1. Regarding the use of Suxamethonium, which statement is correct?
(A) Tachycardia is a complication
(B) Phase II block occurs more commonly with neonates
(C) Prolonged duration of action may be seen in around one patient in 40
(D) Can raise the serum potassium by 0.5 mmol/ L
Answer: D
Explanation:
Suxamethonium (also known as succinylcholine) is a depolarizing neuromuscular blocker that can cause transient elevation of serum potassium due to potassium efflux from muscle cells during depolarization. The increase is typically around 0.5 mmol/L, which can be significant in patients with pre-existing hyperkalemia or upregulated acetylcholine receptors, such as in burns, neuromuscular disorders, or prolonged immobilization. This potassium rise is a well-documented physiological response and forms the basis for caution in susceptible individuals.
2. Concerning electroencephalography (EEG):
(A) voltages are in the range of 10-100 millivolts
(B) spontaneous EEG activity is lost when the body temperature drops below 25 degrees C
(C) b waves are enhanced by sedatives
(D) d waves only occur in brain injury
Answer: C
Explanation:
Beta waves (b waves) in EEG are typically associated with alertness and active thinking. However, they are also enhanced by sedative medications, particularly benzodiazepines and barbiturates, which increase GABAergic activity. This enhancement reflects a shift in cortical activity toward higher frequency, lower amplitude patterns, characteristic of sedation and light sleep. The presence of beta wave augmentation is a useful indicator in monitoring depth of anaesthesia and sedative drug effects.
3. Desflurane:
(A) is a fluorinated methylisopropyl ether
(B) boils at 60 degrees C
(C) is safe to use in patients with malignant hyperpyrexia
(D) stimulates the sympathetic system when inspired concentration is suddenly increased
Answer: D
Explanation:
Desflurane is known to stimulate the sympathetic nervous system when its inspired concentration is rapidly increased, leading to tachycardia and hypertension. This effect is due to its pungent odor and airway irritant properties, which can provoke catecholamine release. Clinicians often avoid abrupt increases in concentration to prevent these hemodynamic fluctuations, especially in patients with cardiovascular sensitivity.
4. Action potentials:
(A) are all or none signals of about 100 mV in amplitude
(B) are generated by leakage of K+ down their concentration gradient
(C) are normally conducted antidromically
(D) summate at high frequencies
Answer: A
Explanation:
Action potentials are all-or-none electrical signals with an amplitude of approximately 100 mV, generated when the threshold potential is reached. They result from rapid depolarization due to sodium influx, followed by repolarization via potassium efflux. This binary nature ensures consistent signal transmission along neurons, crucial for neuromuscular coordination and anaesthetic monitoring.
5. Conduction velocity of a nerve impulse:
(A) is greater in C fibres than in group A fibres
(B) is lesser in large diameter nerve fibres
(C) is greater in unmyelinated nerve fibres because of saltatory conduction
(D) is decreased in hypothermia
Answer: D
Explanation:
Hypothermia slows nerve conduction velocity by reducing ion channel kinetics and membrane excitability. This effect is particularly relevant during anaesthesia, where temperature regulation impacts neuromuscular function and drug metabolism. Myelinated fibres conduct faster due to saltatory conduction, and larger diameter fibres have higher conduction speeds, contrary to options A and B.
6. Atropine:
(A) Rarely may cause bradycardia
(B) No action on pupil in premedicant dose
(C) Increases the physiological dead space
(D) Has both Muscarinic and Nicotinic effects
Answer: D
Explanation:
Atropine is a competitive antagonist of acetylcholine at muscarinic receptors, but at high doses, it can also exhibit nicotinic effects, influencing autonomic ganglia and neuromuscular junctions. Its anticholinergic properties make it useful for reducing secretions and preventing bradycardia during anaesthesia, though paradoxical bradycardia may occur at low doses.
7. In the pulmonary circulation:
(A) Capillary hydrostatic pressure is about 25 mm Hg
(B) 50% of the cardiac output goes to the pulmonary circulation in the foetus
(C) angiotensin is broken down
(D) hypoxia causes vasodilatation
Answer: C
Explanation:
In the pulmonary circulation, angiotensin I is converted to angiotensin II, and angiotensin is also broken down, highlighting the metabolic role of the lungs beyond gas exchange. The pulmonary endothelium contains angiotensin-converting enzyme (ACE), which is central to blood pressure regulation and fluid balance, making this a key consideration in perioperative care.
8. Regarding local anaesthetic agents (LA):
(A) the potency of LAs is proportional to their lipid solubility
(B) the duration of action is dependent on blood pH
(C) agents with low pKa have a slower onset of action
(D) all local anaesthetics are vasodilators
Answer: A
Explanation:
The potency of local anaesthetics correlates with their lipid solubility, as more lipophilic agents penetrate nerve membranes more effectively, leading to stronger blockade. This property also influences duration of action and toxicity profile. While many LAs are vasodilators, exceptions like cocaine exhibit vasoconstrictive effects, making option D inaccurate.
9. Cisatracurium Besylate:
(A) is a mixture of three stereoisomers
(B) in equipotent doses has a similar duration of action to Vecuronium
(C) is less potent than Atracurium
(D) in equipotent doses has a similar onset time to Atracurium
Answer: D
Explanation:
Cisatracurium, a stereoisomer of atracurium, has a similar onset time when used in equipotent doses, but offers greater hemodynamic stability and less histamine release. Its metabolism via Hofmann elimination makes it suitable for patients with hepatic or renal impairment, enhancing its utility in critical care anaesthesia.
10. If an electric current is fed through the body:
(A) Risk of injury is largely dependent upon the area of contact
(B) Antistatic shoes provide good protection due to their high conductance
(C) High frequencies are more dangerous than low frequencies
(D) Ventricular fibrillation occurs at a lower current in patients with dysrhythmias
Answer: D
Explanation:
Patients with pre-existing dysrhythmias are more susceptible to ventricular fibrillation at lower current thresholds, due to altered myocardial excitability. This underscores the importance of electrical safety in the operating room, especially during procedures involving electrocautery or defibrillation, where current pathways and patient condition must be carefully managed.
11. The counter current concentrating mechanism in the kidney:
(A) Depends on active transport of sodium and chloride out of the ascending loop of Henle.
(B) Allows an osmolality of 1200 mosmoles/kg in distal tubules.
(C) Occurs predominantly in the cortical nephrons.
(D) Depends on a low concentration of urea in the medullary interstitium.
Answer: A
Explanation:
The countercurrent concentrating mechanism relies on the active transport of sodium and chloride out of the ascending limb of the loop of Henle, which is impermeable to water. This creates a hyperosmotic medullary interstitium, allowing water reabsorption from the descending limb and collecting ducts. This mechanism is essential for urine concentration and water conservation, especially under the influence of antidiuretic hormone (ADH).
12. The adverse effects of NSAIDs on the kidney:
(A) Are reversible in normal kidneys
(B) Are not dose related
(C) Rarely causes acute interstitial nephritis
(D) Are counteracted by the use of ACE inhibitors
Answer: A
Explanation:
In individuals with normal renal function, NSAID-induced renal effects such as reduced renal perfusion and sodium retention are typically reversible upon discontinuation. NSAIDs inhibit prostaglandin synthesis, which plays a key role in maintaining renal blood flow, especially during volume depletion or stress. However, in patients with pre-existing renal disease, these effects may be more severe and persistent.
13. The following triggers the secretion of antidiuretic hormone from the posterior hypothalamus:
(A) 5% reduction in extracellular fluid
(B) Chronic renal failure
(C) Anxiety
(D) Supine position
Answer: C
Explanation:
Anxiety and stress can stimulate ADH (vasopressin) secretion via central nervous system pathways, independent of osmotic or volume stimuli. This neuroendocrine response is part of the hypothalamic-pituitary-adrenal axis, contributing to fluid retention during emotional or physiological stress. ADH acts on the renal collecting ducts to promote water reabsorption, helping maintain homeostasis.
14. Which of the following statements about Malignant Hyperthermia is FALSE?
(A) Phenomena that can occur with malignant hyperthermia include tachycardia, increased carbon dioxide excretion, muscle stiffness, and elevated body temperature
(B) Routine use of succinylcholine is recommended for patients with Duchenne’s muscular dystrophy
(C) Patients with malignant hyperthermia have an inherited condition
(D) The occurrence of malignant hyperthermia is associated with hypermetabolism in skeletal muscle
Answer: B
Explanation:
Succinylcholine is contraindicated in patients with Duchenne’s muscular dystrophy, as it can precipitate life-threatening hyperkalemia and rhabdomyolysis, mimicking malignant hyperthermia-like reactions. These patients are at high risk due to abnormal muscle membrane physiology. Malignant hyperthermia itself is a genetic disorder involving ryanodine receptor mutations, leading to uncontrolled calcium release and hypermetabolism.
15. Which of the following physiological monitoring instruments CANNOT measure cardiac output or ejection fraction?
(A) pulse-induced contour cardiac output (PiCCO)
(B) Transesophageal echocardiogram (TEE)
(C) pulmonary artery catheter
(D) ECG (electrocardiogram)
Answer: D
Explanation:
An ECG provides information on electrical activity of the heart, such as rhythm and conduction, but it does not measure cardiac output or ejection fraction. In contrast, TEE, PiCCO, and pulmonary artery catheters offer hemodynamic data, including stroke volume, cardiac output, and ventricular function, which are critical in perioperative and critical care settings.
16. Regarding the regulation of cerebral blood flow (CBF), which of the following factors CANNOT significantly affect CBF?
(A) Metabolic acidosis
(B) Mean arterial pressure
(C) Sevoflurane
(D) PaO2
Answer: A
Explanation:
Metabolic acidosis has minimal direct effect on cerebral blood flow, unlike PaCO₂, which is a potent regulator. Mean arterial pressure, PaO₂, and volatile anaesthetics like sevoflurane can significantly influence CBF. Sevoflurane causes cerebral vasodilation, while hypoxia increases CBF to maintain oxygen delivery. Thus, acidosis alone does not substantially alter CBF.
17. A 60-year-old patient receiving general anaesthesia with 100% oxygen for 8 hours will NOT develop which of the following comorbidities?
(A) Lung collapse (Atelectasis)
(B) Increased pulmonary shunt (Shunt)
(C) Increased pulmonary microvascular permeability
(D) Retrograde Fibroplasia
Answer: D
Explanation:
Retrograde fibroplasia, also known as retinopathy of prematurity, is a condition seen in neonates exposed to high oxygen concentrations, not in adults. In adults, prolonged exposure to 100% oxygen can cause atelectasis, pulmonary shunting, and microvascular changes, but retinal complications are not expected. Therefore, this option is not applicable to the described scenario.
18. What is the main source of the intra-abdominal organs of the genitourinary system, that is, the nerves of the kidneys and ureters?
(A) T10-L1
(B) S2-S4
(C) T8-L2
(D) T10-S4
Answer: C
Explanation:
The sympathetic innervation of the kidneys and ureters arises from the T8–L2 spinal segments, forming the renal plexus. These nerves regulate renal blood flow, ureteral peristalsis, and pain transmission. Understanding this distribution is crucial for regional anaesthesia techniques and pain management in urological procedures.
19. What is WRONG about the IV anaesthetic Dexmedetomidin?
(A) It is metabolized by the liver and excreted through urine and faeces
(B) The sedative effect of α2 agonist is due to the α2 receptors on the locus caeruleus and spinal cord
(C) α2 agonist is administered into the human body, via intrathecal or epidural route, to produce analgesic effect
(D) If rapidly administered to the human body, BP will drop initially, mainly because it stimulates the surrounding α2 receptor, resulting in vasodilation
Answer: C
Explanation:
Dexmedetomidine is not approved for intrathecal or epidural administration, as its safety and efficacy via these routes are not established. While it acts on α2 receptors in the locus coeruleus and spinal cord to produce sedation and analgesia, its use is typically intravenous. Rapid IV administration can cause transient hypotension due to peripheral vasodilation.
20. Regarding the autonomic nervous system, which of the following is FALSE?
(A) Patients with DM are more likely to develop Autonomic dysfunction
(B) Epidural anaesthesia can effectively reduce the surgical stress response
(C) With age, sympathetic tone will continue to decline
(D) After Spinal anaesthesia, blood vessels dilate and cannot shake, which can cause hypothermia
Answer: C
Explanation:
Sympathetic tone tends to increase with age, contributing to vascular stiffness and hypertension. Therefore, the statement that it declines is incorrect. Epidural and spinal anaesthesia reduce sympathetic outflow, leading to vasodilation, reduced stress response, and hypothermia due to impaired thermoregulation. Autonomic dysfunction is common in diabetic patients, affecting cardiovascular and gastrointestinal systems.
21. The characteristics of the arterial blood pressure waveform in Aortic regurgitation, which of the following?
(A) Wide pulse pressure
(B) Narrow pulse pressure
(C) Delayed pulse (Pulsus tardus; delayed upstroke)
(D) Strange Vein (Pulsus paradoxus)
Answer: A
Explanation:
In aortic regurgitation, the diastolic pressure drops due to backflow of blood into the left ventricle, while systolic pressure rises from increased stroke volume, resulting in a wide pulse pressure. This is a hallmark finding and reflects the volume overload and hyperdynamic circulation seen in chronic regurgitation.
22. The Child-Turcotte-Pugh scoring system used to assess the severity of liver cirrhosis DOES NOT include which of the following factors?
(A) Albumin
(B) Transaminase (GOT/GPT)
(C) Prothrombin time (prothrombin time)
(D) Bilirubin (bilirubin)
Answer: B
Explanation:
The Child-Turcotte-Pugh (CTP) score evaluates liver function using bilirubin, albumin, prothrombin time (or INR), ascites, and encephalopathy. Transaminases (GOT/GPT) are not part of the scoring system, as they reflect hepatocellular injury rather than synthetic function or clinical severity.
23. Which of the following statements about blood sugar is FALSE?
(A) When removing organs from brain-dead donors, try to maintain blood glucose concentration < 200 mg/dl
(B) Most patients who want to receive kidney transplantation are diabetic patients, and hypoglycemia may occur during surgery
(C) After the blood vessels of the transplanted pancreas are released, the blood sugar should be checked every 30 minutes, and the blood sugar generally drops by 50 mg/dl every hour
(D) Blood glucose is usually high in acute liver failure; patients with chronic end-stage liver disease are prone to hypoglycemia
Answer: C
Explanation:
The statement about blood sugar dropping by 50 mg/dl every hour after pancreas transplantation is inaccurate. While glucose levels may decrease, the rate is variable and depends on graft function and insulin release. Close monitoring is essential, but the fixed rate of decline stated is not physiologically reliable.
24. During laparoscopic surgery, the patient developed desaturation, hypotension, no airway pressure change, and decreased PETCO₂, which is the most likely clinical diagnosis?
(A) Pneumothorax
(B) Subcutaneous emphysema
(C) Massive CO₂ embolism
(D) Endobronchial intubation
Answer: C
Explanation:
Massive CO₂ embolism presents with sudden desaturation, hypotension, and decreased PETCO₂, due to impaired pulmonary perfusion and gas exchange. The absence of airway pressure change helps rule out endobronchial intubation or pneumothorax, making CO₂ embolism the most likely diagnosis.
25. Which of the following effects is NOT through α1-adrenergic receptor?
(A) Contraction of radial muscle of the iris
(B) Constriction of skin blood vessels
(C) Relaxation of the uterus
(D) Contraction of the bladder sphincter
Answer: C
Explanation:
Relaxation of the uterus is mediated by β2-adrenergic receptors, not α1 receptors. The α1 receptor is responsible for vasoconstriction, pupil dilation, and bladder sphincter contraction, all of which involve smooth muscle activation via Gq protein pathways.
26. Regarding the causes of hypoxemia, which of the following is most likely to cause an increase in P(A–a)O₂ gradient?
(A) Reduced barometric pressure
(B) Decrease FiO₂
(C) Shunting (high Qs/Qt)
(D) Hypoventilation
Answer: C
Explanation:
Shunting, where blood bypasses ventilated alveoli, leads to increased alveolar-arterial oxygen gradient (P(A–a)O₂). It reflects ventilation-perfusion mismatch, a key cause of refractory hypoxemia. In contrast, hypoventilation lowers both alveolar and arterial oxygen levels without widening the gradient.
27. What is WRONG with the Fluid management of Pulmonary resection surgery?
(A) Urine output > 0.5 ml/kg/hr must still be maintained
(B) Positive fluid balance should not exceed 20 ml/kg in the first 24 hours
(C) During lung resection, it is not necessary to give water because of third space
(D) Crystalloid should not be given more than 3 L within 24 hours
Answer: C
Explanation:
The claim that no water is needed due to third space loss is incorrect. Even during lung resection, patients require carefully titrated fluid to maintain hemodynamic stability and organ perfusion, while avoiding pulmonary edema. Third space losses must be considered in fluid planning.
28. What are the symptoms of chronic renal failure?
(A) Hypovolemia, anaemia
(B) Hyperkalemia
(C) Acidemia
(D) Cardiopulmonary insufficiency
Answer: D
Explanation:
Cardiopulmonary insufficiency is a common consequence of chronic renal failure, due to fluid overload, hypertension, and uremic cardiomyopathy. While electrolyte disturbances and acidemia occur, the systemic impact on heart and lungs is more clinically significant in advanced stages.
29. Which of the statements about the effects of Opioids on the CVS is FALSE?
(A) Meperidine is less likely to cause Bradycardia, but more likely to cause tachycardia
(B) During coronary artery bypass surgery, during induction of anaesthesia, injection of fentanyl can cause significant QT prolongation
(C) Opioids have obvious coronary diastolic effect, and there is no so-called myocardial metabolism
(D) Meperidine is more prone to histamine release than other types of opioids
Answer: C
Explanation:
The statement that opioids have no myocardial metabolism is false. While opioids like fentanyl and morphine have minimal direct myocardial depressant effects, they do undergo hepatic metabolism, and their hemodynamic effects are mediated via central and peripheral mechanisms, not coronary vasodilation alone.
30. What are the characteristics of kidney Glomerular capillaries?
(A) Divided by efferent arterioles
(B) Is an extension of Bowman’s capsule
(C) The vessel wall of Glomerular capillaries has several layers of cells
(D) Glomerular capillaries feed into arterioles
Answer: D
Explanation:
Glomerular capillaries are unique in that they drain into efferent arterioles, maintaining high pressure for filtration. Unlike typical capillaries that drain into venules, this arrangement supports efficient ultrafiltration. They are not extensions of Bowman’s capsule, and their walls are composed of fenestrated endothelium, basement membrane, and podocytes, not multiple cell layers.
31. Which of the hormones affecting myocardial contractility has an inhibitory role?
(A) Angiotensin
(B) Vasopressin
(C) Neuropeptide Y
(D) Adrenaline
Answer: B
Explanation:
Vasopressin, also known as antidiuretic hormone (ADH), can exert negative inotropic effects on the myocardium, particularly under certain pathological conditions. Unlike adrenaline and angiotensin, which enhance contractility via sympathetic stimulation, vasopressin may increase afterload through vasoconstriction, thereby reducing cardiac output. Its role in fluid balance and vascular tone is critical, but it does not directly enhance myocardial contractility.
32. Which of the following data is required to calculate MELD (Model for End stage Liver Disease) score?
(A) Albumin
(B) GPT (glutamic-pyruvic transaminase)
(C) Creatinine
(D) Ammonia
Answer: C
Explanation:
The MELD score is calculated using serum bilirubin, serum creatinine, and INR (International Normalized Ratio). Creatinine reflects renal function, which is crucial in assessing prognosis in liver disease. Albumin and transaminases are not part of the MELD formula, and ammonia levels, though clinically relevant, are excluded from the scoring system.
33. First successful administration of Ether Anaesthesia in India was done at Calcutta by Dr. O Shaugressy. What was the date?
(A) 22 Mar 1847
(B) 16 Oct 1856
(C) 02 Jan 1925
(D) 16 Oct 1947
Answer: A
Explanation:
The first successful administration of ether anaesthesia in India was performed by Dr. O Shaugressy on 22 March 1847 in Calcutta, shortly after its global introduction. This marked a historic milestone in Indian medical practice, aligning with the early global adoption of anaesthesia techniques.
34. According to general brain neurophysiology, which of the following is FALSE?
(A) CMRO₂ 3–3.5 ml/100g/min
(B) Cerebral venous PO₂ 32–34 mmHg
(C) ICP 8–12 mmHg when lying flat
(D) Cerebral venous SO₂ 30–40%
Answer: D
Explanation:
Cerebral venous oxygen saturation (SO₂) is typically around 55–75%, not 30–40%, making option D incorrect. The other values—CMRO₂, venous PO₂, and ICP—fall within normal physiological ranges. Accurate understanding of these parameters is essential for neuroanaesthesia and intracranial pressure management.
35. The excretion of carbon dioxide in the human body mainly depends on which of the following?
(A) Alveolar ventilation
(B) Minute ventilation
(C) Dead space
(D) Gender
Answer: A
Explanation:
Alveolar ventilation is the primary determinant of carbon dioxide excretion, as it reflects the volume of air reaching the gas exchange areas of the lungs. Minute ventilation includes dead space, which does not contribute to CO₂ elimination. Gender has no direct impact on CO₂ excretion efficiency.
36. Which of the following drugs has the greatest effect on cardiac workload?
(A) Morphine
(B) Buprenorphine
(C) Nalbuphine
(D) Pentazocine
Answer: D
Explanation:
Pentazocine can increase cardiac workload due to its sympathomimetic activity, leading to tachycardia and elevated blood pressure. Unlike morphine and buprenorphine, which tend to reduce preload and afterload, pentazocine may stimulate the cardiovascular system, making it less suitable for patients with ischemic heart disease.
37. During the diastole period, the ventricular diastole can be divided into four phases. The largest amount of ventricular filling occurs in which of the following periods?
(A) Isovolumic relaxation
(B) Slow filling, or diastasis
(C) Rapid filling phase
(D) Atrial systole
Answer: C
Explanation:
The rapid filling phase accounts for the majority of ventricular filling, occurring immediately after isovolumic relaxation when the mitral and tricuspid valves open. This phase is driven by pressure gradients and ventricular suction, making it the most significant contributor to diastolic volume.
38. Regarding TURP syndrome, which of the following statements is the most INAPPROPRIATE?
(A) Tachyarrhythmia may occur
(B) Bradyarrhythmia may occur
(C) In patients with hypotensive symptoms, intravenous fluids and inotropic should be administered rapidly
(D) Cerebral oedema or coma may occur if serum sodium is less than 120 mEq/L
Answer: C
Explanation:
In TURP syndrome, rapid administration of fluids and inotropes may worsen cerebral edema, especially in the presence of hyponatremia. Management requires careful correction of sodium levels, often with hypertonic saline, and controlled volume resuscitation. Hence, option C is inappropriate.
39. One of the pre-anaesthesia assessment items is the patient’s functional capacity, and its unit is MET (metabolic equivalent of the task). What is the meaning of 1 MET?
(A) 3.5 ml/O₂/min/kg of body weight
(B) 35 ml/O₂/min/kg of body weight
(C) 2.5 ml/O₂/min/kg of body weight
(D) 25 ml/O₂/min/kg of body weight
Answer: A
Explanation:
1 MET represents the resting oxygen consumption of an average adult, approximately 3.5 ml O₂/min/kg. It is used to assess functional capacity and cardiopulmonary reserve, which helps predict perioperative risk and guide anaesthetic planning.
40. Which of the following is CORRECT about the change in ventilation-perfusion relationship in a normal person under GA as compared to the awake status?
(A) Dead space is significantly increased
(B) Arterial oxygen is significantly decreased
(C) Pulmonary blood flow is significantly reduced
(D) Significant increase in shunt
Answer: D
Explanation:
Under general anaesthesia, there is a significant increase in intrapulmonary shunting, due to atelectasis, reduced FRC, and altered ventilation-perfusion matching. This leads to decreased oxygenation, even in healthy individuals. Dead space and pulmonary blood flow may change, but shunt increase is the most prominent alteration.
41. Which of the following reflex movements DO NOT disappear in a brain-dead patient?
(A) Pupillary response to light
(B) Corneal reflex
(C) Spinal reflex movements
(D) Oculocephalic reflex (doll’s eye response)
Answer: C
Explanation:
In brain death, all brainstem reflexes including pupillary light reflex, corneal reflex, and oculocephalic reflex are absent. However, spinal reflexes may persist because the spinal cord remains functional. These reflex movements are not indicative of consciousness and can include limb withdrawal or twitching, often seen during organ retrieval procedures.
42. Which of the following statements about cardiac reflex is FALSE?
(A) The afferents of Baroreceptor reflex are via the glossopharyngeal and vagus nerves
(B) Bainbridge reflex is when increased right atrial filling pressure stimulates the vagus nerve and slows the heartbeat
(C) The triad of Bezold-Jarisch reflex is hypotension, slow heartbeat, and coronary dilation
(D) Cushing reflex is induced by increased intracranial pressure resulting in cerebral ischemia, which initially stimulates the sympathetic nervous system
Answer: B
Explanation:
The Bainbridge reflex actually causes tachycardia, not bradycardia. It is triggered by increased venous return, which stretches the right atrium, stimulating mechanoreceptors that send signals via the vagus nerve to the medulla, resulting in increased heart rate. This helps accommodate the increased volume by accelerating circulation.
43. The ventricular diastole can be divided into four phases. The largest amount of ventricular filling occurs in which of the following periods?
(A) Isovolumic relaxation
(B) Slow filling, or diastasis
(C) Rapid filling phase
(D) Atrial systole
Answer: C
Explanation:
The rapid filling phase occurs immediately after the AV valves open, driven by the pressure gradient between the atria and ventricles. It accounts for the majority of ventricular filling, making it the most significant phase. This passive filling is essential for efficient preload before systole.
44. Regarding complications of prone position, which is LESS discussed?
(A) Central retinal artery occlusion, corneal abrasion
(B) Brachial plexus stretch
(C) Radial nerve compression
(D) Endotracheal tube kinking, dislodgment
Answer: C
Explanation:
Radial nerve compression is less commonly discussed in the context of prone positioning compared to ocular injuries, brachial plexus stretch, and airway complications. The radial nerve is more vulnerable in supine or lateral positions, whereas prone positioning primarily affects ocular and airway structures.
45. Components of Horner syndrome
(A) Mydriasis
(B) Ptosis
(C) Anasarca
(D) All of the above
Answer: B
Explanation:
Horner syndrome is characterized by ptosis, miosis, and anhidrosis, due to disruption of the sympathetic pathway. Mydriasis is incorrect—it’s actually pupil constriction (miosis). Anasarca refers to generalized edema and is not a component of Horner syndrome. Thus, only ptosis is correct.
46. Regarding the physiological changes during one-lung ventilation, which of the following is LESS appropriate?
(A) It is prone to hypoxia (hypoxemia) mainly because the non-ventilated lung also has blood flow through it.
(B) Compression of the non-ventilating lung during surgery reduces the production of hypoxia because it reduces blood flow to the non-ventilating lung
(C) The use of positive end-expiratory pressure (PEEP) may alter blood flow to the ventilated lung and worsen hypoxemia
(D) Hypoxia must be combined with hypercapnia because the lungs need to perform oxygenation and carbon dioxide removal at the same time
Answer: D
Explanation:
Hypoxia and hypercapnia are not necessarily coupled during one-lung ventilation. The lungs can have adequate CO₂ elimination even when oxygenation is impaired. The statement that hypoxia must be combined with hypercapnia is inaccurate, making it the least appropriate.
47. Regarding the causes of hypoxemia, which of the following is most likely to cause an increase in P(A–a)O₂ gradient?
(A) Reduced barometric pressure
(B) Decrease FiO₂
(C) Shunting (high Qs/Qt)
(D) Hypoventilation
Answer: C
Explanation:
Shunting, where blood bypasses ventilated alveoli, leads to a widened alveolar-arterial oxygen gradient (P(A–a)O₂). This is a hallmark of ventilation-perfusion mismatch, and is not corrected by increasing FiO₂, making it a serious cause of hypoxemia.
48. Comparing the differences of various endotracheal tube placement methods (nasal intubation vs. oral intubation), which of the following is correct?
(A) Patients with nasal intubation feel more comfortable and the inner tube is less likely to fall off
(B) Oral intubation is more likely to cause laryngeal damage
(C) Regardless of the method, placing the endotracheal tube for more than 3 weeks is likely to cause subglottic stenosis
(D) Nasal intubation is more likely to cause otitis media
Answer: C
Explanation:
Prolonged intubation, regardless of route, can lead to subglottic stenosis due to pressure necrosis and inflammation. This complication is associated with long-term airway instrumentation, emphasizing the need for timely tracheostomy in prolonged ventilation cases.
49. Which of the following is INCORRECT about difficult airway?
(A) Micrognathia
(B) Macroglossia
(C) Morbid obesity
(D) None of the above
Answer: D
Explanation:
All listed conditions—micrognathia, macroglossia, and morbid obesity—are recognized risk factors for a difficult airway. Therefore, the correct answer is “None of the above”, as none of the options are incorrect.
50. Which of the following statements about Malignant hyperthermia is correct?
(A) It is defined as a rapid rise in the patient’s body temperature of more than 1ºC/10 min during general anaesthesia
(B) The early mortality rate can reach more than 70%, which has now dropped to 25%
(C) This disease often has a familial tendency and is an autosomal dominant disease, with gene mutation of Ryanodine receptor.
(D) Dantrolene can treat this disease, mainly because it can reduce the efflux of calcium ions from the sarcoplasmic reticulum
Answer: C
Explanation:
Malignant hyperthermia is an autosomal dominant genetic disorder involving mutations in the ryanodine receptor (RYR1). This leads to uncontrolled calcium release in skeletal muscle, causing hypermetabolism. Dantrolene is the treatment of choice, but the defining feature is the genetic basis, making option C the most accurate.
51. During laparoscopic surgery, what is not TRUE about physiological changes during anaesthesia?
(A) In normal patients, when the head is lowered, the central venous pressure increases and the cardiac output increases
(B) Trendelenburg posture has no effect on glaucoma patients
(C) Lithotomy position and flexion of the knee can result in poor blood circulation to the lower extremities
(D) The head-down position can accelerate the form of atelectasis during surgical anaesthesia
Answer: B
Explanation:
The Trendelenburg position increases intraocular pressure, which can worsen glaucoma. It also affects venous return, pulmonary mechanics, and may contribute to atelectasis. Therefore, the claim that it has no effect on glaucoma patients is incorrect. Proper positioning and monitoring are essential during laparoscopic procedures to avoid these complications.
52. In which year, the Supreme Court of India, ordered the paid services by medical profession to be under Consumer Protection Act?
(A) 1986
(B) 1995
(C) 1947
(D) 2001
Answer: B
Explanation:
In 1995, the Supreme Court of India ruled that paid medical services fall under the Consumer Protection Act, allowing patients to seek legal redress for medical negligence. This landmark decision emphasized accountability in healthcare and empowered patients with consumer rights.
53. A 29-year-old patient with goitre with hyperthyroidism and T3 and T4 were elevated and TSH was decreased. In the preop area BP was 160/90 mmHg and HR110 bpm, which increased to 200/110 mmHg, HR160 bpm after induction intubation, and after 5 minutes of observation was 230/120, HR180, which of the following is the most appropriate treatment?
(A) Immediately give Nifedipine
(B) Give Labetalol immediately
(C) Immediately use Nitroglycerine
(D) Immediately use Nitroprusside
Answer: B
Explanation:
Labetalol, a combined alpha and beta blocker, is effective in managing thyroid storm-induced hypertension and tachycardia. It provides rapid control of both heart rate and blood pressure. Other agents like nifedipine or nitroglycerine may not address the adrenergic surge adequately in this context.
54. Regarding the possible changes in hemodynamics during pneumoperitoneum in patients with normal cardiac function, what is WRONG?
(A) It is usually more common for the cardiac output to drop
(B) Common phenomenon of blood pressure drop caused by SVR drop
(C) Inflation may cause the reflex Vagal tone to rise and cause slow heartbeat
(D) Compression of the inferior vena cava may result in decreased return of blood to the heart, resulting in a drop in BP
Answer: B
Explanation:
During pneumoperitoneum, systemic vascular resistance (SVR) typically increases, not decreases, due to CO₂ absorption and mechanical compression. This can lead to hypertension, not hypotension. The other options correctly describe vagal stimulation and venous return compromise, which may reduce cardiac output.
55. The reason for choosing to use CO₂ for insufflation is because:
(A) It can be quickly excreted from the lungs
(B) In extraperitoneal insufflation it is more likely to cause end-tidal CO₂ to rise rapidly than CO₂ in intraperitoneal insufflation
(C) May cause an increase in dopamine, vasopressin, epinephrine and norepinephrine in the blood, resulting in an increase in blood pressure
(D) All are true
Answer: D
Explanation:
CO₂ is preferred for insufflation due to its high solubility, rapid excretion, and low risk of embolism. It can stimulate neurohumoral responses, increasing catecholamines and vasopressin, which may elevate blood pressure. Extraperitoneal insufflation can cause faster CO₂ absorption, raising ETCO₂ more rapidly.
56. Regarding the anaesthesia treatment of brain-dead patients in organ donation surgery, which of the following is false?
(A) Urine output greater than 100 mL/hr
(B) Central venous pressure (CVP) above 12 mm Hg
(C) Systolic blood pressure greater than 100 mm Hg
(D) Glucose concentrations less than 200 mg/dL
Answer: B
Explanation:
A CVP above 12 mm Hg may indicate fluid overload, which is not desirable in organ preservation. Optimal hemodynamic parameters include adequate urine output, stable systolic pressure, and controlled glucose levels to maintain organ perfusion and viability.
57. Regarding anaesthesia for organ donation surgery for brain-dead patients, which of the following is NOT TRUE?
(A) Vasodilators such as phentolamine or alprostadil reduce vascular resistance and improve preservation fluid distribution
(B) It is done without analgesia
(C) Use atropine to avoid slow heartbeat
(D) The first order of organ removal is the heart
Answer: D
Explanation:
In organ donation, the heart is not removed first. Typically, non-vital organs are removed before the heart and lungs, which require continuous perfusion until retrieval. The use of vasodilators, atropine, and absence of analgesia (due to brain death) are standard practices.
58. Regarding the regulation of cerebral blood flow (CBF), which of the following factors CANNOT significantly affect CBF?
(A) Metabolic acidosis
(B) Mean arterial pressure
(C) Sevoflurane
(D) PaO₂
Answer: A
Explanation:
Metabolic acidosis has minimal direct effect on CBF, unlike PaCO₂, PaO₂, and volatile anaesthetics like sevoflurane, which cause vasodilation and increase CBF. Mean arterial pressure also influences cerebral perfusion, especially when autoregulation is impaired.
59. Which of the following is an indication for the use of FFP (fresh frozen plasma) in non-ASA Task Force?
(A) Urgent warfarin antagonists
(B) Correction of undetermined coagulation factor deficiency
(C) Expansion of intravascular blood volume as a colloid
(D) Correction of microvascular bleeding when prothrombin time or partial thromboplastin time increases by more than 1.5 times
Answer: D
Explanation:
FFP is indicated for correction of coagulopathy, especially when PT or aPTT exceeds 1.5 times normal, and microvascular bleeding is present. It is not recommended for volume expansion, and specific factor deficiencies should be treated with targeted concentrates when available.
60. Which of the following is correct?
(A) Atrial fibrillation will cause loss of a wave and prominent c wave
(B) Atrioventricular dissociation can cause cannon a wave
(C) Tricuspid regurgitation causes tall systolic cv wave and loss of x descent
(D) All of the above are correct
Answer: D
Explanation:
Each statement reflects a distinct CVP waveform abnormality:
- Atrial fibrillation leads to loss of a wave due to absent atrial contraction
- AV dissociation causes cannon a waves from atrial contraction against closed valves
- Tricuspid regurgitation produces tall cv waves and blunted x descent due to retrograde flow
Thus, all are correct.
61. Which of the following physiological monitoring instruments CANNOT measure cardiac output or ejection fraction?
(A) pulse-induced contour cardiac output (PiCCO)
(B) Transesophageal echocardiogram (TEE)
(C) pulmonary artery catheter
(D) ECG (electrocardiogram)
Answer: D
Explanation:
An ECG records the electrical activity of the heart, providing information about rhythm, rate, and conduction, but it does not measure cardiac output or ejection fraction. In contrast, PiCCO, TEE, and pulmonary artery catheters are capable of assessing hemodynamic parameters, including stroke volume and ventricular function, which are essential in anaesthetic and critical care monitoring.
62. What is wrong with the description of the intravenous anaesthetic Dexmedetomidin?
(A) Dexmedetomidine is a non-selective α2 agonist; the corresponding receptor alpha2 adrenoreceptors is a membrane-spanning G protein.
(B) Dexmedetomidine is metabolized by the liver and excreted through urine and faeces.
(C) The sedative effect of α2 agonist is due to the α2 receptors on the locus caeruleus and spinal cord
(D) If rapidly administered, BP will drop initially, mainly because it stimulates the surrounding α2 receptor, resulting in vasodilation.
Answer: A
Explanation:
Dexmedetomidine is a highly selective α2 adrenergic agonist, not a non-selective one. Its sedative and analgesic effects are mediated via central α2 receptors, particularly in the locus coeruleus. The drug is metabolized hepatically and can cause transient hypotension if administered rapidly due to peripheral vasodilation. Therefore, option A is incorrect.
63. Which of the following drugs has the greatest effect on cardiac workload?
(A) Morphine
(B) Buprenorphine
(C) Nalbuphine
(D) Pentazocine
Answer: D
Explanation:
Pentazocine has sympathomimetic properties, which can lead to tachycardia and increased myocardial oxygen demand, thereby raising cardiac workload. In contrast, morphine and buprenorphine tend to reduce preload and afterload, making them more suitable for patients with cardiac compromise.
64. Regarding carotid endarterectomy, which of the following is true?
(A) Surgery under general anaesthesia has a higher mortality rate than local anaesthesia
(B) Surgery with local anaesthesia is less likely to develop postoperative hypertension
(C) Bilateral Carotid body denervation after surgery will result in a weakened ventilatory response to hypoxia or increased partial pressure of carbon dioxide in the body
(D) All of the above are true
Answer: D
Explanation:
All listed statements are accurate. Local anaesthesia during carotid endarterectomy allows for neurological monitoring, reducing mortality and postoperative hypertension. Carotid body denervation can impair chemoreceptor responses, affecting ventilatory drive in response to hypoxia and hypercapnia.
65. What is wrong about the description of respiratory physiology in anaesthesia?
(A) FRC can be greatly reduced by lying down during the operation; which can be maintained by adopting the anti-Trendelenburg.
(B) During anaesthesia, the body’s carbon dioxide elimination becomes poor, but the function of oxygenation is better.
(C) Regardless of the use of IV or gas anaesthesia, patients will experience lung collapse during spontaneous breathing or IPPV.
(D) Physiological response to hypoxia becomes poor, because the carotid body chemoreceptor is affected.
Answer: B
Explanation:
Under anaesthesia, oxygenation is often impaired due to atelectasis, reduced FRC, and ventilation-perfusion mismatch, while CO₂ elimination may remain relatively preserved. The statement that oxygenation is better than CO₂ elimination is incorrect, making option B the wrong description.
66. Which of the following statements about temperature regulation during Anaesthesia is incorrect?
(A) A rapid drop in core body temperature of 0.5–1.5°C is common after induction of anaesthesia, mainly due to the inhibitory effect of anaesthetics on the thermoregulatory reflex.
(B) The inhibition of the thermoregulatory reflex by anaesthetics mainly results in a decrease in the threshold temperature that triggers vasoconstriction or shivering.
(C) The main forms of heat loss of surgical patients are radiation and convection. Therefore, if the room temperature of the operating room can be increased or the temperature of the surrounding skin can be increased, such heat loss can be reduced
(D) The elderly have decreased thermoregulatory reflex function and are more likely to be complicated by hypothermia during surgery.
Answer: C
Explanation:
While radiation and convection are major forms of heat loss, the suggestion that increasing skin temperature alone can reduce heat loss is oversimplified. Room temperature adjustments are more effective. Therefore, option C is less accurate in describing temperature regulation strategies.
67. Even mild hypothermia during surgery may increase the risk of associated complications, excluding which of the following?
(A) Postoperative wound infection
(B) Abnormal coagulation function
(C) Increased blood transfusion requirements
(D) Postoperative cognitive dysfunction
Answer: D
Explanation:
Postoperative cognitive dysfunction is not directly linked to mild hypothermia, unlike wound infection, coagulopathy, and increased transfusion needs, which are well-documented consequences. Thus, option D is excluded from the typical complications.
68. Regarding the description of mitral stenosis (MS) and the precautions for anaesthesia, which of the following is NOT?
(A) Generally speaking, the mitral valve area of MS patients should be less than 1.5 cm² to have symptoms at rest
(B) MS patients are prone to right ventricle dilation or even right ventricle failure due to chronic pulmonary hypertension; and this condition is more difficult to manage than patients with MS with left ventricle (LV) dysfunction
(C) During anaesthesia, the patient’s heart rate should be kept within the normal range as much as possible; however, the key to the deterioration of the patient’s clinical condition is often the loss of atrial kick (atrial contraction) rather than the tachycardia itself
(D) In MS patients, reducing their systemic vascular resistance (SVR) cannot further increase their forward flow
Answer: D
Explanation:
In mitral stenosis, reducing SVR may help forward flow by lowering afterload, especially if left ventricular function is preserved. The statement that SVR reduction cannot improve forward flow is incorrect, making option D the wrong assertion.
69. Which of the following is WRONG about a Lung transplant?
(A) The five-year survival rate of a lung transplant is about 50%. Generally speaking, the prognosis of double lung transplantation is better than that of single lung transplantation.
(B) The different anaesthesia problems faced by patients undergoing lung transplantation depend on the type of lung disease of the patient.
(C) For Emphysema patients, the use of positive pressure breathing during surgery is often likely to cause a drop in blood pressure.
(D) For patients with primary pulmonary hypertension, high airway pressure and hypoxia are often dealt with during the operation
Answer: C
Explanation:
In emphysema, positive pressure ventilation may lead to air trapping and hyperinflation, but it does not typically cause hypotension. Instead, barotrauma and impaired venous return are concerns. Therefore, option C is incorrect in describing the physiological response.
70. In laparoscopic operation, the use of carbon dioxide for pneumoperitoneum will seriously affect the heart and lung function. Arrhythmia, Acidemia, etc. are common. In terms of respiratory physiology, which of the following is correct?
(A) Significant increase in dead space
(B) Increase in respiratory compliance
(C) Increase in shunt
(D) Decrease in vital capacity
Answer: D
Explanation:
Pneumoperitoneum reduces diaphragmatic excursion, leading to a decrease in vital capacity. This impairs lung mechanics, contributing to hypoventilation and atelectasis. Dead space and compliance may change, but the drop in vital capacity is the most consistent and clinically relevant effect.
71. Which statement about the physiological changes of liver cirrhosis is correct?
(A) Intrapulmonary arteriovenous communications may occur, resulting in hypoxia, but the function of hypoxic pulmonary vasoconstriction is not affected
(B) Erythrocyte 2,3-DPG values usually increase and shift the oxyhaemoglobin dissociation curve to the right.
(C) The renal function of patients with liver cirrhosis will be damaged, most of which are caused by post renal reasons.
(D) Mixed venous O₂ saturation will decrease, while arteriovenous O₂ content gap will increase.
Answer: D
Explanation:
In liver cirrhosis, oxygen extraction increases due to circulatory dysfunction, resulting in a decreased mixed venous oxygen saturation and a widened arteriovenous oxygen content gap. This reflects impaired oxygen delivery and systemic hypoperfusion.
72. Which statement about local anaesthetics is WRONG?
(A) The mechanism of action of the local anaesthetic is switched to blocking the Voltage-gated sodium channel
(B) Most of the local anaesthetics currently clinically used are aminoamides
(C) Aminoesters are mainly metabolized by Cytochrome p450- linked enzymes in the liver, while Aminoamides are mainly metabolized by plasma esterases.
(D) First aid after Bupivacaine overdose is more difficult than lidocaine poisoning
Answer: C
Explanation:
Aminoesters are metabolized by plasma esterases, while aminoamides are metabolized by hepatic cytochrome P450 enzymes. The statement incorrectly reverses these pathways, making it factually wrong.
73. Which of the following statements about local anaesthetics is FALSE?
(A) Procaine is an amino ester class
(B) Local anaesthetics of the Aminoamide class are more prone to allergic reactions
(C) CNS toxicity including seizure, respiratory depression and respiratory arrest
(D) Levobupivacaine has lower cardiac toxicity than bupivacaine
Answer: B
Explanation:
Aminoesters are more likely to cause allergic reactions due to their metabolism into para-aminobenzoic acid derivatives. Aminoamides have a lower incidence of hypersensitivity, making the statement about their allergenic potential false.
74. The commonly used inhalation anaesthetics in clinic include sevoflurane, desflurane and isoflurane. Which of the following statements is false?
(A) The highest rate of metabolism absorbed by the body is sevoflurane, which is about 10%
(B) The highest rate of metabolism absorbed by the body is desflurane, which is about 0.02%
(C) Sevoflurane is an isomer of enflurane
(D) When sevoflurane is used, the tracheal flow should be maintained at a flow rate of more than 1000ml/min
Answer: C
Explanation:
Sevoflurane is not an isomer of enflurane. Though both are fluorinated ethers, they differ in structure and pharmacodynamics, making this statement incorrect.
75. Which of the following is correct regarding the secretion and absorption of anaesthetic drugs on cerebrospinal fluid?
(A) Halothane can reduce the secretion and absorption of CSF.
(B) Enflurane can reduce the secretion and absorption of CSF.
(C) Isoflurane can reduce the secretion and absorption of CSF.
(D) Desflurane can reduce the secretion and absorption of CSF
Answer: C
Explanation:
Isoflurane reduces cerebrospinal fluid production and absorption, helping to lower intracranial pressure. This property is beneficial in neurosurgical anaesthesia.
76. Which of the following is the inherent risk of abdominal laparoscopy?
(A) Renal failure
(B) Bronchospasm
(C) Gas Emboli
(D) Hypothermia
Answer: C
Explanation:
Gas embolism, especially with carbon dioxide, is a recognized risk during laparoscopy, particularly if vascular injury occurs during insufflation. It can lead to cardiovascular collapse and requires immediate management.
77. Which of the statements about the pharmacology of paediatric anaesthesia is FALSE?
(A) Diazepam is metabolized by the liver and should be avoided in infants under six months of age with immature livers
(B) Remifentanil is safe in infants with hepatic and renal failure
(C) Cisatracurium is safe to use in infants with hepatic and renal failure
(D) Propofol use in infants induces lower doses in older children
Answer: D
Explanation:
Infants require higher doses of propofol per kg than older children due to larger volume of distribution and faster clearance. The statement that older children need lower doses is false.
78. Which of the following narcotic pain relievers affects liver function?
(A) In patients with end-stage liver disease, it can also be found that the metabolic rate of midazolam is reduced, thus prolonging its Half-life
(B) In patients with liver failure, Mivacurium has a longer half-life because the activity of cholinesterase in plasma is reduced
(C) The metabolism of Atracurium belongs to nonspecific ester hydrolysis, so in normal people and liver failure the rate of metabolism in patients is similar.
(D) Cisatracurium is metabolized by Hofmann elimination, so its half-life and duration of action are longer in patients with liver failure.
Answer: D
Explanation:
Cisatracurium undergoes Hofmann elimination, which is organ-independent, but its metabolism can be influenced by changes in pH and temperature. In acidotic or hypothermic states, metabolism may slow, leading to prolonged action.
79. Acetylcholine receptor structure contains 5 subunits, including α, β, δ, ε, γ subunits. The immature receptor structure combination in infancy is:
(A) α2 βδγ
(B) α2 βδε
(C) αβ2δε
(D) αβ2δγ
Answer: D
Explanation:
In infants, the immature acetylcholine receptor includes the γ subunit instead of ε, forming the structure αβ2δγ. This configuration alters neuromuscular sensitivity and affects response to muscle relaxants.
80. Which of the following descriptions of infants and children is ABNORMAL?
(A) Term new-born, HR 150 beats/min, systolic BP 70 mmHg
(B) 6 months, HR 120 beats/min, systolic BP 80 mmHg
(C) One year old, HR 90 beats/min, systolic BP 80 mmHg
(D) Five years old, HR 90 beats/min, systolic BP 90 mmHg
Answer: B
Explanation:
A 6-month-old typically has a heart rate of 130–140 bpm, so HR 120 bpm is lower than expected, making this description abnormal. The systolic BP is acceptable, but the bradycardia is concerning.
81. Which of the following drugs increases intracranial pressure?
(A) Methohexital
(B) Ketamine
(C) Propofol
(D) Midazolam
Answer: B
Explanation:
Ketamine increases intracranial pressure by causing cerebral vasodilation, which leads to increased cerebral blood flow. This effect makes it unsuitable for patients with raised ICP, despite its cardiovascular stability.
82. What are the characteristics of kidney Glomerular capillaries?
(A) Separated by efferent arterioles
(B) Is an extension of Bowman’s capsule
(C) The vessel wall of Glomerular capillaries has several layers of cells
(D) Glomerular capillaries drain into arterioles
Answer: D
Explanation:
Glomerular capillaries are unique in that they drain into efferent arterioles, maintaining a high-pressure filtration system. This arrangement supports efficient ultrafiltration, unlike typical capillaries that drain into venules.
83. How does pulmonary blood flow respond when Cardiac output increases?
(A) Pulmonary vascular resistance will decrease
(B) Pulmonary artery pressure will increase
(C) Physiological dead space will decrease
(D) All the above
Answer: D
Explanation:
With increased cardiac output, the pulmonary circulation adapts by decreasing vascular resistance, raising pulmonary artery pressure, and reducing dead space through better perfusion of alveoli. All listed changes occur simultaneously.
84. Which of the following is correct?
(A) Closing capacity (CC) is higher when lying down than when sitting up
(B) Functional residual capacity increases slightly with age
(C) Patients with Obstructive lung disease have higher CC
(D) Closure of the airway can also occur in young people in their 30s under GA
Answer: D
Explanation:
Under general anaesthesia, even young adults may experience airway closure due to reduced muscle tone, decreased FRC, and supine positioning, which increases the risk of atelectasis and hypoxia.
85. The Child-Turcotte-Pugh scoring system used to assess the severity of liver cirrhosis DOES NOT include which of the following factors?
(A) Albumin
(B) Transaminase (GOT/GPT)
(C) Prothrombin time (prothrombin time)
(D) Bilirubin (bilirubin)
Answer: B
Explanation:
The Child-Turcotte-Pugh score includes bilirubin, albumin, prothrombin time, ascites, and encephalopathy. Transaminases are not part of the scoring system, as they reflect hepatocellular injury, not synthetic function.
86. Which of the following cardiac reflexes causes the heart to beat faster?
(A) Baroreceptor reflex
(B) Bainbridge reflex
(C) Bezold-Jarisch reflex
(D) Oculocardiac reflex
Answer: B
Explanation:
The Bainbridge reflex is triggered by increased venous return, which stretches the right atrium and activates mechanoreceptors, leading to increased heart rate via vagal afferents to the medulla.
87. Which of the following statements about electrolyte physiology is correct?
(A) Sodium ion is the most abundant cation in extracellular fluid and plays an important role in maintaining osmotic pressure inside and outside cells
(B) Potassium ion is the most abundant cation in intracellular fluid and plays an important role in maintaining cell membrane potential
(C) Calcium is an important component of muscle contraction, endocrine and cell growth
(D) All of the above
Answer: D
Explanation:
All statements are correct. Sodium maintains extracellular osmotic pressure, potassium regulates membrane potential, and calcium is essential for muscle contraction, hormone secretion, and cell signaling.
88. What is the main source of the nerve supply of the kidneys and ureters?
(A) T10-LI
(B) S2-S4
(C) T8-L2
(D) T10-S4
Answer: C
Explanation:
The sympathetic innervation of the kidneys and ureters arises from T8–L2, forming the renal plexus, which regulates renal blood flow, ureteral motility, and visceral pain transmission.
89. What are the symptoms of chronic renal failure?
(A) Hypovolemia, anaemia
(B) Hyperkalemia
(C) Acidemia
(D) Cardiopulmonary insufficiency
Answer: D
Explanation:
Cardiopulmonary insufficiency is a common consequence of chronic renal failure, due to fluid overload, hypertension, and uremic cardiomyopathy, affecting both cardiac and pulmonary function.
90. Which of the following data is required to calculate MELD score?
(A) Albumin
(B) GPT (glutamic – pyruvic transaminase)
(C) Creatinine
(D) Ammonia
Answer: C
Explanation:
The MELD score uses serum creatinine, bilirubin, and INR to assess liver disease severity and predict mortality risk. Creatinine reflects renal function, which is critical in advanced liver disease.
91. Which of the following statements about blood sugar is FALSE?
(A) When removing organs from brain-dead donors, try to maintain blood glucose concentration < 200 mg/dl
(B) Most patients who want to receive kidney transplantation are diabetic patients, and hypoglycemia may occur during surgery
(C) After the blood vessels of the transplanted pancreas are released, the blood sugar should be checked every 30 minutes, and the blood sugar generally drops by 50 mg/dl every hour
(D) Blood glucose is usually high in acute liver failure; patients with chronic end-stage liver disease are prone to hypoglycemia
Answer: C
Explanation:
The statement that blood sugar drops by 50 mg/dl every hour after pancreas transplantation is an oversimplification and not physiologically consistent. Blood glucose changes depend on graft function and insulin release, and require close monitoring, but not at a fixed rate.
92. Which of the following statements about coagulation is INCORRECT?
(A) The bleeding tendency of patients with end-stage renal failure is mainly caused by the lack of coagulation factors caused by protein restriction diet
(B) PT prolongation can be observed 2–3 days after right liver resection in living donors
(C) Patients with end-stage liver disease have reduced coagulation factors and therefore an increased risk of bleeding
(D) Patients with end-stage liver disease have reduced anticoagulant factors and therefore an increased risk of thrombosis
Answer: A
Explanation:
Bleeding tendency in end-stage renal failure is primarily due to platelet dysfunction, not lack of coagulation factors from dietary protein restriction. Uremia impairs platelet aggregation, making this the incorrect statement.
93. Which of the following is WRONG about anaesthesia precautions for patients with myasthenia gravis?
(A) May be combined with thyroid, rheumatoid arthritis, etc.
(B) Aminoglycosides may exacerbate myasthenia gravis
(C) Steroids alone may initially worsen the condition temporarily
(D) Ketamine and lidocaine in anaesthetics have less effect on this disease
Answer: D
Explanation:
Ketamine and lidocaine can affect neuromuscular transmission and may exacerbate symptoms in myasthenia gravis. Their use should be cautious. The other options correctly describe associated conditions and drug interactions.
94. Which of the following are the risk factors for acute renal insufficiency after surgery?
(A) Patients who have previously undergone coronary artery bypass surgery
(B) History of heart failure
(C) Type I Diabetes
(D) All of the above
Answer: D
Explanation:
All listed conditions—CABG history, heart failure, and Type I diabetes—are recognized risk factors for postoperative acute kidney injury, due to compromised renal perfusion and susceptibility to nephrotoxins.
95. BURP (backward, upward, rightward pressure) to assist in intubation, its location is:
(A) Cricoid cartilage
(B) Thyroid cartilage
(C) Hyoid bone
(D) Tracheal cartilage
Answer: B
Explanation:
The BURP maneuver is applied to the thyroid cartilage to improve laryngeal visualization during intubation. It repositions the larynx to align the glottic opening with the line of sight.
96. The sensory part of the larynx between epiglottis and vocal cords is innervated by which nerve?
(A) Mandibular division of trigeminal nerve
(B) Glossopharyngeal nerve
(C) Internal laryngeal nerve
(D) Recurrent laryngeal nerve
Answer: C
Explanation:
The internal branch of the superior laryngeal nerve provides sensory innervation to the laryngeal mucosa between the epiglottis and vocal cords, playing a key role in airway reflexes.
97. The mechanism of action of various opioid analgesics receptors, which is WRONG?
(A) The μ receptor promotes the release of the neurotransmitter Acetylcholine
(B) The μ receptor inhibits respiratory function
(C) μ, κ receptors temporarily inhibit gastrointestinal motility
(D) μ, δ, κ receptors all have analgesic effect in the spinal cord
Answer: A
Explanation:
The μ receptor does not promote acetylcholine release; instead, it inhibits neurotransmitter release, including acetylcholine, contributing to analgesia and respiratory depression. The other statements are correct.
98. The maximum recommended occupational whole-body exposure to radiation each year is:
(A) 1 Rem/y
(B) 5 Rem/y
(C) 10 Rem/y
(D) 15 Rem/y
Answer: B
Explanation:
The maximum recommended annual occupational exposure to ionizing radiation is 5 Rem (50 mSv). This limit is set to minimize long-term health risks for healthcare workers.
99. Which of the following functional indices is least likely to rise in advanced stages of cholestasis?
(A) Aminotransferases
(B) Prothrombin time
(C) Alkaline phosphatase
(D) Blood urea nitrogen
Answer: D
Explanation:
Blood urea nitrogen (BUN) is not typically elevated in cholestasis, as it reflects renal function, not hepatic or biliary obstruction. Alkaline phosphatase and prothrombin time are more relevant markers.
100. Which of the following about the physiological effects of inhalation anaesthetics on the brain is FALSE?
(A) All inhibit brain metabolic activity in a dose-related manner similar to IV agents
(B) Inhalation agents have a vasodilatory effect on cerebral blood vessels and the order of the degree of dilation is halothane > enflurane > desflurane > isoflurane > sevoflurane
(C) All inhalation anaesthetics can reduce the cerebral metabolic rate. With 1.0 MAC Isoflurane, Sevoflurane and Desflurane, the reduction ratios are 25%, 38% and 22%, respectively
(D) Cerebral hemodynamics of inhalation anaesthetics increase both cerebral blood flow volume and intracranial pressure in patients with normal and abnormal intracranial compliance
Answer: D
Explanation:
In patients with normal intracranial compliance, inhalation anaesthetics may increase cerebral blood flow but do not necessarily raise intracranial pressure. The statement generalizes the effect across all patients, making it false.
101. Which of the following drugs DOES NOT cause desensitization of nicotinic cholinergic receptors?
(A) Inhalation anaesthetics such as Halothane, Sevoflurane, Isoflurane
(B) Alcoholic drugs (Alcohols), such as Ethanol, Butanol, Propanol, Octanol
(C) Barbiturates
(D) Propofol
Answer: D
Explanation:
Propofol does not cause desensitization of nicotinic cholinergic receptors, unlike inhalation agents, alcohols, and barbiturates, which can interfere with receptor sensitivity and neuromuscular transmission. Propofol acts primarily via GABA-A receptor modulation.
102. α1 Acid Glycoprotein (AAQ) level decreased in
(A) Infection
(B) Myocardial Infraction
(C) Pregnancy
(D) Chronic pain
Answer: C
Explanation:
During pregnancy, levels of α1 acid glycoprotein decrease, which can affect drug binding and pharmacokinetics. In contrast, conditions like infection and infarction typically increase its concentration due to acute phase response.
103. Which statement about coagulation is correct?
(A) Prothrombin time (PT) was used to assess the coagulation of the intrinsic pathway and the common pathway.
(B) Heparin-induced thrombocytopenia (HIT) is caused by an autoimmune response to the drug.
(C) Factor XI is a member of the outer pathway.
(D) Bleeding time was used to assess the function of coagulation factors.
Answer: B
Explanation:
Heparin-induced thrombocytopenia (HIT) is an immune-mediated adverse reaction where antibodies form against heparin-platelet factor 4 complexes, leading to thrombosis despite low platelet counts. The other statements are incorrect regarding pathway classification and test purposes.
104. Which of the following is FALSE about agonist and antagonist drugs for each sympathetic receptor?
(A) α2 → agonist: Dexmedetomidine
(B) β1 → agonist: Dobutamine
(C) β1 → antagonist: Metoprolol
(D) β2 → antagonist: Terbutaline
Answer: D
Explanation:
Terbutaline is a β2 agonist, not an antagonist. It is used for bronchodilation in asthma and preterm labor. The other drugs correctly match their receptor targets and actions.
105. Which of the following statements is true about blockade caused by non-depolarizing neuromuscular blocking agents?
(A) The staging of Train-of-four (TOF) can be divided into four phases: Intense blockade, deep blockade, surgical blockade and recovery phase.
(B) TOF count cannot be seen in the stage of Deep blockade.
(C) In principle, before administering muscle relaxant reversal, it is best to confirm that there is at least a third stimulus response to TOF.
(D) All of the above
Answer: D
Explanation:
All statements are correct. TOF monitoring helps assess the depth of neuromuscular blockade, and reversal agents should be given only when adequate recovery is evident, typically with at least 3 twitches. The classification aids in clinical decision-making.
106. Which of the following is an indication for the use of FFP (fresh frozen plasma) as per ASA Task Force guidelines:
(A) Urgent warfarin antagonists
(B) Correction of undetermined coagulation factor deficiency
(C) Expansion of intravascular blood volume as a colloid
(D) Correction of microvascular bleeding when prothrombin time or partial thromboplastin time increases by more than 1.5 times
Answer: D
Explanation:
FFP is indicated for coagulopathy correction, especially when PT or aPTT exceeds 1.5 times normal and bleeding is present. It is not recommended for volume expansion, and specific factor deficiencies should be treated with targeted concentrates.
107. The affect of Spinal Anaesthesia on bowel includes
(A) Increased peristalsis
(B) Contraction
(C) Dilation
(D) Atony
Answer: D
Explanation:
Spinal anaesthesia causes sympathetic blockade, leading to bowel atony due to unopposed parasympathetic activity. This can result in delayed gastric emptying and ileus, especially in abdominal surgeries.
108. Regarding the changes of Base Deficit or Excess caused by acute and chronic acid-base balance disorders, which of the following conditions is correct?
(A) Acute respiratory acidosis; A BDE = 0
(B) Acute respiratory alkalosis; A BDE = 0
(C) Metabolic acidosis; APaCO₂ = 4 BDE
(D) All of the above
Answer: D
Explanation:
In acute respiratory disorders, base deficit/excess remains unchanged initially. In metabolic acidosis, PaCO₂ compensation follows Winter’s formula, approximated as PaCO₂ = 1.5 × HCO₃ + 8 ± 2, or simplified as PaCO₂ = 4 × BDE, validating all options.
109. During laparoscopic surgery, the patient developed desaturation, hypotension, no airway pressure change, and decreased ETCO₂, which is the most likely clinical diagnosis?
(A) Pneumothorax
(B) Subcutaneous emphysema
(C) Massive CO₂ embolism
(D) Endobronchial intubation
Answer: C
Explanation:
Massive CO₂ embolism presents with sudden hypoxia, hypotension, and drop in ETCO₂ due to pulmonary perfusion impairment. The absence of airway pressure change helps exclude pneumothorax or tube malposition, making embolism the most likely cause.
110. What is WRONG about the changes in each segment of the CVP waveform?
(A) Atrial fibrillation will cause loss of a wave and prominent c wave.
(B) Atrioventricular dissociation can cause cannon a wave.
(C) Tricuspid regurgitation causes tall systolic cv wave and loss of x descent.
(D) All of the above are correct
Answer: D
Explanation:
All listed waveform changes are accurate. Atrial fibrillation leads to absent a wave, AV dissociation causes cannon a waves, and tricuspid regurgitation results in tall cv waves and blunted x descent, confirming the correctness of each statement.
111. What is true about the impact of electrolyte abnormalities on ECG?
(A) Hypercalcemia will cause decrease in T-wave amplitude or T-wave inversion.
(B) Hyperkalemia can cause narrowing and peaking of T wave and wide QRS
(C) Hypokalemia can cause flattened T-wave and prominent U wave.
(D) All of the above are correct
Answer: D
Explanation:
Electrolyte disturbances produce characteristic ECG changes. Hyperkalemia causes peaked T waves and widened QRS, hypokalemia leads to flattened T waves and prominent U waves, and hypercalcemia may cause shortened QT interval and T-wave changes. All listed effects are accurate.
112. Which of the following statements is FALSE about Ketamine?
(A) Ketamine is metabolized by the liver and excreted by the kidneys
(B) The Bioavailability of Ketamine is 20% to 30% for oral administration and about 40% to 50% for nasal administration
(C) Ketamine can preserve the cornea, cough, swallowing and other reflexes, which can be regarded as a protective effect on the respiratory tract
(D) Ketamine is an NMDA receptor antagonist
Answer: C
Explanation:
While ketamine preserves airway reflexes, it does not reliably protect the respiratory tract, especially under deep sedation. The statement overstates its protective role. The other options correctly describe its pharmacokinetics and mechanism.
113. Which of the following is NOT a clinical manifestation of Propofol infusion syndrome?
(A) Refractory bradycardia
(B) Hypercalcemia
(C) Rhabdomyolysis
(D) Metabolic acidosis
Answer: B
Explanation:
Propofol infusion syndrome includes bradycardia, rhabdomyolysis, metabolic acidosis, and cardiac failure, but hypercalcemia is not a typical feature. Instead, hypocalcemia may occur due to fat emulsion effects.
114. For routine surgery, if Succinylcholine is given for induction, how much will the blood potassium concentration of most patients increase?
(A) 0.1 meq/dl
(B) 0.3 meq/dl
(C) 0.5 meq/dl
(D) 1 meq/dl
Answer: C
Explanation:
Succinylcholine causes a transient rise in serum potassium, typically around 0.5 meq/dl, due to potassium efflux from muscle cells during depolarization. This is significant in patients with upregulated acetylcholine receptors.
115. What is the traditional dose of muscle relaxant used for intubation?
(A) 1 dose of ED50
(B) 2 doses of ED50
(C) 3 doses of ED50
(D) 4 doses of ED50
Answer: D
Explanation:
The intubating dose of non-depolarizing muscle relaxants is traditionally 4 times the ED50, ensuring rapid onset and adequate paralysis. Lower doses may result in incomplete blockade and intubation difficulty.
116. Regarding “complementary and alternative medicine CAM”, which of the following is WRONG?
(A) It generally refers to some treatments that are not currently taught in American medical schools and are not widely used in general hospitals
(B) In 2002, 35% of Americans had received CAM treatment
(C) Europeans receive CAM treatments more often than in the United States
(D) It is not relevant to anaesthesiologists, so it is a medical treatment that needs no attention
Answer: D
Explanation:
CAM practices can interact with anaesthetic drugs, affect coagulation, and influence perioperative outcomes, making them highly relevant to anaesthesiologists. Ignoring CAM is unsafe and inappropriate.
117. Which of the following is/are within the scope of complementary and alternative medicine (CAM)?
(A) Homeopathic medicine, naturopathic medicine, traditional Chinese medicine, Ayurveda
(B) Herbal medicines, dietary supplements
(C) Meditation; prayer; art, music, or dance therapy
(D) All of the above
Answer: D
Explanation:
CAM encompasses a wide range of practices including traditional systems, natural products, and mind-body therapies. All listed modalities fall within its scope and may influence anaesthetic care.
118. A 2-month-old baby is undergoing complete revision surgery in Tetralogy of Fallot. An acute drop in oxygen saturation, from 88% to 50%, was found before CPB was performed. Vital signs: BP 58/30 mmHg; HR 175 beats per minute (sinus rhythm); CVP 5 mmHg. Which of the following management is the most appropriate initial treatment?
(A) Phenylephrine
(B) Epinephrine
(C) Normal saline bolus
(D) Esmolol
Answer: A
Explanation:
Phenylephrine, a pure alpha agonist, increases systemic vascular resistance, improving coronary perfusion and oxygen delivery in cyanotic heart disease. It is preferred over fluid bolus or beta blockers in this context.
119. Which of the following local anaesthetics is pure S(-) isomer?
(A) Lidocaine
(B) Bupivacaine
(C) Ropivacaine
(D) Tetracaine
Answer: C
Explanation:
Ropivacaine is a pure S(-) isomer, offering reduced cardiotoxicity compared to racemic bupivacaine. Its stereoselectivity contributes to safer clinical profiles, especially in regional anaesthesia.
120. A single dose of opioids is often injected into the spinal or epidural space as a sole or adjunctive analgesic treatment. Determining clinical efficacy is often related to the degree of lipophilicity. Which of the following is false?
(A) Fentanyl, Sufentanil is a hydrophilic opioid, and Morphine is a lipophilic opioid
(B) Hydrophilic opioids act faster than lipophilic opioids
(C) The distribution of lipophilic opioids in cerebrospinal fluid is wider than that of hydrophilic opioids
(D) All of the above
Answer: A
Explanation:
Fentanyl and sufentanil are lipophilic opioids, while morphine is hydrophilic. Lipophilic agents have faster onset and limited CSF spread, whereas hydrophilic agents have slower onset but wider distribution. The statement reverses their properties.
121. Which of the following muscle relaxants is least related to renal function in excretion?
(A) Vecuronium
(B) Pancuronium
(C) Gallamine
(D) Atracurium
Answer: D
Explanation:
Atracurium is eliminated primarily via Hofmann degradation and ester hydrolysis, making it independent of renal function. This property makes it suitable for patients with renal impairment, unlike agents like pancuronium, which rely heavily on renal excretion.
122. Which of the following statements about interactions between nondepolarizing muscle relaxants and other drugs is true?
(A) Concomitant use of two non-depolarizing muscle relaxants will produce additive or synergistic effects
(B) Inhaled anaesthetic gas will enhance neuromuscular blockade, and Desflurane has the best effect
(C) The antibiotic Aminoglycoside may increase neuromuscular blockade
(D) All of the above
Answer: D
Explanation:
All listed interactions are valid. Combining non-depolarizing agents can lead to synergistic blockade, inhalational agents like desflurane potentiate the effect, and aminoglycosides impair neuromuscular transmission, enhancing blockade.
123. Which of the following statements about the effects of the intravenous anaesthetic thiopental is FALSE?
(A) The effect is sedation at low doses, and hypnosis at high dose.
(B) It has good analgesic effect for adults at a dose of 2.5 mg/kg
(C) For patients with brain trauma, it can reduce brain pressure and protect nerves
(D) For alkaline preparations, it must be prepared with isotonic sodium chloride, not Ringer’s lactate
Answer: B
Explanation:
Thiopental has poor analgesic properties, even at standard doses. It is primarily a hypnotic agent, not an analgesic. The other statements correctly describe its neuroprotective effects and preparation requirements.
124. Which of the following inhalation anaesthetics produces the least potency under fixed conditions and at the same concentration?
(A) Isoflurane
(B) Desflurane
(C) Halothane
(D) Sevoflurane
Answer: B
Explanation:
Desflurane has a high MAC value, indicating low potency compared to other agents. It requires higher concentrations to achieve the same depth of anaesthesia, making it the least potent among the options.
125. Which of the following affects thyroxin binding globulin in blood?
(A) Use birth control pills
(B) Hepatitis
(C) Pregnancy
(D) All of the above
Answer: D
Explanation:
Thyroxin-binding globulin (TBG) levels are influenced by estrogen (birth control pills, pregnancy) and liver function (hepatitis). All listed conditions can alter TBG levels, affecting thyroid hormone availability.
126. Which of the following is FALSE regarding the use of pneumatic tourniquet for artificial knee replacement?
(A) Used pressure is systolic pressure plus 100 mmHg.
(B) There will be no tourniquet pain with regional anaesthesia
(C) May be related to nerve damage (peroneal nerve palsy)
(D) Tourniquet pain may be related to unmyelinated C fibres
Answer: B
Explanation:
Tourniquet pain can occur even under regional anaesthesia, due to deep tissue ischemia and C-fibre activation. The belief that regional blocks eliminate pain is incorrect, making option B false.
127. Which of the following is not true about Fat embolism syndrome in hip replacement surgery?
(A) Petechial rash
(B) PaO₂ < 70 mmHg when FiO₂ 100%
(C) Confusion
(D) Bradycardia
Answer: D
Explanation:
Fat embolism syndrome typically presents with tachycardia, not bradycardia, along with hypoxemia, neurological symptoms, and petechiae. Bradycardia is not a recognized feature, making it incorrect.
128. Which of the following statements is FALSE about visual loss after spine surgery under GA in prone position?
(A) Can be caused by central retinal artery occlusion
(B) Can be caused by central retinal vein occlusion
(C) Improper and inadequate cotton paddings of the eyes
(D) All the above are true
Answer: D
Explanation:
All listed causes are valid. Visual loss after prone surgery can result from arterial or venous occlusion, often due to external pressure or hypotension. Therefore, the statement that one is false is itself incorrect.
129. What is the most common occurrence of deep vein thrombosis (DVT) and pulmonary embolism after orthopaedic surgery?
(A) Spine surgery
(B) Upper extremity
(C) Knee arthroscopy
(D) Total-hip replacement
Answer: D
Explanation:
Total hip replacement carries the highest risk for DVT and pulmonary embolism, due to immobility, vascular trauma, and hypercoagulable state. Prophylaxis is essential in these patients.
130. Which of the following statements is INCORRECT about caudal anaesthesia?
(A) The sacral hiatus is between the sacral cornua and forms an isosceles triangle with the posterior superior iliac spines
(B) The angle of needle insertion is 45 degrees. After touching the bone, lay it flat, and then push it inward by 1~2 cm to enter the caudal canal.
(C) 5 ml of normal saline can be used; bulge under the skin should not be felt
(D) The capacity of Caudal canal can vary by 2~3 times, so the effect of anaesthesia is difficult to predict
Answer: B
Explanation:
The correct angle for caudal needle insertion is typically 20–30 degrees, not 45. Excessive angulation may lead to misplacement or trauma. The other statements accurately describe anatomy and variability.
131. Which of the following is NOT a characteristic of epidural anaesthesia?
(A) The height of a sympathectomy is usually 2–6 knots higher than that of a sensory block
(B) Whether it is thoracic or lumbar epidural anaesthesia, it will not affect the function of the diaphragm (phrenic or diaphragmatic function)
(C) The pH of the stomach is higher than that of patients under GA, which can protect the gastric mucosa
(D) After the drug is absorbed systemically, the use of other pain relievers can be reduced
Answer: C
Explanation:
General anaesthesia tends to increase gastric pH due to reduced acid secretion, whereas epidural anaesthesia does not offer such protection. The statement that epidural raises gastric pH is incorrect. The other options correctly describe sympathetic block height, diaphragmatic preservation, and opioid-sparing effects.
132. The peak block level of spinal anaesthesia is related to the volume of cerebrospinal fluid. Which of the following can be used to estimate the volume of cerebrospinal fluid?
(A) Height
(B) Weight
(C) Age
(D) Gender
Answer: B
Explanation:
Body weight influences CSF volume, which in turn affects spread of spinal anaesthesia. Heavier individuals may have lower CSF volume, leading to higher block levels. Therefore, weight is a key predictor.
133. What are the influencing factors of post-spinal puncture headache?
(A) Young women
(B) Height and weight
(C) Needle face direction of puncture needle
(D) Timing of postoperative activity
Answer: D
Explanation:
Early postoperative ambulation increases the risk of post-dural puncture headache due to CSF leakage. Delaying activity allows dural healing, reducing incidence. The other factors also contribute but timing of activity is most modifiable.
134. Which of the following statements about paediatric regional anaesthesia is INCORRECT?
(A) The spinal cord and dura sac of children are lower than adults
(B) Children’s nerve fibres are not fully developed with sheathing, so the onset time of local anaesthetics is shorter
(C) The height of the iliac crests on both sides is about L4–L5, which is an important indicator for regional anaesthesia
(D) Epidurals in children require larger doses of local anaesthetic than adults
Answer: C
Explanation:
In both children and adults, the iliac crest line typically corresponds to L4, not L4–L5. This landmark helps guide lumbar puncture, and the statement is anatomically inaccurate.
135. Mahatma Gandhi was operated for emergency appendicectomy by Surgeon Col. C Maddock at Pune, and because of power failure during the surgery; the surgery was completed with the help of kerosene lantern and a torch. Which was the date of operation?
(A) 12th Jan 1925
(B) 10th July 1920
(C) 14th Aug 1947
(D) 26th Jan 2050
Answer: A
Explanation:
Mahatma Gandhi’s emergency appendicectomy was performed on 12th January 1925 under challenging conditions, including power failure, highlighting the resilience of early surgical practice in India.
136. Which of the following statements about spinal nerves is FALSE?
(A) The location of the caudal end of the adult spinal cord is approximately at the height of L1
(B) The volume of dorsal (sensory) roots in the spinal cord is usually smaller than that of anterior (motor) roots, so it is easier to block
(C) The barrier that affects the entry and exit of drugs into the CSF is mainly arachnoid
(D) The position of the adult subarachnoid space terminates approximately at the height of S2
Answer: B
Explanation:
Dorsal roots are typically larger than ventral roots, and sensory blockade is often more difficult than motor. The statement reverses this anatomical fact, making it false.
137. The thickness of Ligamentum Flavum for adults is:
(A) 1.5–3.0 mm
(B) 3.0–5.0 mm
(C) 5.0–6.0 mm
(D) 2.0–6.0 mm
Answer: D
Explanation:
The ligamentum flavum varies in thickness from 2.0 to 6.0 mm, depending on spinal level and individual anatomy. This range is important during epidural placement, where tactile feedback is key.
138. Which are the nerve roots of Obturator Nerve?
(A) L1, L2
(B) T12, L1
(C) L3, L4
(D) T11, T12
Answer: C
Explanation:
The obturator nerve arises from the L3 and L4 nerve roots, supplying the medial thigh muscles and contributing to hip joint innervation. It is relevant in lower limb blocks and pelvic surgery.
139. Horner’s syndrome caused by successful Stellate ganglion Blockade include symptoms like:
(A) Anhidrosis
(B) Nasal stuffiness
(C) Increased skin Temperature
(D) All of the above
Answer: D
Explanation:
Stellate ganglion block interrupts sympathetic outflow, producing Horner’s syndrome, which includes ptosis, miosis, anhidrosis, nasal congestion, and warm skin due to vasodilation.
140. The safety of epidural anaesthesia can be achieved by the following methods?
(A) Test volume
(B) Repeated small injections
(C) Choose a less toxic drug
(D) All of the above
Answer: D
Explanation:
Safe epidural practice involves test dosing to detect intravascular or intrathecal placement, incremental dosing to avoid toxicity, and selecting low-toxicity agents. All strategies contribute to patient safety.
141. Which of the following statements about Aortic cross-clamping is correct?
(A) The LV wall tension increases and the Ejection fraction decreases
(B) The body’s oxygen consumption and carbon dioxide production both decrease
(C) Preload will increase
(D) All are correct
Answer: D
Explanation:
Aortic cross-clamping leads to increased LV wall tension, reduced ejection fraction, and elevated preload due to afterload augmentation. Additionally, metabolic demands decrease as perfusion to distal tissues is interrupted. All listed effects are accurate.
142. Which of the following statements about mediastinal tumor surgery is correct?
(A) The most common mediastinal tumours include Thymoma, teratoma, lymphoma, cystic hygroma
(B) The most common complication of mediastinal tumor anaesthesia induction is airway obstruction
(C) Common complications of Mediastinoscopy include compression of the innominate artery, pneumothorax, recurrent laryngeal nerve and phrenic nerve injury
(D) All are correct
Answer: D
Explanation:
Mediastinal tumors pose significant anaesthetic challenges, especially airway obstruction during induction. Thymomas, teratomas, and lymphomas are common, and mediastinoscopy risks include vascular compression and nerve injury. All options are correct.
143. Which of the following is/are correct about fentanyl patch for post-operative analgesia?
(A) Changes in vascular volume do not affect the penetration and absorption of fentanyl and thus cause fluctuations blood drug level
(B) Direct coverage of warm blankets to promote penetration and absorption as exposure to cold temperature may impair absorption
(C) NSAIDs and other concomitant medications do not help post-operative pain
(D) All of the above factors need to be considered
Answer: D
Explanation:
Fentanyl patch absorption is influenced by skin temperature, vascular volume, and concomitant medications. Warmth increases absorption, while cold impairs it. NSAIDs can enhance analgesia. All factors must be considered for safe and effective use.
144. Which of the following is NOT a statement about the pericardial tamponade and anaesthesia considerations?
(A) Severe will have “The Beck triad”, which is low BP, increased jugular venous pressure, and distant heart sounds
(B) When pericardial tamponade is present, PCWP and LV, RV and RA diastolic pressure will increase to be equivalent to pericardium pressure
(C) If the patient with this tamponade must receive GA, spontaneous breathing is to be maintained until the pericardial sac is opened
(D) If muscle relaxants have to be used, it is best to target a larger tidal volume and a slower respiratory rate
Answer: D
Explanation:
In pericardial tamponade, maintaining spontaneous ventilation is critical to preserve venous return. Using muscle relaxants and positive pressure ventilation can worsen hemodynamics. The suggestion to use larger tidal volumes and slower rates is inappropriate.
145. How to deal with perioperative right-sided heart failure?
(A) Preserving coronary perfusion by maintaining systemic blood pressure
(B) Optimizing RV preload
(C) Reducing RV afterload by decreasing pulmonary vascular resistance
(D) All of the above
Answer: D
Explanation:
Management of right-sided heart failure includes maintaining systemic pressure to ensure coronary perfusion, optimizing preload without overload, and reducing afterload via pulmonary vasodilation. All strategies are essential for RV support.
146. During one lung ventilation, the goals should include:
(A) Maximize pulmonary vascular (PVR) resistance in the non-ventilated lung
(B) Maintain ventilation of the ventilated lung close to its functional reserve capacity (FRC)
(C) Determine the correct position of the double lumen endotracheal tube (DLT)
(D) All are correct
Answer: D
Explanation:
Effective one-lung ventilation requires DLT positioning, optimizing ventilated lung volume, and minimizing perfusion to the non-ventilated lung to reduce shunt and hypoxia. All listed goals are valid and clinically relevant.
147. A 56-year-old patient wants to perform laparoscopic thoracotomy due to a lung tumor. Which of the following will increase the risk of desaturation during the operation?
(A) Patients with restrictive lung disease
(B) Supine position is used for One-lung ventilation
(C) V/Q scans before surgery show that the lung lobe on the surgery side has worse ventilation than the contralateral side or perfusion
(D) All of the above
Answer: D
Explanation:
Restrictive lung disease, supine positioning, and poor V/Q match in the operative lung all contribute to desaturation risk during thoracoscopic procedures, especially under one-lung ventilation. All factors increase vulnerability.
148. Which of the following is not a function of Positive End-Expiratory Pressure?
(A) Reopening of collapsed alveoli
(B) Redistribute water in the lungs
(C) Decrease V/Q mismatch
(D) To raise blood pressure
Answer: D
Explanation:
PEEP improves oxygenation by recruiting alveoli and reducing V/Q mismatch, but it may lower blood pressure due to reduced venous return. It does not raise BP, making option D incorrect.
149. Which of the following statements about the Acute Respiratory Distress Syndrome is FALSE?
(A) Is an inflammatory response to the lungs
(B) PaO₂/FiO₂ < 200
(C) Pulmonary artery wedge pressure greater than 18 mmHg
(D) In the absence of left atrial hypertension
Answer: C
Explanation:
In ARDS, pulmonary artery wedge pressure is typically normal or low, distinguishing it from cardiogenic pulmonary edema. A value >18 mmHg suggests left heart failure, making this statement false.
150. Which of the following breathing patterns allows the patient to breathe spontaneously between set breaths?
(A) Synchronized mandatory ventilation (SIMV)
(B) Pressure support ventilation (PSV)
(C) Proportional assisted ventilation (PAV)
(D) Neurally adjusted ventilatory assist (NAVA)
Answer: A
Explanation:
SIMV allows spontaneous breathing between mandatory breaths, supporting patient autonomy and weaning. Other modes like PSV, PAV, and NAVA also permit spontaneous effort but SIMV is the classic example.
151. When judging brain death, which statement about brainstem function is WRONG?
(A) Pupils in normal or fully constricted in size
(B) No voluntary eye movements
(C) No movement of the bulbar muscles, coughing, sucking, etc.
(D) Lack of breathing movements
Answer: A
Explanation:
In brain death, pupils are typically fixed and dilated, not normal or constricted. This reflects loss of brainstem function, including the oculomotor nerve. The other signs—absence of eye movements, bulbar reflexes, and spontaneous respiration—are consistent with brain death.
152. Which of the following statements is false about complications of ICU management?
(A) A 10-degree head height can reduce the rate of ventilator-related pneumonia
(B) Ultrasound can effectively help subclavian venous catheter placement
(C) Central venous catheter has no role in rise of infection rate
(D) All are correct
Answer: C
Explanation:
Central venous catheters are a known source of nosocomial infections, especially catheter-related bloodstream infections. Proper insertion technique and maintenance are essential. The claim that they have no role in infection risk is false.
153. Which of the following is NOT an indication for ECMO?
(A) Preoperative stabilization for patients with complex congenital heart disease
(B) Perform post-cardiotomy follow-up care
(C) Myocarditis combined with ARDS
(D) Multiple organ failure due to sepsis
Answer: D
Explanation:
Multiple organ failure due to sepsis is a contraindication for ECMO, as outcomes are poor. ECMO is indicated for reversible cardiac or respiratory failure, such as in myocarditis or post-cardiotomy support.
154. In the intensive care unit, ventilators are commonly used in patients with cardiopulmonary failure. Regarding the setting of positive end expiratory pressure (PEEP) and its impact on hemodynamics, which of the following statements is FALSE?
(A) PEEP lowers blood pressure in patients with insufficient intravascular water
(B) PEEP improves pulmonary oedema in patients with severe heart failure
(C) PEEP should not be used for patients with acute exacerbation of chronic obstructive pulmonary disease and respiratory failure, so as not to aggravate dyspnoea
(D) For patients with acute respiratory distress syndrome (ARDS), high PEEP should be used to avoid alveolar collapse
Answer: C
Explanation:
PEEP is often beneficial in COPD exacerbations, helping to prevent airway collapse and improve oxygenation. The statement that it should not be used is incorrect. The other statements reflect valid clinical considerations.
155. The CDC recommends five evidence-based procedures to improve catheter-related bloodstream infections. Which of the following statements is FALSE?
(A) Wash your hands
(B) Skin cleansing with chlorhexidine
(C) Try to choose the subclavian vein to place the catheter
(D) Removal of unnecessary catheter lines
Answer: C
Explanation:
While the subclavian vein has a lower infection risk, it is not always preferred due to mechanical complications. The CDC emphasizes site selection based on risk-benefit, not a blanket preference. The other practices are universally recommended.
156. Which of the following is FALSE for preoperative management of patients with COPD (chronic obstructive pulmonary disease)?
(A) Respiratory physiotherapy
(B) If bronchospasm occurs, bronchodilator should be given as soon as possible; if the response to sympathomimetic and anticholinergic bronchodilators is poor, steroid treatment should be considered
(C) Antibiotic treatment for respiratory infections
(D) Most patients respond to steroid, so patients with stable COPD should still be given steroid before surgery
Answer: D
Explanation:
Routine steroid use in stable COPD is not recommended unless there is exacerbation. Overuse may lead to side effects without benefit. The other options reflect appropriate preoperative optimization strategies.
157. Which of the following patient conditions is an absolute contraindication to hyperbaric oxygen therapy in acute and severe cases?
(A) Patients with severe soft tissue infection (gas gangrene) still have high fever
(B) The patient with carbon monoxide poisoning is in a coma and is intubated with a respirator
(C) Patients with crush injury due to trauma, combined with untreated pneumothorax
(D) Patients with abdominal distension with adynamic ileus after surgery
Answer: C
Explanation:
Untreated pneumothorax is an absolute contraindication to hyperbaric oxygen therapy, due to risk of barotrauma and tension pneumothorax. It must be drained before therapy. The other conditions are not contraindications.
158. Which of the following is true for the management of haemorrhagic shock?
(A) Consider using recombinant activated factor VII (NovoSeven) supplementation when severe bleeding persists
(B) Avoid using a large amount of physiological salt solution (0.9% normal saline) to avoid hyperchloride metabolic acidosis
(C) Patients should avoid excessive use of Ringers lactate solution if combined with traumatic brain injury
(D) All the above
Answer: D
Explanation:
All listed strategies are valid. Factor VIIa may help in refractory bleeding, normal saline can cause hyperchloremic acidosis, and Ringer’s lactate may worsen cerebral edema in brain injury. Tailored fluid and coagulation management is essential.
159. What is the minimum time interval between two brain death determinations?
(A) 1 hour
(B) 2 hours
(C) 3 hours
(D) 4 hours
Answer: D
Explanation:
A minimum interval of 4 hours between two clinical brain death assessments ensures irreversibility and allows for confirmation of findings. This standard supports ethical and legal clarity in organ donation protocols.
160. Upper extremity vascular suturing often requires a tourniquet to be tied to the upper arm. Which of the following brachial plexus blockade methods often fails to block the pain caused by the tourniquet?
(A) Axillary approach is performed from the axilla
(B) Interscalene approach from the serratus anterior
(C) Infraclavicular approach is performed from the subclavian
(D) Blocking from the armpit plus blocking the musculocutaneous nerve
Answer: A
Explanation:
The axillary block often misses the musculocutaneous nerve, which innervates the skin and muscles of the upper arm, leading to inadequate tourniquet pain relief. Supplementary blocks may be needed for complete coverage.
161. Which of the following substances produces the least amount of heat per unit weight (Kcal/g)?
(A) Carbohydrate
(B) Dextrose (glucose monohydrate)
(C) Protein
(D) Ethanol
Answer: B
Explanation:
Dextrose (glucose monohydrate) contains water of crystallization, making its energy yield lower than pure carbohydrate. While carbohydrates and proteins yield around 4 kcal/g, and ethanol yields 7 kcal/g, dextrose provides less energy per gram due to its hydrated form.
162. Of the following anticoagulants commonly used in haemodialysis, which one is mainly used to inhibit platelet aggregation?
(A) Fractioned Heparin
(B) Low-Molecular-Weight Heparin
(C) Prostacyclin
(D) Citrate
Answer: C
Explanation:
Prostacyclin inhibits platelet aggregation and causes vasodilation, making it useful in haemodialysis to prevent clot formation without systemic anticoagulation. Heparins and citrate act via different mechanisms, primarily affecting coagulation factors.
163. What is WRONG about the use of Adenosine?
(A) Its half-life is very short and requires rapid intravenous injection
(B) Can be used to diagnose stable rule-wide QRS tachycardia
(C) Safe to use in asthmatic patients
(D) The initial dose for adults is 6 mg
Answer: C
Explanation:
Adenosine can cause bronchospasm, making it unsafe in asthmatic patients. It is otherwise effective for supraventricular tachycardia due to its short half-life and rapid action. The initial adult dose is 6 mg IV push.
164. Which of the following drugs CANNOT be given from endotracheal route?
(A) Sodium bicarbonate
(B) Atropine
(C) Lidocaine
(D) Epinephrine
Answer: A
Explanation:
Sodium bicarbonate is not suitable for endotracheal administration due to its alkaline nature and risk of mucosal injury. The other drugs—atropine, lidocaine, epinephrine—can be administered via ET route in emergencies.
165. A 55-year-old lady has acute liver failure due to overdose of Acetaminophen, complicated by hepatic encephalopathy and increased intracranial pressure. Which of the following is the correct treatment for intracranial hypertension?
(A) Hypothermia
(B) Continuous renal replacement therapy to remove blood ammonia (Ammonia, NH₃)
(C) Intravenous Mannitol
(D) All the above are correct
Answer: D
Explanation:
Management of intracranial hypertension in acute liver failure includes mannitol, hypothermia, and ammonia removal via CRRT. These interventions help reduce cerebral edema and improve neurological outcomes.
166. Early resuscitation goals for trauma patients, which of the following is LESS recommended?
(A) Maintain systolic blood pressure of 80–100 mm Hg
(B) Maintain Haematocrit 15–20%
(C) Maintain core body temperature above 35°C
(D) To prevent the deterioration of acidosis
Answer: B
Explanation:
A haematocrit of 15–20% is too low and may impair oxygen delivery. The goal is to maintain adequate perfusion and oxygenation, while avoiding hypothermia and acidosis. The other options are part of damage control resuscitation.
167. Which of the following is LESS likely to be a symptom or sign of shock?
(A) Low blood pressure and fast heartbeat
(B) Widened pulse pressure
(C) Diaphoresis
(D) Urine output decreased
Answer: B
Explanation:
Widened pulse pressure is not typical of shock; instead, narrowed pulse pressure is common due to low stroke volume. Hypotension, tachycardia, sweating, and oliguria are classic signs of shock.
168. Predictors of successful use of non-invasive ventilation, including which of the following?
(A) Younger age
(B) Patient cooperation
(C) Moderate severity Hypercapnia & Acidosis
(D) All of the above
Answer: D
Explanation:
Successful non-invasive ventilation (NIV) depends on patient cooperation, moderate disease severity, and younger age, which correlates with better respiratory mechanics and tolerance. All listed factors are predictive.
169. Which of the following is/are the quality indicators of critical care?
(A) Percentage of patients with ventilator-associated pneumonia or central venous catheter infection
(B) Incidence of gastrointestinal bleeding
(C) Average length of stay in ICU
(D) All of the above
Answer: D
Explanation:
Quality indicators in ICU include infection rates, GI bleeding incidence, and length of stay, reflecting patient safety, resource utilization, and clinical outcomes. All are used for benchmarking and improvement.
170. Regarding the description of positive end-expiratory pressure (PEEP), which of the following is INCORRECT?
(A) A patient with chronic bronchitis may have Auto-PEEP if the respiratory rate is 30 breaths per minute
(B) If a patient using a respirator suddenly suffers severe shock due to Auto-PEEP, the respirator connector can be temporarily separated from the endotracheal tube
(C) Optionally infuse fluids to maintain proper right ventricular output prior to PEEP
(D) In patients with severe left ventricular dysfunction or congestive heart failure, PEEP can worsen left ventricular function
Answer: D
Explanation:
PEEP often benefits left ventricular function by reducing preload and afterload, especially in congestive heart failure. The statement that it worsens LV function is incorrect. The other options describe valid PEEP-related physiology.
171. What makes the intraocular pressure drop?
(A) Ketamine without premedication
(B) Laryngoscopy
(C) Endotracheal intubation
(D) Sleeping doses of barbiturates
Answer: D
Explanation:
Barbiturates, when used in sedative doses, reduce cerebral metabolic rate and intraocular pressure. In contrast, ketamine, laryngoscopy, and intubation may increase intraocular pressure due to sympathetic stimulation.
172. A 60 kg middle-aged man required incision and drainage for deep neck infection. After the patient entered the operating room, it was checked that the mouth opening was half a finger width. Which of the following is inappropriate?
(A) Awake nostril intubation with Fiberscope
(B) Ask an otolaryngologist to perform a tracheostomy with local anaesthesia first and then apply general anaesthesia
(C) Anaesthesia with transtracheal jet ventilation (TTJV)
(D) Administer Pentothal 300 mg, succinylcholine 100 mg, wait 1 minute and intubate
Answer: D
Explanation:
In a patient with severe airway restriction, administering induction agents and muscle relaxants without securing the airway is dangerous. This approach risks cannot intubate, cannot ventilate scenarios. The other options are safer alternatives.
173. Accidental eye puncture injury, while eaten full stomach, and emergency surgery is required under GA, the following clinical treatments are often used, EXCEPT which ones?
(A) Use rapid-sequence induction anaesthesia during general anaesthesia intubation
(B) 3 to 5 minutes before induction of anaesthesia, give lidocaine (1.5 mg/kg) and Remifentanil (0.7 mg/kg)
(C) Depolarizing muscle relaxants (e.g. succinylcholine) can be used when rapid induction of anaesthesia is used, as they do not increase intraocular pressure
(D) When rapid induction of anaesthesia is used, short-acting non-depolarizing muscle relaxants (e.g. mivacurium) are recommended to avoid increased intraocular pressure
Answer: D
Explanation:
Succinylcholine is known to increase intraocular pressure, making it less suitable in cases of ocular trauma. Mivacurium, a non-depolarizing agent, is preferred to avoid pressure spikes. The statement suggesting succinylcholine is safe is incorrect.
174. What are the complications that are more likely to occur with jet ventilation than with traditional endotracheal tube intubation during anaesthesia for laryngeal laser surgery?
(A) Pneumothorax
(B) Airway on fire
(C) Acute Respiratory Distress Syndrome
(D) Hemothorax
Answer: A
Explanation:
Jet ventilation can cause barotrauma, leading to pneumothorax, especially if exhalation is impaired. It is more likely than hemothorax or ARDS in this context. Airway fire is a risk with laser surgery, but not specific to jet ventilation.
175. For children undergoing ENT surgery, which of the following DOES NOT reduce the risk of Laryngospasm?
(A) Intravenous lidocaine
(B) Topical use of lidocaine
(C) Intravenous administration of magnesium
(D) Light extubation
Answer: D
Explanation:
Light extubation increases the risk of laryngospasm due to airway stimulation during inadequate depth of anaesthesia. Lidocaine and magnesium help suppress airway reflexes, reducing spasm risk.
176. Which of the following is WRONG in the preoperative anaesthesia assessment for laryngeal surgery?
(A) For throat tumours, the size, location, degree of obstruction, etc. of the tumor need to be evaluated
(B) If stridor occurs in adult breathing, it means that the diameter of the airway is less than 1 cm
(C) More active disease (e.g. multiple vocal cord polyps), common with partial airway obstruction, complete airway obstruction is rare
(D) Supraglottic lesions that may obstruct the airway or make identification of the inlet of the larynx difficult
Answer: B
Explanation:
Stridor typically occurs when the airway diameter is less than 5 mm, not 1 cm. The statement exaggerates the threshold. The other options correctly describe airway assessment in laryngeal pathology.
177. What is NOT a contraindication to Outpatient Surgery?
(A) Potentially life-threatening chronic diseases
(B) Morbid obesity
(C) Is receiving multiple chronic intensive drug therapy
(D) There is no responsible adult available to assist the patient on the night after surgery
Answer: D
Explanation:
Lack of a responsible adult postoperatively is a contraindication to outpatient surgery, due to risks of complications and inadequate care. The other conditions may be managed with appropriate planning.
178. For patients with liver failure, which of the following is NOT a contraindications for liver transplantation?
(A) Life-threatening systemic diseases
(B) Severe Hepatorenal syndrome
(C) Current drug or alcohol abuse
(D) Severe and uncontrolled sepsis or infection
Answer: B
Explanation:
Severe hepatorenal syndrome is an indication, not a contraindication, for liver transplantation, as it reflects end-stage liver disease. The other conditions may preclude transplantation due to poor outcomes.
179. Which factors are correctly classified as cognitive impairment and postoperative delirium?
(A) Deterioration persists for weeks, months or longer
(B) Characterized by memory impairment, learning difficulties, and reduced ability to concentrate
(C) Neuropsychological testing is required
(D) All of the above
Answer: D
Explanation:
Postoperative cognitive dysfunction includes persistent decline, memory and concentration issues, and requires formal testing for diagnosis. All listed features are accurate descriptors.
180. Hypoxia after anaesthesia surgery is an important complication. Which of the following statements about this is FALSE?
(A) Breathing room air during transport is the most significant contributor to hypoxia, other factors include obesity, sedation score and respiration rate
(B) It can be divided into two categories: immediate and delayed hypoxia, of which delayed hypoxia has a higher incidence
(C) Factors associated with delayed hypoxia include age, weight, ASA class, anaesthesia method, and infusion volume
(D) Immediate hypoxia occurs earlier and lasts for a shorter period of time
Answer: C
Explanation:
Delayed hypoxia is influenced by sedation, residual anaesthetic effects, and airway obstruction, not directly by infusion volume or ASA class. The statement overstates these associations, making it false.
181. Regarding the description of central venous catheters in critically ill patients, which of the following is/are correct?
(A) For critically ill patients who are expected to use a central venous catheter for more than 3 days, consider using a central venous catheter containing antibacterial ingredients
(B) Common antibacterial ingredients are chlorhexidine silver sulfadiazine or minocycline/rifampin
(C) The need for central catheters should be assessed daily in the ICU and removed when not needed
(D) All are correct
Answer: D
Explanation:
To reduce the risk of catheter-related bloodstream infections, antibacterial-coated central venous catheters are recommended for prolonged use. Daily assessment ensures timely removal when no longer needed. All listed practices align with infection control guidelines.
182. Indian Society of Anaesthetists was formally established with 19 members and has presently 30000 (approx.) members. Which year it was established?
(A) 1947
(B) 1949
(C) 1953
(D) 1956
Answer: B
Explanation:
The Indian Society of Anaesthetists was established in 1949, marking the formal organization of anaesthesia professionals in India. It has since grown into a major body promoting education, research, and standards in anaesthesiology.
183. Which of the following opioid analgesics has a different equi-analgesic dosage than the other options?
(A) Oral morphine 30 mg
(B) Parenteral fentanyl 100 µg
(C) Parenteral meperidine 75 mg
(D) Oral methadone 10 mg
Answer: C
Explanation:
Meperidine has a lower potency and shorter duration compared to other opioids listed. Its equi-analgesic dose differs significantly, and it is less preferred due to neurotoxic metabolite accumulation.
184. When placing an epidural catheter for postoperative pain relief according to different surgical methods, which of the following is LESS appropriate?
(A) Thoracotomy: T4–8
(B) Whipple procedure: T6–8
(C) Nephrectomy: T7–10
(D) Colectomy: T12–L2
Answer: C
Explanation:
For nephrectomy, the ideal epidural placement is T10–L1, not T7–10. The listed range may not provide optimal coverage. The other placements match the dermatomal distribution of surgical pain.
185. What kind of eye damage can be caused by incorrect positioning?
(A) Ocular vein thrombosis
(B) Corneal abrasion
(C) Central retinal artery occlusion caused by direct eyeball compression
(D) All of the above
Answer: D
Explanation:
Improper patient positioning, especially in prone surgeries, can lead to corneal abrasions, vascular occlusions, and vision loss. Protecting the eyes with adequate padding and monitoring is essential.
186. What kind of patient positioning complications can occur when lying down?
(A) Back pain
(B) Decubitus
(C) Stress Alopecia
(D) All of the above
Answer: D
Explanation:
Supine positioning can cause pressure injuries, musculoskeletal discomfort, and even stress-induced hair loss due to prolonged immobility. All listed complications are recognized in perioperative care.
187. Which of the following postures preserves the most hemodynamic function?
(A) Lie flat
(B) Lie on your side
(C) Lie prone
(D) Sitting position
Answer: A
Explanation:
The supine position maintains venous return and cardiac output most effectively. Other positions may compromise hemodynamics due to gravity effects or vascular compression.
188. Which of the following descriptions and management of diabetic ketoacidosis is correct?
(A) Due to the diuretic effect of hyperglycemia, there is often severe dehydration and hypovolemia
(B) Hyperkalemia at the beginning is mainly due to excess body fluid deficiency, but attention should be paid to hypokalemia after infusion and insulin therapy
(C) Acidemia will improve after infusion and insulin therapy, rather than immediate administration of bicarbonate
(D) All are correct
Answer: D
Explanation:
DKA management involves correcting dehydration, electrolyte imbalance, and acidosis. Initial hyperkalemia shifts to hypokalemia with treatment. Bicarbonate is reserved for severe acidosis. All statements are accurate.
189. Which of the following is Correct for a statement related to rheumatoid arthritis (RA) and anaesthesia?
(A) Peripheral neuropathy, hydropericardium, conduction abnormalities, etc. may be combined
(B) Atlantodens subluxation may be caused by laxity of the ligaments affecting the cervical spine
(C) Restrictive lung disease may be due to progression of the disease
(D) All are correct
Answer: D
Explanation:
RA affects multiple systems, including neurological, cardiac, pulmonary, and cervical spine. Atlantoaxial instability poses a risk during intubation, and lung involvement may impair ventilation. All listed complications are valid.
190. Which of the following patients is the most INAPPROPRIATE choice of infusion?
(A) Diabetic patients treated with insulin use 5% dextrose (D5W) to prevent hypoglycemia
(B) Use 0.9% saline in patients undergoing arteriovenous catheter surgery for uremia
(C) Hetastarch infusion in healthy patients with acute blood loss
(D) Lactated Ringer’s solution in patients with brain injury
Answer: D
Explanation:
Lactated Ringer’s contains lactate, which may be metabolized to glucose, potentially worsening cerebral edema in brain injury. It is not preferred in neurocritical patients. The other infusions are appropriate in their contexts.
191. Which of the following statements is LESS appropriate regarding anaesthesia in patients with myasthenia gravis?
(A) Pulmonary function testing may be required before surgery to predict the need for ventilator care after surgery
(B) Succinylcholine should not be used in order to avoid cardiac arrest caused by excessive potassium ions
(C) When using non-depolarizing muscle relaxants, a small (0.1 or 0.2 ED95) increase should be the principle
(D) Inhalational/Gas anaesthetics already provide sufficient muscle relaxation for most surgeries
Answer: B
Explanation:
In myasthenia gravis, succinylcholine is generally avoided due to unpredictable response, but the concern is prolonged paralysis, not hyperkalemia-induced cardiac arrest. The potassium risk is more relevant in conditions with upregulated acetylcholine receptors, such as burns or paralysis, not MG.
192. Regarding pheochromocytoma, which of the following is FALSE?
(A) Symptoms of hypertension are often present
(B) Preoperative use of oral α-adrenergic blocker reduces postoperative mortality in pheochromocytoma resection
(C) The sensitivity of abdominal CT was better than that of Vanillyl mandelic acid excretion
(D) Regarding preoperative oral medication, β-Adrenergic blocker should be used and α-adrenergic blocker should be discontinued when pheochromocytoma patients have tachycardia
Answer: D
Explanation:
In pheochromocytoma, α-blockade must be initiated before β-blockade to prevent unopposed α-adrenergic stimulation, which can cause hypertensive crisis. Discontinuing α-blockers while using β-blockers is dangerous and contraindicated.
193. Which of the following statements about patient positioning is FALSE?
(A) Trendelenburg position increases intraocular and intracranial pressure
(B) Trendelenburg position can easily lead to air emboli
(C) Keeping the head in a neutral position reduces the chance of brachial plexus injury
(D) Prone position for prolonged periods may increase the chance of postoperative vision loss
Answer: B
Explanation:
Trendelenburg position does not increase the risk of air embolism; this is more associated with sitting or semi-upright positions during neurosurgery or ENT procedures. The other statements correctly describe position-related complications.
194. Complications occur in about one-quarter of post-anaesthesia patients in the recovery room, which is the most common?
(A) Nausea and vomiting
(B) Breathing problems
(C) Hypertension
(D) Low blood pressure
Answer: A
Explanation:
Postoperative nausea and vomiting (PONV) is the most common complication in the recovery room, affecting up to 25% of patients, especially those with risk factors like female gender, opioid use, and volatile anaesthetics.
195. Which of the following patients can be anesthetized for outpatient surgery?
(A) Patients with a history of asthma and current upper respiratory tract infection
(B) Use of addictive drugs such as cocaine
(C) Preterm infants with post conceptual age < 60 weeks
(D) None of the above
Answer: D
Explanation:
All listed patients have contraindications to outpatient anaesthesia due to airway risk, cardiovascular instability, or apnoea risk. Therefore, none are suitable for ambulatory surgery without further evaluation.
196. Contraindications to outpatient surgery, which is WRONG?
(A) No responsible adult at home
(B) Mild obesity
(C) Multiple chronic centrally active drug therapies
(D) Active cocaine abuse
Answer: B
Explanation:
Mild obesity is not a contraindication to outpatient surgery. The other conditions—lack of home support, polypharmacy, and substance abuse—pose significant risks and are valid contraindications.
197. Which of the following may be the cause of Oliguria in surgical anaesthesia?
(A) Dehydration
(B) Acute interstitial nephritis
(C) Ischemic injury from shock
(D) All of the above
Answer: D
Explanation:
Oliguria during anaesthesia can result from pre-renal causes like dehydration, intrinsic renal injury such as interstitial nephritis, or ischemic damage due to hypotension and shock. All listed causes are valid.
198. A 70-year-old man with history of aortic stenosis on irregular treatment has to undergo laparotomy due to acute appendicitis. What is the advice to the anaesthesiologist?
(A) Cardiac echo is performed first to check the severity of aortic stenosis
(B) Do a cardiac scan first to check the severity of myocardial hypoxia
(C) Consult Cardiology first
(D) Surgery followed by treatment
Answer: C
Explanation:
In patients with aortic stenosis, cardiology consultation is essential before surgery to assess severity and risk, especially if symptomatic or untreated. Proceeding without evaluation may lead to perioperative cardiac complications.
199. Which of the following is WRONG?
(A) After the doctor obtains the patient’s consent, it does not imply that the doctor can be exempted from legal responsibility in the event of an adverse accident
(B) Many studies have pointed out that the patient’s understanding of medical treatment is directly related to the relationship between doctors and patients, and the occurrence of medical litigation
(C) Do-Not-Attempt-Resuscitation Orders are automatically released during anaesthesia and surgery
(D) The ethical distinction between acts of omission (“letting die”) and acts of commission (“killing”) remains a difficult and controversial issue
Answer: C
Explanation:
Do-Not-Attempt-Resuscitation (DNAR) orders are not automatically suspended during anaesthesia and surgery. They require explicit discussion and documentation. Assuming automatic release is incorrect and ethically problematic.
200. Regarding the mechanism of action of pain relievers, which of the following is FALSE?
(A) Opioids mainly act on G protein-coupled μ, δ, κ-receptors
(B) NSAIDs mainly act on Cyclooxygenases
(C) Serotonin agonists mainly act on G protein-coupled 5-HT receptors
(D) Antiepileptics cause Na⁺ currents, Ca²⁺ currents, GABA receptor activity
Answer: D
Explanation:
Antiepileptics typically inhibit Na⁺ and Ca²⁺ currents, and enhance GABAergic activity, not cause these currents. The statement misrepresents their mechanism, making it false. The other options correctly describe drug actions.