Anaesthesiology End Posting Group 4 2017/2018

Multiple Choice Question (True-False)

1. Regarding common drugs in anaesthesia;

a. T Suxamethonium raises intraocular pressure.
b. F Propofol is a hydrophilic substance.
c. F Ketamine can only be administered intravenously.
d. T Bupivacaine act by increasing the resting permeability of the nerve membrane.
e. T Adverse effects of nitrous oxide include diffusion hypoxia.
2. Monitoring in anaesthesia:
a. F Essential monitoring for anaesthesia includes capnography and temperature.
b. F HbF giving a low reading in pulse oximetry.
c. T In capnography, a sloping plateau of the waveform is seen in patients with chronic
obstructive pulmonary disease.
d. T 3-lead electrocardiography recording is useful in determining heart and arrhythmia
and accurately assessing signs of ischemia.
e. F In capnography, end-tidal carbon dioxide is equal to arterial carbon dioxide
3. Regarding lines and tubes on chest radiograph:
a. T Surgical subcutaneous emphysema can be detected on chest radiograph.
b. F The chest tubes side hole should lie outside the thoracic wall.
c. F The inflated endotracheal cuff should distend the lumen of the trachea.
d. F The tip of the central venous catheter should be below the carina level.
e. T The tip of the endotracheal tubes should be about 3-5 cm above the carina.
4. Regarding fluid resuscitation:
a. F Average blood volume for male is 65 ml/kg and female 75 ml/kg.
b. F Half-life of crystalloids is approximately 30mins.
c. F Isotonic crystalloid is distributed throughout the intracellular and extracellular
compartment so approximately three times the volume of blood lost is required
when crystalloids alone are used as replacement.
d. T Transfusion of packed cells are reserved for patients whose haemoglobin levels
fallen below 7 g/dl.
e. T Daily water requirement is 30-40 m/kg.
5. Spinal anaesthesia (subarachnoid block):
a. F ann be performed at the lumbar, thoracic or cervical level.
b. F Has a slower onset and not as dense as epidural anaesthesia.
c. T Most common local anaesthetic used is Bupivacaine.
d. T Results in urinary retention until the block wears off.
e. T Smaller gauge, pencil-point needles results in lower incidence of post-Dural
puncture headache (PDHD).
6. For cricoid pressure to be effective the following are required:
a. T A complete cricoid ring.
b. F Nasogastricc tube must be removed.
c. T Neckk extension
d. F Pre-oxygenation for 5 minutes
e. T Pressure on the oesophagus against the vertebral body.
Anaesthesiology End Posting Group 4 2017/2018

ONE BEST ANSWER QUESTION

1. A 28-year-old female patient with a history of asthma arrives in emergency department by

ambulance. She is short of breath with audible wheeze. She has used her inhalers repeatedly
over the last few hours but she has not improved and is unable to talk. On arrival, her
respiratory rate was 30 breaths/min with oxygen saturation of 90%. She is treated with 10
litre/minute oxygen and nebulized salbutamol 5mg. 10 minutes later after the treatment her
respiratory rate is 32 breaths/min and saturation 88%. Arterial gas shows PaCO2 of 70
mmHg and PaO2 of 90 mmhg.

Which of the following is your immediate airway management?

a. Insert oropharyngeal airway and perform bag-mask-ventilation.✔️

b. Insert oropharyngeal airway and put patient on ventilation.
c. Insert supraglottic airway (Laryngeal Mask Airway)
d. Perform endotracheal intubation and connect to ventilator.
e. Put her on non-rebreathing mask with 15 litre/min oxygen.

2. A 24-year-old male fell off a horse and sustained a femoral shaft fracture. The chest X-ray
and cervical spine were clear. He is presented to the operation theatre for insertion of
intramedullary nail. His blood pressure measured at reception bay was 130/80 mmHg with a
heart of 76 beats per minute. Following spinal anaesthesia, the blood pressure drops to
80/35 mmHg with a heart rate of 80 beats/min. He has received 500 mL of 0.9% Sodium
Chloride.

Which of the following is the most appropriate next step?

a. To give incremental bolus of 6mg ephedrine along with the crystalloid.✔️

b. To give 250 mL of gelofusin along with the bolus of 6 mg of ephedrine
c. To give 100 mcg phenylephrine as bolus, along with the rest of the crystalloid and
recheck the blood pressure.
d. To position the patients heads downwards and infuse 500 mL crystalloid.
e. To transfuse 500 mL crystalloid and recheck blood pressure every 3 minutes.
Anaesthesiology End Posting Group 4 2017/2018

3. A 72-year-old patient underwent vitro-retinal surgery for detached retina under general
anaesthesia. He has history of hypertension and diabetes mellitus. He is on amlodipine 10
mg once daily and metformin 500 mg 12 hourly. His preoperative review was unremarkable.
His blood pressure was 150/80 mmHg and blood glucose was 8.9 mmol/L. His blood
investigations results: haemoglobin – 9.2 g/dl, Urea – 6.3 mmol/L, Sodium – 145 mmol/L,
and Kalium – 3.8 mmol/L. During the operation, he had severe bradycardia, which was
successfully treated by atropine 600mcg. Twenty minutes after arrival in recovery he
became very agitated, confused and restless. His blood pressure is 180/100 mmHg, heart
rate is 120 beats per minute, respiratory rate is 20 breaths/minute with oxygen saturation of
94%

Which of the following is the most likely cause?

a. Hypoglycemia
b. Hyponatremia
c. Hypoxia
d. Perioperative Stroke✔️
e. Postoperative delirium

4. An otherwise healthy 49-year-old patient undergoes exploration laparotomy for perforated

gastric ulcer. Intraoperatively, intravenous paracetamol 1 gram was administered for pain
control. Surgery went uneventfully and he was extubated immediately. In recovery, the
patient has Numerating Rating Scale (NRS) of 8. His heart rate is 120 beats per minute and
blood pressure is 160/85 mmHg.

Which of the following is the most appropriate for management of his pain?

a. Intravenous morphine✔️
b. Intravenous paracetamol
c. Intravenous parecoxib
d. Intravenous pethidine
e. Lumbar epidural with 2% lignocaine as bolus dose.

5. You are called to the orthopaedic theatre to assist with an emergency case. A 78-year-old
male with a known history of difficult intubation due to rheumatoid arthritis of his neck, is
scheduled for open reduction and internal fixation of radius and ulna under brachial plexus
block. The block was performed via the supraclavicular approach, infiltrating 25 ml 0.5%
levo-bupivacaine. Shortly after the injection was completed he began convulsing. His blood
pressure is 150/98 mmHg, heart rate 72 beats/minute and oxygen saturation of 92% on
room air.

Which of the following is your immediate medical strategy?

a. Airway, Breathing, Circulation and oxygenation

b. Intralipid 20% 1.5 mL/kg
c. Midazolam 50mg
d. Rapid sequence induction and intubation
e. 3 minutes of preoxygenation and followed by RSI and intubation.✔️
Anaesthesiology End Posting Group 4 2017/2018

6. A 66-year-old man with a history of coronary artery disease, chronic renal insufficiency,
alcohol cirrhosis, hypertension, and anxiety is brought to the emergency department after a
motor vehicle accident. He has traumatic brain injury and rib fractures. After tracheal
intubation, he is transferred to the intensive care unit (ICU) for further management. The
patient appears very agitated and uncomfortable. His Richmond Agitation-Sedation Scale
(RASS) is +3. He is tachycardic, with a heart rate of 120 beats/minute, blood pressure of
188/72 mmHg and breathing 38 breaths/minute. His home medications include aspirin and
clopidogrel.

At this point of time, which of the following is the most suitable sedative and analgesic

a. Propofol and fentanyl

b. Propofol and morphine
c. Midazolam and fentanyl✔️
d. Midazolam and morphine
e. Thiopentone and Morphine
Anaesthesiology End Posting Group 4 2017/2018

Extended Matching Question A

Theme

Type of Anaesthesia

Options

A. CSE Anaesthesia
B. Epidural Anaesthesia
C. General Anaesthesia – controlled anaesthesia
D. General Anaesthesia – spontaneous anaesthesia
E. Local anaesthesia
F. Monitored anaesthesia care
G. Peripheral nerve block
H. Spinal Anaesthesia

Lead In

For each of the following patients, select the most appropriate type of anaesthesia. Each
option may be used only once, more than once or not at all.

Stems

1. A 32-year-old pregnant women is admitted to the labour ward for induction of labour due to
reduced fetal movement. She suffers from multiple sclerosis, with her last exacerbation 3
years ago. Her pregnancy had been unremarkable throughout. The CTG shows severe fetal
bradycardia requiring emergency caesarean section. On examination, she is conscious and
alert. Her body weight is 85 kg with height of 165 cm. Airway examination: Mallampati II,
mouth opening 3 finger breadth, thyromental distance more than 3finger breadth and good
neck range of motion. Other examination findings are unremarkable. Her haemoglobin level
is 9.6 g/dl with platelet count of 188x10^9/L.

Answer : ________B

2. A 41-year-old man, who has no medical illness planned for ilizarov frame fixation due to non-
union right tibia. The previous two surgeries were uneventful. According to the orthopaedic
surgeon, this surgery might take approximately 4 to 5 hours. On examination, he is conscious
and alert. He is obese, with body weight of 127 kg and height of 165 cm. Airway
examination: Mallampati III, mouth opening 3 finger breadth and good neck range of
motion. Other examination findings are unremarkable.

Answer : ________H
Anaesthesiology End Posting Group 4 2017/2018

Extended Matching Question B

Theme

Advanced life support and resuscitation

Options

A. Atrial fibrillation
B. Atrial Flutter
C. Sinus Rhythm
D. Sinus Tachycardia
E. Ventricular Fibrillation (coarse)
F. Ventricular Fibrillation (fine)
G. Ventricular Tachycardia
H. Supraventricular Tachycardia

Lead In

For each of the following patients, select the most appropriate type of anaesthesia. Each
option may be used only once, more than once or not at all.

Stems

1.

Answer : ________

2.

Answer : ________
Anaesthesiology End Posting Group 4 2017/2018

Extended Matching Question C

Theme

Airway Equipment

Options

A. Endotracheal tube
B. Laryngeal Mask Airway
C. Manual Resuscitator
D. Nasal Prong
E. Non-rebreather mask
F. Partial Re-breather mask
G. Simple face mask
H. Venturi mask

Lead In

For each of the following patients, select the most appropriate type of anaesthesia. Each
option may be used only once, more than once or not at all.

Stems

1. A 58-year- old women with a history of hypertension, hyperlipidemia and tobacco use was
found by family members with left-sided paralysis, rightward eye deviation, and change in
mental status and was brought to emergency department. Computed axial tomography
(CAT) showed a large non-hemorrhagic right hemispheric infarct within the vascular territory
of the right middle cerebral artery. Patient is awake with left hemiparesis. Blood pressure is
89/56 mmHg, heart rate 77 beats/min, respiratory rate 15 breaths/minute and arterial
oxygen saturation 90% on room air. Cardiovascular examination is notable for jugular
venous extension. First and second heart sounds are normal. The lungs are clear to
auscultation bilaterally.

Answer : ________ A

2. A 55-year-old women presented to the emergency department (ED) because sudden loss of
consciousness. She is brought into the ED by emergency medical services, who transported
her from a grocery store near her home. She is accompanied by her husband, who describes
the sudden onset of headache quickly followed by paralysis of the right face, arm and leg.
On examination she is found to be unresponsive to painful stimuli. The pupils are 7 mm and
non-reactive to light. There are no spontaneous breaths and no gag response. Her blood
pressure is 212/123 mmHg , heart rate 121 beats/minute and oxygen saturation of 96% on
manual resuscitator with oxygen flow rate of 15 L/min.

Answer : ________ A

Essay
Anaesthesiology End Posting Group 4 2017/2018

70 -year old male. Presented to ED, with loss of consciousness

Known History of HTN, DM, Cholesterol problems
70 kg, 170 cm

1. Why is it important to asses the cardiovascular status of the patient? (8marks)

2. How would you manage the fluids of this patient if needed for operation, and why? (10
marks)

Patient post surgery in recovery room, resusced once in OT, BP and HR falling in recovery
room

1. Definds Multiorgan Disfunction Syndrome based on …. (4 marks)

2. Differentiate between septic shock and sepsis (8 marks)

OSCE
Anaesthesiology End Posting Group 4 2017/2018

1. Name component A
2. How many litres (L) of oxygen can be given
3. State (3) conditions for proper use of A

B
1. Identify equipment B
2. How many litres of oxygen can be given?
3. State 2 advantages of equipment B
Anaesthesiology End Posting Group 4 2017/2018

X
Y

1. Identify:
a. X:
b. Y:
2. State 3 functions of Y
3. Draw the waveform shown of Y in a patient with COPD