Ent and Anesthesia PDF

Copyright 2014 Delhi Academy of Medical Sciences, All Rights Reserved.
1/79
Test Information
Test Name
ENT & ANESTHESIA -SWT(MD/MS) 2016
Total Questions
200
Test Type
Examination
Difficulty Level
Difficult
Total Marks
600
Duration
120minutes
Test Question Language:- ENGLISH

(1).
Which of the following inhalation anaesthetics should be avoided in middle ear surgery?
a. Halothane
b. Nitrous oxide
c. Ether
d. Isoflurane
Solution. Ans-1: (b) Nitrous oxide
Ref.:Read the text below
Sol :
- Nitrous oxide enters closed air spaces like middle ear from blood stream and leads to expansion of air cavity.
- This may cause displacement of grafts or prosthesis.
Correct Answer. b
(2).
Minimal tidal volume for adult resuscitation is

a. > 600ml
b. 500ml
c. 100ml
<100ml>d.
Solution. Ans-2: (a) > 600ml
Sol :
In CPR, breaths are delivered slowly with a smaller tidal volume of 700-1000ml, smaller (400-600ml) if supplemental O2 is used.
Correct Answer. a
2/79
(3).
Mallampati score is for

a. Difficult airway
b. Laryngeal obstruction
c. Pain diagnosis
d. Assessing the planes of anesthesia
Solution. Ans-3: (d) Assessing the planes of anesthesia
Sol :
ASSESMENT OF AIRWAY
The 1-2-3 test :
On opening the mouth, one should insinuate one finger in the temporo mandibular joint.
There should be atleast two finger breadths distance between his incisors.
There should be atleast three finger breadths distance between chin and thyroid cartilage of the patien
MALLAMPATI TEST :
Devised by Mallampati & Samson Young
Widely used & simpler classification of the pharyngeal view.
Patient is made to sit upright, open his mouth wide and protrude his tongue.
Failure to visualize posterior pharyngeal walls indicate difficult airway establishment.
Class : I Uvula, Faucial pillars & soft palate visible
Class : II Faucial pillars & soft palate visible
Class : III Soft palate & Hard palate visible
Class : IV Only hard palate visible
Correct Answer. d
(4).
Ohngrens classification of maxillary sinus carcinoma is based on

a. Imaginary plane between medial canthus of eye and angle of mandible.
b. Imaginary plane between lateral canthus of eye and angle of mandible.
c. Two horizontal lines, one passing through floor of obit and other through floor of antrum
d. none
Solution. Ans-4: (a) Imaginary plane between medial canthus of eye and angle of mandible.
Sol :
In head and neck cancer, Ohngren's line is a line that connects the medial canthus of the eye to the angle of the mandible.
The line defines a plane orthogonal to a sagittal plane that divides the maxillary sinus into (1) an anterior-inferior part, and (2)
a superior-posterior part.
Tumours that arise in the anterior-inferior part, i.e. below Ohngren's line, generally have a better prognosis than those in the other group
Correct Answer. a
(5).
Vidian neurectomy done in:

a. Allergic rhinitis
b. Vasomotor rhinitis
c. Atrophic rhinitis
d. Drug-induced rhinitis
Solution. Ans-5: (b) Vasomotor rhinitis
Sol :
Indication for vidian neurectomy:
1. Vasomotor rhinitis
2. Intrinsic rhinitis
3. Crocodile tears
Correct Answer. b
3/79
(6).
During Tonsillitis, pain in the ear is due to involvement of?

a. Vagus Nerve
b. Chorda tympani Nerve
c. Glossopharyngeal Nerve
d. Hypoglossal Nerve
Solution. Ans-6: (c) Glossopharyngeal Nerve
Sol :
The tympanic nerve (Jacobson nerve, a branch of cranial nerve IX) directly innervates the ear but also has pharyngeal, lingual, and
tonsillar branches to supply the posterior one-third portion of the tongue, tonsillar fossa/pillars, pharynx, eustachian tube
Correct Answer. c
(7).
True about Brewer-Luckhardt reflex include the following except:

a. Associated with ear surgeries
b. Causes intense pain
c. Causes laryngospasm
d. Causes cardiac arrhythmias/tachypnea.
Solution. Ans-7: (a) Associated with ear surgeries
Ref.:Lees synopsis of anaesthesia 11th p. 448
Sol :
Brewer- Luckhardt reflex is reflex inspiratory closurewhile the grunting reflex of Guedel is glottis closure on expiration. Whilst many
surgical stimuli trigget vagal reflexes, stimulation of the anus or cervix causes Brewer Luckhardt reflex.
Anorectal surgery requires deep anesthesia because the zone gets multiple nerve supply and is reflexogenic.
Operations under light planes of anesthesia cause intense pain, reflex body movements, tachypnea and laryngeal spasm, the so-called
Brewer Luckhardt reflex.
The Brewer-Luckhardt reflex describes laryngospasm that is provoked by a distant stimulus. Vagal reflexes can be attenuated by the
use of an anticholinergic such as atropine, but in low doses it can stimulate the vagus before it blocks (Bezold Jarisch reflex).
Brewer-Luckhardt reflex is characterized by intense pain, reflex body movements, tachypnea, and laryngeal spasm.
Correct Answer. a
(8).
Central neuroaxial blockade if the patient is on LMWH, then ow much hours before surgery it must be stopped?
a. 2-4 hrs
b. 4-8 hrs
c. 8-12 hrs
d. 12-24 hrs
Solution. Ans-8: (c) 8-12
Sol :
Different books and literature havementioned different guideline to stop LMWH.
But the standard criterion by ARSA mentions : LMWH should be held for 10-12 hours prior to neuraxial blockade for normal dosing.
Correct Answer. c
4/79
(9).
Approach used for Brachial plexus block include the following except
a. Suprascapular
b. Interscalene
c. 3 in 1 block
d. Axillary
Solution. Ans-9: (c) 3 in 1 block
Sol :
Brachial plexus block approaches :
Continuous interscalene approaches
Interscalene block classic approach.
Intersternocleidomastoid approach
Parascalene approach
Paravertebral approach (Posterior Approach)
Continuous Infraclavicular approaches :
The coracoids Approach of whiffler
The modified approach of the Raj Technique
Correct Answer. c
(10).
Eustachian tube is opened if pressure difference is more than?

a. 15 mm Hg
b. 30 mm Hg
c. 50 mm Hg
d. 90 mm Hg
Solution. Ans-10 : (a) 15 mm Hg
Sol :
The closed tube can be opened against a pressure difference of 10-15 mm Hg.
However, when the difference in pressure between the middle ear and the atmosphere is 90 mm Hg or more, the Eustachian tube can
no longer be opened by swallowing.
Correct Answer. a
(11).
Narrowest part in infants respiratory tract is?

a. Subglottis
b. Glottis
c. Carina
d. None of these
Solution. Ans-11: (a) Subglottis
Ref.: Readthe text below
Sol :
Infants larynxis small and conical.
The diameter of cricoids cartilage is smaller than the size of glottis, making subglottis the narrowest part.
It has a bearing in the selection of paediatricendotracheal tube
Correct Answer. a
5/79
(12).
Lower limit of Hypo-pharynx is?

a. Lower border of cricoids Cartilage
b. Upper border of corticoid cartilage
c. Upper border of thyroid cartilage
d. Lower border of thyroid cartilage
Solution. Ans-12: (a) Lower border of cricoids Cartilage
Sol :
Divisions of Pharynx
Division of Pharynx
Superior border
Inferior border
Nasopharynx/ epipharynx
Base of the skull
Soft palate anteriorly, deficient posteriorly

(nasopharyngeal isthmus)
Oropharynx
Plane of hard palate
Plane of hyoid bone
Hypopharynx
Plane passing from the body of hyoid bone to

posterior pharyngeal wall
Lower border of criocoid cartilage
Correct Answer. a
(13).
High tracheostomy is indicated in?

a. Carcinoma
b. TB
c. Tetanus
d. Diphtheria
Solution. Ans-13: (a) Carcinoma
Sol :
High tracheostomy is indicated in malignant cases where we require actual site for permanent tracheostomy
Correct Answer. a
(14).
Tobey Ayer test is positive in?

a. Lateral sinus thrombosis
b. Petrositis
c. Cerebral abscess
d. Subarachnoid haemorrhage
Solution. Ans-14: (a) Lateral sinus thrombosis
Sol :
LATERAL SINUS THROMBOPHLEBITIS
Inflammation with subsequent thrombus formation of the sigmoid and/or transverse sinus
Picket fence spiking fevers
Griesingers sign(pain over mastoid from occlusion of the mastoid emmisary vein)
Tobey-Ayer or Queckenstedts test(normally external compression of jugular vein results in a rapidincrease in CSF pressure of
50100 mm Hg, compression on theside of lateral sinus thrombosis results in a slow rise or no rise inCSF pressure secondary to
obstruction
Parenteral antibiotics and possible surgical exploration via a mastoidectomy, may require ligation of internal jugular vein
recalcitrant disease.
Correct Answer. a
6/79
(15).
Ayers T piece is :
a. Mapelson A circuit
b. Mapelson B circuit
c. Mapelson D circuit
d. Mapelson E circuit
Solution. Ans-15: (d) Mapelson E circuit
Sol :
The Mapleson E is a modificationof Ayre s T-piece, which was developed in 1937 by Phillip Ayre for use in paediatric patients
undergoing cleft palate repair or intracranial surgery.
Correct Answer. d
(16).
Which of the following is a pleasant anesthetic agent preferred for inhalation mask anaesthesia in children?
a. Sevolfurane
b. Desflurane
c. Isoflurane
d. Enflurane
Solution. Ans-16: (a) Sevolfurane
Sol :
Sevoflurane, with low bloodgas solubility allows rapid induction and early emergence.
Due to its pleasant odor, it is non irritant to the airway which makes it an attractive alternative for inhalational induction in children.
An area where sevoflurane might be expected to find increasing use is that of laryngeal mask airway (LMA) insertion which is
becoming more frequent in paediatric ambulatory surgery as this avoids some of the hazards of endotracheal intubation.
Correct Answer. a
(17).
Which is not a feature of the ebb and flow model?

a. Decreased basal metabolic rate
b. Decrease in blood pressure
c. Increase in cardiac output
d. Hypothermia
Solution. Ans-17: (c) Increase in cardiac output
Sol :
The Ebb phase is characterized by hypovolemia, decreased basal metabolic rate, reduced cardiac output, hypothermia and lactic
acidosis.
The predominant hormones regulating the Ebb phase are catecholamines, cortisol and aldosterone (following the activation of the
rennin angiotensin system).
The magnitude of this neuroendocrine response depends on the degree of blood loss and the stimulation of somatic afferent nerves at
the site of injury.
Correct Answer. c
7/79
(18).
Maximum O2 that can be delivered in non-intubated patient is by:

a. Venturi mask
b. Nasal prongs
c. Both A and C equal
d. ETT
Solution. Ans-18: (a) Venturi mask
Sol :
Maximum 02 that can be delivered in non-intubated Patient by venture mask/oxygen mask is 60%
Maximum 02 that can be delivered by nasal canula is 44%.
Correct Answer. a
(19).
Portion of middle ear around the tympanic orifice of the eustachian tube is:
a. Mesotympanum
b. Epitympanum
c. Hypotympanum
d. Protympanum
Solution. Ans-19: (d) Protympanum
Ref:Read the text below
Sol :
Middle ear is sometimes divided into
Mesotympanum (opp. the pas tensa)
Epitympanum(attic) above the pas tensa
Hypotympanumbelow the pas tensa
Protympanum portion of middle ear around the tympanic orifice of the eustachian tube
Narrowest part of middle ear: mesotympanum
Widest part of middle ear: Epitympanum
Correct Answer. d
8/79
(20).
Mulberry shaped polypoidal mass is seen in

a. Rhinosporidiosis
b. Rhinoscleroma
c. Rhinophyma
d. Inferior turbinate hypertrophy
Solution. Ans-20: (a) Rhinosporidiosis

Sol :
Rhinosporidiosis
Organism : Rhinosporidium seeberi
Distribution:India (Southern parts), Sri lanka
Sites of Affection:
1. Most commonly: Nose and Nasopharynx
Mulberry shaped polypoidal massstudded with white dots or sporangia on its under surface.
Site: Vestibule (septal area)
Treatment:
Complete excision of the mass with a cutting diathermy and cauterization of its base.
Medical management: Local injection of corticosteroids and courses of dapsone and amphotericin.
Correct Answer. a
(21).
Aspergillosis is most commonly caused by

a. A.Fumigatus
b. A.Niger
c. A.Flavus
d. None
Solution. Ans-21: (a) A.Fumigatus
Sol :
Aspergillosis:
Aspergillosis: is the commonest fungal infection of the nose & sinuses
1. Frequency: A. Fumigatus (90%) > A. niger & A. flavus
Correct Answer. a
(22).
Chondromas are most commonly seen in:

a. Cricoid
b. Thyroid
c. Arytenoid
d. Epiglottis
Solution. Ans-22: (a) Cricoid
Sol :
Chondromas
More common in men
Pathophysiology: most commonly arise from internal posterior cricoid cartilage (hyaline cartilage), may also arise from thyroid,
arytenoid, epiglottic cartilage (fibroelastic)
SSx: insidious hoarseness from vocal fold restriction, dyspnea for subglottic lesions, dysphagia for posterior cricoid lesions, globus
sensation
Dx:endoscopic wedge biopsy, CT of neck (calcification)
Rx: complete excision via an endoscopic or external approach (depending on the size of lesion)
Correct Answer. a
9/79
(23).
Congenital displacement of the pinna is:

a. Coloboma lobuli
b. Melotia
c. Scroll ear
d. Cleft pinna
Solution. Ans-23: (b) Melotia
Sol :
Anotia
Congenital absence of pinna
Cleft pinna
Congenital fissure of the pinna
Coloboma lobuli
Congenital fissure of the earlobe
Macrotia
Congenital excessive enlargement of the auricle
Microtia
Congenital small pinna
Melotia
Congenital displacement of the pinna
Low-set-ears
Congenitally displaced pinna
Polyotia
Additional pinna on one or both sides
Preauricular tags
Small appendage anterior to pinna
Scroll ear
Rim (helix) of pinna is rolled forward and inward
Correct Answer. b
(24).
Tonsillectomy is indicated in all, except

a. Quinsy
b. Atrophic tonsillitis
c. Polio epidemic
d. Recurrent acute tonsillitis
Solution. Ans 24: (c) Polio epidemic
Ref Read the text below
Sol:
Indications
Recurrent acute tonsillitis.

Two or more episodes of peritonsillar abscess quinsy or tonsillitis requiring hospital admission
Suspected neoplasm (unilateral enlargement or ulceration)
Airway obstruction in obstructive sleep apnoea
Contraindications
Episode of tonsillitis within 2 weeks

Bleeding disorder
Cleft palate
During polio epidemics
Correct Answer. c
10/79
(25).
Secondary haemorrhage in tonsillectomy operation occurs

a. Within 8 hours on the day of operation
b. At the time of surgery
c. Between 5-7 days after operation
d. 2-3 days after.
Solution. Ans 25: (c) Between 5-7 days after operation
Sol:
Complications of Tonsillectomy:
1. Peroperative bleeding:. Primary Haemorrhage
2. Reactionary haemorrhage(venous bleed)
(occurs within 24 hrs of surgery)
Causes: - Slippage of ligature
Treatment:
Bleeder ligated G.A.
3. Secondary haemorrhage(bleeding after 24 h post op)
Occurs at: 6-8 days
Treatment:
Systemic antibiotics
Any blood clot removed
Pressure pack with 1: 1000
Correct Answer. c
(26).
Blue drum is seen in

a. Tympanosclerosis
b. Secretory otitis media
c. Otosclerosis
d. Myringitis bullosa
Solution. Ans 26: (b) Secretory otitis media
Sol:
Appearance of the ear drum in various diseases:
The normal ear drum is pearly white in color. In pathological states this color of the drum may change.
Red drum: Is seen in acute otitis media and in glomus jugulare.. In acute suppurative otitis media discharge may be seen extruding
from a small perforation in the pars tensa portion of the ear drum. This is known as the light house sign.
Blue drum: is commonly seen in secretory otitis media, high jugular bulb etc.
Correct Answer. b
11/79
(27).
LAM is related with:

a. Laser Assisted Myringoplasty
b. Laser Assisted Myringotomy
c. Laser Assisted Meatoplasty
d. Laser Assisted Mastoidectomy
Solution. Ans 27: (b) Laser Assisted Myringotomy
Ref-Read the text below
Sol:
LAM-Laser Assisted Myringotomy
Laser Assisted Myringotomy, sometimes referred to as OtoLAM, for OtoScan Laser Assisted Myringotomy (OtoScan is the tradename
of one of the otoscope-mounted systems used), is a treatment that utilizes a laser to create the hole in the eardrum rather than using a
surgical incision.
The laser technique is less invasive than surgical incision and can be performed in an office setting or outpatient clinic using only
topical anesthesia. With the aid of a specialized CO2 laser system, the procedure creates a precisely sized hole in the tympanic
membrane that remains open for several weeks.
During this time, the middle ear stays ventilated, providing fast relief from otitis media related pain and allowing the underlying
infection time to resolve.
If more time is needed for resolution, tubes can easily be inserted into the bloodless hole, although at the expense of increasing
invasiveness over just the laser technique alone. Clinical studies found that 60% of the cases resolved after a single OtoLAM treatment
and clearing the underlying infection helps prevent recurring episodes of otitis media.
Correct Answer. b
(28).
Local anaesthetic solution used to produce extradural anaesthesia is:

a. Bupivacaine
b. Ropivacaine
c. Cocaine
d. Procaine
Solution. Ans 28: (a) Bupivacaine
Sol:
Local anaesthetic solutionsare deposited in the epidural space between the dura mater and the periosteum lining the vertebral
canal. The epidural space contains adipose tissue, lymphatics and blood vessels. The injected local anaesthetic solution produces
analgesia by blocking conduction at the intradural spinal nerve roots.
The quality and extent of the blockade produced by each agent is determined by the volume as well as the total dose of the drug. The
spread of local anaesthetic solutions may be more extensive ipregnant women as the volume of the potential space is reduced by venous
engorgement in the epidural space. Enhanced effects may also be seen in the elderly and in patients with arteriosclerosis due to
impairment of vascular absorption from the epidural space.
Bupivacaine (0.5%) or lignocaine (1.5-2.0%) are usually used to produce extradural anaesthesia. Repeated administration of
lignocaine or mepivacaine into the epidural space may result in a diminished response with each subsequent dose (tachyphylaxis). This
may be due to local changes in pH due to the relative acidity of these solutions. The reduction in pH may reduce the amount of free base
available for diffusion across the neuronal membrane
Correct Answer. a
12/79
(29).
Commonest indication for myringotomy is

a. Myringitis bullosa
b. Serous otitis media
c. Middle ear defect
d. Mastoiditis
Solution. Ans 29: (b) Serous otitis media
Sol:
Myringotomy is a surgical procedure in which a tiny incision is created in the eardrum, so as to relieve pressure caused by the
excessive build-up of fluid, or to drain pus.
Myringotomy is often performed as a treatment for otitis media.

Correct Answer. b
(30).
The length of Eustachian tube is

a. 16mm
b. 24mm
c. 36mm
d. 40mm
Solution. Ans 30: (c) 36mm
Sol:
The Eustachian tube (or auditory tube or pharyngotympanic tube) is a tube that links thepharynx to the middle ear. In adults the
Eustachian tube is approximately 35 mm long.
Embryologic development
The Eustachian tube is derived from the first pharyngeal pouch, which during embryogenesis forms a recess called the tympanic
membrane. The distal part of the tubotympanic sulcus gives rise to the tympanic cavity, while the proximal tubular structure becomes the
Eustachian tube.
Muscles
There are four muscles associated with the function of the Eustachian tube:
Levator veli palatini (innervated by the vagus nerve)
Salpingopharyngeus (innervated by the vagus nerve)
Tensor tympani (innervated by the mandibular nerve of CN V)
Tensor veli palatini (innervated by the mandibular nerve of CN V)

Correct Answer. c
(31).
The commonest cause of conductive deafness in children is

a. Secretory otitis media
b. Otosclerosis
c. Congenital Stapedial fixation
d. Trauma
Solution. Ans 31: (a) Secretory otitis media
Sol:
Secretory otitis media is an accumulation of fluid in the middle ear.
Secretory (serous) otitis media can develop from acute otitis media that has not completely cleared or from a blocked eustachian
tube (which connects the middle ear and the back of the nose).
Secretory otitis media is the commonest cause of conductive deafness in children
Allergies are a common cause of eustachian tube blockage.

Correct Answer. a
13/79
(32).
In conductive deafness Webers test is lateralized to

a. Deaf ear
b. Normal ear
c. Both ears
d. Any of the above.
Solution. Ans 32: (a) Deaf ear
Sol:
The Weber test is a quick screening test for hearing. It can detect unilateral (one-sided) conductive hearing loss and unilateral
sensorineural hearing loss.
Detection of conductive hearing loss
A patient with a unilateral conductive hearing loss would hear the tuning fork loudest in the affected ear. This is because the
conduction problem masks the ambient noise of the room, whilst the well-functioning inner ear picks the sound up via the bones of the
skull causing it to be perceived as a louder sound than in the unaffected ear.
Detection of sensorineural hearing loss
A patient with a unilateral sensorineural hearing loss would hear the sound louder in the unaffected ear, because the affected ear is
less effective at picking up sound even if it is transmitted directly by conduction into the inner ear.
Correct Answer. a
(33).
Pre-medication with the following causes tachycardia, flushing of face and hyperthermia in children:
a. Atropine
b. Chlorpromazine
c. Glycopyrrolate
d. Clonazepam
Solution. Ans 33: (a) Atropine
Sol:
Atropine, a parasympatholytic, causes tachycardia and at high doses causes sweating inhibition, hyperthermia (=Atropine fever) and
flushing of face.
Children are especially more susceptible for the vascular effects of atropine.
Correct Answer. a
(34).
Use of pre-operative morphine is all of the following except:

a. Decrease anxiety
b. Produce analgesia
c. Cause sedation
d. Cause muscle relaxation.
Solution. Ans 34: (d) Cause muscle relaxation
Sol:
The main use of pre-operative morphine is to provide good analgesia.
Additional benefits of morphine are sedation and decreased apprehension and anxiety.
Correct Answer. d
14/79
(35).
Which of the following is an anti-emetic used in the pre-operative period :

a. Atropine
b. Hyoscine
c. Glycopyrrolate
d. Homatropine
Solution. Ans 35: (b) Hyoscine
Sol:
Out of all the anticholinergics mentioned, only Hyoscine has additional anti-emetic and amnesic effects.
Correct Answer. b
(36).
Which of the following fibers participates in high-frequency pain transmission?

a. Type A delta and C fibers
b. Type A alpha fibers
c. Type B fibers
d. Type A beta fibers
Solution. Ans 36: (a) Type A delta and C fibers
Sol:
A delta fibers, or A fibers, are a type of sensory fiber. They are associated with cold and pressure, and as nociceptors they convey fast
pain information.
They are thinly myelinated, so conduct signals more rapidly than unmyelinated C fibers, but more slowly than other, more thickly
myelinated "A" class fibers.
Because of their higher conduction velocity, A fibers are responsible for the sensation of a sharp first pain. They respond to a
weaker intensity of stimulus. C fibers, however, respond to a stronger intensity of stimulus and are responsible for the slow, dull, longerlasting, second pain.
C fibers are considered polymodal because they can respond to thermal, mechanical, and chemical stimuli.C fibers respond to all kinds of
physiological changes in the body. For example, they can respond to hypoxia, hypoglycemia, hypo-osmolarity, the presence of muscle
metabolic products, and even light or sensitive touch.C fiber receptors include:
C fiber nociceptors
o Responsible for the second, burning pain
C fiber warming specific receptors
o Responsible for warmth
Ultra-slow histamine-selective C fibers
o Responsible for itch
Tactile C fibers
o Sensual touch
C mechano- and metabo- receptors in muscles or joints
o Responsible for muscle exercise, burn and cramp
Correct Answer. a
15/79
(37).
Which of the following local anesthetics is an useful antiarrhythmic agent?

a. Cocaine
b. Lidocaine
c. Bupivacaine
d. Ropivacaine
Solution. Ans 37: (b) Lidocaine
Sol:
Lidocaine is a common local anesthetic and antiarrhythmic drug. Lidocaine is used topically to relieve itching, burning and pain from
skin inflammations, injected as a dental anesthetic or as a local anesthetic for minor surgery.
Lidocaine alters signal conduction in neurons by blocking the fast voltage gated sodium (Na+) channels in the neuronal cell
membrane, which are responsible for signal propaga
tion.
With sufficient blockade, the membrane of the postsynaptic neuron will not depolarize and so fail to transmit an action potential,
leading to its anaesthetic effects.
Correct Answer. b
(38).
Mayer and Overton postulated that anesthetic potency is related to

a. Direct effect on cellular colloids
b. Effects on cellular permeability
c. Lipid solubility
d. Inhibition of oxidative enzyme system
Solution. Ans 38: (c) Lipid solubility
Sol:
Mayer and overton founda direct relationship between lipid solubility of the general anesthetic and its anesthetic potency.
The more an agent is lipid soluble, the more it crosses all (lipophilic) membranes, cross BBB and produce CNS effects
Correct Answer. c
(39).
The duration of action of lignocaine would be increased in the presence of

a. Acetylcholine
b. Epinephrine
c. Pseudocholinesterase
d. Nitroglycerine
Solution. Ans 39: (b) Epinephrine
Sol:
Adrenaline causes vasoconstriction, so decreases rate of removal of lignocaine from the deposited site.
Therefore, addition of adrenaline, increases duration of L.A. action and decreases adverse effects of lignocaine.
Adrenaline should never be used in organs of end-arteries e.g. penis, finger, nose, ear-pinna.
Correct Answer. b
16/79
(40).
A patient who has an untreatable hepatic carcinoma must undergo foot surgery. All of the following local anesthetic agents may be
deleterious to this patient based on his history, except
a. Lidocaine
b. Mepivacaine
c. Procaine
d. Etidocaine
Solution. Ans 40: (c) Procaine
Sol:
Procaine, an ester linked local anesthetic, is metabolized in plasma by pseudocholinesterase.
Lidocaine, mepivacaine, and etidocaine are amides, so metabolized in the liver by microsomal mixed-function oxidases.
Thus, procaine would be the anesthetic agent of choice, as in this patient hepatic function impairment is there. (Procaine does not
require liver enzymes to be metabolized)
Correct Answer. c
(41).
A patient with pseudocholinesterase deficiency requires minor surgery. A local anesthetic will be used. The choice of an anesthetic agent
will depend on all of the following factors, except
a. Procaine should not be used in the patient because a psuedocholinisterase deficiency would lengthen its duration of action
b. Tetracaine should not be used because it is most commonly used for spinal anesthesia.
c. Dibucaine would be contraindicated since it is a surface anesthetic.
d. Although cocaine has abuse potential, because it is metabolized in the liver, it would be of therapeutic value in this case.
Solution. Ans 41: (d) Although cocaine has abuse potential, because it is metabolized in the liver, it would be of therapeutic value in this
case.
Sol:
Cocaine is an ester linked local anesthetic like procaine. It is also metabolized via ester hydrolysis in the blood by pseudocholinesterase and is not metabolized in the liver.
Therefore, cocaine should not be used in this patient with cholinesterase deficiency.
Correct Answer. d
(42).
Impairment of hearing due to noise starts at

a. 1000 Hz
b. 2000 Hz
c. 3000 Hz
d. 4000 Hz
Solution. Ans 42: (d) 4000 Hz
Sol:
Noise trauma: Can be divided into 2 types
(1) Acoustic Trauma - It is caused by a single brief exposure to very intense sound. May damage outer hair cells, disrupt organ of corti &
rupture the Reissner's membrane. A severe blast may rupture TM & disrupt ossicular chain
(2) Noise Induced HL - It is caused by chronic exposure to less intense sound
(a) Temporary threhold shift - The hearing is impaired immediately after exposure to noise but recovers after an interval of a few minutes
to a few hours
(b) Permanent threshold shift - Hearing impairment is permanent
A noise of 90dB(A) SPL, 8hrs a day for 5 days per week is the maximum safe limit
The audiogram of NIHL shows a typical notch at 4khz, both for AC & BC. It is usually symmetrical on both sides. NIHL causes
damage to hair cells, starting in the basal turn of cochlea. Outer hair cells are affected before the inner hair cells
Ear plugs or muffs provide protection upto 35dB

Correct Answer. d
17/79
(43).
A negative Rinnes test indicates the presence of

a. Profound Sensorineural hearing loss
b. Conductive hearing loss
c. Recuitment
d. None of the above
Solution. Ans 43: (b) Conductive hearing loss
Sol:
Rinnie Test:
In this AC. of the ear is compared with its BC.
It is +ve when AC > BC ( normal / SN deafness ).
If -ve Rinne BC > AC in conductive deafness
False -ve rinne : Severe unilateral SNHL.

Correct Answer. b
(44).
Para-sympathetic fibres of the sublingual salivary gland are found in

a. Facial nerve
b. Glossopharyngeal nerve
c. Vagus nerve
d. Hypoglossal nerve
Solution. Ans 44: (a) Facial nerve
Sol:
The parasympathetic aspect of the facial nerve controls secretion of the sublingual and submandibular salivary glands, the lacrimal
gland, and the glands associated with the nasal cavity.
The preganglionic fibers originate within the CNS in the superior salivatory nucleus and leave as the intermediate nerve (which
some consider a separate cranial nerve altogether) to connect with the facial nerve just distal (further out) to it surfacing the CNS. Just
after the facial nerve geniculate ganglion (general sensory ganglion) in the temporal bone, the facial nerve gives off two separate
parasympathetic nerves. The first is the greater petrosal nerve and the second is the chorda tympani.
The greater petrosal nerve travels through the middle ear and eventually combines with the deep petrosal nerve (sympathetic fibers)
to form the nerve of the pterygoid canal. The PSN fibers of the nerve of the pterygoid canal synapse at the pterygopalatine ganglion,
which is closely associated with the maxillary division of the trigeminal nerve (CN V2).
The postganglionic PSN fibers leave the pterygopalatine ganglion in several directions.One division leaves on the zygomatic division
of CN V2 and travels on a communicating branch to unite with the lacrimal nerve (branch of the ophthalmic nerve of CN V1) before
synapsing at the lacrimal gland. These PSN to the lacrimal gland control tear production.
Correct Answer. a
18/79
(45).
Which of the following induction agent supress steroidogenesis

a. Thiopental
b. Propofol
c. Ketamine
d. Etomidate
Solution. Ans-45: (d) Etomidate
Ref: Lippincott's Illustrated Reviews: Pharmacology, 4th Edition pg 137.
Sol:
Etomidateis used to induce anesthesia.
It is a hypnotic agent but lacks analgesic activity.
Its water solubility is poor, so etomidate is formulated in a propylene glycol solution. Induction is rapid, and the drug is short-acting.
It is only used for patients with coronary artery disease or cardiovascular dysfunction, such as shock.
Etomidate is hydrolyzed in the liver.
Among its benefits are little to no effect on the heart and circulation. Its adverse effects include a decrease in plasma cortisol and
aldosterone levels, which can persist for up to 8 hours. This is apparently due to inhibition of 11--hydroxylase.
Etomidate should not be infused for an extended time, because prolonged suppression of these hormones can be hazardous.
Venous pain can occur, and skeletal muscle movements are not uncommon.
The latter are managed by administration of benzodiazepines and opioids.

Correct Answer. d
(46).
Patient with liver disease and Mitral Stenosis posted for surgery. All should not be given for induction of anesthesia except
a. Halothane
b. Enflurane
c. Xenon
d. Sevoflurane
Solution. Ans-46: (c) Xenon
Ref: Morgan Clinical Anesthesiology4th ed.
Sol:
Clinical Pharmacology of Inhalational Anesthetics.
Nitrous Oxide
Halothane
Isoflurane
Desflurane
Sevoflurane
Decrease
Decrease
Decrease
Decrease
Hepatic
Blood flow
Advantages and Disadvantages of Xenon (Xe) Anesthesia.

Advantages
Inert (probably nontoxic with no metabolism)
Minimal cardiovascular effects
Low blood solubility
Rapid induction and recovery
Does not trigger malignant hyperthermia
Environmentally friendly
Nonexplosive
Disadvantages
High cost
Low potency (MAC = 70%)
No commercially available anesthesia equipment
Correct Answer. c
19/79
(47).
Pin index of nitrous oxide cylinder is

a. 2, 5
b. 3, 6
c. 3, 5
d. 1, 6
Solution. Ans-47: (c) 3, 5
Ref: Read the text below
Sol :
In order to ensure that the correct cylinder is attached to the yoke of the anesthetic machine a series of pins on the machine yoke is
made to fit an identical pattern of indentations of the cylinder. This is called the Pin-index system.
Pin Index system
Oxygen
2 and 5
Nitrous oxide
3 and 5
Entonox
Carbon dioxide
1 and 6
Cyclopropane
3 and 6
Air
1 and 5
Correct Answer. c
(48).
The triad of General Anesthesia include all the following except

a. Controlled hypotension
b. Analgesia
c. Amnesia
d. Muscle relaxation
Solution. Ans-48: (a) Controlled hypotension
Ref: KD Tripathi-365.
Sol :
THE CARDINAL FEATURES OF GENERAL ANESTHESIA ARE :
Loss of all sensation (especially pain, analgesia).
Sleep (unconsciousness) and amnesia.
Immobility and muscle relaxation.
Abolition of somatic and autonomic reflexes.
Correct Answer. a
20/79
(49).
International color code of helium cylinder is

a. Green
b. Black
c. Brown
d. White and black
Solution. Ans-49: (c) Brown
Ref: Understanding Anesthesia - 68.
Sol :
COLOR OF MEDICAL GAS CYLINDERS
Oxygen
Black body with white shoulder
Nitrous oxide
Blue
Entonox
Blue body with white/blue quartered shoulders
Cyclopropane
Orange
Ethylene
Red
Halothane bottle Amber

Helium
Brown
Air (medical)
Grey with white and black valve
Carbon dioxide
Grey with grey valve
Correct Answer. c
(50).
pH of the Thiopentone Na is
a. 11.5
b. 10.5
c. 9.5
d. 8.5
Solution. Ans-50: (b) 10.5
Ref: Pharmacology for Anesthesia and Intensive Care-104.
Sol :
Thiopentone is the sulphur analog of the oxybarbiturate pentobarbitone. It is formulated as the sodium salt and presented as a pale
yellow powder. The vial contains sodium carbonate and nitrogen in place of air.
These two measures are designed to improve the solubility of the solution. Sodium carbonate reacts with water forming sodium
bicarbonate resulting in a strongly alkaline solution (pH 10.5) favoring the water soluble enol form which is more desirable as
preparation.
The 2.5% solution is stable for many days and should be bacteriostatic due to its alkaline pH.
Correct Answer. b
21/79
(51).
Adverse effects of central neuraxial block include all of following except

a. Tachycardia
b. Hypotension
c. Nausea and vomiting
d. Urinary retention
Solution. Ans-51: (a) Tachycardia
Ref: Lees Anesthesia, 13th edn. Pg. 477, 506-523
Sol :
Central neuraxial blockade is commonly use for abdominal perineal, gynecological and lower limb surgeries.
It offers excellent anesthesia and fewer side effects than general anesthesia.
Central neuraxial blockade is obtained by :
Spinal (intradural) anesthesia.
Extradural (epidural) anesthesia.
Combined intradural and extradural anesthesia.
Continuous spinal (intradural) anesthesia.
Correct Answer. a
(52).
In anesthesia sodalime is used in the following

a. In oxygen concentrators
b. In breathing circuits to absorb CO2
c. In vaporizers
d. The treatment of acidosis
Solution. Ans-52: (b) In breathing circuits to absorb CO2
Ref: Ajay Yadav-29-30
Sol :
Soda lime is mixture of 94% calcium hydroxide and 5% sodium hydroxide, and 1% potassium hydroxide, which reacts with CO2 to form
calcium carbonate.
Soda lime also contains small amounts of silica to make the granules less likely to disintegrate into powder and a chemical dye which
change color with pH.
As more CO2 is absorbed the pH decrease and the color of the dye changes from pink to yellow/white (Clayton yellow-pH indicator).
Size of granules 4-8 mesh (i.e. granules - 1/8 inch in diameter); 50% of volume of canister is granules, 50% is air. Pack tightly to
avoid chanelling.
Fresh soda lime contains 35% water by weight, which is necessary for the reaction between carbon dioxide and soda lime to take
place.
This generates considerable heat. The soda lime may rise in temperature to 40C. This rewarms the gases within the circle systems.
Correct Answer. b
22/79
(53).
Supine hypotension syndrome is commonly encountered in

a. High spinal anesthesia
b. Total spinal anesthesia
c. LSCS under spinal anesthesia
d. Diabetics undergoing surgery
Solution. Ans-53: (c) LSCS under spinal anesthesia
Ref: Bailey and Loves, 25th edn. Pg. 1387.
Sol :
If a pregnant patient lies in supine position, gravid uterus can compress the IVC and aorta decreasing the cardiac output and blood
pressure which leads to supine hypotension syndrome and this causes severe hypotension or even cardiac arrest after spinal anesthesia.
To prevent this, patient should be in leftlateral position. This can be accomplished by :
Putting a wedge under the right buttock.
Tilting the delivery table by 15 degrees to the left.
Manually displacing the uterus to the left.
Regional anesthesia is preferred over GA for cesarean section.

Correct Answer. c
(54).
40 year old man met motor vehicle catastrophe came to hospital in an hour severe maxillo facial trauma PR 120 / min BP - 100 / 70 mm
hg sPo2 - 80% with oxygen . which was the immediate management required
a. Intravenous acess
b. Orotracheal intubation
c. Naso tracheal intubation
d. Tracheostomy
Solution. Ans-54: (d) Tracheostomy
Ref:Sabiston Textbook of Surgery, 18thed
Sol:
After all critical issues in the primary survey have been addressed, a full head-to-toe secondary survey is undertaken, with the goal
of carefully examining the entire patient and identifying all injuries. The primary survey is conducted according to the mnemonic ABCDE:
airway, breathing, circulation, disability, exposure.
Airway
The crucial first step in managing an injured patient is securing an adequate airway.
Mechanical removal of debris and the chin-lift or jaw-thrust maneuver, both of which pull the tongue and oral musculature forward
from the pharynx, are often useful in clearing the airway of less severely injured patients.
However, if there is any question about the adequacy of the airway, if there is evidence of severe head injury, or if the patient is in
profound shock, more definitive airway control is necessary and appropriate.
In the majority of patients this is accomplished by endotracheal intubation.
Endotracheal intubation must be donerapidly, under the assumption of cervical spine instability, and in a fashion that does not
induce increased intracranial pressure (ICP) in patients with head injury.
Intubation is best accomplished by a technique borrowed from surgical anesthesia, known as rapid-sequence induction.
In rapid-sequence induction the patient is given a fast-acting anesthetic agent, followed by a neuromuscular blocking agent.
This combination of deep sedation andmuscular relaxation allows careful intubation without cervical hyperextension and with
minimal physiologic impact.
The technique can be used with a number of different pharmacologic agents, depending on the knowledge and preferences of the
individual practitioner. It is incumbent on the individual responsible for the procedure to be fully aware of the dosage, risks, and
indications associated with the agents chosen.
Excessive ventilation must be avoided after intubation, particularly in a hypovolemic patient because excessive ventilation will
increase mean intrathoracic pressure and compromise cardiac filling.
Although nasotrachealintubation had been widely suggested as a central modality for emergency airway control in the past, it should
now be used only rarely in the initial management of an injured patient.
Nasotracheal intubationhas a number of drawbacks, and the goal of safe endotracheal intubation with cervical spine precautions can
better be accomplished by orotracheal intubation after rapid-sequence induction.
In a few patients endotracheal intubation is either impractical or impossible, and a surgical airway is required.
Indications for a surgical airway include massive maxillofacial trauma, anatomic distortion as a result of neck injury, and inability to
visualize the vocal cords because of the presence of blood, secretions, or airway edema.
Cricothyroidotomy is the preferred emergency procedure in the majority of circumstances.
Actual tracheotomy may be indicated in select patients, such as those with laryngeal injuries.
Either surgical procedure may be preceded by needle cricothyroidotomy with jet insufflation to improve oxygenation and allow the
surgical procedure to be performed in more orderly fashion.
Correct Answer. d
23/79
(55).
What is the reason that an infant can breathe while suckling breast milk
a. Small wide tongue
b. High place larynx
c. Small pharynx
d. Short soft palate
Solution. Ans-55: (b) High place larynx
Sol:
The newborns larynx is located so much higher in its throat than that of an adult that the opening (covered by the epiglottis) is
above the stream of milk and the baby can breathe and eat at the same time without choking.
At about three years of age, the larynx moves down into the throat along with the back of the tongue which is fastened to it
Correct Answer. b
(56).
Opioid effects on respiratory rate and rhythm include all the following except
a. Decreased respiratory rate
b. Irregular respiratory rate
c. Cheyne-Stokes breathing patterns
d. Increased respiratory pauses
Solution. Ans-56: (c) Cheyne-Stokes breathing patterms
Ref:Read the text below.
Sol:
A Cheyne-Stokes respiratory pattern consists of periods of increasing hyperventilation alternating with apnea. The rate of ventilation
increases markedly and then declines until apnea occurs.
This pattern repeats in a rhythmic fashion.
Cheyne-Stokes respiration usually occurs after a cerebral anoxic event and reflects brain damage. Opioids do not cause this respiratory
pattern.
Correct Answer. c
(57).
Factors that increase the magnitude of opioid-induced respiratory depression include all the following except
a. Increased age
b. Concomitant use of benzodiazepines
c. Decreased hepatic blood flow
d. Increased clearance with decreased volume of distribution
Solution. Ans-57: (d) Increased clearance with decreased volume of distribution
Sol:
An increased clearance with a decreased volume of distribution will decrease the half-life of any opioid and, therefore, all the opioids
properties will be of shorter duration including respiratory depression.
When opioids are combined with any other respiratory depressant, the effects are synergistic. In addition the magnitude of respiratory
depression will increase with bolus injections of narcotics, increased age, and decreased hepatic blood flow.
Correct Answer. d
24/79
(58).
Adequate anesthesia for surgical incision is least likely to be provided by

a. 0.5% halothane in 66% nitrous oxide/33% O2
b. 1.0% halothane in 100% O2
c. 0.5% isoflurane in 70% nitrous oxide/30% O2
d. 1.0% isoflurane in 100% O2
Solution. Ans-58: (d) 1.0% isoflurane in 100% O2
Sol:
MAC for halothane is 0.77% in 100% O2and 0.3% in 66% nitrous oxide/33% O2.
MAC for isoflurane is 1.15% in 100% O2 and 0.5% in 70% nitrous oxide.
Correct Answer. d
(59).
Which of the following inhaled agents has been shown to be mutagenic in humans ?
a. Enflurane
b. Halothane
c. Isoflurane
Solution. Ans-59: (d) None of the above
Sol:
No inhaled agents havebeen shown to be mutagenic in humans. Halothane and nitrous oxide have been found to be weakly mutagenic
in in vitro testing.
Correct Answer. d
(60).
CNS toxicity of local anesthetics is thought to be due to

a. Direct stimulation of seizure foci in the cerebral cortex
b. Depression of the cardiovascular system
c. Direct stimulation of excitation neurons in the cerebral cortex
d. Depression of inhibitor fibers in the cerebral cortex, which leads to unopposed facilitory neurons
Solution. -NACorrect Answer. d
25/79
(61).
During cardiopulmonary resuscitation, external defibrination should be done with

a. 10 joules
b. 50 joules
c. 100 joules
d. 200 joules
Solution. Ans-61: (c) 100 joules
Ref.:Davidsons, 20th edn. Pg. 557 and Fig 18.33
Sol :
Advanced life support (ALS) aims to restorenormal cardiac rhythm by defibrillation when the cause of cardiac arrest is due to a
tachyarrhythmia, or to restore cardiac output by correcting other reversible causes of cardiac arrest.
If cardiac arrest is witnessed, a precordial thump may sometimes convent ventricular fibrillation (VF) or tachycardia(VT) to normal
rhythm, but this is futile if cardiac arrest has lasted longer than few seconds.
The priority is to assess the patients cardiac rhythm by attaching a defibrillator/monitor. VF or pulseless VT is treated with immediate
defibrillation.
During cardiopulmonary resuscitation, external defibrination should be done with biphasic shock of 100 joules or 200 joules of
monophasic shock.
Correct Answer. c
(62).
Histamine release is one of the common features with the administration of

a. Atracurium
b. Adrenaline
c. Thiopentone
d. Ketamine
Solution. Ans-62: (a) Atracurium
Ref.:KD Tripathi, 6th edn. Pg. 343, 345
Sol :
Atracurium
At body temperature and pH, atracurium undergoes spontaneous degradation via Hoffmann elimination and is therefore stored at 4C
to reduce the rate of spontaneous degradation; major metabolite is landanosine, which is a CNS stimulant.
It is the non depolarizing muscle relaxant of choice in patients with hepatic or renal (anephric) dysfunction.
It is suitable for patients with atypical cholinesterase; organophosphorus poisoning, and in myasthenia gravis.
Its actions will be prolonged in hypothermic patients, e.g. during cardiac surgery.
Histamine release occurs causing flushing of skin. Also contraindicated in asthmatics.
Correct Answer. a
(63).
One of the following is an intravenous induction agent

a. Desflurane
b. Atracurium
c. Midazolam
d. Promethazine
Solution. Ans-63: (c) Midazolam
Ref.:KD Tripathi, 6th edn. Pg. 376
Sol :
Intravenous midazolamis indicated for procedural sedation (often in combination with an opioid, such as fentanyl), for preoperative
sedation, for the induction of general anesthesia, and for sedation of ventilatedpatients in critical careunits.
Midazolam is superior to diazepamin impairing memory ofendoscopy procedures, but propofolhas a quicker recovery time and a
better memory-impairing effect.
It is the most popular benzodiazepine in the intensive care unit (ICU) because of its short elimination half-life, combined with its
water solubility and its suitability for continuous infusion.
Correct Answer. c
26/79
(64).
The purpose of cuff in endotracheal tube is

a. To prevent the tube from slipping out
b. To stabilize the tube in the midline
c. To prevent regurgitation of gastric contents
d. To have an air tight seal
Solution. Ans-64 : (c) To prevent regurgitation of gastric contents
Ref.:Lees Synopsis of Anesthesia, - 209
Sol :
Cuffs prevent leakage between the endotracheal tube and the trachea-both leakage of gas outwards during IPPV and of gastric
contents, blood and mucus into the lungs.
Correct Answer. c
(65).
The cause for contact ulcer in vocal cords is :

a. Voice abuse
b. Smoking
c. TB
d. Malignacny
Solution. Ans-65 : (a) Voice abuse
Ref: Readthe text below
Sol:
Contact granuloma, also known as a contact ulcer, is a condition where an ulcer is found in the vocal folds.
The most common cause of the condition is sustained periods of increased pressure on the vocal folds, and is commonly seen in
people who use their voice excessively.
Gastroesophageal reflux diseaseis also thought to be a contributing factor in the development of contact ulcers.
Correct Answer. a
(66).
Otitic barotraumas results due to :

a. Ascent in air
b. Descent in air
c. Linear acceleration
d. Sudden acceleration
Solution. Ans-66: (b) Descent in air
Sol:
Barotrauma can affect the external, middle, or inner ear. Middle ear barotrauma (MEBT) is the most common being experienced by
between 10% and 30% of divers and is due to insufficient equilibration of the middle ear.
External ear barotrauma may occur on ascent if high pressure air is trapped in the external auditory canaleither by tight fitting
SCUBA equipment or ear wax.
Inner ear barotrauma (IEBT) though much less common than MEBT shares a similar mechanism.
Mechanical trauma to the inner ear can lead to varying degrees of conductiveand sensorineural hearing lossas well as vertigo
Correct Answer. b
27/79
(67).
Virus causing acute onset sensorineural deafness :

a. Corona virus
b. Mumps
c. Adeno virus
d. Rota virus
Solution. Ans-67: (b) Mumps
Sol:
Sensorineural hearing loss may be congenitalor acquired.
Congenital
Lack of development (aplasia) of the cochlea
Chromosomalsyndromes (rare)
Congenital cholesteatoma- squamous epitheliumis normally present on either side of the tympanic membrane. Externally, within the
external auditory meatusor ear canaland internally within the middle ear. Within the middle ear the simple epithelium gradually
transitions into ciliated pseudostratified epithelium lining the Eustachian tubenow known as the pharyngotympanic tubebecoming
continuous with the respiratory epitheliumin the pharynx. The squamous epithelium hyperplasia within the middle ear behaves like an
invasive tumourand destroys middle ear structures if not removed.
Delayed familial progressive

Acquired
Inflammatory
o Suppurative labyrinthitis
o Meningitis
o Mumps
o Measles
o Viral
o Syphilis
Ototoxicdrugs
o Aminoglycosides(most common cause; e.g., tobramycin)
o Loop diuretics(e.g., furosemide)
o Antimetabolites(e.g., methotrexate)
Salicylates(e.g., aspirin)
Correct Answer. b
(68).
Fistula test stimulates :

a. Lateral semicircular canal
b. Posterior semicircular canal
c. Anterior semicircular canal
d. Cochlea
Solution. Ans-68: (a) Lateral semicircular canal
Sol:
Compression or rarefaction of the air in the external auditory canalexcites nystagmus when there is an erosion of the otic capsule, so
long as the labyrinth remains capable of functioning.
Fistula test stimulates lateral semicircular canal

Correct Answer. a
28/79
(69).
CSF Rhinorrhea occurs due to fracture of :

a. Roof of orbit
b. Cribriform plate of ethmoidal bone
c. Frontal sinus
d. Sphenoid bone
Solution. Ans-69: (b) Cribriform plate of ethmoidal bone
Sol:
CSF discharging from the nose is known as CSF rhinorrhoea. Cerebrospinal fluid is a clear colorless fluid that bathes the brain and
spinal cord, cushioning them against trauma.
In fact in literal terms the brain and spinal cord floats in the cerebrospinal fluid. The specific gravity of brain is only 4% of that of
CSF, hence it could float easily in the CSF.
The high pressure leaks are commonly encountered in the cribriform area. This is due to the fagility and unique anatomy in this area
i.e. (prolongation of the subarachnoid space along the olfactory filaments).
The leak during these conditions functions as a safety valve alleviating the increased intracranial pressure. These high pressure
leaks are associated with slow growing tumors and 1/4 of them have hydrocephalus.
Pituitary neoplasms are the most common type of intracranial tumor found, next common are the posterior cranial fossa lesions.
Direct invasion of the skull base is not the usual mechanism of this leak.
Closure of these leaks may worsen the condition of the patient if the causative lesion is left untreated.
Correct Answer. b
(70).
The pathognomonic test for CSF in suspected CSF rhinorrhea is

a. Glucose concentration
b. Handkerchief test
c. Halo sign
d. Beta-2 transferrin
Solution. Ans-70: (d) Beta-2 transferrin
Sol:
Tests for detecting CSF rhinorrhoea:
Reservoir sign: This test is ideally performed immediatly on rising from the bed. The patient is asked to place the chin over their chest.
The patient must stay in that position for one full minute. Clear fluid dripping from the nose is CSF.
Handkerchief test: Discharge from the nose is blown into a handkerchief and is allowed to dry. If the discharge is CSF the handherchief
will not stiffen, if the discharge is secretions from the nose the handkerchief stiffens due to the presence of mucin in the nasal secretions.
The most sensitive laboratory test is to look for Beta 2 transferrin in the nasal secretions. In CSF Beta 2 transferrin is present, and it is
absent in normal nasal secretions.
The most sensitivve test to detect CSF leak is intrathecal radionucleotide test.
Correct Answer. d
29/79
(71).
Arterial supply of tonsil is mainly :

a. Tonsillar branch of facial artery
b. Maxillary artery
c. Middle meningeal artery
d. Ext. carotid artery
Solution. Ans-71: (a) Tonsillar branch of facial artery
Sol:
The main artery of the tonsil is the tonsillar branch of the facial artery which enters the tonsil near its lower pole by piercing the
superior constrictor just above the styloglossus muscle. Other arteries supplying the tonsil are lingual artery through its dorsal lingual
branches, ascending palatine branch of facial artery, and ascending pharyngeal vessels.
Venous drainage occurs through the para tonsillar vein, and the vessels also pass through to the pharyngeal plexus or facial vein
after piercing the superior constrictor.
Lymphatic vessels from the tonsil pierce through the buccopharyngeal fascia and pass to the upper deep cervial group of nodes,
particularly to the jugulodigastric group.
Correct Answer. a
(72).
Swelling between tonsillar area and superior constrictor muscle is knows as

a. Quinsy
b. Dental abscess
c. Parapharyngeal abscess
d. Retropharyngeal abscess
Solution. Ans-72: (a) Quinsy
Sol:
Quinsy otherwise also known as peritonsillarabscess is a collection of pus in the peritonsillar space between the superior constrictor
and capsule of the tonsil. It is usually unilateral, and commonly affects adolescent males.
Pathophysiology:
Infection usually starts in the crypta magna from where it spreads beyond the confines of the capsule causing peritonsillitis initially, and
peritonsillar abscess later.
Another proposed mechanism is necrosis and pus formation in the capsular area, which then obstructs the weber glands, which then
swell, and the abscess forms.
Correct Answer. a
30/79
(73).
Treatment for peritonsillar abscess is

a. Tonsillectomy
b. Incision and drainage
c. Antibodies alone
d. I & D + antibiotics
Solution. Ans-73 : (d) I & D + antibiotics
Sol:
Medical management:
1. Broad spectrum antibiotics. Theanti bacterial spectrum should ideally innclude gram postive, gram negative and anaerobes.
Commonly used drugs are broad spectrum penicillins like ampicillin / amoxycillin, in addition to which metronidazole or clindamycin can
be combined to take care of anaerobes.
2. Antiinflammatory drugs like Ibuprofen and antipyretics like paracetomol.
Surgical management:
Incision and drainage: This is perrformed with patient in sitting position to prevent aspiration of pus into the larynx.
Site of incision:
Is commonly over the point of maximum bulge. It can also be made at the junction between a horizontal imaginary line drawn from
the base of the uvula to the anterior pillar and a vertical imaginary line drawn along the anterior pillar.
After incison is made a sinus forceps is introduced to complete the drainage procedure.
Six weeks after I&D tonsillectomy is performed in this patient to prevent further rucurrence. This is known as interval tonsillectomy.
Some authors prefer to do tonsillectomy immediatly on a quinsy patient. This is known as Hot tonsillectomy.
Correct Answer. d
(74).
The medial bulging of pharynx is seen in

a. Parapharyngeal Abscess
b. Retropharyngeal abscess
c. Peritonsillar abscess
d. Paratonsillar abscess
Solution. Ans-74: (b) Parapharyngeal Abscess
Sol:
Parapharyngeal Abscess
Parapharyngeal abscess (PPA) is a rare cause of deep space infection. It is caused by dental infection (30%), peritonsillar abscess (PTA),
pharyngeal infections, mastoiditis, or parotitis and may spread rapidly and extend into the mediastinum and soft tissues of the neck,
leading to airway obstruction, erosion into the carotid artery, suppurative mediastinitis, and sepsis.
Signs
Displacement of lateral pharyngeal wall toward the midline
Brawny or erythematous lateral neck swelling
Palpable, usually nonfluctuant tender mass below the angle of the mandible ++++
Stridor +++
Respiratory distress (rare)

Correct Answer. b
31/79
(75).
A 65 year old male presents with cervical lymphadenopathy with recurrent epistaxis. Most likely cause is
a. Angiofibroma
b. Ca Nasopharynx
c. Rhabdomyosarcoma
d. None
Solution. Ans-75: (b) Ca Nasopharynx
Sol:
CA NASOPHARYNX
Clinical Features:
- Painless cervical lymphadenopathy : 60%
(commonest Jugulodigastric)
- Epistaxis and nasorespiratory symptoms : 40%
- Audiological symptoms (Tinnitus, otalgia, Deafness) : 30%
- Neurological symptoms : 20% all cranial nerves except 1,2 and 7,8 can be involved
(Most commonly: V, VI, IX, X)
Correct Answer. b
(76).
Trotters triad is seen in carcinoma of

a. Maxilla
b. Larynx
c. Nasopharynx
d. Ethmoid sinus
Solution. Ans-76: (c) Nasopharynx
Sol:
CA NASOPHARYNX
Trotters Triad:
1.U/L middle ear effusion and so conductive hearing loss
2.Pain in that ear
3.Paralysis of the soft palate (X nerve)
Correct Answer. c
(77).
False positive fistula test is associated with

a. Perilymph fistula
b. Malignant sclerosis
c. Congenital syphilis
d. Cholesteatoma
Solution. Ans-77: (c) Congenital syphilis
Sol:
False positive fistula test(Hennebert sign)
False negative fistula test
Congenital syphilis
(here stapes footplate is hypermobile, so even small pressure changes in
ear, cause excessive movement of stapes footplate & excessive
stimulation of utricular macule)
In Dead ear ( inner ear is damaged), there will be NO

response even if a Perilymphatic fistula exists.
25% cases of Meneires disease.

(here in 25% cases of menieres ,fibrous bands form connecting to
utricular macule to stapes footplate)
Also seen when cholesteatoma covers the site of fistula&

doesnt allow pressure changes to be transmits to labyrinth.
Correct Answer. c
32/79
(78).
Malignant otitis externa is :

a. Malignacny of external ear
b. Caused by hemophilus influenza
c. Blackish mass of aspergillus
d. Pseudomonas infection in diabetic patient
Solution. Ans-78: (d) Pseudomonas infection in diabetic patient
Sol:
Malignant otitis externa
Osteomyelitis of the skull; Otitis externa - malignant
Malignant otitis externa is a disorder involvinginflammation and damage of the bones and cartilage at the base of the skull.
Causes, incidence, and risk factors
Malignant otitis externa is caused by the spread of an outer ear infection (otitis externa, also called swimmer's ear). It is an uncommon
complication of both acute swimmer's earand chronic swimmer's ear.
Risks for this condition include:
Chemotherapy
Diabetes
Weakened immune system

Symptoms
Drainage from the ear- yellow, yellow-green, foul smelling, persistent
Ear pain- felt deep inside the ear and may get worse when moving head
Hearing loss
Itchingof the ear or ear canal
Fever
Trouble swallowing
Weakness in the face
Voice loss
Treatment
The goal of treatment is to cure the infection. Treatment often lasts for several months, because it is difficult to treat the bacteria and
reach an infection in bone tissue.
Antibiotics that are effective against the microorganism are given for long periods of time. They may be given through a vein
(intravenously), or by mouth. Antibiotics should be continued until scans or other tests show that inflammation has gone down.
Occasionally, surgery to remove dead or damaged tissue (surgical debridement) in the skull is needed.
Correct Answer. d
33/79
(79).
Keratosis obturans is
a. Foreign body in external auditory canal
b. Desquamated epithelial cell+Cholesterol
c. Cholesterol crystals surrounded by calcium
d. Wax in external auditory canal
Solution. Ans-79: (b) Desquamated epithelial cell+Cholesterol
Sol:
Keratosis obturans: is accumulation of desquamated keratin in the external auditory meatus. This should be differentiated from primary
auditory canal cholesteatoma which is characterized by invasion of squamous tissue from the external ear canal into a localized area of
bone erosion.
Keratosis obturans commonly occur in young patients.
Clinical features:
1. Severe ear pain
2. Mild / moderate conductive hearing loss
3. Associated bronchitis / sinusitis - common
Management:
1. Surgical removal under G.A.
2. Canal plasty is helpful in recurrent cases
3. Mastoidectomy should be performed in cases with primary cholesteatoma of external canal.
Correct Answer. b
(80).
Cholesteatoma is commonly caused by :

a. Attico-antral perforation
b. Tubotympanic disease
c. Central perforation of tympanic membrane
d. Menieres disease
Solution. Ans-80: (a) Attico-antral perforation
Sol:
Atticoantral disease, in whichthe perforation is located in the eardrum at the attic region, and is typically associated with the
development of cholesteatoma.
Atticoantral disease is alsoassociated with a higher risk of major complications, e.g. brain abscess and other intracranial infection.
Correct Answer. a
34/79
(81).
Treatment of choice for Perforation in pars flaccid of the tympanic membrane with cholesteatoma is :
a. Myringoplasty
b. Modified Radical Mastoidectomy
c. Antibiotics
d. Radical mastoidectomy
Solution. Ans-81: (b) Modified Radical Mastoidectomy
Sol:
Modified Radical Mastoidectomy is surgery to eradicate disease of the middle ear cavity and mastoid process, in which the mastoid and
epitympanic spaces are converted into an easily accessible common cavity by removing the posterior and superior external canal walls
Feature
Safe
Unsafe
1. Discharge
2. Perforation
3. Polyps
4. Cholesteotoma
5. Complication
Copious, odourless
Central
Pale coloured
Absent
Rare
Scanty, foul-smelling
Attic or marginal
Fleshy
Present
Common
Correct Answer. b
(82).
Treatment of choice for CSOM with vertigo and facial nerve palsy is :
a. Antibiotics and labyrinthine sedative
b. Myringoplasty
c. Immediate mastoid exploration
d. Labyrinthectomy
Solution. Ans-82: (c) Immediate mastoid exploration
Sol:
CSOM with vertigo and facial nerve palsyis a emergency situation immediate mastoid exploration is indicated
Correct Answer. c
(83).
To withdraw the cerebrospinal fluid, lumbar puncture is commonly performed

a. Upper border of L1
b. Upper border of L2
c. Between L1 and L2
d. Between L3 and L4
Solution. Ans-83: (d) Between L3 and L4
Ref.:Davidsons, 20th edn. Pg. 1158, 1159
Sol :
The spinal cord terminates at approximately the L1 vertebral level in 94% of individuals. In the remaining 6% the conus extends to the
L2-L3 interspace.
Lumber Puncture is therefore performed at or below the L3-L4 interspace. A useful anatomic guide is a line drawn between the
posterior superior iliac crests, which corresponds closely to the level of the L3-L4 interspace.
The interspace is chosen following gentle palpation to identify the spinous processes at each lumbar level.
Correct Answer. d
35/79
(84).
Endoscopic surgery through Intranasal approach is used for surgery of all organs except
a. Lacrimal gland
b. Cerebellum
c. Pituitary gland
d. Optic nerve
Solution. Ans-84: (b) Cerebellum
Ref:Dhingra 4th ed pg 373
Sol:
Indications
1. Chronic bacterial sinusitis unresponsive to adequate medical treatment.
2. Recurrent acute bacterial sinusitis.
3 . Polypoid rhinosinusitis (diffuse nasal polyposis) .
4. Fungal sinusitis with fung<11 ball or nasal polypi.
5. Antrochnanal polyp.
6. Mucocele of frontoethmoid or sphenoid sinus.
7. Control of epistaxis is by endoscopic cautery.
8. Removal of foreign body from the nose or sinus.
9. Endoscopic se ptoplasty.
Advanced Nasal Endoscopic Techniques
1. Removal of benign tumours, e.g. inverted papillomas or angiofibromas.
2. Orbital abscess or cellulitis management.
3. Dacryocystorhinostomy.
4 Repair of CSF leak.
5. Pituitary surgery.
6. Optic nerve decompress ion.
7. Orbital decompression for Graves disease.
8. Control of posterior epistaxis (endoscopic clipping of sphenopalatine artery).
9. Choanal atresia.
Correct Answer. b
(85).
Cochlear implant which is true

a. Not Contraindicated in cochlear malformation
b. Contraindicated in children< 5yr of age
c. Indicated in mild to moderate hearing loss
d. Port is inserted through oval window
Solution. Ans-85: (a) Not Contraindicated in cochlear malformation
Sol:
Criteria for adults
(a) Age: 18 years or more
(b) Bilateral severe to profound hearing loss
(c) Limited or no benefit from hearing aids
(d) No medical contraindication to undergo surgery.
Post- lingually deafened adults are good candidates.Results are not so good in pre-lingually deaf adults unless they had been
receiving aural-oral training forcommunication .
Criteria for children.
Auditory deprivation , i.e. lack of auditory stimulus in the early developmental period causesdegenerative changes in central auditory
pathways. Anearly auditory stimulation by cochlear implants can prevent it. Now implants can be used at an age as early as 12 months.
implants can be used in both pre-lingualy or postlingually deafened infants and children. The criteria are:
(a) Bilateral profound or severe to profound hearing Loss
(b) Minimal or no benefit from hearing aid
(c) No medical contraindication
(d) Willingness and support of family to enrol the child for post-implant training programme
Intracochlear placement of the electrode(s) into the scala tympani is superior to extracochlear placementover the promontory or
round window .
Correct Answer. a
36/79
(86).
CSF rhinorrhea treatment of choice

a. Putting swab in nostril
b. Craniotomy
c. Advising frequent blowing of nose
d. Wait and watch for 7 days and start antibiotics
Solution. Ans-86: (d) Wait and watch for 7 days and start antibiotics
Ref:Dhingra 4th ed pg 155
Sol:
Early cases of post-traumatic CSF rhinorrhoeaare managed conservatively by placing the patient in the semi-sitting position,
avoiding blowing of nose, sneezing and straining. Prophylactic antibiotics are also administered to prevent meningitis.
Persistent cases of CSF rhinorrhoea are treated surgically by nasal endoscopic or intracranial approach. Nasal endoscopic approach
is useful for leaks from the frontalsinus, cribriform plate, ethmoid or sphenoid sinuses
Correct Answer. d
(87).
Regarding retropharyngeal abscess all are true except

a. Lies only on one side
b. Presents behind prevertebral fascia
c. Surgical drainage is required
d. Can be palpated by inserting finger in mouth
Solution. Ans-87: (b) Presents behind prevertebral fascia
Ref:PL Dhingra 4th ed pg 247
Sol:
Retropharyngeal space.
It lies behind the pharynx between the buccopharyngeal fascia covering pharyngeal constrictor musc les and the pre vertebral
fascia.
It extends from the base of skull to the bifurcation of trachea.
The space is divid ed into two late ral compartments (spaces of Gillette) by a fibrous raphe .
Each lateral space contains retropharyngealnodes which usually disappear at 3-4 years of age.
Parapharyngeal space communicates with the retropharyngea l space. Infection of retropharyngeal space can pass down behind the
oesophagus into the mediastinum .
Prevertebral space.
It lies between the vertebral bodies posteriorly and the prevertebral fascia anteriorly. It extends from the base to skull of coccyx.
Infection of this space usually comes from the caries of spine.
Abscess of this space produces a midline bulge in contrast to abscess of retropharyngeal space which causes unilateral bulge.
ACUTE RETROPHARYNGEAL ABSCESS
Aetiology
It is commonly seen in children below 3 years. It is the result of suppuration of retropharyngeal lymphnodes secondary to infection in
the ade noids , nasopharynx, posterior nasal sinuses or nasal cavity.
In adults, it may result from penetrating injury of posterior pharyngealwall or cervical oesophagus.
Rarely, pus from acute mastoiditistracks along the undersurface of petrous bone topresent as retropharyngeal abscess.
Clinical Features
1. Dysphagia and difficultyin breathing are prominent symptoms as the abscess obstructs the air and food passages.
2. Stridor and croupy cough may be present.
3. Tonicollis. The neck becomes stiff and the head is kept extended.
4. Bulge in posterior pharyngeal wall. Usually seen on one side of the midline .
Radiograph of soft tissue lateral view of the neck shows widening of prevertebral shadow and poss ibly even the presence of gas
Treatment
Incision and drainage of abscess . Thisis usually done without anaesthesia as there is risk of rupture of abscess during intubation.
Child is kept supine with head low. Mouth is opened with a gag. A vertical incision IS given in the m.ost fluctuant area of the abscess.
Suction should always be available to prevent aspiration of pus.
Systemic antibiotics . Suitableantibiotics are given.
Tracheostomy. A large abscess may cause mechanical obstruction to the airway or lead to la ryngeal oedema.
CHRONIC RETROPHARYNGEAL ABSCESS
Cl inical Features
Patient may complain of discomfort in throat. Dysphagia,though present, is not marked. Posterior pharyngeal wallshows a fluctuant
swelling centrally or on one side ofmidline. neck may show tuberculous lymph nodes. Incases with caries of cervical spine, X-rays are
diagnostic
Correct Answer. b
37/79
(88).
Perineural invasions seen in

a. Adenocarcinoma
b. Adenoid cystic carcinoma
c. BCC
d. Squamous.Cell Carcinoma
Solution. Ans-88: (b) Adenoid cystic carcinoma
Ref:Textbook of surgery by Joe J. Tjandra 3rd ed pg 33
Sol:
Adenoid cystic carcinoma:
Adenoid cystic carcinoma, formerly known as cylindromas, also present with a slowly growing asymptomatic parotid mass.
These tumours are characterised by early perineural spread and have a propensity for late recurrence, often to bone or lung,even up
to 20 years following an apparent cure.
Correct Answer. b
(89).
Adrenaline is added to Lignocaine to prolong its effect and decrease its absorption into blood stream in a ratio of
a. 1 : 50,000
b. 1 : 100,000
c. 1 : 200,000
d. 1 : 500,000
Solution. Ans-89: (b) 1 : 100,000
Ref: Bailey and Loves, 25th edn. Pg. 1387.
Sol :
Along with local anesthetics, adrenaline 1 in 100,000 or phenylephrine 1 in 20,000 is used for infiltration, nerve blocks and spinal
anesthesia. Reasons are :
Duration of anesthesia is prolonged
Systemic toxicity of local anesthetic is reduced.
Correct Answer. b
(90).
Bupivacaine
a. Cause depolarization of nerve membranes
b. Has a shorter duration of action than lignocaine
c. Is unsuitable for intrathecal use
d. Is contraindicated for intravenous regional anesthesia (IVRA)
Solution. Ans-90: (d) Is contraindicated for intravenous regional anesthesia (IVRA)
Ref: KD Tripathi--357.
Sol :
Bupivacaine is widely used in obstetric analgesia, both spinally and epidurally.
Onset is relatively slow, and may take 30 minutes for a full effect when used epidurally, but it has long duration of action lasting up to
10 hours after a nerve block.
Maximum safe dose with or without adrenaline is 2 mg/kg, maximum 150 mg in any 4 hours.
Bupivacaine is contraindicated in IVRA as it is more prone to prolong QTc interval and induce ventricular tachycardia or cardiac
depression.
Correct Answer. d
38/79
(91).
Ketamine should be avoided

a. In the presence of increased arterial pressure
b. In pregnancy
c. IN hypovolemic shock
d. In the asthmatic
Solution. Ans-91 : (a) In the presence of increased arterial pressure
Ref: KD Tripathi -376.
Sol :
Ketamine
Pharmacology
A phencyclidine derivative; produces an anesthetic state frequently called dissociative anesthesia which
implies that the patient is detached from their surroundings; vivid hallucinations are common during
recovery (emergence delirium) and can be minimized by concurrent use of benzodiazepines (e.g.
midazolam).
Systemic Effects
IOP, ICT; may be dangerous for hypertensives and in ischemic heat disease; since heart rate, BP
cardiac output are well-maintained even in shocked patients, it is useful in emergency surgery; laryngeal
reflexes are better maintained and bronchodilatation occurs; it increase salivation.
Advantages
Ketamine can also be administered by IM injection even when venous access is difficult.
Common procedures undertaken with ketamine anesthesia include lower leg surgery including
manipulation of fractures), gynaecological surgery (e.g. dilatation and curettage and other minor surgical
procedures), drainage of abscesses, debridement of burns, change of dressings.
Correct Answer. a
(92).
Athlete after surgery using succinylcholine cant move both limbs because
a. Psuedocholinesterase deficiency
b. Undiagnosed muscular dystrophy
c. Phase II Sch block
d. Due to fasciculation produced by succinyl choline as a side affect
Solution. Ans-92: (a) Psuedocholinesterase deficiency
Sol:
Prolonged paralysis from succinylcholinecaused by abnormal pseudocholinesterase (atypical cholinesterase) should be treated with
continued mechanical ventilation until muscle function returns to normal
The dibucaine number is proportional to pseudocholinesterase function and independent of the amount of enzyme. Therefore,
adequacy of pseudocholinesterase can be determined in the laboratory quantitatively in units per liter (a minor factor) and qualitatively
by dibucaine number (the major factor).
Correct Answer. a
39/79
(93).
All of the following agents can be given for induction of anaesthesia in children Except:
a. Halothane
b. Servoflurane
c. Morphine
d. Nitrous oxide
Solution. Ans-93: (c) Morphine
Sol:
Morphine should not be used in infants specially those less than 6 months of age.Morphine is also not commonly recommended in
older children(3-10 years) of age
Most commonly used method for inducing gaseous anaesthesia is with O2 with or without N2O and either halothane or sevoflurane
Halothane is well tolerated in children, in which the risk of halothane induced hepatitis on repeated administration is small
Enflurane and isoflurane are more pungent and not recommended
Sevo flurane, if a available is the agent of choice Nitrous oxide particularly useful because of the speed of induction, absence of
cardiovascular and respiratory depression, its rapid on set and offset powerful analgesic action.
Correct Answer. c
(94).
A post dental extraction patient presents with swelling in posterior one third of the sternocliedomastoid, the tonsil is pushed medially.
Most likely diagnosis is
a. Retopharyngeal ascess
b. Parapharyngeal abscess
c. Ludwig angina
d. Vincent angina
Solution. Ans-94: (b) Parapharyngeal abscess
Sol:
A parapharyngeal abscess is a deep neck abscess treated with antibiotics and surgical drainage.
The parapharyngeal (pharyngomaxillary) space is lateral to the superior pharyngeal constrictor and medial to the masseter muscle.
This space connects to every other major fascial neck space and is divided into anterior and posterior compartments by the styloid
process.
The posterior compartment contains the carotid artery, internal jugular vein, and numerous nerves. Infections in the parapharyngeal
space usually originate in the tonsils or pharynx, although local spread from odontogenic sources and lymph nodes may occur.
Abscess swelling can compromise the airway. Posterior space abscess can erode into the carotid artery or cause septic
thrombophlebitis of the internal jugular vein (Lemierre syndrome).
Correct Answer. b
(95).
Anaesthetic agent of choice in renal failure is:

a. Methoxyflurane
b. Isoflurane
c. Enflurane
Solution. Ans-95: (b) Isoflurane
Sol:
Methoxyflurane has a high nephrotoxic potential (snow)
Enflurane is best avoided as nephrotoxic levels of fluoride ions have been just after 3.5 MAC hours.
Isoflurane, Sevoflurane, desflurane and halothane result in little or no increase in fluoride levels and are preferred
Correct Answer. b
40/79
(96).
A patient undergoes thoracotomy what analgesia should be given postoperatively

a. IV Fentanyl
b. Oral Morphine
c. NSAID repository
d. Intercostal cryoanalgesia
Solution. Ans-96: (d) Intercostal cryoanalgesia
Sol:
Opioid analgesia is achieved at a specific blood level for each patient for a given pain intensity.
Patients with severe pain typically continue to report pain until the analgesic blood level reaches a certain concentration above
which the patient experiences analgesia and the severity of pain rapidly diminishes.
That point is referred to as the minimum effective analgesic concentration (MEAC). Small increases above this point produce a large
increase in analgesia.
Intercostal and epidural anesthesia can additionally improve respiratory function following thoracic and upper abdominal operations
and encourage early ambulation.
Epidural and possibly spinal anesthesia reduce the incidence of thromboembolism following hip surgery and attenuate the
hypercoagulation state following vascular procedures.
A long-acting agent such as 0.5% ropivacaine (45 mL), injected two levels above and below the thoracotomy incision, typically
provides excellent pain relief. These blocks may be done under direct vision intraoperatively or via the standard technique
postoperatively.
Intercostal or paravertebral nerveblocks improve postoperative arterial blood gases and pulmonary function tests and shorten
hospital stay.
Alternatively, a cryoanalgesia probe may be used intraoperatively to freeze the intercostal nerves (cryoneurolysis) and produce longlasting anesthesia; unfortunately, maximum analgesia may not be achieved until 2448 h after the cryoanalgesia procedure.
Nerve regeneration is reported to occur approximately 1 month after the cryoneurolysis.

Correct Answer. d
(97).
Turbinate that articulates with ethmoid is

a. Superior
b. Middle
c. Inferior
d. All of the above
Solution. Ans 97: (c) Inferior
Sol:
The inferior nasal concha (Inferior Turbinated Bone) is one of the turbinates in the nose. It extends horizontally along the lateral wall
of the nasal cavity [Fig. 1] and consists of a laminaof spongy bone, curled upon itself like a scroll.
Each inferior nasal concha is considered a facial pair of bones since they arise from the maxillae bones and projects horizontally into
the nasal cavity.
The paired inferior nasal conchae are separate bones (i.e., they are not part of the ethmoid bone) instead articulates with ethmoid
and form part of the lateral walls of the nasal cavity
Correct Answer. c
41/79
(98).
Which of the following is an indication of viridian neurectomy?

a. Vasomotor neuritis
b. Allergic rhinitis
c. Polyp
d. Sluders neuralgia
Solution. Ans 98: (a) Vasomotor neuritis
Sol:
Vasomotor Rhinitis:
* Non allergic
* Stimulates nasal allergy (nasal obstruction, rhinorrhoea, sneezing)
* Sneezing is less
* Usually persists throughout the year
* Nasal mucosa is congested
Complications: Long standing cases develop nasal polyp, hypertrophic rhinitis & sinusitis
T/t:Medical - Avoidance of physical factors, antihistaminics, oral nasal decongestants, topical &
Surgical - Nasal obstruction - reduce size of nasal turbinates (Polyp, DNS)
Excessive rhinorrhoea - Vidian Neurectomy
systemic steroids
Correct Answer. a
(99).
Youngs operation is indicated for

a. Vasomotor thinitis
b. Atrophic rhinitis
c. Rhinitis sicca
d. Rhinitis caseosa
Solution. Ans 99: (b) Atrophic rhinitis
Sol:
ATROPHIC RHINITIS
[SURGICAL TREATMENT
* LAUTENSLAGER'S OPERATION:- Surgical procedures aimed at medializing the lateral nasal wall
- Substance injected:- Paraffin , teflon, polythene , cartilage
* Young's operation:- Closure of the nostril following elevation of the nasal vestibular folds
* Modified Young's operation:- partial closer of the nostril leaving behind a 3m hole
- this remains for a period of 2 yrs
Correct Answer. b
42/79
(100).
Unilateral blood stained nasal discharge in a child of three years, old is most probably may be due to
a. Sinusitis
b. Dental infection
c. Viral rhinitis
d. A neglected foreign body
Solution. Ans 100: (d) A neglected foreign body
Sol:
Common nasal FBs include hair beads, toy parts, paper, and food [1,11]. Nasal FBs are usually asymptomatic.
Symptomatic patients may present with unilateral nasal occlusion and fetid, purulent, or blood-stained nasal discharge.
They may be complicated by unilateral sinusitis or periorbital cellulitis.
The FB usually can be seen with anterior rhinoscopy after suctioning purulent secretions. Radiographs are of limited diagnostic
value because most FBs are radiolucent.
Correct Answer. d
(101).
Appearance of fever with rigor in a person with otitis media should make you suspect
a. Cerebellar abscess
b. Extradural abscess
c. Lateral sinus thrombosis
d. Apex petrositis
Solution. Ans 101: (c) Lateral sinus thrombosis
Sol:
Although seldom encountered in the practice of modern otology, lateral sinus thrombosis (LST) and other intracranial complications
of otitis media still occur
The intracranial complications of otitis media include purulent meningitis, extradural or peridural abscess, LST, brain abscess and
otitic hydrocephalus. Respiratory mucosa, intact boney walls and protective granulations provide natural defense barriers within the
middle ear; complications occur when these are overcome. The spread of infection through the natural defenses can occur by
osteothrombosis, bone erosion and when present along preformed pathways.
Classic symptoms of LST include a "picket fence" fever pattern; chills; progressive anemia (especially with beta-hemolytic strep);
and, symptoms of septic emboli, headache and papilledema may indicate extension to involve the cavernous sinus. The Toby-Ayer test is
measured by monitoring the CSF pressure during a lumbar puncture. No increase in CSF pressure during external compression of the
internal jugular vein on the affected side, and an exaggerated response on the patent side, is suggestive of LST.
Correct Answer. c
(102).
Woodruff plexus is seen at

a. Anteroinferior part of superior turbinate
b. Middle turbinate
c. Posterior part of inferior turbinate
d. Anterior part of inferior turbinate
Solution. Ans 102: (c) Posterior part of inferior turbinate
Sol:
Shaheen described Woodruff's plexus as an arterial plexus formed by anastomosis between pharyngeal, posterior nasal,
sphenopalatine and posterior septal arteries.
Microdissection and histological studies have proved Woodruff's plexus to be venous in origin.
Bleeding from the blood vessels of Woodruff's plexus could result in a slow but prolonged ooze. Since these blood vessels have no
muscle walls, hemostasis is poor. Post nasal packing will have to be resorted to in rare cases to stop bleeding.
Correct Answer. c
43/79
(103).
Lateral sinus thrombosis is associated with all except

a. Gresinger sign
b. Gradenigo sign
c. Crowe-beck sign
d. Tobey ayer test
Solution. Ans 103: (b) Gradenigo sign
Sol:
LATERAL SINUS THROMBOPHLEBITIS:
Pallor: due to the hemolytic nature of the infected organism
Griesingers sign: Pitting oedema over the occipital region (due to mastoid emissary vein thrombosis)
Tobey-Ayer test/ Quekenstedt test: Tests the change in the C.S.F following compression of either jugular veins
Crowe-Beck Test: Pressure on jugular vein of the healthy side produces engorgement of the retinal and supraorbital veins.
Gradenigo's syndrome (DDD)
Correct Answer. b
(104).
Following is true of carcinoma of the nasopharynx:

a. Unknown aetiology
b. Excellent prognosis
c. High incidence of nodal metastasis
d. Surgery offers good chances of cure
Solution. Ans 104: (c) High incidence of nodal metastasis
Sol:
Nasopharyngeal carcinoma (NPC) is a squamous cell carcinoma that occurs in the epithelial lining of the nasopharynx.
Among head and neck cancers, NPC has the highest propensity for developing distant metastases.
Histologies of NPC range from well-differentiated squamous carcinoma (WHO type I), to non-keratinizing squamous carcinoma
(WHO type II), to lympho-epithelial carcinoma (WHO type III), where non-keratinizing squamous carcinoma cells are mixed with
numerous benign lymphocytes.
Type III cancers are regarded as having the highest response to treatment, but also the greatest propensity for developing distant
micrometastatic spread.
Due to the anatomical location of the disease, NPC is typically not treated with surgical resection; rather concurrent
chemoradiotherapy is the preferred approach.
Correct Answer. c
44/79
(105).
Treatment of choice for Nasopharyngeal carcinoma is

a. Surgery
b. Radiotherapy
c. Radiotherapy + Chemotherapy
d. Surgery + Chemotherapy
Solution. Ans 105: (c) Radiotherapy + Chemotherapy
Sol:
TREATMENT OF CHOICE FOR NASOPHARYNGEAL CARCINOMA
Chemotherapy. Several factors are taken into account in deciding the chemotherapy regimen. Firstly, efficacy: the figures for event-free
survival are similar for most small chemotherapy series but therapy usually involves fairly high-dose radiotherapy to the nasopharynx
60 to 65 Gy. However, the most promising results with a recent update, are those obtained using the Mertens protocol NPC-91-GPOH
(Society of Pediatric Oncology and Hematology). Radiotherapy. Although treatment with radiotherapy controls the primary tumor,it does
not prevent the appearance of distant metastases Radiotherapy is given with megavoltage equipment after initial chemotherapy. A
maximum dose of 45 Gy is given to the clinical target volume, which is a 1 cm margin around the MRI-detected primary site, and
inferiorly down to the clavicles to include the lymph nodes. Treatment is given in two phases:
Phase I parallel pair (mostly lateral unless the tumor extends anteriorly between the eyes). Eyes, brain and brain stem are shielded as
much as possible. A mid-plane dose of 30 Gy in 15 fractions is given.
Phase II a lateral parallel pair or three-fields technique is used for the primary site, delivering 15 Gy in seven fractions to the clinical
target volume of the tumor with a 1 cm margin. Brain stem and eyes should be shielded. Any overlap with the neck field should be
shielded. A matching anterior neck node field is used to deliver a prescribed maximum subcutaneous dose of 15 Gy in seven fractions.
The spinal cord should be shielded in this field. This prescription for radiotherapy is used in Manchester, but it is recognized that higher
doses may be used in some centers, possibly to a total of 60 Gy to the tumor volume. In an current GPOH study, patients in complete
remission (CR) after three courses of chemotherapy, will have their radiotherapy dosage reduced to 54 Gy instead of 59 Gy.
Surgery. Due to the anatomical position of NPC and its tendency to present with cervical lymph node metastases, it is not amenable to
surgery for local control. Biopsy of the involved lymph node is the usual surgical procedure. The nasopharyngeal primary tumor is rarely
biopsied.
Correct Answer. c
(106).
Laryngeal spasm induced during intubation can be prevented by the following drugs except :
a. Fentanyl
b. Local anesthetic spray
c. Rofecoxib
d. Diltiazem
Solution. Ans-106: (c) Rofecoxib
Ref.: Paul AK. Anesthesia, 5th pg. 178
Sol :
Endotracheal intubation should always be done when the jawmuscles are relaxed and laryngeal reflexes are absent. This can be achieved
in various ways.
Deep general anesthesia employing inhalational anesthetics.
Intravenous anesthetic agent combined with muscle relaxants (suxamethonium, gallamine, tubocurarine)
Local anesthesia 4% lignocaine sprayed into larynx and down the trachea.
Reflex responses to laryngoscopy, intubation and extubation responses minimized by ?
Fentanyl, alfentanyl
Lignocaine, IV or inhalation
Vasodilator
Premedication with clonidine or mivazerol.
Esmenol
Induction with propofol
Verapamil, nifedipine, diltiazem
Enalapril, captopril
Correct Answer. c
45/79
(107).
Capnography basically monitors :

a. Central venous pressure
b. Blood pressure during anaesthesia
c. concentration of exhaled CO2
d. Concentration of inhaled O2
Solution. Ans-107: (c) concentration of exhaled CO2
Sol :
Capnography measuresend tidal CO2 in inspired and expired gases.
End tidal CO6 is a reliable estimate of Paco2 in most setting.
Correct Answer. c
(108).
Reversal of non-depolarising muscle relaxants action is done with the help of:
a. Atropine and neostigmine
b. Atropine and glycopyrrolate
c. Atropine and vecuronium
d. Neostigmine and edrophonium
Solution. Ans-108: (d) Neostigmine and edrophonium
Ref.:Paul AK Anesthesia, 5th ed. Pg 170
Sol :
Common antagonists to non-depolarizing relaxants :
Neostigmine anticholinesterase drug given IV, very slowly to counteract the action of non-depolarising muscle relaxants (0.5 2.5 m).
In order to counteract adverse effects (excessive salivary and bronchial secretion, bronchospasm and contraction of gut) atropine should
always be given, at least 5 min before neostigmine.
Endrophonium
Short acting synthetic anticholinesterase
Its anticurare action is due to its depolarizing action along with its direct action on motor end plate.
Atropine should be administered beforehand to combat muscarinic effects.
Correct Answer. d
(109).
Gutzmann Pressure test is related with :

a. Laryngomalacia
b. Puberphonia
c. Laryngeal stenosis
d. Subglottic hemangioma
Solution. Ans-109: (b) Puberphonia
Sol :
Puberphonia:
Adams apple was prominent.
Laryngeal contour normal.
Gutzmann pressure test ( external downward pressure on the thyroid cartilage will often evoke normal sounding voice) was positive.
Secondary sexual characters developed normally.
Psychological evaluation shows the patient was psychologically disturbed.

Correct Answer. b
46/79
(110).
Posterior ethmoidal sinus drains into :

a. Sphenoethmoidal recess
b. Superior meatus
c. Inferior meatus
d. Middle meatus
Solution. Ans-110: (b) Superior meatus
Sol :
The groups of the ethmoidal air cells:
The posterior group (sometimes the posterior ethmoid sinus) drains into the superior meatusabove the middle nasal concha;
sometimes one or more opens into the sphenoidal sinus.
The middle group (sometimes the middle ethmoid sinus) drains into the middle meatusof the noseon or above the bulla ethmoidalis.
The anterior group (sometimes the anterior ethmoid sinus) drains into the middle meatusof the noseby way of the infundibulum.
Correct Answer. b
(111).
Chevallet fracture of nasal septum is:

a. Horizontal backwards
b. Vertical backwards
c. Transverse backwards
d. Oblique backwards
Solution. Ans-111: (b) Vertical backwards
Sol :
Chevallet fracture of septal cartilage results from blows from below.
It runs vertically from the anterior nasal spine upwards to the junction of bony and cartilagenous dorsum of nose.
Correct Answer. b
(112).
Turban Shaped Epiglottis is seen in a. Acute laryngitis

b. Allergic laryngitis
c. Laryngeal tuberculosis
d. Carcinoma larynx
Solution. Ans-112: (c) Laryngeal tuberculosis
Sol :
Correct Answer. c
47/79
(113).
Trismus in parapharyngeal abscess is due to spasm to :a. Medial pterygoid

b. Lateral pterygoid
c. Masseter
d. Temporalis
Solution. Ans-113: (a) Medial pterygoid
Sol :
Parapharyngeal abscess
Anterior compartment :- Produce triad of symptoms 1. Prolapse of tonsil
2. Trismus (spasm of medial pterygoid muscle)
3. External swelling behind the jaw.
Posterior compartment involvement produces 1. Bulge of pharynx behind posterior pillar
2. Paralysis of CN IX, X, XI, XII and sympathetic chain.
3. Swelling of parotid region.
Correct Answer. a
(114).
Mastoid infection which erodes through the outer cortex of bone results in :
a. Sub-periosteal abscess
b. Epidural abscess
c. Perichondritis
d. Lateral sinus thrombosis
Solution. Ans-114: (a) Sub-periosteal abscess
Sol :
Mastoid infection which erodes through the outercortex of bone results in sub-periosteal abscess.
Correct Answer. a
(115).
Dysphagia is caused by all except :

a. Esophageal varices
b. Achlasia cardia
c. Stricture
d. Gastro-esophageal reflux of long standing duration
Solution. Ans-115 : (a) Esophageal varices
Ref.:Dhingra /308
Sol :
Dysphagia
Oesophageal causes :
1. Lumen : Obstruction to lumen (atresia, foreign body, strictures, benign or malignant tumours)
2. Wall : Due to acute or chronic esophagitis (Long standing GERD) or motility disorders.
a. Hypomotility disorders : achlasia, scleroderma, amyotrophic lateral sclerosis
b. Hypermotility disorders : Cricopharyngeal spasm, diffuse esophageal spasm
3. Outside the wall : the lesions cause obstruction by pressing on esophagus from outside.
a. Hypopharyngeal diverticula, Hiatus hernia
b. Cervical osteophytes
c. Thyroid lesions
d. Mediastinal lesions
e. Vascular rings (Dysphagia lusoria)
Correct Answer. a
48/79
(116).
The position adopted for tonsillectomy is also adopted for this procedure (Rose Position) :
a. Direct laryngoscopy
b. Bronchoscopy
c. Tracheostomy
d. Indirect laryngoscopy
Solution. Ans-116: (c) Tracheostomy
Ref.:Dhingra -382, 292
Sol :
The position adopted for tonsillectomy is also adopted for Tracheostomy (Rose Position).
The position of patient during tonsillectomy is Rose position i.e. patient lies supine with head extended by placing a pillow under
shoulders.
In tracheostomy also patient lies in the same position.
Rose position is also used for Adenoidectomy.
Correct Answer. c
(117).
Cardiac or central nervous system toxicity may result when standard lignocaine doses are administered to patients with circulatory
failure. This may be due to the following reason :
a. Lignocaine concentration is initially higher in relatively well perfused tissues such as brain and heart.
b. Histamine receptors in brain and heart get suddenly activated in circulatory failure
c. There is a sudden outburst of release of adrenaline, noradrenaline and dopamine in brain and heart
d. Lignocaine is converted to a toxic metabolite due to its longer stay in the liver.
Solution. Ans-117: (a) Lignocaine concentration is initially higher in relatively well perfused tissues such as brain and heart.
Sol :
Lignocaine has very high first pass metabolism.
Its metabolism is dependent on hepatic blood flow. Its t1/2 increases in patients with CHF.
It is initially distributed rapidly to well perfused tissues (like brain and heart) but action terminates rapidly due to redistribution.
Correct Answer. a
(118).
Thiopentione
a. 2.5% in aqueous solution has a pH of approximately 10.5
b. Is metabolized only by the kidney
c. Is an oxybarbiturate
d. Is unstable in solution if it is kept for 24 hrs
Solution. Ans-118: (d) Is unstable in solution if it is kept for 24 hrs
Ref.:Lees anesthesia, 13th edn. Pg. 150-156.
Sol :
Barbiturates
Oxybarbiturate pentobarbital and methohexital
Thiobarbiturates thiopental and thiamylal
Sodium thiopentone(also known as thiopental or pentothal) is prepared by dissolving a yellowish powder in sterile water to provide a
2.5% solution (i.e. 25 mg/ml). In this concentration 20 mls of solution will contain 500 mg.
The solution should be used within 24 hours of preparation and kept cool.
The solution is alkaline with a pH of greater than 10, and can be irritating and painful if accidentally injected into tissues. Because of
the alkalinity, thiopentone should not be mixed in the same syringe as other drugs, as it may cause formation of a cloudy precipitate and
inactivate the drug.
Correct Answer. d
49/79
(119).
The following increase the speed of induction with an inhalational agent

a. Opiate premedication
b. Increased alveolar ventilation
c. Increased cardiac output
d. Reducing FiO2
Solution. Ans-119: (b) Increased alveolar ventilation
Ref.:KD Tripathi, 6th edn. Pg. 368.
Sol :
Pulmonary ventilation governs delivery of the general anesthetic to the alveoli.
Hyperventilation will bring in more anesthetic per minute and respiratory depression will have the opposite effect.
Influence of minute volume on rate of induction is highest in the case of agents which have high blood solubility because their PP in
blood takes a long time to approach the PP in the alveoli.
Correct Answer. b
(120).
In spinal anaesthesia the segmental level of

a. Sympathetic block is lower than the sensory block
b. Sympathetic block is higher than the sensory block
c. Motor block is higher than the sensory block
d. Sympathetic, motor and sensory block has the same level
Solution. Ans-120: (b) Sympathetic block is higher than the sensory block
Ref.:KDTs - 360
Sol :
Spinal anesthesia createsa zone of differential blockade in which sympathetic fibres are blocked two segments higher and motor fibres
are blocked two segments lower than the level of sensory block.
Correct Answer. b
(121).
Intravenous regional anaesthesia is suitable for

a. Orthopedic manipulation on the upper limb
b. Vascular surgery on the lower limb
c. Head and neck surgery
d. Caesarian section
Solution. Ans-121: (a) Orthopedic manipulation on the upper limb
Ref.:KDTs - 361
Sol :
IVRA is indicated for procedures on upper limb or lower limb of less than one hour duration.
Correct Answer. a
50/79
(122).
Color coding for chlorine cylinder is

a. Black
b. Yellow
c. Block with white shoulders
d. Gray
Solution. Ans-122: (b) yellow
Sol :
Specifically named gases
Acetylenecylinders are maroon.
Argoncylinders have a dark greenshoulder.
Carbon dioxidecylinders have a greyshoulder.
Chlorinecylinders have a yellowshoulder.
Heliumcylinders have a brownshoulder.
Hydrogencylinders have a redshoulder.
Nitrous oxidecylinders have a blueshoulder.

Correct Answer. b
(123).
Thiopentone is preferred as an induction agent because of

a. Anticonvulsant properties
b. Fast elimination
c. Cardiovascular stability
d. Smoothness of induction
Solution. Ans-123: (d) Smoothness of induction
Ref.:Lees Synopsis of Anesthesia, 13th edn. Drugs chapter.
Sol :
Thiopentone is preferred as an induction agent because of Ease and rapidity of induction
Absence of stage of delirium
Rapid recovery
Ability to increase depth rapidly
Correct Answer. d
(124).
Neostigmine antagonizes non-depolarizing blockade by all of the following mechanisms except

a. Decreasing the breakdown of acetylcholine at the motor end plate
b. Preventing the K+ efflux from the cell
c. Increasing the release of acetylcholine at the motor end plate
d. Depolarization at the motor end plate
Solution. Ans-124: (b) Preventing the K+ efflux from the cell
Ref.:Katzung 10th Ed. Pg. 436
Sol :
Neostigmine is an anti-cholinesterase. It inhibits the breakdown of Ach at the motor end plate. This results in the increased activity of
Ach that causes depolarization of motor end plate by opening Na+ channels (increasing the influx of Na+).
It possesses some direct agonistic activityon NM receptors resulting in depolarization.
In addition, a minor effect to increase the release of Ach at motor end plate is also present.
Correct Answer. b
51/79
(125).
Bupivacaine poisoning is treated with

a. Esmolol
b. Sotalol
c. Lignocaine
d. All of above
Solution. Ans-125: (d) All of above
Ref.: Read the text below
Sol :
Bupivacaine is most cardiotoxic local anesthetic.
At toxic doses, local anesthetics can result in CNS (convulsions) or CVS (hypotension, bradycardia, arrhythmias) symptoms.
Diazepam is used to treat convulsions, if not responding, thiopentone may be used.
Arrhythmias should be promptly treated using bretylium, amiodarone, disopyramide, magnesium sulphate, esmolol or sotalol.
Lignocaine should be avoided as anti-arrhythmic because it can exacerbate the CNS toxicity.
In refractory arrhythmias, intravenous lipid emulsion (like intralipid) has been found to be extremly useful.
Bupivacaine induced cardiotoxicity is enhanced by acidosis, hypercarbia and hypoxemia.
Correct Answer. d
(126).
Remifentanil is
a. Useful for short painful procedures
b. Metabolized by plasma esterase
c. Equipotent as fentanyl
d. All of above.
Solution. Ans-126: (d) All of above.
Ref.:Goodman and Gilman 11th ed. Pg. 572
Sol :
Remifentanil is shortest acting opioid due to its metabolism by plasma esterases.
Due to its short duration of action, it is indicated for short term painful procedures.
Intravenous bolus dosing is not practical because of short duration of action, rather it is administered by constant i.v. infusion.
Potency is equal to fentanyl and similiarly it can also cause post operative muscle rigidity.
Correct Answer. d
(127).
Which focal length in the objective piece of microscopes commonly used for ear surgery :
a. 100 mm
b. 250 mm
c. 450 mm
d. 950 mm
Solution. Ans-127: (b) 250 mm
Sol :
250 mm of focal length in the objective piece of microscope is commonly used for ear surgery.
Focal length of objective lens
For ear surgery : 200 mm/250 mm
For nose/Paranasal sinus surgery : 300 mm
For laryngeal surgery : 400 mm
Correct Answer. b
52/79
(128).
A 5-year old patient is scheduled for tonsillectomy. On the day of surgery he had running nose, temperature 37.5 C and dry cough.
Which of the following should be the most appropriate decision for surgery :
a. Surgery should be cancelled
b. Can proceed for surgery if chest is clear and there is not history of asthma
c. Should get X-ray chest before proceeding for surgery
d. Cancel surgery for 3 weeks and patient to be on antibiotic
Solution. Ans-128: (d) Cancel surgery for 3 weeks and patient to be on antibiotic
Sol :
Contraindications to Tonsillectomy
Hemoglobin less than 10 gm%

Children under 3 years of age (poor surgical risk)
Overt or submucous cleft palate
Bleeding disorders (leukemia, purpura, aplastic anemia, hemophilia)
At the time of polio epidemic
Uncontrolled systemic diseases (diabetes, cardiac diseases, hypertension, asthma)
Correct Answer. d
(129).
The usual location of glomus jugular tumor is :

a. Epitympanum
b. Hypotympanum
c. Mastoid tip cells
d. Internal auditory meatus
Solution. Ans-129: (b) Hypotympanum
Ref.:Dhingra /107
Sol :
Glomus Tumour
MC benign neoplasm of middle ear, origin from glomus bodies
Glomus bodies resemble carotid body in structure and are found in dome of jugular bulb or on the promontory along the course of
tympanic branch of IXth cranial nerve (Jacobsons nerve)
Tumour consists of paraganglionic cells derived from the neural crest
Generally seen in the middle age, females are affected five time more
Arises from dome of jugular bulb or hypotympanum
Correct Answer. b
(130).
Condition where pulsatile tumor is found in external auditory meatus which bleed on touch :
a. Cholesteatoma
b. Polyp
c. Glomus tumor
d. Malignancy middle ear
Solution. Ans-130: (c) Glomus tumor
Ref.:Dhingra /107
Sol :
In Glomus tumor, pulsatile tumor is found in external auditory meatus which bleed on touch.
When tumor presents as a polyp :
Profuse bleeding from the ear either spontaneously or an attempts to clean it
Examination reveals a red, vascular polyp filling the meatus
Correct Answer. c
53/79
(131).
One of the following statements about succinylcholine is true

a. It may induce life threatening hyperkalemia
b. It has a long duration of action
c. It is the drug of choice in non traumatic rhabdomyolysis
d. It is useful in patients with spinal cord injuries with paraplegia
Solution. Ans-131: (a) It may induce life threatening hyperkalemia
Ref.:KDTs 6th Ed. Pg. 344
Sol :
SCh is the shortest and fastest acting muscle relaxant.
SCh is contra-indicated in patients with nerve or muscle disorders due to the risk of hyperkalemia
o Nerve disorders : Hemiplegia, paraplegia, Guillain Barre syndrome etc.
Muscle disorders : Myopathy, myasthenia gravis, rhabdomyolysis, crush injury etc.
Correct Answer. a
(132).
Epinephrine added to a solution of lignocaine for a peripheral nerve block will

a. Increase risk of convulsions
b. Increase the duration of action of the local anesthetic
c. Both (a) and (b)
d. None of these
Solution. Ans-132: (b) Increase the duration of action of the local anesthetic
Sol :
Adrenaline and felypressinare the vasoconstrictors that are added to LA solution.
By causing vasoconstriction, these drugs decrease the systemic absorption resulting in less CNS adverse effects (decreased changes of
seizures).
Prolong the stay of drug at the site of action resulting in the increase in duration of action of LA.
Correct Answer. b
(133).
A young man having pheochromocytoma has BP of 188/92 mm Hg and a hematocrit of around 50%. Pulmonary function tests and renal
functions are normal. His catecholamines are elevated. Which of the following drugs should not be included in the anesthesia protocol ?
a. Desflurane
b. Fentanyl
c. Halothane
d. Midazolam
Solution. Ans-133: (c) Halothane
Sol :
Halothane sensitizes the heart to arrhythmogenic action of catecholamines.
In pheochromocytoma, there are elevated levels of catecholamines.
Therefore, halothane should not be used in patients with pheochromocytoma.
Correct Answer. c
54/79
(134).
If ketamine is the only agent used in reducing a dislocated shoulder, its actions will include
a. Analgesia
b. Bradycardia
c. Hypotension
d. Respiratory depression
Solution. Ans-134: (a) Analgesia
Sol :
Ketamine is a powerful analgesic agent.
It increases blood pressure, intraocular pressure and intracranial tension.
It does not depress CVS and respiratory system.
Correct Answer. a
(135).
The most important adverse effect of i.v. administration of large dose of an amide anesthetic is
a. Bronchoconstriction
b. Hepatic damage
c. Renal failure
d. Seizures
Solution. Ans-135: (d) Seizures
Sol :
The most important adverse effect of i.v. administration of large dose of an amide anesthetic is seizures.
Correct Answer. d
(136).
Which of the following drugs has a high surface activity and vasoconstrictor actions that reduce bleeding in mucus membranes ?
a. Bupivacaine
b. Cocaine
c. Lidocaine
d. Procaine
Solution. Ans-136: (b) Cocaine
Sol :
All local anesthetics are vasodilators except cocaine. It possesses vasoconstrictor activity.
Cocaine also has good surface activity.
Correct Answer. b
55/79
(137).
The commonest site of lvory osteoma :

a. Fronto-Ethmodial region
b. Mandible
c. Sphenoid
d. Maxilla
Solution. Ans-137: (a) Fronto-Ethmodial region
Ref.:Meheshwari 3rd/214
Sol :
Osteoma
Bosselated round to oval sessile tumor projected from subperiosteal or endosteal surface of cortex.
Composed of sclerotic well formed bone
Most common site : Skull & facial bones
MC site of ivory osteoma is Frontal-ethmoidal region
Usually solitary; multiple osteomas seen in Gardeners syndrome.
Generally slow growing and asymptomatic but can cause obstruction of sinus cavity, impinge on brain or eye.
Not premalignant and do not transform into Osteosarcoma.
Generally no treatment given but excision may be done if causes cosmetic problems.
Correct Answer. a
(138).
Delayed speech in a 5-year old child with normal motor and adaptive development is most likely due to :
a. Mental retardation
b. Cerebral palsy
c. Kernicterus
d. Deafness
Solution. Ans-138: (d) Deafness
Ref.:Dhingra / 148
Sol :
Delayed speech in a 5-year old child with normalmotor and adaptive development is most likely due to deafness.
Correct Answer. d
(139).
Kartageners syndrome : Characteristic is :

a. Absence of cilia
b. Decreased Cilia number
c. Ultrastructural abnormality of cilia
Solution. Ans-139: (c) Ultrastructural abnormality of cilia
Ref.:Harrison 17th/1629
Sol :
Kartageners Syndrome
Axonemal dyenin, the ATPase molecular motor that produces ciliary beating is absent.
Ciliary motility is defective, mucus transport is virtually absent.
This leads to chronic sinusitis, recurrent lung infections and bronchiectasis, infertility & situs inversus.
Correct Answer. c
56/79
(140).
Which of the following does not form Waldeyers ring?

a. Palatine Tonsils
b. Adenoids
c. Jugulodigastric node
d. Lateral pharyngeal bands.
Solution. Ans-140: (c) Jugulodigastric node
Ref.:Dhingra-Chapter on Anatomy of Nose
Sol :
Waldeyers ring is formed by aggregated collections of lymphoid tissues distributed in the pharyngeal mucosa.
It is formed by :
Adenoids
Palatine tonsils
Lingual tonsils
Tubal tonsils in the fossa of Rossenmuller
Lateral pharyngeal bands
Nodules in the posterior pharyngeal wall
Correct Answer. c
(141).
Sound reaches maximum amplitude depending on its frequency at :

a. Tympanic membrane
b. Ear ossicles
c. Semicircular canals
d. Basilar membrane
Solution. Ans-141: (d) Basilar membrane
Ref.:Dhingra- Chapter on Anatomy of Nose
Sol :
A sound wave depending on its frequency reaches maximum amplitude on a particular place on basilar membrane and stimulates that
segment.
Higher frequencies are represented in the basal turn of cochlea and progressively lower ones towards the apex.
Correct Answer. d
(142).
True about tympanic membrane :

a. Attached to oval window
b. Forms an angle of 45 degree with external auditory canal
c. Chorda tympani nerve passes through pars tensa
d. Cone of light forms on the antero superior quadrant.
Solution. Ans-142: (b) Forms an angle of 45 degree with external auditory canal
Ref.:Dhingras chapter on Anatomy of the Ear
Sol :
Tympanic membrane at birth is almost horizontal. In adults it forms an angle of 45 degrees with the floor of the external canal.
The point of maximum convexity lies at the tip of handle of malleus called umbo.
Cone of light forms on anterior inferior quadrant
Total surface area of tympanic membrane is 85 sq mm and the vibrating area is 55 sq. mm.
Vibrating surface is pars tensa.
Pars flaccid (Sharpnells membrane) is flaccid to allow movement of head of malleus.
Correct Answer. b
57/79
(143).
Staging of glottic carcinoma of larynx with fixation of vocal cords is :

a. T1
b. T2
c. T3
d. T4
Solution. Ans-143: (c) T3
Sol :
TNM staging of cancer glottis
T1 tumourconfined to vocal cords with normal mobility.
confined to one vocal cord
extending to both vocal cords
T2 supraglotticor subglottic extension of tumour with normal cord mobility.
T3 tumour confined to larynx with vocal cord fixation.
T4 massive tumourwith thyroid cartilage destruction and/or extension to confines of larynx.
Correct Answer. c
(144).
Endolymph is present in :
a. Scala media
b. Scala vestibule
c. Scala tympani
d. Cochlear aqueduct
Solution. Ans-144: (a) Scala media
Sol :
Scala vestibule and scala tympani are filled with perilymph.
Scala media filled with endolymph.
Correct Answer. a
(145).
Most common intracranial complication of CSOM is :

a. Meningitis
b. Brain abscess
c. Lateral sinus thrombosis
d. Subdural abscess
Solution. Ans-145: (a) Meningitis
Sol :
Meningitis may be associated with acute or subacute/chronic infection. Acute otitis media is the most common cause of meningitis.
Extradural granulation tissue or frank pus may be found.
In adults and children, meningitis in the setting of chronic suppurative otitis media may be secondary to the direct extension of
infection through the dura, through a previous stapedectomy site, or through a cholesteatoma-induced labyrinthine fistula.
Correct Answer. a
58/79
(146).
What is the largest size endotracheal tube that will pass readily through the lumen of a size3 laryngeal mask airway (LMA)?
a. 6.00 mm Internal Diameter (ID).
b. 6.50 mm ID.
c. 7.00 mm ID.
d. 7.5 mm ID.
Solution. Ans-146: (a) 6.00 mm Internal Diameter (ID).
Sol :
A size 3 or 4 LMA will allow up to a size 6.00 mm ID endotracheal tube to be passed without an introducer.
1. An adult size 5 LMA takes a 7.0 ID Endotracheal tube (ETT).
In paediatric practice:
1. A size 2.5 LMA will allow the passage of a 5.0 mm ID ETT or a 4.0mm outside diameter flexible bronchoscope with an ETT loaded on it.
2. A size 1 LMA will allow the passage of a 3.5 mm ID ETT which will protrude 8 cm from grille using ETT adaptor
Correct Answer. a
(147).
The following capnograph trace was obtained from an intubated patient who was ventilated using a circle system with the absorber on.
The trace is most compatible with:
a. A correctly positioned tube.

b. Inspiratory valve malfunction.
c. Expiratory valve malfunction.
d. Right main bronchial intubation.
Solution. Ans-147: (d) Right main bronchial intubation.
Sol :
The tube is in the right main bronchus. - Under these circumstances the left lung is poorly ventilated (ie has a low overall V:Q ratio)
and a long overall time constant.
Thus the initial plateau represents gas exchange in the right lung and the later plateau that in the left.
Correct Answer. d
59/79
(148).
A lower Segment Caesarean Section (LSCS) can be carried out under all the following techniques of anesthesia except :
a. General anesthesia
b. Spinal anesthesia
c. Caudal anesthesia
d. Combined Spinal Epidural anesthesia
Solution. Ans-148: (c) Caudal anesthesia
Sol :
Regional anaesthesia is the technique of choice for elective caesarean section.
Techniques are :
Spinal anaesthesia
Epidural anaesthesia
Combined spinal epidural anaesthesia
The proportion of Mothers being delivered under general anaesthesia by caesarean section depends on many factors. It is gradually
falling.
The primary advantages of GA for Caesarian section is the reliability and rapidity of onset of a state in which the operation is
performed.
Caudal anaesthesia is unpopular because of the risk of introducing needle passing through the mother's sacrum and rectum and into
fetal presenting parts.
Correct Answer. c
(149).
The most appropriate circuit for ventilating a spontaneously breathing infant during anesthesia is :
a. Jackson Rees 'modification of Ayress' T Piece
b. Mapleson A or Magill's circuit
c. Mapleson C or Water to and fro canister
d. Bains circuit
Solution. Ans-149: (a) Jackson Rees 'modification of Ayress' T Piece
Sol :
Ayre's T piece is an example of mapleson E.
It is advocated primarily for use in infants and young children.
Jackson Ree's modified it and added a bag for monitoring and IPPV. (Maplesion F)
Gases can be scavenged.
The main advantage of the T-piece technique is the absence of resistance to expiration, a factor of crucial importance in small
children.
Efficacy of systems with spontaneous respiration.
A > D &E > C > B
Although A is more efficaeous but E is more suitable for infants.
Efficacy of systems with IPPV
D&E>B>C>A
Correct Answer. a
60/79
(150).
A 30 year old layd is to undergo surgery under intravenous regional anesthesia for her left 'trigger finger' Which of he following should
not be used for this patient :a. Lignocaine
b. Bupivacaine
c. Prilocaine
d. Liignocaine + Ketorolac
Solution. Ans-150: (b) Bupivacaine
Sol :
Intravenous regional anaesthesia or Bier's block is used for producing intense surgical anaesthesia for short surgical procedures of the
forearm and hand.
An esmarch bandage or an orthopaedic pneumatic splint is used to compress the arm of the forearm
The anaesthetic is inserted on the dorsum of the hand through an intravenous catheter.
This technique is most commonly used for carpal tunnel release.
Local anesthetics used are - Lidocaine

Prilocaine
Local aneasthetic contraindicated- Bupivacaine ( because of its potential side effects )
Bupivacaine prolongs QTC and cause ventricular tachycardia or cardiac depression.

NOTE :
The site of action of drug in the technique is peripheral nerve ending.
Correct Answer. b
(151).
A 21 year old lady with a history of hypersensitivity to neostigmine is posted for an elective caesarean section under general anesthesia.
The best muscle relaxant of choice in this patient should be :a. Pancuronium
b. Atracurium
c. Rocuronium
d. Vecuronium
Solution. Ans-151: (b) Atracurium
Sol :
Neostigmine is given for reversalof the action of non-depolarizing muscle relaxants.
Neostigmine is ananticholinesterase. Its action prevents the metabolism of acetylcholine by the enzyme acetylcholinesterase. This
increases the concentration of Acetylcholine in the synaptic cleft and leads to development of action potential.
This causes the muscles paralysed by the muscle relaxants to return back to their normal contractile state.
Neostigmine is usually requiredafter long acting muscle relaxants have been used. to hasten recovery at the end of operation.
Mivacurium is the shortest acting competitive blocker therefore it does not need reversal.
Correct Answer. b
(152).
The main mechanism by which local anesthetics exert their effect is blockade of :a. Receptor operated sodium channels.
b. N type of calcium channels
c. Voltage operated sodium channels
d. Voltage operated potassium channels.
Solution. Ans-152: (c) Voltage operated sodium channels
Sol :
The primary mechanism of action of local anesthetics is blockade of voltage gated sodium channels in the nerve axons.
Correct Answer. c
61/79
(153).
The artery which does not contributes to kiesselbachs plexus:

a. Greater palatine artery
b. Posterior ethmoidal artery
c. Superior labial artery
d. Sphenopalatine artery.
Solution. Ans 153: (b) Posterior ethmoidal artery
Sol:
Correct Answer. b
(154).
Perforation of bony nasal septum occurs in which of the following conditions?

a. Chrome toxicity
b. Syphilis
c. Lupus vulgaris
d. Leprosy
Solution. Ans 154: (b) Syphilis
Sol:
The etiology of nasal septal perforations can be classified into the following 4 main categories: traumatic, iatrogenic,
inflammatory/malignant, and inhalant related.
Most traumatic or iatrogenic perforations result from (1) mucosal lacerations on corresponding sides of the septum with exposure of
the underlying cartilage or (2) a fracture of the cartilaginous septum.
Perforation occurs because the cartilage relieson the overlying mucoperichondrium for its blood supply and nutrients. Traumatic
injuries may be self-induced from nose picking or may result from facial trauma.
Iatrogenic causes include nasal surgical procedures and nasal intubation or nasogastric tube placement; prior septal surgery is the
most common cause of septal perforations.
Septal hematoma, if not identified and treated early, may also result in perforation secondary to loss of cartilaginous structure,
infection, and/or abscess formation.
Infectious and inflammatory etiologies, including tuberculosis, syphilis, Wegener granulomatosis, and sarcoidosis, should always be
considered in the differential diagnosis.
Correct Answer. b
62/79
(155).
Which one of the following local anesthetics causes methemoglobinemia?

a. Prilocaine
b. Procaine
c. Ropivacaine
d. None.
Solution. Ans 155: (a) Prilocaine
Sol:
Four types of local anesthetic have been reported as possibly causing methemoglobinemia: prilocaine, benzocaine, lidocaine, and
tetracaine.
Correct Answer. a
(156).
Which of the following local anesthetics is more likely to cause allergic reactions?
a. Lidocaine
b. Bupivacaine
c. Procaine
d. Ropivacaine
Solution. Ans 156: (c) Procaine
Sol:
A cause of local toxicity is allergic reaction to para-aminobenzoic acid (PABA). These reactions range from urticaria to anaphylaxis.
PABA is a metabolic product of the degradation of Ester class of local anesthetics, such as Procaine (Novocaine), Benzocaine, and, to
a lesser degree, amide class anesthetics such as Lidocaine, and Prilocaine. It is also a metabolic by-product of Methylparaben, a
preservative in multi-dose vials of Lidocane.
When allergic response to injected anesthetics does occur, it is most likely due to the ester class local anesthetics. The amide class of
local anesthetics is far less likely to produce allergic reaction
Correct Answer. c
(157).
All of the following statements about the action of local anesthetics are true, except:
a. A resting nerve is lesser sensitive than one that is repetitively stimulated
b. Small nerve fibres are more susceptible that the large nerve fibres
c. Somatic fibres are more susceptible than the autonomic fibres
d. Temperature sense is blocked earlier than the deep pressure sense.
Solution. Ans 157: (c) Somatic fibres are more susceptible than the autonomic fibres
Sol:
Autonomic nerve fibresare smaller and are more susceptible and are blocked earlier than the somatic fibres.
In the somatic fibres also, sensory fibres are more susceptible than the motor.
Some L.A.s areeven motor sparing e.g. Bupivacaine, so are preferred in obstetrics as the mother can actively cooperate in the
delivery.
Among the somatic afferentsorder of blockade is: pain-temperature sense-touch sensation-deep pressure sense.
Correct Answer. c
63/79
(158).
Lignocaine can be used in all, except:

a. Ventricular fibrillation
b. Spinal anesthesia
c. Epidural anesthesia
d. Covulsions
Solution. Ans 158: (d) Covulsions
Sol:
Lignocaine is an antiarrhythmic(as for ventricular fibrillation) and a local anesthetic (as for spinal and epidural anesthesia).
Lignocaine is not useful in convulsions, rather it can cause convulsions in higher doses.
Correct Answer. d
(159).
Shortest acting local anesthetic is:

a. Procaine
b. Chloroprocaine
c. Bupivacaine
d. Lignocaine
Solution. Ans 159: (b) Chloroprocaine
Sol:
Chloroprocaine is the shortest acing L.A. as it is rapidly metablolized by plasma pseudocholinesterases and has plasma half-life of
just 25 seconds.
Correct Answer. b
(160).
For anaesthetizing intact skin, lignocaine is commonly mixed with:

a. Procaine
b. Chloroprocaine
c. Prilocaine
d. Cinchocaine
Solution. Ans 160: (c) Prilocaine
Sol:
Lignocaine is commonlymixed with prilocaine to make an Eutectic Mixture for Local Anesthesia (EMLA) to anesthetize the intact
skin.
Rest of surface acting local anesthetics can anesthetize only the mucus membrane and abraded skin and not the intact skin.
Correct Answer. c
64/79
(161).
Correct statements concerning bupivacaine include all of the following EXCEPT:

a. It has low cardiotoxicity
b. It has amide linkage
c. It is a long-acting drug
d. An intravenous injection can lead to seizures
Solution. Ans 161: (a) It has low cardiotoxicity
Sol:
Bupivacaine is a local anaesthetic drug belonging to theamino amide group.
Bupivacaine is indicated for local anaesthesiaincluding infiltration, nerve block, epidural, andintrathecal anaesthesia. Bupivacaine
often is administered by epidural injection before total hiparthroplasty. It also is commonly injected to surgical wound sites to reduce
pain for up to 20 hours after the surgery.
Sometimes, bupivacaine is co-administered with epinephrine to prolong the duration of its action, fentanyl for epidural analgesia,
or glucose.
Compared to other local anaesthetics, bupivacaine is markedly cardiotoxic. However, adverse drug reactions (ADRs) are rare when it
is administered correctly. Most ADRs relate to administration technique (resulting in systemic exposure) or pharmacological effects of
anesthesia, however allergic reactions can rarely occur.
Systemic exposure to excessive quantities of bupivacaine mainly result in central nervous system (CNS) and cardiovascular effects
CNS effects usually occur at lower blood plasmaconcentrations and additional cardiovascular effects present at higher
concentrations,though cardiovascular collapse may also occur with low concentrations.
CNS effects may include CNS excitation (nervousness, tingling around the mouth, tinnitus, tremor, dizziness, blurred vision,seizures)
followed by depression (drowsiness, loss of consciousness, respiratory depression and apnea). Cardiovascular effects
includehypotension, bradycardia, arrhythmias, and/or cardiac arrest some of which may be due to hypoxemia secondary to respiratory
depression.
Correct Answer. a
(162).
Indicate the anesthetic, which is used intravenously:

a. Propofol
b. Halothane
c. Desflurane
d. Nitrous oxide
Solution. Ans 162: (a) Propofol
Sol:
Intravenous Anesthetics: Non-Opioid Agents
Non-opioid Agents
This class of agents can be further broken down into barbiturates, benzodiazepines and other drugs such as etomidate, ketamine,
propofol, etc.
Propofol
Propofol is a substituted phenol which also has rapid onset and short duration of action. It can be used in a similar manner to
barbiturates and etomidate as an induction agent. The usual dose for this is 1.5-2.5 mg/kg which produces unconsciousness within a
minute.
Propofol is rapidly redistributedlike the barbiturates but it is also rapidly metabolized by the body. The fast redistribution is
reponsible for its initial short duration of action. The rapid metabolism means that, unlike the barbiturates, propofol does not build up in
the tissues. As a result, propofol can be used as a continuous infusion for maintenance of unconsciousness without prolonging wake-up.
Propofol comes as a soybean emulsion. This emulsion does support bacterial growth, so care must be taken to maintain the drugs
sterility and to use freshly prepared drug. This emulsion is also responsible for some pain on injection.
Propofol will decrease blood pressure by dilating blood vessels, but otherwise has few other side effects.
Correct Answer. a
65/79
(163).
Sevoflurane has largely replaced halothane and isoflurane as an inhalation anesthetic of choice because:
a. Induction of anesthesia is achieved more rapidly and smoothly
b. Recovery is more rapid
c. It has low post- anesthetic organ toxicity
d. All of the above
Solution. Ans 163: (d) All of the above
Sol:
Sevoflurane has several properties which make it potentially useful as a day case anaesthetic.
Following induction of anaesthesia with propofol, awakening from sevoflurane is faster compared to isoflurane, faster or similar
compared to propofol and comparable (in the majority of studies) to desflurane. Subsequent recovery and discharge is generally similar
following all agents.
Sevoflurane may also be used to induce anaesthesia, which is generally well-received and causes less hypotension and apnoea
compared to propofol. When used as a maintenance anaesthetic, the incidence of postoperative nausea and vomiting after sevoflurane is
comparable to other inhaled anaesthetics, but this complication appears more common after inhaled inductions.
The tolerability and low solubility of sevoflurane facilitate titration of anaesthesia and may reduce the need for opioid analgesia,
which in turn may limit the occurrence of nausea and vomiting.
Correct Answer. d
(164).
Which of the following inhaled anesthetics causes centrally mediated sympathetic activation leading to a rise in blood pressure and heart
rate?
a. Desflurane
b. Sevoflurane
c. Nitrous oxide
d. Isofurane
Solution. Ans 164: (a) Desflurane
Sol:
Desflurane is a halogenated ether inhalation general anaestheticagent with low solubility in blood and body tissues, and
approximately one-fifth the potency of isoflurane.
The pharmacodynamic properties of desflurane generally resemble those of isoflurane; thus, it produces dose-dependent depression
of the central nervous and cardiorespiratory systems, and tetanic fade at the neuromuscular junction. The alveolar equilibration of
desflurane is rapid (90% complete at 30 minutes compared with 73% for isoflurane). Both desflurane and isoflurane are distributed to
various tissues to a similar extent.
Acts on GABAA, Glycine receptors and inhibits nicotinic receptors

Correct Answer. a
(165).
Which of the following agents is used to accelerate recovery from the sedative actions of intravenous benzodiazepines?
a. Naloxone
b. Flumazenil
c. Ketamine
d. Fomepizole
Solution. Ans 165: (b) Flumazenil
Sol:
Flumazenil is a benzodiazepine antagonist.
Flumazenil is of benefit in patientswho become excessively drowsy after benzodiazepines are used for
either diagnostic or therapeutic procedures.
It has been used as an antidote in the treatment of benzodiazepine overdoses.
It reverses the effects of benzodiazepines by competitive inhibition at the benzodiazepine binding site on theGABAA receptor.
There are many complications that must be taken into consideration when used in the acute care setting.
Correct Answer. b
66/79
(166).
In porphyria, drug contraindicated is

a. Solium thiopentone
b. Halothane
c. Ketamine
d. Atracurine
Solution. Ans 166: (a) Solium thiopentone
Sol:
Acute intermittent porphyria can be precipitated by barbiturates like thiopentione.
This is because barbiturates induce microsomal enzymes and increase the porphyrin synthesis.
Correct Answer. a
(167).
About general anesthetics, all statements are true, except

a. MAC is a measure of potency
b. Depth of anesthesia is proportional to concentration in brain
c. Increased induction if gases
d. Insoluble gases have more rapid effect.
Solution. Ans 167: (c) Increased induction if gases
Sol:
Induction of anesthesia is more with injectable agents (e.g. thiopentone) rather than gaseous and volatile agents.
The insoluble gases and volatile agents have a rapid effect.
The more the blood solubility, the less rapid is the induction and recovery MAC is the minimal alveolar concentration required to a
painful stimulus (surgical incision) in 50% individuals.
It is a measure of potency of the anesthetics. Depth of anesthesia would be more with more anesthetic conc. In brain.
Correct Answer. c
(168).
Hepatotoxic drugs are all of the following except:

a. Chloroform
b. N2O
c. Halothane
d. Enflurane
Solution. Ans 168: (b) N2O
Sol:
Chloroform causes fatty liver.
Halothane causes hepatitisin susceptible individuals after repeated use.

Enflurane may also cause hepatic necrosis.
Correct Answer. b
67/79
(169).
True statements regarding halothane is that:

a. Hepatitis occurs in susceptible individuals after its repeated dose
b. It potentiates competitive neuromuscular blockers
c. It causes respiratory depression
d. All of the above
Solution. Ans 169: (d) All of the above
Sol:
Halothane is a volatile liquid which is nonirritant and noninflammable,it is a potent anesthetic but not a good analgesic or muscle
relaxant.
But it potentiates the competitive neuromuscular blockers. Halothane causes relatively greater depression of respiration.
It suppresses pharyngeal, laryngeal and cough reflexes and dilate the bronchi, so preferred in asthmatics.
Halothane can cause 3 most important side effects:

Hepatitis in susceptible individuals after its repeated doses
Heart sensitization to the arrhythmogenic actions of adrenaline
Hyperthermia (malignant) which is genetically determined reaction accentuated by succinylcholine
Correct Answer. d
(170).
Thiopentione sodium is short acting inducing agent because of high:

a. Metabolism in the liver
b. Redistribution in the body
c. Excretion in the body
d. Absorption in the body
Solution. Ans 170: (b) Redistribution in the body
Sol:
Thiopentone sodium is an ultrashort acting barbiturate,reason of being ultrashort acting is its high redistribution in the body.
Redistribution means after initial distribution in the organs of high blood flow like brain (producing instant action within 15 sec),it
gets redistributed in the less vascular organs like muscle & fat, terminating its action (consciousness regained within 10 min.)
This phenomenon is due to its highly lipophilic nature.

Correct Answer. b
(171).
In the clinical use of general anesthetic agents:

a. Chloroform is a stable agent for cardiovascular surgery
b. Diethyl ether is still highly regarded and widely used
c. Methoxyflurane is reserved for long anesthetic procedures
d. The concept of balanced anesthesia is usually employed.
Solution. Ans 171: (d) The concept of balanced anesthesia is usually employed.
Sol:
Nowadays concept of balanced anesthesia is usually followed.
Balanced anesthesia means using a variety of agents to decrease the dose of each agent and get optimum analgesia, amnesia and
skeletal muscle relaxation.
For example we combine: Pre-anesthetics+Induction agent+Analgesic+Anesthetic+Muscle relaxant.

Correct Answer. d
68/79
(172).
The commonest complication of CSOM is

a. Mastoiditis
b. Brain abscess
c. Meningitis
d. Bezolds abscess
Solution. Ans 172: (a) Mastoiditis
Sol:
Chronic Suppu-rative Otitis Media
The commonest intracranialcomplication --- Meningitis
The commonest extracranialcomplication --- Mastoiditis
The commonest complication --- Mastoiditis

Correct Answer. a
(173).
Benign Juvenile papilloma of the larynx in children

a. Is solitary and sessile
b. Has tendency to develop into papillary carcinoma
c. Is multiple and fungating
d. Is a familial inherited disease
Solution. Ans 173: (c) Is multiple and fungating
Sol:
Benign Juvenile papilloma of the larynx
Multiple
Often involves infants & young children
Mostly seen on true & false cords & epiglottis
Presents with hoarseness & stridor
Known for recurrence after removal
Disappears spontaneously after puberty
CO2 laser is preffered
Interferon therapy may be given (to prevent recurrence)

Correct Answer. c
(174).
Temporal fascia is used in tympanoplasty operations, because

a. It is closer to the ear
b. It is easy to remove
c. Its metabolic rate is low
d. Its consistency is same as that of tympanic membrane
Solution. Ans 174: (c) Its metabolic rate is low
Sol:
Tympanoplasty is now popularized in our country due to its great success rate with less complication. Outcome depends on selection
of patients.
Central perforation with wide margin is a wide margin is a good candidate for tympanoptasty operation.
Ear should be dry for at least 3 months. Eustachian tube must be patent for good result.In our study post auricular incision was
given in all cases. It is easy to perform and the view of site under microscope is wide.
For the beginner it is a better approach. Other incision like endaural or permeatal can also be given.
Temporals facial was used in every case because it is thin but tough, can be obtained in same incision, has low O2 demand i.e. low
metabolic rate, after healing look like normal TM.
Correct Answer. c
69/79
(175).
Which of the following intravenous anesthetics has antiemetic actions?

a. Thiopental
b. Propofol
c. Ketamine
d. Fentanyl
Solution. Ans 175: (b) Propofol
Sol:
Propofol is a short-acting, intravenouslyadministered hypnotic agent. Its uses include the induction and maintenance of general
anesthesia, sedation for mechanically ventilated adults, and procedural sedation.
Chemically, propofol is unrelated to barbiturates, and has largely replaced sodium thiopental(Pentothal) for induction of anesthesia
because recovery from propofol is more rapid and "clear" when compared with thiopental.
Propofol is not considered an analgesic, so opioids such asfentanyl may be combined with propofol to alleviate pain.
Due to its amnestic effects and appearance as a white liquid, propofol has been humorously dubbed "milk of amnesia" by doctors
Correct Answer. b
(176).
Indicate the intravenous anesthetic, which causes minimal cardiovascular and respiratory depressant effects:
a. Propofol
b. Thiopental
c. Etomidate
d. Midazolam
Solution. Ans 176: (c) Etomidate
Sol:
Etomidate is a short acting intravenous anaesthetic agent used for the induction of general anaesthesia and for sedationfor short
procedures such as reduction of dislocated joints andcardioversion.
The use of etomidate infusions for sedation of critically ill patients in intensive care units has been associated with increased
mortality, which is due to suppression of steroid synthesis (both glucocorticoids and mineralocorticoids) in the adrenal cortex, which
sometimes leads to death due to an adrenal crisis; Thus, etomidate contributes to critical illnessrelated corticosteroid insufficiency.
Seizure-like activity is occasionally seen with anesthetic induction. In the absence of concurrent EEG monitoring, it is difficult to
ascribe this to cortical activity. Myoclonic movement originating at the spinal cord level is often a likely mechanism.
Excitatory phenomena, and epileptiform movements and EEG activity may be observed during induction. Etomidate consistently
increases the amplitude of somatosensory evoked potentials (in contrast to most anaesthetic agents).
Correct Answer. c
(177).
Indicate the intravenous anesthetic, which produces dissociative anesthesia:

a. Midazolam
b. Ketamine
c. Fentanyl
d. Thiopental
Solution. Ans 177: (b) Ketamine
Sol:
Ketamine has a wide range of effects,including analgesia, anesthesia, hallucinations, elevated blood pressure, and bronchodilation.
Ketamine is primarily used for the induction and maintenance of general anesthesia, usually in combination with some sedative drug.
Other uses include sedation in intensive care, analgesia (particularly in emergency medicine), and treatment of bronchospasm. It is
also a popular anesthetic in veterinary medicine.
Correct Answer. b
70/79
(178).
Hallucinations are related with :

a. Ketamine
b. Thiopentone
c. Fentanyl
d. Nitrous oxide
Solution. Ans 178: (a) Ketamine
Sol:
Ketamine is pharmacologically related to the hallucinogen phencyclidine.

In about 50% patients recovering from ketamine anesthesia, hallucinations, delirium and involuntary movements occur.
Correct Answer. a
(179).
The best analgesic action is seen with:

a. Ether
b. Halothane
c. Isoflurane
d. Desflurane
Solution. Ans 179: (a) Ether
Sol:
Ether is not only an excellent analgesic but also very good skeletal muscle relaxant.
Halogenated ethers such as Halothane, Isoflurane and Desflurane are not so good analgesics and relaxants.
So with their use in surgery, additional analgesics and muscle relaxants are required.
Correct Answer. a
(180).
Adrenaline is contraindicated during anesthesia with:

a. Thiopentone
b. Ether
c. Trilene
d. Halothane
Solution. Ans 180: (d) Halothane
Sol:
Halothane sensitizes the heart, so that if Adrenaline is used concurrently, tachyarrhythmias occur.
Correct Answer. d
71/79
(181).
Broncholdilatation is caused by:

a. Morphine
b. Ether
c. Ketamine
d. None of above.
Solution. Ans 181: (c) Ketamine
Sol:
Bronchodilatation is maximally caused by Halothane and then by ketamine.

So they are preferred in asthmatics. Morphine and Ether cause bronchoconstriction
Correct Answer. c
(182).
Increased intracranial tension is caused by:

a. Ketamine
b. Nitrous oxide
c. Succinylcholine
d. None of above.
Sol:
Ketamine and halogenated anestheticsincrease the intracranial tension.
Nitrous oxide and succinylcholinehas no effect on the intracranial tension.

Correct Answer. a
(183).
Which of the following intravenous anesthetic agent is the drug of choice in patients of shock:
a. Ketamine
b. Thiopentone
c. Althesin
d. Propanidid
Sol:
Ketamine is uniquein this regard that it raises the blood pressure hence the anesthetic of choice in shock.
Correct Answer. a
72/79
(184).
Which amongst the following is ototoxic?

a. Achromycin
b. Chlorpromazine
c. Kanamycin
d. Metronidazole
Solution. Ans 184: (c) Kanamycin
Sol:
Ototoxicity: Ototoxic drugs
Aminoglycoside antibiotics
Streptomycin
Gentamicin
Tobramycin
Neomycin
Kanamycin
Amikacin
Diuretics
Furosemide
Ethacrinic acid
Cytotoxic drugs
Nitrogen mustard
Cisplatin
Analgesics
Salicylates
Indomethacin
Chemicals
Alcohol
Tobacco
Marijuana
Carbon monoxide poisoning
Antimalarials
Quinine
Chloroquin
Kanamycin:
Although less toxic than neomycin, kanamycin is quite ototoxic.
Kanamycin has a propensity to cause profound cochlear hair cell damage, marked high-frequency hearing loss, and complete
deafness.
The damaging effect is primarily to the cochlea, while the vestibular system is usually spared injury.
Kanamycin has limited clinical use today. As with neomycin, parenteral administration is generally not recommended.
Correct Answer. c
(185).
Bone-anchored hearing aid is composed of all of the following except:

a. Titanium implant
b. Receiver
c. External abutment
d. Sound processor
Solution. Ans-185: (b) Receiver
Sol :
Bone-anchored hearing aid is based on bone conduction. Bone-anchored hearing aids use a surgically implanted abutment to
transmit sound by direct conduction through bone to the inner ear, bypassing the external auditory canal and middle ear.
The device is composed of three main parts: a titanium implant, an external abutment, and a sound processor. The titanium
prosthesis is surgically embedded into the skull with a small abutment exposed outside the skin.
BAHA- bone anchored hearing aid will be given to hearing impaired individulas where conentional hearing aids can not be given like in
bilateral Anotia, EAC atresia, discharging ear, EAC stenosis. Its is a specialised device which is surgically fitted partly on to mastoid bone
.
Correct Answer. b
73/79
(186).
Chronic rhinosinustis are defined as symptoms of sinusitis persist for more than
a. 2 weeks
b. 4 weeks
c. 6 weeks
d. 12 weeks
Solution. Ans-186: (d) 12 weeks
Sol :
CHRONIC RHINOSINUSTIS
When symptoms of sinusitis persist for more than 12 weeks Chronic State develops. Commonest cause is incomplete resolution of acute
episode.
Organism: Mixed aerobic & anerobic
Treatment (Medical line)
Correct Answer. d
(187).
First stapedectomy was done by:

a. Julius Lempert
b. Dr Hayes Martin
c. John Shea
d. William House
Solution. Ans-187: (c) John Shea
Sol :
Julius Lempertis father of modern otology
John Sheadid first stapedectomy
William Houseis father of neuro otology
Dr Hayes Martin is father of Head Neck Surgery
Travelling theory of hearing was given by Von Bekesy

Correct Answer. c
(188).
Voice abnormality produced by faulty use of false cord is:

a. Dysphonia Plica ventricularis
b. Functional aphonia
c. Puberphonia
d. Mogi phonia
Solution. Ans-188: (a) Dysphonia Plica ventricularis
Sol :
VOICE ABNORMALITIES
1.Dysphonia Plica ventricularis (Ventricular dysphonia) Voice is produced by false cord (Ventricular folds)
2.Functional aphonia (Hysterical aphonia)
Females emotionally labile , 15 - 30yrs
3.Puberphonia (mutational falsetto voice) Gutzmann's pressure test - Pressing the thyroid prominence in backward & downward direction relaxes the overstretched cords & low
tone voice can be produced
Correct Answer. a
74/79
(189).
Best pulmonary vasodilator is

a. Nitric oxide
b. Nitrous oxide
c. Heliox
d. All of the above
Solution. Ans-189 : (a) Nitric oxide
Sol :
Nitric oxide, an inhaled pulmonary vasodilator (iNO), has been administered to patients with ARDS. Since pulmonary arterial
hypertension is a large part of the pathophysiology of the syndrome, iNO could be an effective treatment.
Because it would only be delivered to well ventilated parts of the lung, iNO in theory could improve V/Q matching while it lowered
PAP.
In adult studies, iNO has indeed been shown to decrease PAP and Qs/Qt. there is an emerging experience with iNO administration to
children with ARDS but no controlled studies have documented improved survival.
Oxygen, a potent pulmonary vasodilator, may increase pulmonary blood flow at the expense of systemic perfusion.
Correct Answer. a
(190).
Which of the following is used to make the anesthetic solution hyperbaric?

a. Ringer
b. Adrenaline
c. Normal saline
d. Dextrose
Solution. Ans-190: (d) Dextrose
Ref.:KDT 5th ed. 328
Sol :
Drugs and dosage of spinal anaesthesia
Lignocaine 2% plain
Hyperbaric 5% with 3% dextrose
Prilocaine 5% in 5% dextrose (used for prolonged effect)
Bupivacaine 0.5% upto 4 ml.
Correct Answer. d
(191).
Mucocele is commonest in which among the following sinuses?

a. Frontal
b. Maxillary
c. Ethmoid
d. Sphenoid
Solution. Ans-191: (a) Frontal
Sol :
Mucocelesmost likely occur as a result of obstruction of the ostium of a sinus with resultant accumulation of mucus and eventual
expansion of the sinus.
Some authors (the minority) believe that they represent a mucous retention cyst which gradually enlarges, eventually filling the
whole sinus .
Chronic non-invasive fungal sinusitis has also been associated with the formation of mucocoeles
The frontal sinus is particularly prone to developing a mucocoeles, and up to two-thirds of all mucocoeles occur there. The ethmoidal
sinuses are the next most common, whereas maxillary and sphenoidal sinuses are infrequently involved
Correct Answer. a
75/79
(192).
Treatment of choice of Nasopharyngeal carcinoma is?

a. Surgery
b. Chemotherapy
c. Radiotherapy
d. Chemoradiation
Solution. Ans-192: (c) Radiotherapy
Sol :
Radiation therapy for nasopharyngeal carcinomais usually administered in a procedure called external beam radiation.
For small nasopharyngeal tumors, radiation therapy may be the only treatment necessary.
In other situations, radiation therapy may be combined with chemotherapy
Correct Answer. c
(193).
Space of Tucker is seen in?

a. Larynx
b. Oesophagus
c. Femoral canal
d. Laparoscopic approach to hernia.
Solution. Ans-193 : (a) Larynx
Sol :
Space of Tucker/Paraglottic space
Medially by the ventricleand the quadrangular membrane
Bounded laterally by the thyroid cartilage,

Correct Answer. a
(194).
Chromosome responsible for hereditary Menieres disease is?

a. 6
b. 9
c. 11
d. 14
Solution. Ans-194 : (d) 14
Sol :
Cochleovestibular impairmentwas evaluated, in relation to age, in a longitudinal follow-up study on a Dutch family with a DFNA9
trait caused by a Pro51Ser mutation in the COCH gene on chromosome 14q12-q13. Fourteen cases were genotyped.
The onset age of progressive impairment reported by the mutation carriers was between age 35 and 45 years. Pure-tone thresholds
deteriorated by about 2-7 dB per year (mean 3.8 dB per year) in a variable, often asymmetrical, fashion. One mutation carrier developed
recurrent episodes of vertigo accompanied by nausea and vomiting, resembling Mnire's disease.
DFNA9/COCH should be considered as a possible cause in patients developing combined progressive cochlear and vestibular
impairment, or suspected hereditary Mnire-like disease, from around middle age.
Correct Answer. d
76/79
(195).
Phlep sign is seen in?

a. Otosclerosis
b. Glomus tumors
c. Meniere disease
d. CSOM
Solution. Ans-195 : (b) Glomus tumors
Sol :
PHELP'S SIGN - loss of crust of bone between carotid canal and jugular canal in glomus jugulare
Correct Answer. b
(196).
Organism responsible for Rhinosporidiosis is?

a. Fungus
b. Bacteria
c. Protozoa
d. Virus
Solution. Ans-196 : (c) Protozoa
Sol :
Rhinosporidiosis and its causative pathogen Rhinosporidium seeberi have been known for over a hundred years.
Recent work included in this review are molecular biological classification of R.seeberiamong the hydrophilic organisms of the
former DRIP clade, establishment of a method for the purification of the developmental stages, and some aspects of the immunology
of R.seeberi with reference to mechanisms of immune evasion - antigenic variation, host immunoglobulin binding, immune deviation in
relation to the chronicity, recurrence and dissemination seen in rhinosporidiosis.
The mechanism of endospore release from the sporangium has been described. Some problems involved in the resolution of enigmas
that persist are briefly discussed.
Moreover, it shows morphological featuresresembling those of protozoa
Correct Answer. c
(197).
Tympanoplasty is most commonly performed for tympanic membrane perforations greater than :
a. 0 20% of the size of tympanic membrane.
b. 20 % 30% of the size of tympanic membrane.
c. 30 % 40% of the size of tympanic membrane.
d. 40 % 50% of the size of tympanic membrane.
Solution. Ans-197: (a) 0 20% of the size of tympanic membrane.
Sol :
Tympanoplasty includesall procedures when the tympanic membrane is lifted from its position in the ear canal.
Tympanoplasty is most commonly performed for tympanic membrane perforations greater than 10 20% of the size of the entire
tympanic membrane.
Tympanoplasty alone or type 1 tympanoplasty denotes that the surgery is confined to the eardrum alone, and no manipulation of the
middle ear bones (ossicles) occurs.
Tympanoplasty that includes manipulation of the ossicles is defined as tympanoplasty with ossicular reconstruction, or
tympanoossiculoplasty.
Correct Answer. a
77/79
(198).
Anesthesia as we use today was first introduced by

a. Coller
b. Simpson
c. W. G. Morton
d. John Show
Solution. Ans-198: (c) W. G. Morton
Sol :
Dioscorides used the term anesthesia
Oliver Wendell Holmes 1846 termed anesthesiology
William T.G. Morton October 16, 1846 (World effects of ether.
Carl Koller 1884 introduced cocaine as an ophthalmic anesthetic.
Correct Answer. c
(199).
Assessment of oxygen in a cylinder attached to anesthesia machine is by

a. Oxygen analyzer
b. Flow in flow meter
c. Pressure regulator
d. Bourdon pressure gauge
Solution. Ans-199: (d) Bourdon pressure gauge
Ref.: Read the text below
Sol :
GAS SUPPLY :
Pipeline Inlets
Oxygen, nitrous oxide, and often air are delivered to the operating room through a piping network.
The tubing is color coded and has a diameter index safety system (DISS) fitting that prevents incorrect hose attachment.
Cylinder Inlets
Cylinders are attached to the machine via hanger-yoke with a pin index safety system to prevent error.
The yoke assembly includes index pins, a washer, a gas filter, and a check valve that prevents retrograde gas flow.
Cylinder pressure is usually measured by a Bourdon pressure gauge.
A flexible tube within this gauge straightens when exposed to gas pressure, causing a gear mechanism to move.
Correct Answer. d
(200).
The permissible level of concentration of micro-organisms in an operating room

a. 30/m3
b. 150/m3
c. 180/m3
d. 130/m3
Solution. Ans-200: (c) 180/m3
Sol :
Operating room air conditioning efficiency :
In surgical theatres, the concentration of bacteriologically contaminated air borne particles in the operation room averaged over any
5-min period should not exceed 180 per m3.
Minimum of 15 changes/hour (20/hr is satisfactory)
Correct Answer. c
Test Answer
1.(b)
2.(a)
3.(d)
4.(a)
5.(b)
6.(c)
7.(a)
8.(c)
9.(c)
10.(a)
11.(a)
12.(a)
13.(a)
14.(a)
15.(d)
16.(a)
17.(c)
18.(a)
19.(d)
20.(a)
21.(a)
22.(a)
23.(b)
24.(c)
25.(c)
26.(b)
27.(b)
28.(a)
29.(b)
30.(c)
78/79
31.(a)
32.(a)
33.(a)
34.(d)
35.(b)
36.(a)
37.(b)
38.(c)
39.(b)
40.(c)
41.(d)
42.(d)
43.(b)
44.(a)
45.(d)
46.(c)
47.(c)
48.(a)
49.(c)
50.(b)
51.(a)
52.(b)
53.(c)
54.(d)
55.(b)
56.(c)
57.(d)
58.(d)
59.(d)
60.(d)
61.(c)
62.(a)
63.(c)
64.(c)
65.(a)
66.(b)
67.(b)
68.(a)
69.(b)
70.(d)
71.(a)
72.(a)
73.(d)
74.(b)
75.(b)
76.(c)
77.(c)
78.(d)
79.(b)
80.(a)
81.(b)
82.(c)
83.(d)
84.(b)
85.(a)
86.(d)
87.(b)
88.(b)
89.(b)
90.(d)
91.(a)
92.(a)
93.(c)
94.(b)
95.(b)
96.(d)
97.(c)
98.(a)
99.(b)
100.(d)
101.(c)
102.(c)
103.(b)
104.(c)
105.(c)
106.(c)
107.(c)
108.(d)
109.(b)
110.(b)
111.(b)
112.(c)
113.(a)
114.(a)
115.(a)
116.(c)
117.(a)
118.(d)
119.(b)
120.(b)
121.(a)
122.(b)
123.(d)
124.(b)
125.(d)
126.(d)
127.(b)
128.(d)
129.(b)
130.(c)
131.(a)
132.(b)
133.(c)
134.(a)
135.(d)
136.(b)
137.(a)
138.(d)
139.(c)
140.(c)
141.(d)
142.(b)
143.(c)
144.(a)
145.(a)
146.(a)
147.(d)
148.(c)
149.(a)
150.(b)
151.(b)
152.(c)
153.(b)
154.(b)
155.(a)
156.(c)
157.(c)
158.(d)
159.(b)
160.(c)
161.(a)
162.(a)
163.(d)
164.(a)
165.(b)
166.(a)
167.(c)
168.(b)
169.(d)
170.(b)
171.(d)
172.(a)
173.(c)
174.(c)
175.(b)
176.(c)
177.(b)
178.(a)
179.(a)
180.(d)
181.(c)
182.(a)
183.(a)
184.(c)
185.(b)
186.(d)
187.(c)
188.(a)
189.(a)
190.(d)
191.(a)
192.(c)
193.(a)
194.(d)
195.(b)
196.(c)
197.(a)
198.(c)
199.(d)
200.(c)
79/79

Ent and Anesthesia PDF

Uploaded by

Copyright:

Available Formats

You might also like

Ent and Anesthesia PDF

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Ent and Anesthesia PDF

Uploaded by

Copyright:

Available Formats

Copyright 2014 Delhi Academy of Medical Sciences, All Rights Reserved.

ENT & ANESTHESIA -SWT(MD/MS) 2016

Test Question Language:- ENGLISH

Minimal tidal volume for adult resuscitation is

Copyright 2014 Delhi Academy of Medical Sciences, All Rights Reserved.

Mallampati score is for

Ohngrens classification of maxillary sinus carcinoma is based on

Vidian neurectomy done in:

Copyright 2014 Delhi Academy of Medical Sciences, All Rights Reserved.

During Tonsillitis, pain in the ear is due to involvement of?

True about Brewer-Luckhardt reflex include the following except:

Copyright 2014 Delhi Academy of Medical Sciences, All Rights Reserved.

Eustachian tube is opened if pressure difference is more than?

Narrowest part in infants respiratory tract is?

Copyright 2014 Delhi Academy of Medical Sciences, All Rights Reserved.

Lower limit of Hypo-pharynx is?

Base of the skull

Soft palate anteriorly, deficient posteriorly

Plane of hard palate

Plane of hyoid bone

Plane passing from the body of hyoid bone to

Lower border of criocoid cartilage

High tracheostomy is indicated in?

Tobey Ayer test is positive in?

Picket fence spiking fevers

Copyright 2014 Delhi Academy of Medical Sciences, All Rights Reserved.

Which is not a feature of the ebb and flow model?

Copyright 2014 Delhi Academy of Medical Sciences, All Rights Reserved.

Maximum O2 that can be delivered in non-intubated patient is by:

Copyright 2014 Delhi Academy of Medical Sciences, All Rights Reserved.

Mulberry shaped polypoidal mass is seen in

Solution. Ans-20: (a) Rhinosporidiosis

Aspergillosis is most commonly caused by

Chondromas are most commonly seen in:

More common in men

Dx:endoscopic wedge biopsy, CT of neck (calcification)

Copyright 2014 Delhi Academy of Medical Sciences, All Rights Reserved.

Congenital displacement of the pinna is:

Congenital absence of pinna

Congenital fissure of the pinna

Congenital fissure of the earlobe

Congenital excessive enlargement of the auricle

Congenital small pinna

Congenital displacement of the pinna

Congenitally displaced pinna

Additional pinna on one or both sides

Small appendage anterior to pinna

Rim (helix) of pinna is rolled forward and inward

Tonsillectomy is indicated in all, except

Recurrent acute tonsillitis.

Episode of tonsillitis within 2 weeks

Copyright 2014 Delhi Academy of Medical Sciences, All Rights Reserved.

Secondary haemorrhage in tonsillectomy operation occurs

Blue drum is seen in

Copyright 2014 Delhi Academy of Medical Sciences, All Rights Reserved.

LAM is related with:

Local anaesthetic solution used to produce extradural anaesthesia is:

Copyright 2014 Delhi Academy of Medical Sciences, All Rights Reserved.