Questions

Question 1

How will you manage patient who developed Laryngospasm after Scoline admin and wear off?

Answer 1

2nd Dose of Scoline (sensitizn of heart by hydrolysis products - Succmonocholine and choline) m/c causes * Junctional Rythms * Ventricular arrythmias SA Node (-) so AV Node acts as Pacemaker If SA and AV (-) Ventricular escape beats Extreme cases –> Ventricular Fibrillation

Question 2

What is the role of Calcium Gluconate is cardiac resuscitation?

Answer 2

Calcium restores the difference between resting membrane potential and threshold potential. So it antagonizes cardiac effects of Hyperkalemia which reduces the difference and causes cardiac irritability.

Question 3

What is Laudanosine?

Answer 3

Principle metabolite of atracurium Accumulates after prolonged infusion in renal failure patients Causes CNS stimulation and seizures. Does not possess any NMB property.

Question 4

How will you manage a patient with impaired LFT posted for Omfs surgery? Induction? Maintanence? Analgesia?

Answer 4

Induction: Propofol- Extrahepatic mechs also +nt, not affected by Hepatic & Renal impairment Atrac/Cisatrac- Hoffman degradation Maintainence: Sevoflurane- only 1-5% metabolised (Iso to be avoided) Analgesia: Diclo- Metab max in Kidney (PCT to be avoided)

Question 5

What is the circulation time of Propofol? (means onset of action time?)

Answer 5

Within one arm Brain circulation time(about 30 seconds)

Question 6

How do you calculate Bicarb deficit?

Answer 6

Bicarbonate deficit = 0.4 x Pt wt in kg x (desired HCO3 - measured HCO3)

Question 7

Effects of smoking cessation?

Answer 7

Question 8

Rule of 10 for steroid continuation?

Answer 8

>10 weeks >10mg For more than 10 days continuously Means HPA axis is impaired

Question 9

What is the Steroid equivalent doses?

Answer 9

Question 10

Why is Morphine avoided in COPD?

Answer 10

Causes Histamine release - > Bronchospasm

Question 11

What is the most important precaution before using Ketamine?

Answer 11

Glycopyrolate to reduce secretions

Question 12

What is the concern with Thiopentone use in COPD patients?

Answer 12

Causes Histamine release - > Bronchospasm Causes sudden lighter plane of anaes - > Spasm

Question 13

What is the main concern with Etomidate use?

Answer 13

Adrenocortical suppression, but can be avoided with steroid coverage

Question 14

What beta blocker will you use in COPD patients?

Answer 14

B1 selective blocker Bisoprolol Nebivolol Metoprolol

Question 15

Why don’t we use Halothane inspite of good Bronchodilator effect?

Answer 15

Causes Dysarrthmias (as patient already on B-blocker and also theophylline)

Question 16

What are causes of Post op Hypoxia in COPD patients?

Answer 16

Bronchospasm Laryngospasm Diffusion hypoxia Atelectasis d/t pain Opiods Sedatives Inadequate reversal A/e of COPD Decreased O2 flux - d/t decreased Cardiac output Causes of decreased CO in COPD patients - post op Pulmonary embolism Basal Atelectasis - closing capacity increases leads to intrapul shunting

Question 17

What is the formula of O2 Flux?

Answer 17

CO x O2 content of arterial blood O2 content of art blood= HB bound O2 + Dissolved O2 (20ml + 0.3ml) i.e. 20.3ml per 100ml So O2 flux = 20.3/100 x 5000 = 1000ml

Question 18

What are the precautions in extubation in COPD?

Answer 18

Deep and early extubation Or in our setup fully awake extubation Recovery in sitting position improves FRC

Question 19

What analgesic to avoid in COPD patients?

Answer 19

Diclofenac - Bronchoconstriction and Eosinophilia in 20% asthma patients

Question 20

What is Berry sign?

Answer 20

Carotid pulsation not felt in Large thyroid swellings invading Carotid sheath called as Berry sign.

Question 21

What is Kocher’s test?

Answer 21

Ans

Question 22

What electrolyte disturbances do Hyperthyroid patients have?

Answer 22

Hyperkalemia Hyponatremia Hypercalcemia So optimize S/E b4 surgery.

Question 23

What is the dosage reqd for Vascular Air embolism?

Answer 23

Systemic circulation - 5ml/kg Cerebral circulation - 2-3ml/kg Left anterior descending artery - 0.5ml

Question 24

What will you do to manage a patient presenting with huge Thyroid swelling and stridor?

Answer 24

Heliox via face mask - coz lighter gas bypasses turbulence and pulls o2 along with it.

Question 25

The most strongest arterial dilator among the foll Nitroglycerin Nitroprusside Hydralazine Verapamil

Answer 25

Nitroprusside

Question 26

Maximal beneficial effects of cessation of smoking in 2 weeks 4 weeks 8 weeks 12 weeks

Answer 26

8 weeks

Question 27

What are the tests for Cardiopulmonary reserve?

Answer 27

Ans

Question 28

What are the bed side Pulmonary function tests?

Answer 28

Ans

Question 29

What is the Normal TFT values?

Answer 29

* T3 - 0.5-1.5ng/dl * T4 - 6-12mcg/dl * TSH - 0.5-5.5mcU/ml

Question 30

What is the definition of Difficult mask ventilation?

Answer 30

Ans

Question 31

What are the anaesthetic drugs given based on Actual Body weight?

Answer 31

Propofol Dexmeditomedine Neostigmine Scoline Remaining based on Ideal body weight.

Question 32

What is the reflex on lifting zygoma in OMFS surgeries?

Answer 32

Oculocardiac reflex or Trigeminocardiac reflex Bradycardia Hypotension Bradyapnea

Question 33

1 kpa = ?mmhg

Answer 33

7.5mmhg 7.5torr 0.01bar(1bar=750mmhg) 0.145psi(1psi=51mmhg)

Question 34

NPO Guidelines?

Answer 34

Non-Human Milk - 6hours as the clearance time is similar to Solid food (more protein content vs Human Milk)

Question 35

Effects of Shivering and Hypothermia?

Answer 35

Ans

Question 36

Euthyroid sick syndrome?

Answer 36

Ans

Question 37

Selmon’s law :

Answer 37

The abductor fibers are more vulnerable, and moderate trauma causes a pure abductor paralysis. Severe trauma causes both abductor and adductor fibers to be affected. N.B.:- Pure adductor paralysis does not occur as a clinical entity.

Question 38

Cholestasis causing drugs?

Answer 38

Gold salts, nitrofurantoin, **anabolic steroids**, **chlorpromazine**, prochlorperazine, sulindac, cimetidine, erythromycin, **estrogen**, and statins

Question 39

Amount of Alcohol consumption for ALD & Cirrhosis?

Answer 39

ALD -\> 80gms per day for 8yrs Cirrhosis -\> More than 20yrs

Question 40

Hepatic Facies

Answer 40

Shrunken eyes Hollowed temporal fossa Pinched up nose and malar prominences Parched lips Muddy complexion of skin Shallow and dry face Icteric tinge of conjunctiva

Question 41

Puddle sign

Answer 41

http://notes.medicosnotes.com/2017/01/how-to-elicit-puddle-sign.html?m=1

Question 42

Moynihan sign

Answer 42

Murphy's sign modification using left tumb to palpate

Question 43

Prothrombin time measures which pathway?

Answer 43

Extrinsic Pathway S.N.: Intrinsic Pathway is long so APTT

Question 44

Transfusion trigger for Pregnant patients Critically ill Pulmonary/Cardiac Compromise patients

Answer 44

Pregnant patients: 7mg/dl Critically ill: 9mg/dl Pulmonary/Cardiac Compromise patients\*: 10mg/dl \*In Pul/Cardiac compromise we have to transfuse more soon coz of O2 Flux(their CO will already be less) O2 Flux = PaO2 x CO

Question 45

RULE OF 50’S: PULMONARY FUNCTION CRITERIA SUGGESTING HIGH RISK IN RESECTIVE SURGERY [LUNG CA]

Answer 45

* FVC \< 50% predicted * FEV1 \< 50% of FVC or \< 2L * DLCO \< 50% predicted * MVV (maximal voluntary ventilation) \< 50% * RV/TLC \> 50%

Question 46

Why Normal saline nebulisation(for COPD pts) is given with O2 & not Air?

Answer 46

NS neb inhibits Hypoxemic Pul Vasoconstriction & hence O2 supplementation is also given

Question 47

For Bronchodilation why Salbumatol/Formetorol is used? Why not Adrenaline...?

Answer 47

Salbumatol/Formetorol is Selective B2 agonist Adrenaline also increases endogenous catecholamines by B1 stimulation -\> Tachycardia....

Question 48

ECG Features demonstrating the Digoxin Effect

Answer 48

https://litfl.com/digoxin-effect-ecg-library/

Question 49

ET tube size in Children

Answer 49

Age \<6yrs Age/3 + 3.5 Age \>6yrs Age/4 + 4.5 Other Formulas: Height of child/20 Dia of middle phalanx of little finger

Question 50

MICROCUFF Endotracheal Tubes in Children -Adv & disadv?

Answer 50

**Adv:** Alters to the anatomy of pead airway - narrowest part is Subglottic Reduced risk of laryngeal odema **Disadv:** Monitoring of cuff pressure required Expensive

Question 51

Muffling of FIRST/SECOND HEART SOUND post induction and intubation of Pediatric pt - troubleshoot?

Answer 51

FIRST: Induction dial value of Sevoflurane not changed from **8 mac or high mac** SECOND: Decreased SVR, hypovolemia - increase fluid therapy

Question 52

Minute ventilation (VE)? Alveolar ventilation (VA)? Dead space ventilation (VD)?

Answer 52

1. **Minute ventilation (VE):** The amount of air entering the lungs per minute. It can be defined as **_VE=Tidal Volume×Breaths Per Minute_** 2. **Alveolar ventilation (VA):** The amount of gas per unit of time that reaches the alveoli and becomes involved in gas exchange. It is defined as **_VA=(Tidal Volume−Dead Space Volume)×Respiratory Rate_** 3. **Dead space ventilation (VD):** The amount of air per unit of time that is not involved in gas exchange, such as the air that remains in the conducting zones. It is defined as **_VD=Dead Space Volume×Respiratory Rate_**

Question 53

Blood loss estimation on Gauze pad soakage?

Answer 53

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