Anesthetic Equipment and Monitoring Practice Questions

Q: Which of the following Mapleson system is shown below?

Mapleson D. ***Mapleson D*** - This system is characterized by the **fresh gas inlet (FG)** being close to the patient end (P) and the **reservoir bag** and **adjustable pressure-limiting (APL) valve (T)** being further away, typically near the expiratory limb. The corrugated tube separates the bag and valve from the patient. - The image clearly depicts the **fresh gas entering near a reservoir bag**, which is then connected via a corrugated tube to the patient end, with an **APL valve (T)** situated near the patient, right before the patient connection, which is characteristic of the Mapleson D system. *Mapleson A* - In a Mapleson A system, the **fresh gas inlet** is located near the **reservoir bag**, which is positioned far from the patient. The APL valve is also near the reservoir bag. - This arrangement is highly efficient for **spontaneous ventilation** but less so for controlled ventilation. The image shows a different configuration. *Mapleson B* - The Mapleson B system has both the **fresh gas inlet** and the **APL valve** close to the patient, with the reservoir bag at the end of a long expiratory limb. - This system is **not very efficient** for either spontaneous or controlled ventilation due to significant rebreathing potential, which is unlike the depicted system. *Mapleson C* - This system is similar to Mapleson B but with a **shorter expiratory limb**, making it more compact. - Both the **fresh gas inlet** and the **APL valve** are near the patient, with the reservoir bag also close to the patient. The image clearly shows a long corrugated tube, making this option incorrect.

Q: Which of the knobs shown below represent the knob controlling oxygen flow in the anesthesia machine?

Blue. ***Blue*** - In anesthesia machines, the blue knob typically controls the flow of **nitrous oxide**. However, in the provided image, the blue knob is labeled with "O2" (implied by the digital display indicating "10" which typically refers to **liters per minute of oxygen**). The question asks for the knob controlling oxygen flow, and based on the provided image, the blue knob corresponds to oxygen. - The digital display next to the blue knob reads "10", which in the context of anesthesia machines, usually signifies a flow rate in **liters per minute**. Given that the question asks for the oxygen flow control, and it is common for oxygen to be blue-coded in some parts of the world, this is the most logical choice depicted. *Yellow* - The yellow knob is labeled "Air" (implied by the digital display indicating "10"). This knob would control the flow of **medical air**, not oxygen. - Medical air is a distinct gas from oxygen, used for different purposes in anesthesia. *Green* - The green knob is labeled "N2O," representing **nitrous oxide**. This knob controls the flow of nitrous oxide, which is an anesthetic gas. - Nitrous oxide is typically color-coded blue in some regions (like the US) but green in others (like the UK/Europe), similar to how oxygen can be white or green. However, in this specific image, green is clearly labeled N2O. *None* - This option is incorrect because the image clearly shows a knob, specifically the blue one, designated for oxygen flow (implied by the "O2" display). - The presence of color-coded knobs with corresponding digital displays for gas flow negates the possibility of "None" being the correct answer.

Q: The following drug is colour coded for perioperative use:

Blue. ***Blue*** - The image shows a **Pancuronium** vial with a blue cap and blue accents on its label and packaging, indicating that the drug is color-coded **blue**. - Color-coding of vials, particularly the cap color, is a common practice in anesthesiology to quickly identify drug classes and reduce medication errors. *Red* - While red is used for color-coding in some perioperative drugs, typically for specific drug classes like muscle relaxants, the drug shown (**Pancuronium**) is depicted with a **blue** color code. - Drug color-coding schemes can vary slightly between manufacturers and regions, but pancuronium is frequently associated with blue. *Yellow* - Yellow is a common color code for certain anesthetic drugs, such as **non-depolarizing muscle relaxant antagonists** (e.g., neostigmine, sugammadex) or some vasoactive drugs. - However, it is not the color code associated with Pancuronium in the provided image. *Orange* - Orange is also used for specific drug classes in perioperative settings, but it is not typically associated with **Pancuronium**. - For example, propofol (anesthetic induction agent) is sometimes color-coded orange.

Q: (1) Identify the spinal needles shown in the image:

A= Whitacre, B= Quincke, C= Sprotte. ***A= Whitacre, B= Quincke, C= Sprotte*** - Image A depicts a **Whitacre needle**, characterized by a **pencil-point tip** with a side port for fluid delivery. This design is known for reducing the incidence of post-dural puncture headache (PDPH). - Image B shows a **Quincke needle**, which has a **beveled cutting tip**. This design is associated with a higher risk of PDPH due to its cutting action on the dura mater. - Image C illustrates a **Sprotte needle**, also a **pencil-point tip** with a larger oval side port compared to the Whitacre. It is recognized for its ability to spread dural fibers rather than cut them, minimizing PDPH risk. *A= Quincke, B= Whitacre, C= Sprotte* - This option incorrectly identifies needle A as Quincke; the **beveled cutting tip** belongs to the Quincke needle, not the pencil-point tip. - It also misidentifies needle B as Whitacre; the **side port with an opening towards the tip** is characteristic of the Whitacre, not the cutting tip. *A= Whitacre, B= Sprotte, C= Quincke* - This option incorrectly identifies needle B as Sprotte; the **Sprotte needle has a specific pencil-point design with a large oval side port**, not a cutting tip. - It also misidentifies needle C as Quincke, confusing the **pencil-point Sprotte** with the **beveled cutting tip of a Quincke**. *A= Sprotte, B= Whitacre, C= Quincke* - This option incorrectly identifies needle A as Sprotte; the **Sprotte needle has a distinctive design with a large oval side port**, not the precise pencil-point and smaller side port of the Whitacre. - It also misidentifies needle B as Whitacre, as the **cutting tip shown in B is characteristic of a Quincke**, not a pencil-point needle.

Q: Identify the test performed in the image:

Allen's Test. ***Allen's Test*** - The image demonstrates **Allen's test**, performed to assess the patency of the **radial and ulnar arteries** and adequacy of collateral circulation to the hand before radial artery cannulation or harvest. - The examiner compresses **both radial and ulnar arteries** at the wrist; the patient clenches the fist to blanch the hand. The **ulnar artery is then released** — colour return within **< 7 seconds** indicates adequate ulnar collateral circulation (normal/negative test). - This is a mandatory preoperative check before **radial artery catheterisation** or use of the radial artery as a coronary artery bypass graft conduit. *Adson's Test* - Performed for **thoracic outlet syndrome** — the patient extends the neck, rotates the head toward the affected side, and takes a deep breath; obliteration of the **radial pulse** indicates subclavian artery compression. Does NOT involve bilateral wrist artery compression. *Phalen's Test* - Performed for **carpal tunnel syndrome** — maximum **wrist flexion** held for 60 seconds reproduces paraesthesia in the median nerve distribution. Involves wrist posture, not arterial compression. *Finkelstein's Test* - Performed for **De Quervain's tenosynovitis** — the patient folds the thumb into the palm, closes the fingers over it, and deviates the wrist ulnarly; pain over the radial styloid is a positive test. Involves tendons, not vasculature.

Q: All are correct about the pressure recording shown below except: (Recent NEET Pattern 2016-17)

Can be used to assess left ventricular function. ***Can be used to assess left ventricular function*** - Central venous pressure (CVP) primarily reflects **right atrial pressure** and, indirectly, **right ventricular end-diastolic pressure**. - It is **not a reliable indicator** for assessing **left ventricular function**, which is better gauged by pulmonary artery wedge pressure (PAWP) or echocardiography. *Normal CVP is 2-10 cm of water* - The image depicts a manometer measuring CVP in **cm of water**. - The generally accepted normal range for CVP is **2-10 cm H2O** (or 0-8 mmHg), reflecting adequate right heart filling and venous return. *Pressure recording of more than 10 cm of water implies restricting IV fluids to the patient* - A CVP **above 10 cm H2O** (or 8 mmHg) typically indicates **fluid overload**, increased right ventricular preload, or right ventricular dysfunction. - In such cases, **restricting intravenous fluids** is often appropriate to prevent further circulatory congestion and potential complications like pulmonary edema. *Venous catheter is advanced into subclavicular IVC* - For CVP measurement, the catheter tip should ideally be positioned in the **superior vena cava (SVC)**, near its junction with the **right atrium**. - Advancing the catheter into the **inferior vena cava (IVC)** is anatomically incorrect for standard CVP measurement, as it would not reflect right atrial pressure as directly or accurately.

Q: You are asked to put a 22-gauge cannula in a patient. Which of the following cannula will you put?

C. ***C*** - This cannula is blue, which correlates to a **22-gauge** size according to standard color-coding for IV cannulas. - A **22-gauge** cannula matches the specific requirement in the question and is generally used for patients with fragile veins, pediatric patients, or for slow infusions. *A* - This cannula is green, typically indicating an **18-gauge** size. - An 18-gauge cannula provides a larger bore for faster fluid administration but is **too large** for the 22-gauge requirement specified. *B* - This cannula is pink, which corresponds to a **20-gauge** size according to standard color-coding. - A 20-gauge cannula is commonly used for routine infusions but is **larger than the requested 22-gauge** size. *D* - This cannula is yellow, indicating a **24-gauge** size, the smallest common size. - A 24-gauge cannula is **smaller than the requested 22-gauge** and is primarily reserved for very fragile veins and infants.

Q: The image shows:

Rebreathing mask. ***Rebreathing mask*** - The image clearly displays a **reservoir bag** and **oxygen tubing** attached to a mask-like structure, characteristic of a rebreathing mask used for oxygen delivery. - This device is designed to deliver high concentrations of oxygen, with or without partial rebreathing of exhaled air, depending on the type (partial or non-rebreather). *Nebulizer* - A nebulizer typically includes a **medication cup** and generates a **fine mist** for inhalation, which is not visible here. - While it uses tubing and can have a mask, the prominent reservoir bag is not a feature of a standard nebulizer. *AMBU Bag* - An **AMBU bag (Ambulatory Manual Bag Unit)** is a self-inflating bag resuscitator used for manual ventilation, characterized by a large, squeezable bag, an oxygen inlet, and a one-way valve for positive pressure ventilation. - The device in the image lacks the large, squeezable bag for manual ventilation and the specific valve system of an AMBU bag. *PEFR meter* - A **Peak Expiratory Flow Rate (PEFR) meter** is a small, handheld device used to measure how fast air is exhaled from the lungs. - It does not involve a reservoir bag or oxygen tubing and looks significantly different from the device pictured.

Q: Identify the instrument shown in the image, which is a lumbar puncture needle with a sharp cutting edge and a hub indicating CSF.

Quincke's needle. ***Quincke's needle*** - This image shows a **Quincke's needle**, which is a type of spinal needle commonly used for lumbar punctures. - It features a **sharp, beveled cutting edge** designed to cut through tissue layers, and the hub allows for CSF flow immediately upon entry into the subarachnoid space. - Quincke needles are **cutting needles** with a traditional beveled tip. *Whitacre needle* - This is a **pencil-point, atraumatic needle** with a rounded tip and side opening. - Designed to separate rather than cut dural fibers, reducing post-dural puncture headache risk. *Sprotte needle* - Another **pencil-point, atraumatic needle** similar to Whitacre but with a larger side opening. - Also designed to minimize post-dural puncture headache. *Tuohy needle* - A **curved-tip needle** primarily used for **epidural anesthesia**, not lumbar puncture. - Features a Huber tip that helps guide the epidural catheter.

Q: A pulmonary artery (Swan-Ganz) catheter measures all of the following except

Left ventricular end diastolic volume (LVEDV). ***Left ventricular end diastolic volume (LVEDV)*** - While a Swan-Ganz catheter can measure **pulmonary artery wedge pressure (PAWP)**, which is a surrogate for **left ventricular end-diastolic pressure (LVEDP)**, it cannot directly measure **left ventricular end-diastolic volume (LVEDV)**. - LVEDV requires imaging techniques like **echocardiography** or **cardiac MRI** for direct measurement. *Pulmonary artery wedge pressure (PAWP)* - The Swan-Ganz catheter can measure **PAWP**, which reflects **left atrial pressure** and, in the absence of mitral valve disease, - Is an estimate of **left ventricular end-diastolic pressure (LVEDP)**, therefore assessing left ventricular preload. *Mixed venous oxygen saturation (SvO2)* - The catheter has a fiberoptic sensor that can continuously measure **SvO2** from the pulmonary artery. - **SvO2** provides an assessment of the balance between oxygen supply and demand. *Cardiac output (CO)* - **Cardiac output** is commonly measured using the **thermodilution method** via the Swan-Ganz catheter. - A bolus of saline is injected into the right atrium, and temperature changes are detected in the pulmonary artery to calculate flow.

Question 1

Which of the following Mapleson system is shown below?

Accepted Answer

Mapleson D

Answer

Mapleson C

Answer

Mapleson A

Answer

Mapleson B

Question 2

Which of the knobs shown below represent the knob controlling oxygen flow in the anesthesia machine?

Accepted Answer

Blue

Answer

Yellow

Answer

Green

Answer

None

Question 3

The following drug is colour coded for perioperative use:

Accepted Answer

Blue

Answer

Red

Answer

Yellow

Answer

Orange

Question 4

(1) Identify the spinal needles shown in the image:

Accepted Answer

A= Whitacre, B= Quincke, C= Sprotte

Answer

A= Quincke, B= Whitacre, C= Sprotte

Answer

A= Whitacre, B= Sprotte, C= Quincke

Answer

A= Sprotte, B= Whitacre, C= Quincke

Question 5

Identify the test performed in the image:

Accepted Answer

Allen's Test

Answer

Adson's Test

Answer

Phalen's Test

Answer

Finkelstein's Test

Question 6

All are correct about the pressure recording shown below except: (Recent NEET Pattern 2016-17)

Accepted Answer

Can be used to assess left ventricular function

Answer

Normal CVP is 2-10 cm of water

Answer

Pressure recording of more than 10 cm of water implies restricting IV fluids to the patient

Answer

Venous catheter is advanced into subclavicular IVC

Question 7

You are asked to put a 22-gauge cannula in a patient. Which of the following cannula will you put?

Accepted Answer

C

Answer

A

Answer

D

Answer

B

Question 8

The image shows:

Accepted Answer

Rebreathing mask

Answer

Nebulizer

Answer

AMBU Bag

Answer

PEFR meter

Question 9

Identify the instrument shown in the image, which is a lumbar puncture needle with a sharp cutting edge and a hub indicating CSF.

Accepted Answer

Quincke's needle

Answer

Whitacre needle

Answer

Sprotte needle

Answer

Tuohy needle

Question 10

A pulmonary artery (Swan-Ganz) catheter measures all of the following except

Accepted Answer

Left ventricular end diastolic volume (LVEDV)

Answer

Pulmonary artery wedge pressure (PAWP)

Answer

Mixed venous oxygen saturation (SvO2)

Answer

Cardiac output (CO)

Anesthetic Equipment and Monitoring — MCQs

Anesthetic Equipment and Monitoring — MCQs

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