Anesthesia Principles for Surgeons — MCQs

10 questions

The web-based IT system for case-based surveillance under National Tuberculosis Elimination Programme (NTEP, formerly RNTCP) is

In anesthesiology, mild systemic disease is classified under which ASA grade?

What is the most appropriate method for administering oxygen in patients with airway burns?

Malignant hyperthermia is a rare complication of the use of the following anaesthetic:

A 45-year-old patient develops bronchospasm during induction. Which inhalational agent is most suitable for management?

Malignant hyperthermia is due to

A 50 year old male is posted for elective laparoscopic cholecystectomy. No history of comorbidities. His surgery is scheduled at 2 PM on the day of surgery. Which of the following is against the ASA guidelines for preoperative fasting

You are in the operating room and notice the tracing in yellow colour on this device. What does it indicate?

Match the following: A) Caplan syndrome- 1) Found first in coal worker B) Asbestosis- 2) Upper lobe predominance C) Mesothelioma- 3) Involves lower lobe D) Sarcoidosis- 4) Pleural effusion is seen

Q10

What type of knot is depicted in the image?

Anesthesia Principles for Surgeons Indian Medical PG Practice Questions and MCQs

Question 1: The web-based IT system for case-based surveillance under National Tuberculosis Elimination Programme (NTEP, formerly RNTCP) is

A. NIKSHAY (Correct Answer)
B. E-TB Tracker
C. SURAKSHA
D. SAFETY-NET

Explanation: ***NIKSHAY*** - **NIKSHAY** is the official web-based IT system used by the National Tuberculosis Elimination Programme (NTEP, formerly RNTCP) in India for **case-based surveillance** and monitoring of TB cases. - Launched in 2012, it facilitates **real-time data entry**, tracking of patient outcomes, drug logistics management, and program monitoring, significantly improving the efficiency of TB control efforts. - It enables **notification of all TB cases**, both from public and private sectors, ensuring comprehensive surveillance. *E-TB Tracker* - **E-TB Tracker** is not the designated IT system for TB surveillance under NTEP in India. - This term may refer to other electronic tracking systems used in different contexts, but NIKSHAY remains the official platform for India's TB programme. *SURAKSHA* - **SURAKSHA** means safety or protection in Hindi and is not associated with any specific web-based IT system for TB surveillance under NTEP. - This is not a recognized TB surveillance platform in the Indian context. *SAFETY-NET* - **SAFETY-NET** is a generic term referring to social protection programs or health support systems. - There is no specific NTEP initiative for TB surveillance identified by this name.

Question 2: In anesthesiology, mild systemic disease is classified under which ASA grade?

A. 2 (Correct Answer)
B. 4
C. 3
D. 1

Explanation: 2 - ASA Grade 2 is defined as a patient with mild systemic disease that is well-controlled and does not limit daily activities. - Examples include a controlled hypertension, controlled type 2 diabetes without systemic complications, or a mild obesity (BMI 30-40). 4 - ASA Grade 4 indicates a patient with severe systemic disease that is a constant threat to life. - This includes conditions such as recent myocardial infarction, stroke, or severe valvular disease, which pose significant risks to patient safety during surgery. 3 - ASA Grade 3 describes a patient with severe systemic disease that limits activity but is not incapacitating. - Examples include poorly controlled hypertension or diabetes, stable angina, or moderate chronic obstructive pulmonary disease (COPD). 1 - ASA Grade 1 is assigned to a healthy patient without any systemic disease. - This classification implies no physiological, physical, or psychological disturbance, other than the condition requiring surgery.

Question 3: What is the most appropriate method for administering oxygen in patients with airway burns?

A. Elective intubation (Correct Answer)
B. Oxygen mask
C. Nasal cannula
D. Surgical airway management

Explanation: ***Elective intubation*** - **Elective intubation** is the most appropriate method because airway burns can lead to rapid **airway edema** and obstruction, making intubation extremely difficult later. - Early intubation secures the airway before swelling progresses, preventing a potentially life-threatening emergency. *Oxygen mask* - An oxygen mask can provide supplemental oxygen but does not **secure the airway** or prevent potential obstruction from developing airway edema due to the burns. - This method is insufficient for preventing **airway compromise** in patients with airway burns. *Nasal cannula* - A nasal cannula delivers low-flow oxygen but does not offer **airway protection** against swelling or provide adequate respiratory support for patients with compromised airways. - This method is inadequate for ensuring a patent airway in the face of progressive **airway edema**. *Surgical airway management* - A surgical airway (e.g., **cricothyroidotomy** or **tracheostomy**) is a rescue procedure when intubation is impossible due to severe airway obstruction. - It is a more invasive measure and not the primary method for initial airway management when **elective intubation** is still feasible.

Question 4: Malignant hyperthermia is a rare complication of the use of the following anaesthetic:

A. Thiopentone sodium
B. Halothane (Correct Answer)
C. Ether
D. Ketamine

Explanation: **Halothane** - **Halothane** is a potent volatile anesthetic and a classic trigger for **malignant hyperthermia** due to its effect on ryanodine receptors, leading to excessive calcium release from the sarcoplasmic reticulum. - While its use has declined, it remains a critical example of an anesthetic agent known to induce this life-threatening genetic disorder. *Thiopentone Sodium* - **Thiopentone sodium** is an intravenous barbiturate anesthetic and is **not associated** with triggering malignant hyperthermia. - It is often used for induction of anesthesia and has a different mechanism of action involving GABA receptors. *Ether* - **Diethyl ether** was one of the earliest general anesthetics but is **not a trigger** for malignant hyperthermia. - Its use has largely been discontinued due to its flammability and adverse side effects, but it doesn't cause MH. *Ketamine* - **Ketamine** is a dissociative anesthetic that acts as an NMDA receptor antagonist and is **not a trigger** for malignant hyperthermia. - It is often used for its analgesic and sedative properties and is considered safe in patients susceptible to MH.

Question 5: A 45-year-old patient develops bronchospasm during induction. Which inhalational agent is most suitable for management?

A. Sevoflurane (Correct Answer)
B. Halothane
C. Isoflurane
D. Desflurane

Explanation: ***Sevoflurane*** - **Sevoflurane** is an excellent choice for managing intraoperative **bronchospasm** due to its low airway irritancy and potent **bronchodilating** properties. - Its rapid onset and offset allow for quick adjustment of anesthetic depth to help relieve airway constriction. *Halothane* - While **halothane** has significant **bronchodilating effects**, its use is limited due to concerns about **hepatotoxicity** (halothane hepatitis) and cardiac arrhythmias. - It is rarely used in modern anesthetic practice, especially when safer alternatives like sevoflurane are available. *Isoflurane* - **Isoflurane** is a **bronchodilator**, but it tends to be more **pungent** and airway irritant than sevoflurane, potentially exacerbating bronchospasm upon induction or during light anesthesia. - It has a slower onset and offset compared to sevoflurane, making it less ideal for rapid resolution of an acute bronchospasm. *Desflurane* - **Desflurane** is a known **airway irritant** and can precipitate or worsen **bronchospasm**, particularly in patients with reactive airway disease, making it unsuitable for this scenario. - Its strong smell and propensity to cause coughing and laryngospasm make it contraindicated during induction in patients at risk for bronchospasm.

Question 6: Malignant hyperthermia is due to

A. Isoflurane
B. Halothane
C. Scoline
D. All of the options (Correct Answer)

Explanation: ***All of the options*** - Malignant hyperthermia is a rare, **life-threatening condition** triggered by exposure to certain anesthetic agents, including **volatile inhalational anesthetics** (like isoflurane and halothane) and the **depolarizing muscle relaxant succinylcholine (scoline)**. - The condition is characterized by a rapid, uncontrollable increase in body temperature, muscle rigidity, and metabolic acidosis due to an uncontrolled release of **calcium** from the sarcoplasmic reticulum in muscle cells. *Isoflurane* - **Isoflurane** is a **volatile inhalational anesthetic** known to be a potent trigger for malignant hyperthermia in susceptible individuals. - It works by affecting ion channels in nerve cells, but in MH-susceptible individuals, it can induce massive calcium release in skeletal muscle. *Halothane* - **Halothane**, another **volatile inhalational anesthetic**, was historically one of the most common triggers for malignant hyperthermia. - While it is less commonly used today due to its potential for liver toxicity and cardiac arrhythmias, it remains a significant trigger for MH. *Scoline* - **Scoline** (also known as **succinylcholine**) is a **depolarizing muscle relaxant** and is a well-known trigger for malignant hyperthermia. - It acts on acetylcholine receptors, causing initial muscle fasciculations followed by prolonged relaxation, but in MH-susceptible patients, it can initiate an uncontrolled calcium release in muscle cells.

Question 7: A 50 year old male is posted for elective laparoscopic cholecystectomy. No history of comorbidities. His surgery is scheduled at 2 PM on the day of surgery. Which of the following is against the ASA guidelines for preoperative fasting

A. Water at 12:00 PM
B. Black coffee at 5:30 AM
C. Pancakes at 10:00 AM (Correct Answer)
D. A non-clear liquid (e.g., orange juice) at 7:30 AM

Explanation: **Pancakes at 10:00 AM** - According to ASA guidelines, the fasting period for solid food is typically **6-8 hours** before surgery. Eating pancakes, which are solid food, at 10:00 AM for a 2:00 PM surgery (4-hour interval) violates this guideline. - This short fasting period for solids increases the risk of **pulmonary aspiration** during induction of anesthesia. *Water at 12:00 PM* - Water is considered a clear liquid, and ASA guidelines typically allow clear liquids until **2 hours** before surgery. Drinking water at 12:00 PM for a 2:00 PM surgery is within these guidelines. - Rapid gastric emptying of clear liquids minimizes the risk of aspiration. *Black coffee at 5:30 AM* - Black coffee is considered a clear liquid, and it is consumed well within the **2-hour** fasting window for clear liquids before a 2:00 PM surgery. - The absence of milk or cream ensures it is treated as a clear liquid, which empties quickly from the stomach. *A non-clear liquid (e.g., orange juice) at 7:30 AM* - Non-clear liquids, such as orange juice, are treated similarly to light meals and generally require a fasting period of **6 hours** before surgery. Drinking orange juice at 7:30 AM for a 2:00 PM surgery (6.5-hour interval) is compliant with these guidelines. - The protein and pulp in non-clear liquids delay gastric emptying compared to clear liquids.

Question 8: You are in the operating room and notice the tracing in yellow colour on this device. What does it indicate?

A. O2 pressure in exhaled air
B. Capnography (Correct Answer)
C. O2 pressure in inhaled air
D. Airway pressure

Explanation: ***Capnography*** - The yellow tracing displays a waveform that is characteristic of a **capnogram**, which measures the concentration of **carbon dioxide (CO2)** in the expired breath over time. - The rectangular shape with a sudden rise, plateau, and rapid fall is typical of the **CO2 waveform** during a respiratory cycle. *O2 pressure in exhaled air* - While oxygen levels can be monitored, the characteristic waveform shown with its distinct plateau phase is specific to **carbon dioxide** measurement. - Oxygen monitoring provides different types of waveforms or numerical values, such as **pulsus oximetry**, which shows oxygen saturation. *O2 pressure in inhaled air* - Monitoring devices typically display **inspired oxygen concentration (FiO2)** as a numerical value rather than a waveform. - The waveform shown is indicative of gas exchange dynamics during **exhalation**, not inhalation. *Airway pressure* - Airway pressure tracings typically show a waveform that correlates with the **inspiratory and expiratory phases** of breathing, indicating the pressure within the airway. - However, the specific shape and plateau of the waveform in yellow are distinct from typical **airway pressure** curves and are characteristic of CO2.

Question 9: Match the following: A) Caplan syndrome- 1) Found first in coal worker B) Asbestosis- 2) Upper lobe predominance C) Mesothelioma- 3) Involves lower lobe D) Sarcoidosis- 4) Pleural effusion is seen

A. A-3, B-4, C-2, D-1
B. A-1, B-4, C-3, D-2 (Correct Answer)
C. A-4, B-2, C-3, D-1
D. A-2, B-4, C-3, D-1

Explanation: **A-1, B-4, C-3, D-2** - **Caplan syndrome** was first described in **coal workers** with **rheumatoid arthritis** and progressive massive fibrosis. - **Asbestosis** is often associated with **pleural effusion**, which can be benign or malignant. - **Mesothelioma** typically involves the **lower lobes** of the lungs, specifically the pleura, and is strongly linked to asbestos exposure. - **Sarcoidosis** is characterized by **non-caseating granulomas**, which have a predilection for the **upper lobes** of the lungs. *A-3, B-4, C-2, D-1* - This option incorrectly states that Caplan syndrome involves the lower lobe; **Caplan syndrome** is defined by the presence of large nodules in the lungs of coal workers with rheumatoid arthritis, and their specific lobar distribution is not a defining characteristic. - This option incorrectly states that Mesothelioma has an upper lobe predominance; **Mesothelioma** is a pleural malignancy and typically involves the **lower lobes**, extending along the pleura. *A-4, B-2, C-3, D-1* - This option incorrectly associates Caplan syndrome with pleural effusion; **Caplan syndrome** manifests as rheumatoid nodules in the lungs, not primarily pleural effusion. - This option incorrectly states that Asbestosis has an upper lobe predominance; **Asbestosis** predominantly affects the **lower lobes** of the lungs, causing interstitial fibrosis. *A-2, B-4, C-3, D-1* - This option incorrectly states that Caplan syndrome has an upper lobe predominance; the defining feature of **Caplan syndrome** is the combination of rheumatoid arthritis and pneumoconiosis, not specific lobar involvement. - This option correctly identifies pleural effusion with asbestosis and lower lobe involvement with mesothelioma, but **Caplan syndrome** is not characterized by upper lobe predominance.

Question 10: What type of knot is depicted in the image?

A. Half hitch
B. Granny knot (Correct Answer)
C. Surgeon’s knot
D. Reef knot

Explanation: ***Granny knot*** - The image shows a knot where the two half-knots are tied in the **same direction** (left over right, then left over right again, or vice versa), causing it to be unstable and slip. - This instability makes it less secure than a reef knot, as the two end pieces emerge parallel but on opposite sides of the loop. - The granny knot is an **insecure knot** that should be avoided in surgery as it can spontaneously untie. *Surgeon's knot* - A surgeon's knot involves an **extra throw** (double wrap) around the first loop to increase friction and make it more secure, which is not depicted here. - It is typically used to ensure that the first throw holds tension while the second throw is being tied. *Reef knot* - A reef knot (or square knot) is formed by tying two half-knots in **opposite directions** (left over right, then right over left), which creates a flat, stable, and secure knot. - In a reef knot, the two end pieces emerge parallel and on the same side of the loop, unlike the granny knot. *Half hitch* - A half hitch is a simple overhand knot around a standing part of the rope, used as a single throw or in combination with other knots. - It is not the same as the double-throw configuration shown in the image.

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