Anaesthesiology MCQs 1- 5th Year PMU

Mouth opening of only 3 fingerbreadths

Short, thick neck with limited mobility

Mallampati Class IV

Thyromental distance of 2 fingerbreadths

Surgery is a lumbar laminectomy

Surgery is removal of a lymph node of the neck

Surgery is appendectomy

Surgery is tonsillectomy

Vallecula

Cricoid cartilage

Epiglottis

Arytenoid cartilage

Circuit disconnection

Cardiac arrest

Endobronchial intubation

Complete airway obstruction

Esophageal intubation

Ensuring that intubation is achieved as soon as possible

Inserting a laryngeal mask

Ensuring that bag-mask ventilation is achievable

Ensuring that the patient does not awaken until intubation is successfully achieved

It frees up the anesthesiologist’s hands

It protects against aspiration

It can allow mechanical ventilation

It can be readily inserted without the use of muscle relaxants

Auscultation of both lung fields and over the stomach

Visualization of the endotracheal tube through the vocal cords

Easy advancement of the endotracheal tube without resistance

Presence of a stable CO2 trace on the end-tidal capnography

100 g/L

80g/L

60g/L

Individualized to every patient

Tachycardia

Decreased pulse pressure

Decreased urine output

Lactic acidosis

100 cc/hr

120 cc/hr

150 cc/hr

170 cc/hr

Packed red blood cells

Albumin (5%)

Pentaspan

Ringers Lactate

Pentaspan 1500 mL

DSW 500 mL

Ringers Lactate 500 mL

Normal Saline 1500 mL

An intravenous is required for procedures under local anesthesia such as carpal tunnel release or cystoscopy

Cannulation of a lower limb vein is inappropriate for use in the operating room

Cannulation of the jugular vein for central venous pressure monitoring is recommended in lengthy cases with the potential for significant fluid shifts.

A 14 gauge central line will allow more rapid fluid resuscitation than a 14 gauge peripheral canula

Hyperkalemia, hypercalcemia

Hypokalemia, hypocalcemia

Hyperkalemia, hypocalcemia

Hypokalemia, hypercalcemia

Open reduction, internal fixation of the pelvis

Whipple resection of the pancreas

Resection of large frontal brain tumour

Caesarian section

A healthy female over 50 years of age

A patient who has been crossmatched for surgery

A patient on anticoagulant medication

A young female patient with menorrhagia

Patient’s underlying health

Length of surgery

Duration of surgery

Emergency surgery

A pregnant patient (32 weeks gestation) who has been NPO (nil per os) for 10 hours

A patient with fractured femur who has been NPO since the accident 12 hours ago

A healthy patient with appendicitis

A healthy patient who had 8 ounces of clear tea 4 hours pre-operatively

Anticonvulsants

Thyroid replacement

Monoamine-oxidase inhibitors

Antihypertensives

Uncorrected Tetralogy of Fallot

Aortic stenosis

Uncomplicated heart transplant

Prophylaxis is not required for tonsillectomy

30mg prednisone orally on day of surgery

25 mg hydrocortisone IV on day of surgery

25 hydrocortisone IV for 72 hours

100 mg hydrocortisone IV for 72 hours

ASA 1

ASA 2

ASA 3

ASA 4

Changes colour as the soda lime becomes exhausted

Is required if a circle circuit is being used

Allows for economical use of anaesthetic gases

Provides a waveform of exhaled carbon dioxide

Delivers four successive impulses at a rate of 2 per second

Is a sensitive indicator of neuromuscular blockade

Must be used on the awake patient to achieve a baseline

Is commonly applied to the radial nerve

Temperature probe

Agent-specific gas monitor

Peripheral nerve stimulator

Spirometer

Nail polish

Peripheral vasoconstriction due to hypothermia

Severe anemia (Hg 60 g/L)

Methemoglobinemia

Carbon monoxide

Pulmonary embolus

Exhausted CO2 absorber soda lime

Cardiac arrest

Severe bronchospasm

Minimal arterial concentration

Minimal alveolar concentration

Maximal arterial concentration

Maximal alveolar concentration

There is no "gold" standard for measuring level of consciousness

Volatile agents are effective amnestic agents

Changes in heart rate and blood pressure can be used as surrogate indicators of level of consciousness

Opioids (in high doses) provide effective hypnosis

The ability of the patient to protect their airway

Stable cardiovascular status

Normal mental status examination

Effective analgesia

Improved outcomes for certain procedures (e.g. thoracic surgery, Caesarean section

Ability to continue technique postoperatively to provide pain relief

A reliable option for patients not well enough to undergo general anesthesia

Avoidance of systemic administration of drugs and consequent side effects

Post operative hypoxemia

Decreased platelet function

Myocardial ischemia

Increased analgesic requirements

Strong hand grip

The return of the eyelash reflex

Train of four shows 4 twitches with no fade

5 second head lift

Open cholecystectomy

Laparoscopic cholecystectomy

Excision of lymph node from the neck

Tonsillectomy

Brachial plexus injury with arm abduction of 60°

Hypoxemia in the Trendelenburg position

Common peroneal nerve injury in the lithotomy position

Retinal ischemia in the prone position

Venous air embolus with the sitting position

The lumbar puncture for a spinal anesthetic should be performed above L1 to avoid trauma to the cauda equina

The epidural space is identified by puncture of the dura and free flow of cerebral spinal fluid

A postdural puncture headache is a potential complication that occurs with both spinal and epidural techniques

Epidural anesthesia is usually faster in onset than spinal anesthesia

Tinnitus

Perioral numbness

Dizziness

Hypertension

Myocardial ischemia

Increased oxygen consumption

Decreased carbon dioxide production

Interference with monitor signal interpretation

Shivering is a response controlled by the brainstem

Shivering can occur in the absence of hypothermia

Shivering is effectively treated with small doses of naloxone

Shivering is an uncomfortable, though harmless, effect of anesthesia

Prochlorperazine

Ranitidine

Dimenhydrinate

Dexamethasone

History of gastroesophageal reflux

Smoking

Diabetes mellitus

Female gender

All patients should receive pharmacologic prophylaxis

Avoidance of anti-emetic anesthetic agents is an effective management strategy

Prophylaxis must be given prior to induction of anesthesia for maximal effectiveness

Dimenhydrinate remains the mainstay of PONV prevention and treatment

Pain

Airway obstruction

Prolonged spinal blockade

Full bladder

Normal cognitive function

Adequate pain control

Ability to hold down food

Ability to weight-bear

Reduced adrenal activation

Hypertension

Improved respiratory function

Excellent post-operative pain control

Less labor intensive for nurses

More opioid delivered to the patient

Improved patient satisfaction

Small doses at frequent intervals minimizing the pharmacokinetic "peaks" and “valleys”

Multiple sclerosis

Lumbar disc disease

Hypertrophic obstructive cardiomyopathy

Myasthenia gravis

Newer volatile anesthetics such as desflurane are not believed to trigger MH

Nitrous oxide is safe

Dantrolene is the only therapeutic drug treatment

Mortality is as high as 10% even with prompt treatment

Hyperthermia

Hypercarbia

Tachycardia

Ventricular arrhythmias

Turning off the volatile anesthetic

Active cooling measures

Dantrolene

Beta blockers

Decreased blood volume

Decreased peripheral vascular resistance

Decreased hematocrit

Compression of the vena cava

Decreased cardiac output

Delayed gastric emptying

Increased blood volume

Decreased anesthetic requirements

Should be avoided by placing a pillow under her knees

Is detrimental due to the risk of causing excessive venous return to the right heart

Is harmful to the mother, but is harmless to the fetus

Is safe at 20 weeks of pregnancy

Solids up to 8 hours pre-op

Clear fluids up to 3 hours pre-op

Breast milk up to 4 hours pre-op

Formula up to 2 hours pre-op

Glottis

Cricoid

Trachea

Pharynx

4.0

4.5

5.0

6.0

Cardiac output is heart-rate dependent

Hypoxemia is an important cause of bradycardia

Blood volume is greater, relative to size

Vagal responsiveness is under-developed

Increased functional residual capacity (FRC)

Increased oxygen consumption

Increased minute ventilation

Obligate nasal breathing

Larynx situated higher

Larynx situated more anteriorly

Epiglottis shorter and less mobile

Narrowest part of the airway at the cricoid

Prolonged second stage

Increased risk of operative delivery

Neonatal depression

Maternal sedation

Increased risk of aspiration in the pregnant patient

Increased anesthetic requirements

Exacerbation of uterine atony

Increased risk of awareness under anesthesia

Quick and easy in the setting of emergency Caesarian section

Associated with decreased maternal morbidity

Associated with increased neonatal depression

Presents less of a risk of maternal hypotension compared with general anesthesia

Total hip arthroplasty in the lateral position

Laparotomy for bowel obstruction

Multiple trauma with pneumothorax

Patient with history of severe post operative nausea and vomiting

Opioid analgesic agents

Induction agents

Muscle relaxants

Volatile anesthetic agents

Cardiac depression

Sedation

Nausea and vomiting

Respiratory depression

Lower lipid solubility therefore quicker onset and offset of effect

Less pungent therefore more practical for mask induction

Can be used with lower flows therefore more economical

Mild sympathomimetic effect minimizes hypotension

Ester hydrolysis

Liver metabolism

Redistribution

Renal excretion

Hyperkalemia

Hypothermia

Gentamycin administration

Myasthenia gravis

Cervical spinal cord injury (1 week ago)

Monoamine oxidase administration

Malignant hyperthermia susceptibility

Burn injury (24 hours ago)

1 mg/kg

2 mg/kg

5 mg/kg

7 mg/kg

Phenylephrine causes (reflex) bradycardia

Phenylephrine can be safely used in patients with cocaine intoxication

Phenylephrine acts directly at the alpha adrenergic receptor

Phenylephrine improves cardiac performance in cardiogenic shock

Muscle rigidity

Biliary spasm

Myocardial depression

Bradycardia

Desflurane 6%; Sevoflurane 1%; Isoflurane 2%

Desflurane 2%; Sevoflurane 6%; Isoflurane 1%

Desflurane 1%; Sevoflurane 2%; Isoflurane 6%

Desflurane 6%; Sevoflurane 2%; Isoflurane 1%

Desflurane 2%; Sevoflurane 1%; Isoflurane 6%

Desflurane 1%; Sevoflurane 6%; Isoflurane 2%

Morphine and sufentanil

Fentanyl and sufentanil

Morphine and fentanyl

Fentanyl and remifentanil

GABA

Histamine

Serotonin

Dopamine

Bradycardia and bronchospasm

Mydriasis and confusion

Urinary retention and constipation

Dry mouth and dry eyes

IV therapy should be minimized to less than 5 days

Ketorolac must not be given to patients with renal insuffciency

Potentiation of opioid effect is a risk

Gastrointestinal bleeding is not a concern with the Cox 1 inhibitors such as ketorolac

Faster onset of action

Does not cross the blood brain barrier

More effective anticholinergic activity

Safe in patients with narrow angle glaucoma

Most of the body water content is located within the extracellular compartment

Water content in a newborn child is 30-60% of its body weight

Plasma water content is only 5% of the body weight

Total body water content in adult females is 60% of their body weight

Tissue hypoxia with hyperlactatemia

Kidney failure

Methanol intoxication

Diarrhea

Bilateral opacities consistent with pulmonary edema on chest radiography or computed tomography (CT) scan that are not fully explained by pleural effusions, lobar/lung collapse, pulmonary nodules or heart failure are required for the diagnosis

Several conditions’can lead to the development of ARDS, including aspiration of gastric contents, pneumonia, sepsis (most common cause), trauma, transfusion of blood products (particularly plasma-rich products), pancreatitis, fat emboli, and drowning

Most patients with ARDS require intubation and mechanical ventilation with low tidal volumes (6 mL/kg predicted weight) and targeted plateau pressures of equal to or less than 30 cm H2O

Moderate to severe impairment of oxygenation ts defined by the ratio of arterial oxygen tension to fraction of inspired oxygen (PaO2/FiO2). In Severe ARDS (PaO2/FiO2) ts between 200 and 300 mmHg on PEEP >5 cm H2O

Methylprednisolone i.v.

Adrenaline i.m.

Diphenhydramine i.m.

Atropine i.v.

Bilirubin, creatinine and urine output

Blood pressure and PaO2/FiO2 ratio

Platelets and GCS

Body temperature and WBCs

It is a rapid and noninvasive No to evaluate the abdomen for presence of pathological fluid collection in peritoneal and pericardial cavity

It is comparable to diagnostic peritoneal lavage (DPL) as a method for detecting peritoneal fluid

Abdominal areas to examine are three: right upper quadrant, left upper quadrant and subxyphoid

Extended FAST (E-FAST) examination includes views of the bilateral hemithoraces and the upper anterior chest wall

EEG

ETCO2 measurement

CVP measurement

Invasive arterial blood pressure measurement

< 6

< 8

< 10

< 12

Administration of vasopressor drugs if no response to fluid therapy is achieved

HCO3 administration for correction of acidosis

Blood transfusion in case of hemorrhagic shock

Supplementary O2 administration

Pathological process affecting the brain

Decreased extracellular fluid volume (hypovolemia)

Increased Na+ loss with urine

Hyponatremia (serum (Na‘] <135 mmol/l)

Metabolic alkalosis is the most common acid-base disturbance in hospitalised patients

Successful treatment of all acid-base disorders depends on the identification and elimination of the cause

Most cases of respiratory acidosis are due to increased production of CO2

As a rule acid-base disorders of metabolic origin involve a respiratory compensatory response and vice versa

Heart failure → Stagnant hypoxia

Acute hemolysis → Anemic hypoxia

Anaphylaxis → Cytopathic hypoxia

High altitude → Hypoxic hypoxia

Required for diagnosis of sepsis

Required before starting antimicrobial therapy for sepsis

Required for narrowing of the empiric antimicrobial therapy

Required for selection of the optimal route for antimicrobials administration

Fluid redistribution to the vascular space

Decreased venous capacitance

Increased heart rate

Decreased renal losses of fluid

Cerebral edema and brain herniation

Insipid diabetes

Ischaemic Stroke

Central pontine myelinolysis

Immediate administration of sodium bicarbonate to correct the acidosis

Aggressive restoration of extracellular fluid volume with balanced cystalloid solutions

Subcutaneous administration of insulin

Endotracheal intubation and Mechanical Ventilation

Ventilation with low tidal volumes (6 ml/kg) and PEEP

Periodically switching to ventilation in prone position

Avoiding positive fluid balance

Administration of Surfactant and inhaled Nitric Oxide

It is a late sign of respiratory failure

It is characteristic for type 1 (hypoxemic) respiratory failure

It is caused by increased amount of reduced Hb (>50-60 g/l)

Patients with anaemia manifest cyanosis at higher SaO2 values (earlier) than patients with normal Hb values