UNVERIFIED ANSWERS Q51-75 Flashcards
(25 cards)
- Following anterior mediastinal mass biopsy under GA, the patient deteriorates. Most likely cause?
A. Bronchospasm
B. Pneumothorax
C. Superior vena cava obstruction
D. Airway compression
E. Pulmonary embolism
BJA Ed: “Respiratory and cardiovascular complications are likely to
be interrelated or occur simultaneously. Cardiovascular
complications are less common, but it is unknown to what
degree reduced venous return or obstructed cardiac output
may have contributed to a reduction in pulmonary perfusion
and increase ventilation/perfusion mismatch, augmenting
hypoxia and patient deterioration”
so maybe D but unclear.
Sims book and WFSA don’t really commit
- Best test to monitor severity in myasthenia gravis?
A. Acetylcholine receptor antibody titre
B. Vital capacity
C. Anti-MuSK antibody
D. Muscle biopsy
E. Repetitive nerve stimulation
B. Vital capacity
Explanation: Vital capacity reflects respiratory muscle strength and predicts need for ventilatory support.
- Paediatric patient undergoing tonsillectomy with recent URTI. Best airway choice?
A. Classic LMA
B. Reinforced LMA
C. ETT with cuff
D. ETT without cuff
E. Face mask only
B. reinforced LMA
Not specific to tonsillectomy but for paeds URTI in general:
“Tracheal intubation should be avoided if possible, particularly in children less than 5 years. An LMA or facemask are preferable alternatives where appropriate. “
https://resources.wfsahq.org/atotw/upper-respiratory-tract-infection-and-paediatric-anaesthesia/
- Appropriate management of acute hyponatraemia with seizures?
A. Fluid restriction
B. Hypertonic saline bolus
C. Normal saline infusion
D. Desmopressin
E. Furosemide
B. Hypertonic saline bolus
Explanation: Hypertonic (3%) saline rapidly increases Na⁺, reducing cerebral oedema and stopping seizures.
- Most likely mechanism of amniotic fluid embolism?
A. Mechanical obstruction of pulmonary artery
B. Air embolism
C. Right heart failure
D. Anaphylactoid reaction
E. DIC from fetal cell entry
D. Anaphylactoid reaction
Explanation: AFE is now understood as a systemic inflammatory response, not purely mechanical obstruction.
- Which nerve is most at risk during internal jugular vein cannulation?
A. Hypoglossal nerve
B. Phrenic nerve
C. Recurrent laryngeal nerve
D. Vagus nerve
E. Cervical sympathetic chain
D. Vagus nerve
Explanation: The vagus nerve lies within the carotid sheath along with IJV and carotid artery.
- Best block for TKA that preserves quadriceps strength?
A. Femoral nerve block
B. Adductor canal block
C. Sciatic nerve block
D. IPACK block
E. Epidural analgesia
B. Adductor canal block
Explanation: Adductor canal block provides analgesia while preserving quadriceps motor function.
- Which abnormality supports diagnosis of TURP syndrome?
A. Hypernatraemia
B. Hyperchloraemia
C. Hyponatraemia
D. Hypokalaemia
E. Hypermagnesaemia
C. Hyponatraemia
Explanation: Absorption of hypotonic irrigation fluid during TURP causes dilutional hyponatraemia.
- Which feature distinguishes serotonin syndrome from NMS?
A. Hypertension
B. Hyperthermia
C. Myoclonus
D. Elevated CK
E. Altered mental status
C. Myoclonus
Explanation: Myoclonus is more common in serotonin syndrome; rigidity dominates in NMS.
- Which drug reduces cerebral metabolic rate the most?
A. Propofol
B. Ketamine
C. Isoflurane
D. Dexmedetomidine
E. Midazolam
A. Propofol
Explanation: Propofol has the greatest CMRO2 reduction among anaesthetic agents.
- Which structure is pierced during a paravertebral block?
A. Internal intercostal membrane
B. Transversus thoracis muscle
C. Pleura
D. Suprapleural membrane
E. Transversalis fascia
A. Internal intercostal membrane
Explanation: The internal intercostal membrane is passed before reaching the paravertebral space.
- Which anaesthetic agent is most associated with QT prolongation?
A. Propofol
B. Isoflurane
C. Sevoflurane
D. Desflurane
E. Ketamine
C. Sevoflurane
Explanation: Sevoflurane prolongs QT interval more than other agents.
- Which is an independent predictor of postoperative pulmonary complications?
A. Age < 60
B. Serum creatinine
C. Smoking within 8 weeks
D. Normal spirometry
E. BMI < 25
C. Smoking within 8 weeks
Explanation: Recent smoking increases airway inflammation and secretions.
- You notice rising peak and plateau pressures intraop. Most likely cause?
A. Circuit leak
B. Mucus plug
C. Disconnection
D. CO₂ insufflation
E. Patient movement
B. Mucus plug
Explanation: A mucus plug increases resistance and reduces compliance, raising both pressures.
- Which opioid has the shortest duration of action?
A. Morphine
B. Fentanyl
C. Alfentanil
D. Sufentanil
E. Remifentanil
E. Remifentanil
Explanation: Remifentanil is rapidly hydrolyzed by plasma esterases.
- What causes a prolonged PR interval?
A. AV nodal delay
B. LBBB
C. SA node dysfunction
D. Accessory pathway
E. Atrial fibrillation
A. AV nodal delay
Explanation: PR interval reflects AV nodal conduction time.
- Which agent increases gastric volume and pH?
A. Ranitidine
B. Sodium citrate
C. Metoclopramide
D. Omeprazole
E. Erythromycin
B. Sodium citrate
Explanation: Sodium citrate raises pH but increases gastric volume.
- Which volatile agent has highest blood/gas solubility?
A. Nitrous oxide
B. Desflurane
C. Isoflurane
D. Sevoflurane
E. Xenon
C. Isoflurane
Explanation: Higher solubility means slower onset and offset.
- Best predictor of successful weaning from ventilation?
A. SpO₂ > 90%
B. pH > 7.30
C. Negative inspiratory force
D. VC > 15 mL/kg
E. RSBI < 105
E. RSBI < 105
Explanation: Rapid shallow breathing index is most predictive of weaning success.
- Patient at greatest risk of PDPH?
A. Male, 70, spinal for TURP
B. Female, 60, spinal for hip fracture
C. Female, 35, spinal for caesarean
D. Male, 40, spinal for hernia
E. Female, 50, spinal for gynae
C. Female, 35, spinal for caesarean
Explanation: Young females undergoing obstetric spinal anaesthesia are at highest risk.
- Mechanism of dexmedetomidine?
A. Alpha-1 agonist
B. Alpha-2 agonist
C. Beta-1 antagonist
D. GABA-A agonist
E. NMDA antagonist
B. Alpha-2 agonist
Explanation: Alpha-2 agonism provides sedation and analgesia with minimal respiratory depression.
- Best management of bradycardia under GA?
A. Glycopyrrolate
B. Phenylephrine
C. Atropine
D. Adrenaline
E. Ephedrine
C. Atropine
Explanation: Atropine is first-line treatment for vagally mediated bradycardia.
- Mechanism of fentanyl-induced chest wall rigidity?
A. Histamine release
B. Dopamine stimulation
C. GABA antagonism
D. Mu receptor activation in brainstem
E. Alpha stimulation
D. Mu receptor activation in brainstem
Explanation: High doses of fentanyl stimulate central mu receptors causing rigidity.
- Greatest risk factor for intraop awareness?
A. High ASA
B. Use of NMBs
C. Fasting > 12h
D. Volatile anaesthetic
E. BIS monitoring
B. Use of NMBs
Explanation: NMBs suppress motor signs of inadequate anaesthesia.
