Bashir Para Medical Institute Islamabad

Mid-term AHS Exam, January 2019

Anesthesia
Subject: Hepatic & CVS Disease (Objective) Semester: 6 th
Total Marks:_________ Time: 30 mints
Chose correct answer out of following options. Cutting and over writing will lead to
negative marking.
Q1 Which type of shock can be resulted by ventricular fibrillation
a) Hypovolemic shock
b) Cardiogenic shock
c) Obstructive shock
d) Septic shock
Q2 A patient having BP more then 210/120mmHg with papilledema and encephalopathy, is he
suffering from______?
a) Hypertension
b) Severe hypertension
c) Malignant hypertension
d) Non
Q3 Duration of ECG wave is plotted on X-axis in a small box is
a) 0.04 seconds
b) 0.02 seconds
c) 0.20 seconds
d) 4 seconds
Q4 Ischemic heart disease is not caused by_____?
a) Embolism
b) Sever hypertension
c) Blood loss
d) Diarrhoea
Q5 Which of the following things minimize the time of intubation in airway management in
an unconscious patient
a) Considering full stomach
b) Hemodynamic instability
c) Minimal respiratory
d) All
Q6 Furosemide (laxis ) belongs to which class of Diuretic
a) Thiazide diuretics
b) Potassium sparing diuretics
c) Loop diuretics
d) All
Q7 Which of following is not modifiable risk factor of ischemic heart disease
a) Cigarette smoking
b) Lack of exercise
c) Hyperlipidemia
d) Family history
Q8 Negative electrode of Standard Limb Leads I and II are placed on___
a) Right leg
 b) Right arm
c) Left leg
d) Left arm
Q9 You are informed to prepare an o.t for emergency surgery of pelvic fractured patient in
an accident. What will be not your concerning thing
a) Airway management equipment
b) Warm fluids and warming blankets
c) Prepared and labelled injection ketamine
d) Prepared and labelled injection Propofol
Q 10 During your duty in Pre-anaesthesia assessment opd you examined a young leady with normal
blood pressure and heart rate for cholecystectomy. On second day list, On OT table, her BP is
more then 180/134mmHg in first two reading. What kind of hypertension is it?
a) Severe hypertension
b) Malignant hypertension
c) Anxiety induced hypertension
d) All
Q 11 Over medication in ischemic heart diseased patient before a surgery can leads to
a) Hypoxia
b) Respiratory acidosis
c) Hypotension
d) All
Q 12 4th pericardial lead is placed on_____
a) fifth intercostal space at left midclavicular line
b) fourth intercostal space at left midclavicular line
c) fifth intercostal space at left anterior axillary line
d) fourth intercostal space at left anterior axillary line
Q 13 Which type of shock can be resulted by bleeding
a) Hypovolemic shock
b) Cardiogenic shock
c) Obstructive shock
d) Septic shock
Q 14 Pre-operative management of hypertensive patent is based on
a) History
b) Physical examination
c) Laboratory evaluation &Pre-medication
d) All of above
Q 15 The first step of treatment protocol of ischemic heart disease is
a) Modification of patient’s life style
b) Correction of risk factors
c) Pharmacological manipulation
d) Surgery
Q 16 Anterior portion of the heart on ECG is covered by ______group of ECG leads?
a) (V1, V2, V3, V4)
b) (I, aVL, v5,v6)
c) (II, III, aVF)
d) Non

Q 17 All of following are signs of shock except

a) Anxiety
b) Low blood pressure
 c) Decreased urine output
d) Tachycardia
Q 18 Which of following is not complication of hypertension
a) Cognitive heart failure
b) Stroke
c) Renal failure
d) DKA
Q 19 Fluid over load should be avoided in patient with IHD because it causes
a) Ventricular wall tension
b) Hypotension
c) Hypoxia
d) Dilutional anemia
Q 20 QRS complex in ECG shows
a) Atrial depolarization
b) Ventricular repolarization
c) Ventricular depolarization
d) Atrial repolarization
Q 21 Which non-depolarizing muscle relaxant is not used in patent with shock
a) Atracurium
b) Vecuronium
c) Pancaronium
d) Rocuronium
Q 22 The maximum time for intubation in Hypertensive patient after inserting laryngoscope is
a) Less than 15 seconds
b) More than 30 seconds
c) Only 1 mint
d) About three mints
Q 23 Why it is necessary to keep IHD patient euthermic (normal body temperature) during surgery
a) Because its helps in early recovery
b) Euthermic condition avoid disturbance in myocardial oxygen supply demand
c) Euthermic condition cause disturbance in myocardial oxygen supply demand
d) Both a & b
Q 24 PR interval is of
a) 0.12 – 0.20 sec
b) 0.08 – 0.10sec
c) 0.40-0.43sec
d) 0.32 – sec
Q 25 To determine heart rate the number of large boxes between two_____ wave is divided on 300.
a) P and R wave
b) R and T wave
c) R and R wave
d) Between QRS complex
Q26 Which type of shock can be resulted by DRUG reaction?
a) Hypovolemic shock
b) Cardiogenic shock
c) Obstructive shock
d) Septic shock
(It is anaphylactic shock)
Q27 In anaphylactic shock, vasodilatory chemicals are released by
 a) Respiratory system
b) Coordination system
c) Immune system
d) Endocrine system
Q28 The first appropriate action to save life of a patient who comes to you with cold, moist
skin with blue lips, extremities and weak pulse is
a) Give 100% oxygen
b) Intubate patient with ketamine
c) Elevate legs above head
d) Give iv fluid
Q29 You are informed to prepare an o.t for emergency surgery of pelvic fractured patient in
an accident. What will be not your concerning thing
a) Airway management equipment
b) Warm fluids and warming blankets
c) Prepared and labelled injection ketamine
d) Prepared and labelled injection Propofol
e) Prepared and labelled injection suxa
Q30 Which of the following things minimize the time of intubation in airway management in
an unconscious patient
a) Considering full stomach
b) Hemodynamic instability
c) Minimal respiratory
d) All
Q31 Which non-depolarizing muscle relaxant is commonly used in patent with shock
a) Atracurium
b) Vecuronium
c) Pancaronium
d) Rocuronium
Q32 You are called to intubate an unconscious patient in emergency ward, which will be your
preference
a) Intubation with ketamine
b) Intubation with midazolam
c) Intubation with Propofol
d) Intubation without any drug
Q33 What is more dangerous cause of hypovolemic shock for life of patient
a) Fluid and blood loss due to internal injury
b) Fluid and blood loss due to external injury
c) Burn
d) Sweating
Q34 All of following are signs of shock except
a) Anxiety
b) Low blood pressure
c) Decreased urine output
d) Tachycardia
Q35 What is normal heart rate of new borne?
a) 70-190b/m
b) 60-180b/m
 c) 60-100b/m
d) None of these
Q36 Which one of following supplies electric current to right posterior side of head?
a) Bundle of hiss
b) Left posterior fascicles
c) Right posterior fascicles
d) Right bundle branch
Q37 What is voltage of a P-wave plotted in two small box on a ECG paper?
a) 0.1mV
b) 0.2mV
c) 0.04mV
d) 0.08mV
Q38 Which of following statement is incorrect?
a) Positive terminal of Limb lead I is placed on left arm
b) Positive terminal of Limb lead II is placed on left arm
c) Positive terminal of Limb lead II is placed on left leg
d) Positive terminal of Limb lead III is placed on left leg
Q39 V1 is placed on _________________ chest?
a) fourth intercostal space to right of sternum
b) fourth intercostal space to left of sternum
c) mid between the sternum
d) none
Q40 Pericardial leads are _________ in number?
a) 4
b) 3
c) 2
d) 6
Q41 Augmented limb leads are _________ in number?
a) 4
b) 3
c) 2
d) 6
Q42 A QRS complex plotted in three small box is an indication of what type of problem in heart?
a) delayed atrium contraction
b) delayed ventricle contraction
c) heart failure
d) bradycardia
Q43 Benzodiazepine belongs to which class of anti-hypertension class of drugs?
a) Calcium channel blocker
b) Direct vasodilator
c) Central a2 agonist
d) Diuretics
Q44 Abnormalities of septal wall of heat are identified by ___________?
a) V1 and V2
b) V2 only
c) V3
d) Both a and c
Q45 Diuretics are further divided into ___________ sub classes?
a) 2
b) 3
 c) 4
d) 5

Bashir Para Medical Institute Islamabad

Mid-term AHS Exam, January 2019
Anesthesia
Subject: Hepatic & CVS Disease (Subjective) Semester: 6 rd
Total Marks: 25 Time: 90 mints

Attempt all questions. Each question carries 5 marks

Q1 Classify shock and write down their causes? (5 marks)

Q2 a) write down steps and procedure of each step to read ECG of a patient? (2.5 marks)
b) Read this ECG of a patient and give your comments? (2.5 marks)

Q3 a) Define hypertension (1 mark)

b) Write down the stages of hypertension (2 marks)
c) What are complications of hypertension? (2 marks)
Q4 a) What is standard treatment protocol of ischemic heart disease? (2.5 marks)
b) Write down essential Laboratory investigations of an ischemic heart disease
patient before operation? (2.5 marks)
Q5 a) What are emergency airway concerns related to intubation in unconscious
patient for emergency surgical procedure? (2.5 marks)
b) What is intra-operative management of a shock’s patient? (2.5 marks)

Q6 Write down the class and sub-classes of anti-hypertension drugs with at least two
examples? (5 marks)
Q7 a) Draw a table to mention to different portions of heart covered by ECG
leads? (2.5 marks)
b) Write down the normal conduction system of heart? (2.5 marks)
Q8 Define following terms? (5 marks)
a) Hypertension
b) Sever hypertension
c) Malignant hypertension
d) Ischemic heart disease
e) Sinus Tachycardia
Q9 Write down the anaesthesia consideration ( peri-operatively) of traumatic patient
with shock being operated for gunshot surgery? (5 marks)