-blockers** (beta-1 selective) should be used with caution as their selectivity can be lost at higher doses. - Beta-blockers are **contraindicated** in asthma patients due to risk of severe bronchospasm. *Incorrect: theophylline* - **Theophylline** is a bronchodilator used in asthma management, particularly for **nocturnal symptoms** or as add-on therapy. - It works by inhibiting phosphodiesterase, increasing intracellular cAMP, which leads to **smooth muscle relaxation**. *Incorrect: corticosteroids* - **Corticosteroids** (inhaled or systemic) are a cornerstone in asthma management due to their potent **anti-inflammatory effects**. - They reduce airway inflammation, reduce **bronchial hyperresponsiveness**, and decrease the frequency and severity of asthma exacerbations. *Incorrect: sympathomimetic amines* - Many **sympathomimetic amines**, such as **beta-2 agonists** (e.g., albuterol, salmeterol), are primary bronchodilators used in asthma. - They work by stimulating beta-2 adrenergic receptors in the airway smooth muscle, leading to **bronchodilation**.
Question 2: Which of the following structures is not seen on bronchoscopy?
- A. Trachea
- B. Vocal cords
- C. Subcarinal lymph nodes (Correct Answer)
- D. First segmental division of bronchi
Explanation: ***Subcarinal lymph nodes*** - While the **carina** (the division of the trachea into the main stem bronchi) is clearly visible, the **lymph nodes** located beneath it are external to the airway and cannot be directly visualized during a standard bronchoscopy. - Visualization of lymph nodes typically requires imaging studies like CT scans or invasive procedures like **endobronchial ultrasound (EBUS)** with biopsy. *Trachea* - The **trachea** is the main airway tube and is fully visualized during the initial insertion and advancement of the bronchoscope. - Its rings, mucosa, and antegrade lumen are clearly inspected. *Vocal cords* - The **vocal cords** are located in the larynx, superior to the trachea, and are the first structures encountered and assessed during the intubation phase of a bronchoscopy. - Their movement and appearance are routinely checked to ensure proper bronchoscope insertion. *First segmental division of bronchi* - Bronchoscopy allows for the visualization of the **main bronchi** and their subsequent divisions down to the **segmental and subsegmental bronchi**. - The first division branches are readily accessible and are a common area for inspection and biopsy.
Question 3: During rapid sequence intubation in a child after taking brief history and clinical examination next step is:
- A. Administer oxygen (Correct Answer)
- B. Analgesic injection with Fentanyl
- C. Preanaesthetic medication with atropine and lignocaine
- D. IV anesthetic Diazepam/Ketamine
Explanation: ***Administer oxygen*** - Pre-oxygenation with 100% oxygen is critical before **rapid sequence intubation (RSI)** to maximize **oxygen reserves** and extend the safe apnea time. - This step helps prevent **hypoxemia** during the intubation procedure, especially in children who have lower functional residual capacity. *Analgesic injection with Fentanyl* - While fentanyl is often used in RSI for its **analgesic** and **sedative properties**, it typically follows pre-oxygenation and is administered as part of the **induction phase**, often concurrently with a paralytic. - Administering fentanyl alone without prior oxygenation or other induction agents would not be the immediate next step in a structured RSI protocol. *Preanaesthetic medication with atropine and lignocaine* - **Atropine** may be used in children to prevent **bradycardia** during intubation, particularly in infants, but it's not the immediate next step after initial assessment; pre-oxygenation is more critical. - **Lidocaine** can be used to blunt the sympathetic response to intubation or to suppress cough, but it's not universally required and comes after pre-oxygenation and other induction medications. *IV anesthetic Diazepam/Ketamine* - **Diazepam** and **ketamine** are **induction agents** that cause sedation and loss of consciousness, but they are administered after pre-oxygenation and often just before the paralytic agent. - Administering an induction agent without adequate pre-oxygenation would increase the risk of **hypoxemia** during the subsequent apnea.
Question 4: Procedure of choice for control of massive hemoptysis?
- A. Rigid bronchoscopy and Photocoagulation
- B. Bronchial artery embolization (Correct Answer)
- C. Balloon catheter tamponade
- D. Flexible bronchoscopy and cautery
Explanation: ***Bronchial artery embolization*** - **Bronchial artery embolization (BAE)** is the preferred initial treatment for **massive hemoptysis** due to its high success rate and minimally invasive nature. - It works by identifying and occluding the bleeding bronchial arteries, which are the most common source of massive hemoptysis. *Rigid bronchoscopy and Photocoagulation* - **Rigid bronchoscopy** is primarily used for **airway control**, foreign body removal, and occasionally for direct visualization and tamponade in massive hemoptysis. - While **photocoagulation** can be used to treat small bleeds, it is generally ineffective for massive or widespread hemorrhage. *Balloon catheter tamponade* - **Balloon catheter tamponade** can provide temporary control of bleeding by compressing the bleeding site but is not a definitive long-term solution. - It carries risks of tracheal injury and can obstruct the airway, making it a bridging measure until a more definitive treatment can be performed. *Flexible bronchoscopy and cautery* - **Flexible bronchoscopy** is useful for localizing the bleeding site but is **less effective** for controlling massive hemoptysis due to limited suction and instrument channels. - **Cautery** applied through a flexible bronchoscope is generally insufficient for significant bleeding and carries a risk of worsening the hemorrhage.
Question 5: 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 6: Early and reliable indication of air embolism during anaesthesia can be obtained by continuous monitoring of:
- A. Oxygen saturation
- B. End Tidal CO2 (Correct Answer)
- C. ECG
- D. Blood pressure
Explanation: ***End Tidal CO2*** - A sudden and unexplained decrease in **End Tidal CO2 (EtCO2)** is often the first sign of an air embolism. - This occurs because air in the pulmonary circulation obstructs blood flow, leading to reduced CO2 delivery to the lungs. *Oxygen saturation* - **Oxygen saturation** changes are typically a later sign of air embolism, as significant pulmonary impairment or right-to-left shunting must occur before a drop is detectable. - A decrease in saturation indicates a more advanced and potentially severe embolism. *ECG* - **ECG changes**, such as arrhythmias or signs of right heart strain, are usually late and non-specific indicators of air embolism. - These changes reflect the cardiovascular consequences of the embolism rather than its initial event. *Blood pressure* - A drop in **blood pressure** is a late and often profound sign of an air embolism, reflecting significant cardiovascular compromise. - Early detection methods precede observable changes in systemic blood pressure.
Question 7: Which of the following statements about the esophagoscope is correct?
- A. The incisor acts as a fulcrum. (Correct Answer)
- B. It lifts the epiglottis.
- C. The tip is in the pyriform fossa.
- D. It compresses the posterior tongue.
Explanation: ***The incisor acts as a fulcrum.*** - During **esophagoscopy**, the upper incisors serve as the pivotal point or **fulcrum** against which the instrument is manipulated. - This positioning allows for controlled advancement and angulation of the esophagoscope into the esophagus. *It lifts the epiglottis.* - The **esophagoscope** is primarily designed to visualize the esophagus and does not typically lift the **epiglottis**. - **Laryngoscopes** are the instruments specifically used to lift the epiglottis for visualizing the vocal cords and trachea during intubation. *The tip is in the pyriform fossa.* - The **pyriform fossa** is a structure in the **hypopharynx**, and while the esophagoscope passes through this region, its tip is advanced beyond it into the **esophagus** for proper visualization. - Positioning the tip solely in the pyriform fossa would not achieve the purpose of an **esophagoscopy**, which is to examine the esophageal lumen. *It compresses the posterior tongue.* - The esophagoscope is carefully advanced to bypass the tongue and pharyngeal structures, not to **compress** the **posterior tongue**. - Compression of the posterior tongue would obstruct the view and potentially cause trauma or gag reflex, hindering the procedure.
Question 8: Why 100% oxygen has to be given to a patient after recovering from N2O anesthesia?
- A. Second gas effect
- B. Diffusion hypoxia (Correct Answer)
- C. Bronchoconstriction
- D. Atelectasis
Explanation: ***Diffusion hypoxia*** - Upon discontinuation of N2O, its rapid diffusion out of the blood into the **alveoli** can dilute the partial pressures of **oxygen** and **carbon dioxide**, leading to hypoxemia and hypercapnia. - Administering 100% oxygen prevents this, ensuring adequate oxygenation while N2O is exhaled. *Second gas effect* - This phenomenon refers to the rapid uptake of a highly soluble anesthetic (like N2O) from the alveoli, which then concentrates the inspired partial pressure of a co-administered less soluble anesthetic, speeding its induction. - This effect is significant during the **induction phase** of anesthesia, not recovery. *Bronchoconstriction* - This is the narrowing of the airways, which can be caused by various factors like allergies, asthma, or irritants, but is not a direct consequence of recovering from N2O anesthesia or a reason for 100% oxygen administration. - While patients with **reactive airway disease** might experience bronchoconstriction under anesthesia, it is not specifically linked to N2O recovery for the general population. *Atelectasis* - This is the collapse of lung tissue, which can occur during or after surgery due to conditions like hypoventilation, airway obstruction, or pressure on the lungs. - Administering 100% oxygen is not used primarily to prevent atelectasis immediately after N2O cessation, although good ventilation and lung recruitment maneuvers are important in preventing it generally.
Question 9: Subarachnoid block as anaesthesia is contraindicated in –
- A. Atherosclerotic gangrene
- B. Diabetic gangrene
- C. Buerger's disease
- D. Hemophilia (Correct Answer)
Explanation: ***Hemophilia*** - Subarachnoid block, which involves puncturing the dura, is contraindicated in patients with **hemophilia** due to the high risk of **spinal hematoma**. - A spinal hematoma can lead to **cord compression** and devastating neurological deficits. *Atherosclerotic gangrene* - This condition involves **peripheral vascular disease** and tissue necrosis, but does not inherently contraindicate subarachnoid block. - In fact, subarachnoid block can be beneficial by providing **sympathectomy**, improving blood flow to the affected limb. *Diabetic gangrene* - Similar to atherosclerotic gangrene, **diabetic gangrene** is a manifestation of peripheral vascular disease often complicated by neuropathy and infection. - There is no direct contraindication to subarachnoid block for this condition itself, provided there are no concurrent coagulopathies or active infections at the needle insertion site. *Buerger's disease* - **Buerger's disease** (thromboangiitis obliterans) is an inflammatory vasculitis of small and medium-sized arteries and veins, primarily in the limbs. - Subarachnoid block may even be indicated to improve blood flow by inducing **sympathectomy**, helping relieve ischemic pain or prevent further tissue damage.
Question 10: During induction of anesthesia, after thiopentone injection patient develops discoloration of hand. All are true about this condition and its management except:
- A. Immediately remove the needle from the vessel (Correct Answer)
- B. Inject lignocaine
- C. Dilute heparin
- D. Intra-arterial thrombolysis
Explanation: ***Immediately remove the needle from the vessel*** - This is an **incorrect** management step for accidental intra-arterial injection of thiopentone because removing the needle can lead to **vasospasm** and further compromise blood flow. - The needle should be left in place to facilitate administration of vasodilator and antispasmodic agents, helping to mitigate the damage. *Inject lignocaine* - **Intra-arterial lignocaine** (without adrenaline) is a crucial step to induce vasodilation and alleviate pain caused by the irritation and arterial spasm. - This helps to restore blood flow and prevent further tissue ischemia. *Dilute heparin* - Administering **dilute heparin** directly into the artery helps to prevent or treat **thrombosis**, a common complication of intra-arterial injection of irritant substances like thiopentone. - Thiopentone's high pH can cause endothelial damage, leading to clot formation and further reducing perfusion. *Intra-arterial thrombolysis* - If conservative measures fail and there is evidence of severe ischemia or thrombosis, **intra-arterial thrombolysis** with agents like urokinase or streptokinase may be considered. - This highly invasive procedure aims to dissolve existing clots and restore arterial patency to salvage tissue.
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