NEET-PG 2020 - Anesthesiology PYQs Practice Questions

Q: What does the image of the Capnograph depict?

Capnograph indicating spontaneous respiration. ***Capnograph indicating spontaneous respiration*** - The characteristic dip in the **EtCO2 waveform** during the plateau phase (phaselll) is indicative of a breath taken by the individual which is a classic finding of **spontaneous respiration**. This dip is because when a patient takes a breath in, fresh gas with no CO2 is pulled into the sampling line momentarily decreasing the measured CO2. - This pattern is often referred to as a "**curare cleft**" or "**respiratory indentation**," and it signifies incomplete paralysis or return of spontaneous breathing. *Capnograph during inspiration* - During normal inspiration, there is no CO2 in the inhaled air, so the capnograph reading would theoretically drop to **zero** or near-zero, not exhibit a waveform with a plateau. - The baseline of the capnograph reflects inspiration, which should be flat (zero CO2). *Capnograph showing inspiration with cardiac oscillations* - Cardiac oscillations typically appear as **small rhythmic fluctuations** on the baseline or the expiratory plateau, synchronized with the heartbeat. - These oscillations are usually much smaller and do not present as distinct, sharp dips within the expiratory plateau as seen in the image. *Capnograph during expiration* - During a normal expiration, the capnograph waveform rises from a baseline of zero (phase I, **dead space ventilation**) to a plateau (phase III, **alveolar gas emptying**) with a peak value, before returning to baseline during inspiration. - While the image shows expiration with a plateau, the key feature of the dip during the plateau is more specific to spontaneous respiration than just general expiration. [Practice more Anesthesiology PYQs on OnCourse]

Q: Identify the airway device shown in the image.

Laryngeal Mask Airway. ***Laryngeal Mask Airway*** - The image clearly displays a **Laryngeal Mask Airway (LMA)**, characterized by its inflatable, elliptical cuff designed to seal around the laryngeal inlet. - This supraglottic device is used for airway management in anesthesia and emergencies when endotracheal intubation is not required or feasible. *Nasopharyngeal Airway* - A **nasopharyngeal airway** is a soft, flexible tube inserted through the nose into the posterior pharynx. - It does not have an inflatable cuff or the broad, mask-like structure seen in the image. *Cuffed Endotracheal Tube* - A **cuffed endotracheal tube (ETT)** is a long, narrow tube inserted directly into the trachea, featuring a balloon cuff near the distal end for tracheal sealing. - The device in the image has a much broader, mask-like structure designed to sit above the larynx, not within the trachea. *Guedel Airway* - A **Guedel airway** (or oropharyngeal airway) is a rigid, curved device inserted into the mouth to prevent the tongue from obstructing the airway. - It is typically made of plastic and lacks any inflatable components or the sophisticated design of the device shown. [Practice more Anesthesiology PYQs on OnCourse]

Q: A patient scheduled for elective inguinal hernia surgery has a history of myocardial infarction (MI) and underwent coronary artery bypass grafting (CABG). What should be included in the preoperative assessment?

History + c/e + routine labs + stress test. ***History + c/e + routine labs + stress test*** - A **stress test** is crucial in patients with a history of MI and CABG to assess **myocardial ischemia** and functional capacity, guiding perioperative management. - This evaluation helps determine the patient's **cardiac risk** for non-cardiac surgery and the need for further cardiac optimization. *History + c/e + routine labs + angiography to assess graft patency* - **Coronary angiography** is an invasive procedure and is generally not indicated as a routine preoperative assessment unless there are new, significant cardiac symptoms or signs of **graft dysfunction**. - Assessing graft patency through angiography carries risks and would only be justified if there were strong clinical indications suggesting acute or severe **cardiac ischemia**. *History + c/e + routine labs* - While critical for any preoperative assessment, **routine history, physical examination, and basic laboratory tests** are insufficient for a patient with a significant cardiac history like MI and CABG. - This approach would **underestimate the cardiac risk** and might miss undetected ischemia, leading to adverse perioperative cardiac events. *History + c/e + routine labs + V/Q scan* - A **ventilation-perfusion (V/Q) scan** is primarily used to diagnose **pulmonary embolism** or assess regional lung function. - It does not provide information about myocardial ischemia or cardiac functional capacity, making it **irrelevant** for assessing cardiac risk in this clinical scenario. [Practice more Anesthesiology PYQs on OnCourse]

Q: During intraoperative period following capnograph waveform is seen. What does it signify.

Return of spontaneous ventilation. ***Return of spontaneous ventilation*** - The capnogram shows a gradual increase in **tidal volume** and then a drop with a notch towards the end, which is characteristic of the patient taking an occasional **spontaneous breath**. - This pattern, where the patient's own respiratory effort adds to or takes over mechanical ventilation, signifies the **return of spontaneous ventilation**. *Airway obstruction* - Airway obstruction typically manifests as a **sharper upstroke** (phase II) and a **prolonged expiratory phase** (phase III) with a sloped plateau, sometimes with a 'shark fin' appearance if severe. - The waveform in the image does not demonstrate these specific characteristics of obstructed airflow. *Oesophageal intubation* - **Esophageal intubation** would show either **no CO2 waveform** (flat line) or very small, sporadic waveforms due to gastric CO2, which quickly disappear as gastric CO2 depletes. - The sustained CO2 levels and clear respiratory pattern seen in the image rule out esophageal intubation. *Hyperventilation* - **Hyperventilation** would lead to a **decrease in end-tidal CO2 (ETCO2)** values as more CO2 is exhaled. The waveform morphology itself would typically remain normal, just shifted to lower CO2 levels. - While the patient might be breathing more, the specific notch pattern is not indicative of simple hyperventilation but rather spontaneous efforts. [Practice more Anesthesiology PYQs on OnCourse]

Question 1

What does the image of the Capnograph depict?

Accepted Answer

Capnograph indicating spontaneous respiration

Answer

Capnograph during inspiration

Answer

Capnograph showing inspiration with cardiac oscillations

Answer

Capnograph during expiration

Question 2

Identify the airway device shown in the image.

Accepted Answer

Laryngeal Mask Airway

Answer

Nasopharyngeal Airway

Answer

Cuffed Endotracheal Tube

Answer

Guedel Airway

Question 3

A patient scheduled for elective inguinal hernia surgery has a history of myocardial infarction (MI) and underwent coronary artery bypass grafting (CABG). What should be included in the preoperative assessment?

Accepted Answer

History + c/e + routine labs + stress test

Answer

History + c/e + routine labs + V/Q scan

Answer

History + c/e + routine labs

Answer

History + c/e + routine labs + angiography to assess graft patency

Question 4

During intraoperative period following capnograph waveform is seen. What does it signify.

Accepted Answer

Return of spontaneous ventilation

Answer

Airway obstruction

Answer

Oesophageal intubation

Answer

Hyperventilation

NEET-PG 2020 — Anesthesiology