NEET-PG 2017 - Anesthesiology PYQs Practice Questions

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. [Practice more Anesthesiology PYQs on OnCourse]

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. [Practice more Anesthesiology PYQs on OnCourse]

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. [Practice more Anesthesiology PYQs on OnCourse]

Q: What does the following capnographic recording represent?

Asthma. ***Asthma*** - The capnographic tracing shows a characteristic **shark fin waveform**, indicative of **expiratory airflow obstruction**. - This waveform is generated due to uneven emptying of the alveoli, where CO2 continues to be exhaled at a reduced rate during the later phase of expiration. *Spontaneous extubation* - Spontaneous extubation would typically result in a **complete loss of the capnography waveform** due to disconnection from the airway. - The tracing shown still clearly depicts expired CO2, inconsistent with complete extubation. *Raised ICT* - Raised intracranial tension (ICT) can affect breathing patterns (e.g., Cheyne-Stokes, hyperventilation), but it does not directly produce a a **shark fin capnography waveform**. - Capnography reflects CO2 elimination, which can be indirectly affected by changes in ventilatory drive from raised ICT but not in this specific shape. *Air embolism* - An air embolism would cause a sudden **drop in end-tidal CO2 (EtCO2)**, often to zero, due to obstruction of pulmonary blood flow, leading to alveolar dead space. - The waveform shown does not depict a sudden drop to zero or significantly reduced EtCO2. [Practice more Anesthesiology PYQs on OnCourse]

Q: All are complications of this anesthesia technique except: (Recent NEET Pattern 2016-17)

Paralytic ileus. **SPINAL ANESTHESIA COMPLICATIONS ANALYSIS:** ***Paralytic ileus*** - While spinal anesthesia can cause some **decreased bowel motility** due to sympathetic blockade, true **paralytic ileus** is primarily associated with **abdominal surgery**, **prolonged opioid use**, **electrolyte imbalances**, or **systemic illness**. - **Paralytic ileus** is not considered a direct complication of spinal anesthesia technique itself, making it the exception among the given options. *Bradycardia* - Direct result of **sympathetic blockade** affecting **cardiac accelerator fibers**, leading to unopposed **vagal activity**. - Common complication of spinal anesthesia due to blocked sympathetic innervation that normally maintains heart rate. *Sudden cardiac arrest* - Rare but serious complication from severe **bradycardia** and **hypotension**, especially with **high spinal blocks**. - Can occur when sympathetic blockade extends too high, affecting critical **cardiovascular control mechanisms**. *Decrease in vital capacity* - Results from **motor blockade** of **intercostal muscles** and potentially **phrenic nerve** with high spinal blocks. - Respiratory compromise can be significant, particularly in patients with pre-existing **pulmonary disease**. **Conclusion:** Paralytic ileus is the exception as it is not a direct complication of spinal anesthesia, unlike the other cardiovascular and respiratory complications listed. [Practice more Anesthesiology PYQs on OnCourse]

Question 1

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 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

Which of the following Mapleson system is shown below?

Accepted Answer

Mapleson D

Answer

Mapleson C

Answer

Mapleson A

Answer

Mapleson B

Question 4

What does the following capnographic recording represent?

Accepted Answer

Asthma

Answer

Spontaneous extubation

Answer

Raised ICT

Answer

Air embolism

Question 5

All are complications of this anesthesia technique except: (Recent NEET Pattern 2016-17)

Accepted Answer

Paralytic ileus

Answer

Bradycardia

Answer

Sudden cardiac arrest

Answer

Decrease in vital capacity

Question 6

All are contraindications of this anesthesia technique except: (Recent NEET Pattern 2016-17)

Accepted Answer

Aortic aneurysm

Answer

Bleeding diathesis

Answer

Severe aortic stenosis

Answer

Uncooperative patient

Question 7

Which finding indicates correct placement of needle in this nerve block? (Recent NEET Pattern 2016-17)

Accepted Answer

Increase in skin temperature of ipsilateral arm

Answer

Decrease in skin temperature of ipsilateral arm

Answer

Increase in sweating of ipsilateral arm

Answer

Decrease in sweating of ipsilateral arm

Question 8

Which is correct about the anesthetic drugs X and Y in the image shown? (Recent NEET Pattern 2016-17)

Accepted Answer

Drug X is more fast acting than Y

Answer

Drug X and Y have equally fast onset of action

Answer

Drug X and Y have equally fast onset of action but potency of X is more than Y

Answer

Drug Y is more fast acting than X

NEET-PG 2017 — Anesthesiology