| Post Name | Junior Consultant (Anaesthesia) (NCA- E/T/B) - Health Services |
|---|---|
| Question Paper Code | 002/2022/OL |
| Category Code | 160/2020 |
| Date of Test | 13 January 2022 |
| Exam Type | Online Examination |
| Total Questions | 100 |
1
The three legged stool of prethoracotomy respiratory assessment includes all the following except
Answer
A. Predicted preoperative FEV1 > 40%
2
The SPIKES protocol is a communication framework used for
Answer
B. Breaking Bad News
3
All of the criteria must be met for diagnosing Metabolic Syndrome except
Answer
A. Triglycerides ā„ 200 mg/dl
4
Anesthetic concerns involving Robotic radical prostatectomy include all the following except
Answer
C. Steep head up tilt
5
The metabolism of which of the below given muscle relaxant is signiļ¬cantly aļ¬ected in hepatic dysfunction
Answer
C. Mivacurium
6
Hepatopulmonary syndrome is characterised by the triad of i. End stage liver disease ii. Increased alveolar arterial gradient iii. Intrapulmonary vascular dilation iv. Azotemia
Answer
A. i, ii, iii
7
All of the following statements regarding pre-eclampsia are true except
Answer
C. Proteinuria > 5 g/day
8
Schonfeld Index is used for the diagnosis of
Answer
A. Fat embolism syndrome
9
A patient with multiple drug allergy coming for emergency caesarean section in view of severe pre-eclampsia has had LMWH in the morning at 8 am. She is taking ļæ½ļæ½ Enoxaparin at 0.4 ml SC OD since her 3 month of pregnancy since she had an episode of DVT. Which of the following statement is true regarding the management of said patient ?
Answer
D. Needle placement should occur atleast 10-12 hours after LMWH
10
The most common cause of post operative visual loss after spine surgery is
Answer
C. Ischaemic optic neuropathy
11
The diagnosis of TRALI is met by all the following criteria except
Answer
B. Room air Spš2 < 88%
12
During literature review, reviewer bias results from i. Inability to determine the quality of the reported literature accurately ii. Only one reviewer extracting data and interprets study ļ¬nding iii. Preferential selection of studies in the interest of promoting a view point iv. Can be addressed by conducting a reliability check
Answer
C. ii and iv
13
The proposed limit of exposure to inhalational anesthetic agents as recommended by National Institute for Occupational Safety and Health (NIOSH), for nitrous oxide and volatile anesthetic agents respectively are
Answer
A. 25 and 2 ppm
14
A surgical laser is currently used in many surgical procedures to cut or destroy tissue. All of the following are true about lasers except
Answer
B. Lasers produce ionising radiation which may cause eye injury
15
In patients with Automated Implanted Cardioverter Deļ¬brillator, coming for surgery, all of the following are true except
Answer
C. Magnets should be used to change the pacing program that is in an AICD
16
The following statements about VV ECMO are true i. Used only when respiratory assistance is required ii. Native and Artiļ¬cial lungs are in series iii. Native and Artiļ¬cial lungs are in parallel iv. Acts as a passive pumpless lung assistant primarily for decarboxylation
Answer
A. i and ii
17
Which of the following criteria are required for conļ¬rmation of systemic inļ¬ammatory response syndrome ? i. Body temperature > 38Ā°C or < 36Ā°C ii. HR > 90 bpm iii. RR > 20 bpm or Paš¶š2 < 32 3 3 iv. WBC > 12000 šš or < 4000 šš or > 10% immature forms
Answer
B. 2 or more
18
The Hunt and Hess grading system is
Answer
A. A clinical grading system
19
ARDS net goals for mechanical ventilation in patients with ARDS include all except
Answer
C. Spš2 85-95%
20
The modiļ¬ed aldrete scoring system reviews all of the following as criteria for discharge from PACU except
Answer
D. Pain
21
Paediatric CPB has all the following characteristics except
Answer
A. Hypothermic temperatures rarely below 25-30Ā°C
22
Speciļ¬c contraindication to epidural anesthesia in children include all except
Answer
A. Spina biļ¬da occulta
23
All of the following statements pertaining to eye surgery are true except
Answer
D. The oculocardiac reļ¬ex follows the oculovagal reļ¬ex pathway
24
The important pre existing vulnerability factors deļ¬ned in the medical model of delirium include i. Advanced age ii. Visual acuity < 20/70 iii. Apache score > 16 iv. Mini Mental State Examination (MMSE) score < 24
Answer
D. i, ii, iii, iv
25
All of the following statements about fetal physiology are true except
Answer
D. The normal fetal cardiac output is in the range of 50-75 ml/kg/min
26
All of the following about the ethical aspects of anesthesia care are true except
Answer
D. DNAR orders do not require reconsideration before surgery
27
Declarative memory is
Answer
A. Explicit in nature
28
All the following are eļ¬ects of stimulation of the sympathetic nervous system except
Answer
C. Lipolysis
29
Norepinephrine
Answer
B. Causes powerful vasoconstriction and may cause reļ¬ex bradycardia
30
Cardioselective beta blockers include all except
Answer
B. Propranolol
31
The reverse steal or robin hood eļ¬ect is the
Answer
B. Neuroprotective eļ¬ect of barbiturates
32
Hypokalemia produces
Answer
C. Ventricular extrasystoles
33
A patient with ASA 5 status classiļ¬cation during preoperative evaluation signiļ¬es
Answer
C. A moribund patient who is equally likely to die in the next 24 hours with or without surgery
34
The Epworth Sleepiness Scale is used to
Answer
B. Assess patients with excessive day time sleep
35
A patient with smoking history for the past 40 years is scheduled for elective inguinal herniorrhaphy. He has intermittent episodes of breathlessness for which he is having Formeterol and Budesonide MDI twice daily. His last episode of exacerbation was more than 3 months ago. On spirometric evaluation, his post bronchodilator FEV1 is 60% of predicted and FEV1:FVC is 50%. According to the GOLD criteria for COPD severity classiļ¬cation, your patient has
Answer
A. Stage II Moderate COPD
36
Intrinsic PEEP can be detected during mechanical ventilation intraoperatively by the following method
Answer
D. All of the above
37
A 20 yr old male with no signiļ¬cant past history had severe bronchopneumonia and was on mechanical ventilation for 5 days is now showing an ABG with pH 7.31, PaC š2 45 mm Hg, Paš2 of 75 mm Hg at Fiš2 0.5, Pressure support is 5 and PEEP is 4 cm of š»2 O. On clinical assessment RR is 18 bpm and is not showing any signs of increased work of breathing. Which of the following is not advisable in the scenario ?
Answer
A. Weaning criteria have not been met and it is preferable to improve Paš2 to 75 mm Hg at Fiš2 0.3
38
A 63 year old male complaining of acute chest discomfort was brought to the hospital. The 12 lead ECG showed No ST segment elevation in any of the leads. Cardiac markers were sent from the EM department and Trop T marker was signiļ¬cantly elevated. Which of the following is not advisable in this scenario ?
Answer
C. Thrombolytic therapy to be commenced at the earliest
39
3 lead ECG monitoring with most probability to detect intraoperative ischaemia is
Answer
D. II, V4, V5
40
A 70 year old male with a history of hypertension, diabetes and dyslipidemia presents to the emergency department with altered sensorium. Clinical evaluation is suggestive of a likely subdural hematoma. To assess his cardiorespiratory status, with which of the following physical activity is he least likely to have signiļ¬cant cardiopulmonary ailment during surgery ?
Answer
D. Climb one ļ¬ight of stairs
41
Which of the following statements about thermoregulation is untrue ?
Answer
C. AĪ“ nerve ļ¬bres also convey pain sensation which is why intense cold cannot be distinguished from sharp pain
42
All the following statements about Phase II block are true except
Answer
C. Response to tetanic stimulation does not fade
43
In preoperative assessment of patients, physical activity is graded in terms of Metabolic Equivalents (METs). The value that corresponds to oxygen consumption of 1MET in an adult is
Answer
B. 3.5 ml/kg/min
44
If the pressure in a full š2 O E cylinder is 745 psi at 20C, the pressure in a half full cylinder will be about _____________ psi.
Answer
D. 745
45
In a Cš2 absorbent canister, the greatest amount of carbon monoxide is produced by
Answer
D. Desļ¬urane
46
Typical mixed venous oxygen tension in a healthy adult is
Answer
B. 40 mm Hg
47
Normal systemic vascular resistance varies between __________ (dynes)(s)/cš 5 .
Answer
C. 900 and 1500
48
A 48 year old male is posted for excision of a complex spinal cord tumour which may likely cause damage to the anterior spinal artery intraoperatively. Which of the following neuromonitoring aide will help you identify such a damage intraoperatively ?
Answer
B. MEP
49
A prolonged QTc interval may be seen in all the following except
Answer
A. Hyperkalemia
50
A 65 year old woman posted for elective subtotal hysterectomy was given spinal anesthesia. Soon after, the ECG shows narrow complex tachyarrhythmia with HR 180 bpm and a regular R-R interval. All of the following are advisable in this scenario except
Answer
D. Deļ¬brillation
51
Which of the following predictors is likely to be associated with lower incidence of perioperative nausea and vomiting ?
Answer
C. Patients with a history of smoking
52
A 70-year-old male, who is diabetic for the last 20 years, is scheduled for an elective surgery. Which of the following is not a sign of autonomic diabetic neuropathy ?
Answer
D. History of urinary retention
53
Which of the following regarding the neuron action potential is false ?
Answer
C. During the depolarising phase, the K+ permeability rises, leading to an inļ¬ux of K+ ions
54
What is the order of nerve blockade of diļ¬erent types of nerve ļ¬bres ?
Answer
A. B > AĪ“ = C > AĪ³ > AĪ² > AĪ±
55
Regarding action of Local Anaesthetic (LA) on NA+ channels, which of the following is true ?
Answer
A. The aļ¬nity of LA for the inactivated state of the Na+ channel is higher than its resting state
56
A 24 year old female with a history of mild asthma was admitted to the intensive care unit with Guillian Barre syndrome. She is complaining of diļ¬culty in breathing. Which is the best way to monitor her respiratory function and if she needed intubation ?
Answer
D. Measurement of vital capacity
57
A patient with life threatening exacerbation of asthma requires emergency intubation and mechanical ventilation. Which of the following agents is the most likely to improve lung mechanics and bronchospasm ?
Answer
B. Ketamine
58
Which of the following complications is most frequently seen after pulmonary artery catheter insertion via the internal jugular vein ?
Answer
C. Bacterial colonisation
59
Signiļ¬cant intravenous absorption/inadvertent intravenous injection of bupivacaine can cause profound bradycardia and sinus node arrest. Which of the following best describes the mechanism of cardiac toxicity of bupivacaine ?
Answer
A. Bupivacaine binds inactivated fast sodium channels and dissociates from them slowly
60
Which of the following surgeries carries the highest cardiovascular risk ?
Answer
C. Femoral-popliteal bypass surgery
61
Surgical electrocautery may cause a problem with an Automated Implantable Cardioverter Deļ¬brillator (AICD) by all the following mechanisms, except
Answer
D. Cautery current generating too much heat at the location of AICD and causing burns
62
Which of the following statements regarding the structure of Local Anaesthetic (LA) is false ?
Answer
D. Cocaine is synthetically produced
63
Which of the following statements regarding chirality is incorrect ?
Answer
D. Enantiomers have similar optical activities but diļ¬erent physical and chemical properties
64
Tolerance does not develop to which of the following side eļ¬ects of opioids ?
Answer
D. Constipation
65
Which of the following views of Transesophageal Echocardiograph (TEE) is most suited to visualize blood supply of all the segments of the heart ?
Answer
C. Transgastric midshort axis view
66
General guidelines for separation from Cardiopulmonary Bypass (CPB) include all the following, except
Answer
A. Core body temperature of at least 34Ā°C
67
A 25-year-old male with a family history of sudden cardiac deaths is undergoing a laparoscopic appendectomy. Immediately after induction and intubation, you notice a heart rate of 120 bpm and blood pressure of 60/40 mm Hg, with a normal capnogram. You suspect the patient has idiopathic hypertrophic subaortic stenosis. Which of the following maneuvers is most likely to help this patient's hemodynamics ?
Answer
D. Administering a bolus of normal saline and phenylephrine 100 Ī¼g IV
68
A 67-year-old male has a diagnosis of Myasthenia Gravis (MG). Which of the following medications should be avoided to reduce the risk of exacerbation ?
Answer
A. Gentamicin
69
The following biochemical parameters suggest resolution of DKA/HHS except
Answer
D. Negative Urine or serum ketones by nitroprusside test
70
The following apply to levosimendan
Answer
D. It can be used with Ī²-blockers
71
A 55 kg 81-year-old man suļ¬ers an acute myocardial infarction. Following coronary artery bypass grafting he is admitted to the cardiac intensive care unit. He is intubated and ventilated with no inotropic or vasopressor support. Cardiac output studies show: heart rate 115 bpm, blood pressure is 131/78 mmHg, central venous pressure 19 mmHg, cardiac 2 5 2 index 1.9 L/min/š , pulmonary artery wedge pressure 24 mmHg and systemic vascular resistance index 2800 dyne/s/šš /š . His urine output is less than 20 ml/hour, and his lactate is 6.1 mmol/L. There is no evidence of tamponade on echocardiogram. The most appropriate medication would be
Answer
A. Milrinone
72
A 57-year-old male is undergoing coronary artery bypass grafting (left internal mammary artery to left anterior descending artery). After termination of Cardiopulmonary Bypass (CPB), you notice a prominent V wave in the Pulmonary Artery Occlusion Pressure (PAOP) tracing. The most likely reason for the ļ¬nding is
Answer
D. Posterior papillary muscle dysfunction
73
In which of the following situations is applying Continuous Positive-Airway Pressure (CPAP) to the nondependent lung most ideal for improving oxygenation ?
Answer
B. Open lobectomy
74
Critical Illness Polyneuropathy (CIP)
Answer
B. Occurs due to axonal degeneration
75
According to SHEA/IDSA Practice Recommendation 2014, the general strategies to reduce VAP include all except
Answer
A. Prefer nasal intubations to oral unless contraindicated
76
The usual indications of commencing RRT are the following except
Answer
A. Oliguria is less than 0.5 mL/kg/h urine output for at least 2 h
77
MACOCHA Score is a simple score developed for ICU patients which has been shown to diļ¬erentiate between a diļ¬cult from a non diļ¬cult airway in ICU patients. The MACOCHA score has seven easily identiļ¬able variables which include all the following except
Answer
D. Protruding mandible
78
A 65 year old male, recently diagnosed as a case of pulmonary tuberculosis, on antitubercular treatment for the past 2 months, presented to emergency department with history of coughing out blood. For the past 2 weeks, he has a history of sputum streaking of blood, but today morning, he expectorated about a cup of bright red blood. While giving history of his symptoms, he expectorated large amount of blood, about 300 mL. Which of the following is NOT advisable in this scenario ?
Answer
D. IV infusion of Tranexamic acid
79
The oxygen failure safety valve
Answer
A. Will prevent a hypoxic gas mixture from being delivered
80
The cylinder size most commonly used on anesthesia machines and for patient transport is
Answer
D. Size E
81
All of the following statements about conļ¬rmation of epidural space are true except
Answer
C. With the use of nerve stimulator to conļ¬rm proper placement of epidural catheter, presence of a motor response with < 1 mA indicates appropriate catheter location
82
A 6-year-old patient scheduled for laparoscopic bilateral inguinal hernia repair undergoes inhalational induction and intubation with a 5.0-mm cuļ¬ed endotracheal tube. The tube is secured with the 15-cm mark at the patient's gumline. Auscultation reveals equal breath sounds bilaterally. Inļ¬ation of the pilot balloon results in palpation of the inļ¬ated tube cuļ¬ just above the cricoid cartilage. A leak test reveals leak of air into the oropharynx at a positive pressure of 20 cm š»2 O. The next best step in management is
Answer
C. The tube cuļ¬ should be deļ¬ated and the tube advanced until the cuļ¬, when inļ¬ated, is palpable below the cricoid cartilage
83
The Tec 6 desļ¬urane vaporizer
Answer
A. Is electrically heated to 39Ā°C
84
Variable bypass vaporizers should be located
Answer
B. Between the ļ¬owmeters (upstream) and the common gas outlet (downstream)
85
A 50 year old man developed fever on day 3 post inguinal herniorrhaphy under subarachoid block. This was accompanied by severe headache, vomiting, stiļ¬ness of neck and altered sensorium. On clinical examination Kernigs sign and Brudzinskis sign were elicited positive. The most common organism responsible is
Answer
A. Streptococcus Salivarius
86
Regarding the 'gate control' theory of pain, which of the following is the correct statement ?
Answer
B. It explains why local rubbing eases the pain
87
Which one of the following terms is correctly matched with its deļ¬nition ?
Answer
D. Hyperalgesia : an increased response to a stimulus which is normally painful
88
A 67-year-old chronic male smoker, a known case of small cell carcinoma, was admitted to hospital with altered sensorium, nausea and dizziness. His vital signs were stable. Liver function tests, urea, and creatinine were normal. Serum sodium was 118 mEq/L and serum potassium was 4.0 mEq/L. All the following regarding the treatment of hyponatremia are true except
Answer
D. Sodium may be corrected at the rate of 3-4 mEq/L for an initial few hours or till symptoms subside
89
A 75-year-old male patient, a case of Chronic Obstructive Pulmonary Disease (COPD), was transferred from another hospital with complaints of fever, increased breathlessness for 5 days, and altered sensorium since 1 day. He also had an episode of seizure 1 day. He was being managed on the lines of acute exacerbation of COPD with cor pulmonale with pneumonia. He received antibiotics and diuretic therapy in the previous hospital. On evaluation, his laboratory values showed hemoglobin 13 g/dl, packed cell volume of 38.5%, serum sodium 160 mEq/L, serum potassium 3.0 mEq/L, serum urea 146 mg/dl, and serum creatinine of 1 mg/dl. Which of the following is true about the current scenario ?
Answer
C. Correction in chronic (> 48 h) settings :- Total less than 10-12 mEq/24 h
90
A 50-year-old male patient was admitted with generalized weakness and abdominal distension. On examination, he was found to be alert and hemodynamically stable. Neurological examination revealed quadriparesis. Abdominal examination revealed distension with sluggish bowel sounds. His serum potassium level was 2 mEq/L. The ECG taken showed all the following features except
Answer
A. ST segment elevation
91
A 60-year-old diabetic male patient, hypertensive and on Angiotensin-Converting Enzyme (ACE) inhibitors, was admitted with dizzy spells. On admission, his pulse was 60/min, BP was 110/70 mmHg, and sensorium was normal. His blood biochemistry showed urea 90 mg/dl, creatinine 2.0 mg/dl, Na 130 mEq/L and K 6.5 mEq/L. Which of the following statements is untrue regarding calcium therapy in such a patient ?
Answer
B. Intravenous calcium works within minutes and the eļ¬ect is long-lasting (3-6 hrs)
92
Baker's classiļ¬cation of Low ļ¬ow anesthesia states that
Answer
B. Minimal Flow 250-500 ml/min
93
All of the following are true about isoļ¬urane except
Answer
D. Structural isomer of sevoļ¬urane
94
Propofol acts by all the following mechanisms except ā
Answer
D. Increases serotonin level in area postrema
95
A 45 year old male smoker was diagnosed with DVT 6 months ago for which he was started on LMWH 0.6 ml twice daily. He now comes to the casualty with acute pain in right iliac fossa and USG is suggestive of acute appendicitis. Which of the following ASRA guidelines must be followed if he requires surgery ?
Answer
A. Time before puncture 24 hours
96
All of the following drugs increase the mean arterial blood pressure, except
Answer
D. Isoproterenol
97
Which of the following is most likely the (analgesic) mechanism of action of lidocaine when used for neuropathic pain ?
Answer
A. Inhibition of G-protein-coupled receptors
98
You have just administered a bolus of 2% lidocaine (25 mL) through an epidural catheter that has been working well for labor analgesia in preparation for emergency cesarean section for fetal distress in an otherwise-healthy 35-year-old woman. Shortly after administration of lidocaine, the patient complains of nausea, and you notice that her heart rate has decreased from 99 to 38 bpm. The most likely cause is
Answer
C. Epidural level is higher than T4
99
Which of the following nerves is typically spared during performance of an interscalene brachial plexus block ?
Answer
D. Ulnar
100
A 56-year-old patient with a past medical history of hypertension, diabetes and alcohol abuse presents to the operating room for a right-elbow open reduction internal ļ¬xation, secondary to a motor vehicle accident that occurred 24 hours ago. On postoperative day 1, the patient compains of right fourth and ļ¬fth digit numbness and minor pain. A diagnosis of cubital tunnel syndrome has been made. The nerve most likely to be involved is
Answer
B. Ulnar nerve
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