NEET-PG 2013 Practice Questions

Q: Which drug is commonly used for emergency intubation?

Etomidate. ***Etomidate*** - Etomidate is a **short-acting nonbenzodiazepine hypnotic** often preferred for rapid sequence intubation (RSI) due to its minimal impact on **hemodynamic stability**. - It induces **rapid unconsciousness** with a quick onset and offset, making it suitable for emergency airway management in patients who are hemodynamically compromised. *Propofol* - Propofol is a **potent intravenous anesthetic** that can cause significant **hypotension** due to vasodilation and myocardial depression. - While it provides rapid onset of sedation and amnesia, its cardiovascular side effects make it less ideal for patients with **unstable hemodynamics** during emergency intubation. *Ketamine* - Ketamine is a **dissociative anesthetic** that causes a cataleptic state, amnesia, and analgesia, often leading to **bronchodilation** and cardiovascular stimulation. - While useful in patients with **reactive airway disease** or hypotension, it can increase intracranial pressure and may induce sympathetic stimulation, which might not be ideal for all emergency intubation scenarios. *None of the options* - This option is incorrect because **Etomidate is a commonly used drug** for emergency intubation, particularly where hemodynamic stability is a concern. - Other agents are also used but Etomidate is a clear clinical choice in many situations.

Q: Which of the following statements is NOT true regarding rapid induction of anesthesia?

Sellick's maneuver is always required.. ***Sellick's maneuver is always required.*** - **Sellick's maneuver**, or cricoid pressure, is applied to compress the esophagus against the vertebrae, aiming to prevent **gastric regurgitation** and aspiration during rapid sequence intubation (RSI). - While historically considered a standard component of RSI, its routine use has been increasingly questioned due to a lack of strong evidence supporting its efficacy and potential to impede glottic visualization and intubation. It is not "always" required; its application is often at the discretion of the anesthetist based on patient factors and risk assessment. *Pre-oxygenation is mandatory* - **Pre-oxygenation** is a critical step in rapid sequence induction, involving administering 100% oxygen for several minutes prior to induction. - This denitrogenates the functional residual capacity (FRC), creating an oxygen reservoir that extends the safe apnea time, thus preventing **hypoxemia** during the intubation attempt. *Suxamethonium is often used.* - **Suxamethonium** (succinylcholine) is a depolarizing neuromuscular blocker primarily used in rapid sequence intubation due to its **ultra-rapid onset** (30-60 seconds) and short duration of action (5-10 minutes). - Its rapid action facilitates quick muscle relaxation for tracheal intubation, which is crucial for minimizing the risk of aspiration in patients with a full stomach or other risk factors. *Mechanical ventilation is typically avoided before intubation.* - During rapid sequence induction, **positive pressure ventilation** with a bag-valve mask is typically avoided before intubation to prevent gastric insufflation. - Gastric insufflation can increase the risk of **regurgitation** and pulmonary aspiration of gastric contents, which is a major concern in patients undergoing RSI.

Q: Which anaesthetic is contraindicated in renal failure?

Methoxyflurane. ***Methoxyflurane*** - Methoxyflurane undergoes significant **metabolism** to produce inorganic **fluoride ions**, which are directly **nephrotoxic**. - This nephrotoxicity can cause **high-output renal failure** with reduced concentrating ability, making it contraindicated in patients with pre-existing renal impairment. *Isoflurane* - Isoflurane is minimally metabolized and produces very low levels of **fluoride ions**, making it generally **safe** for use in patients with renal failure. - Its elimination is primarily via the **lungs**, with very little hepatic metabolism or renal excretion of active compounds. *Desflurane* - Desflurane is also minimally metabolized, similar to isoflurane, and therefore produces negligible amounts of **fluoride ions**. - It is considered a **safe option** for patients with renal impairment due to its predominantly pulmonary elimination and lack of nephrotoxic metabolites. *Halothane* - While halothane can cause **hepatotoxicity**, it is generally **not directly nephrotoxic** in the way methoxyflurane is. - Its metabolism, though more extensive than isoflurane or desflurane, does not produce clinically significant levels of nephrotoxic fluoride ions to contraindicate its use in renal failure.

Q: What is a significant disadvantage of ketamine?

Delirium. ***Delirium*** - Ketamine is known to cause **emergence phenomena**, which include **vivid dreams, hallucinations**, and **delirium**, particularly during recovery from anesthesia. - This psychotomimetic effect can be distressing for patients and may necessitate the co-administration of a **benzodiazepine** to mitigate these symptoms. *Increased heart rate* - While ketamine does cause an **increase in heart rate** and **blood pressure** due to sympathetic stimulation, this is often considered a disadvantage but not the *most significant* when compared to the unique cognitive side effects. - This effect can be beneficial in patients with **hemodynamic instability**, but can be problematic in those with **cardiovascular disease**. *Increased ICT* - It is often considered a contraindication in patients with **elevated intracranial pressure (ICP)** as it can potentially increase **cerebral blood flow** and thus ICP. - However, recent studies suggest that in adequately ventilated patients, the effect on ICP may be less pronounced than previously thought, making delirium a more consistent and prominent disadvantage for many patients. *All of the options* - While ketamine can cause an **increased heart rate** and potentially affect **intracranial pressure**, **delirium** and other emergence phenomena are often highlighted as a unique and significant disadvantage because they are highly distressing and difficult to manage. - The psychotomimetic effects are a hallmark side effect that often governs its cautious use without concurrent medication.

Q: Intraocular pressure is increased by which anaesthetic?

Ketamine. ***Ketamine*** - **Ketamine** is known to increase **intraocular pressure (IOP)**, making it generally avoided in patients with glaucoma or penetrating eye injuries. - This effect is thought to be due to its dissociative properties, causing **nystagmus**, and stimulating extraocular muscles. *Nitrous Oxide* - **Nitrous oxide** by itself has minimal or no direct effect on **intraocular pressure (IOP)**. - However, in cases of an air-filled globe (e.g., after retinal detachment surgery), it can increase IOP by expanding the gas bubble. *Isoflurane* - **Isoflurane**, like most volatile anesthetics, typically **decreases intraocular pressure (IOP)**. - This reduction is generally due to its effects on reducing aqueous humor production and increasing uveoscleral outflow. *Propofol* - **Propofol** is known for its ability to **decrease intraocular pressure (IOP)**. - This effect is mediated by a reduction in aqueous humor production and an increase in uveoscleral outflow, making it a favorable choice in ophthalmic surgery.

Q: Which of the following anesthetic agents is most notable for its analgesic properties?

Ketamine. ***Ketamine*** - **Ketamine** is unique among general anesthetics for its significant **analgesic properties**, which stem from its action as an **NMDA receptor antagonist**. - Its ability to provide pain relief makes it useful in scenarios where both **anesthesia** and **analgesia** are desired, such as for painful procedures or in trauma settings. *Propofol* - While **propofol** is a widely used intravenous anesthetic, it lacks intrinsic **analgesic properties**. Its primary effects are **sedation** and **hypnosis**. - Pain during propofol injection is common, and other analgesics are usually co-administered for painful procedures. *Thiopentone* - **Thiopentone** is an ultrashort-acting barbiturate primarily used for **induction of anesthesia** due to its rapid onset and profound hypnotic effects. - It has **no analgesic properties** and can even lower the pain threshold, requiring concurrent administration of analgesics.

Q: Dissociative anaesthesia is produced by?

Ketamine. ***Ketamine*** - **Ketamine** is a unique anesthetic that produces a state of **dissociative anesthesia**, characterized by a trance-like state, analgesia, amnesia, and catalepsy. - This effect is primarily due to its antagonism of the **N-methyl-D-aspartate (NMDA) receptor**. *Etomidate* - **Etomidate** is an intravenous anesthetic characterized by its **cardiovascular stability**, making it suitable for patients with heart conditions. - It works primarily by modulating **GABA-A receptors** but does not produce dissociative anesthesia. *Propofol* - **Propofol** is a widely used intravenous anesthetic known for its **rapid onset and recovery**, and it is often used for induction and maintenance of general anesthesia. - Its primary mechanism of action involves enhancing the effects of **GABA-A receptors**, leading to central nervous system depression, but not dissociative anesthesia. *Thiopentone* - **Thiopentone** (Thiopental) is a barbiturate anesthetic that causes rapid loss of consciousness and has been historically used for inducing general anesthesia. - It acts as a **GABA-A receptor agonist**, depressing the central nervous system, but it does not produce the distinct dissociative state seen with ketamine.

Q: Radiological sign in case of Perthes disease?

Flattening of femoral head. ***Flattening of femoral head*** - **Flattening** and **fragmentation** of the femoral head are characteristic radiological findings in **early-stage** Perthes disease. - This flattening is a direct consequence of the **avascular necrosis** and subsequent **remodeling** of the femoral epiphysis. *Fragmentation of femoral head epiphysis* - While **fragmentation** is a key feature of Perthes disease, it's typically observed **after** the initial flattening and sclerosis in the avascular stage. - It represents the process of **resorption** and **revascularization** as the bone attempts to heal. *Lateral femoral head displacement* - **Lateral displacement** of the femoral head is a more common finding in conditions like **slipped capital femoral epiphysis (SCFE)**, where the epiphysis slips from the metaphysis. - In Perthes disease, the primary issue is the **necrosis and collapse** of the femoral head itself, rather than displacement from the neck. *Limited hip abduction* - **Limited hip abduction** is a clinical sign, not a radiological sign, and it is a common symptom in Perthes disease due to pain, inflammation, and deformity of the femoral head. - Radiological signs are visual abnormalities observed on imaging studies like X-rays.

Q: Most common nerve injured in fracture of medial epicondyle of humerus is:

Ulnar nerve. ***Ulnar nerve*** - The **ulnar nerve** runs directly behind the **medial epicondyle** of the humerus in a groove called the **cubital tunnel**, making it highly vulnerable to injury during fractures of this bony prominence. - Injury to the ulnar nerve at this location can cause symptoms like **numbness and tingling** in the **little finger and half of the ring finger**, **weakness in certain hand muscles**, and eventually a **"claw hand" deformity**. *Radial nerve* - The **radial nerve** courses along the posterior aspect of the humerus in the **spiral groove** and is more commonly injured with **mid-shaft humeral fractures**. - Injury typically results in **wrist drop** and **sensory loss over the dorsum of the hand**. *Median nerve* - The **median nerve** travels more anteriorly in the arm and forearm and is most commonly injured with **supracondylar fractures of the humerus** or **carpal tunnel syndrome** at the wrist. - Damage leads to **ape hand deformity** and sensory deficits over the **thumb, index, middle, and radial half of the ring finger**. *Musculocutaneous nerve* - The **musculocutaneous nerve** innervates the biceps brachii and brachialis muscles and provides sensation to the lateral forearm; it is **less commonly injured in elbow fractures**. - Injury would primarily affect **elbow flexion** and **sensation over the lateral forearm**, which is not the typical presentation for medial epicondyle fractures.

Q: Bulge sign in the knee joint is seen after how much fluid accumulation?

< 30 ml. **< 30 ml** - The **bulge sign** is a sensitive test for detecting small amounts of **effusion** in the knee joint. - It is typically positive with as little as 4-8 mL to 10-30 mL of fluid, making "< 30 mL" the most appropriate answer. *100 ml* - An effusion of 100 mL is a **moderate to large amount** of fluid, which would typically elicit a positive **patellar tap test (ballottement)** rather than just a bulge sign. - The **bulge sign** is designed to detect much smaller effusions. *400 ml* - This represents a **very large effusion** that would be clinically obvious and cause significant swelling and discomfort, far exceeding the threshold for a simple bulge sign. - A knee with 400 mL of fluid would likely have a tense, bulging appearance and a very prominent **patellar tap**. *200 ml* - This is also a **significant effusion** that would easily be detected by a patellar tap test and would present with gross swelling. - The **bulge sign** is specifically for subtler fluid collections.

Question 1

Which drug is commonly used for emergency intubation?

Accepted Answer

Etomidate

Answer

None of the options

Answer

Propofol

Answer

Ketamine

Question 2

Which of the following statements is NOT true regarding rapid induction of anesthesia?

Accepted Answer

Sellick's maneuver is always required.

Answer

Suxamethonium is often used.

Answer

Mechanical ventilation is typically avoided before intubation.

Answer

Pre-oxygenation is mandatory

Question 3

Which anaesthetic is contraindicated in renal failure?

Accepted Answer

Methoxyflurane

Answer

Isoflurane

Answer

Desflurane

Answer

Halothane

Question 4

What is a significant disadvantage of ketamine?

Accepted Answer

Delirium

Answer

Increased heart rate

Answer

Increased ICT

Answer

All of the options

Question 5

Intraocular pressure is increased by which anaesthetic?

Accepted Answer

Ketamine

Answer

Nitrous Oxide

Answer

Isoflurane

Answer

Propofol

Question 6

Which of the following anesthetic agents is most notable for its analgesic properties?

Accepted Answer

Ketamine

Answer

Thiopentone

Answer

Propofol

Answer

None of the options

Question 7

Dissociative anaesthesia is produced by?

Accepted Answer

Ketamine

Answer

Etomidate

Answer

Propofol

Answer

Thiopentone

Question 8

Radiological sign in case of Perthes disease?

Accepted Answer

Flattening of femoral head

Answer

Fragmentation of femoral head epiphysis

Answer

Lateral femoral head displacement

Answer

Limited hip abduction

Question 9

Most common nerve injured in fracture of medial epicondyle of humerus is:

Accepted Answer

Ulnar nerve

Answer

Radial nerve

Answer

Median nerve

Answer

Musculocutaneous nerve

Question 10

Bulge sign in the knee joint is seen after how much fluid accumulation?

Accepted Answer

< 30 ml

Answer

200 ml

Answer

100 ml

Answer

400 ml

NEET-PG 2013

Anesthesiology

Orthopaedics