Round 4

RULES
• Multiple choice questions
• Correct answer will give 5 marks
• You can’t pass the question in
this part
• Time 60 secs for each question
ACLS
 1. A callover from ICU was given for the duty
anaesthetist stating that patient went for cardiac
arrest and resuscitated with 2 cycles of adrenaline,
airway secured and connected to mechanical
ventilator and When evaluating an arterial blood gas
in the post-resuscitation phase, 10 breaths-per-
minute should be titrated to achieve a partial
pressure of carbon dioxide at what value?
A)40-50 mmHg
B)35-45 mmHg
C)30-40 mmHg
D)45-55 mmHg
• Ans B 35-45mmHg
2. 37yr old male with complaints of light
headedness was brought to ER. His vitals
were HR- 48,BP- 88/56mmHg,Spo2 -98 in
RA,ECG taken shows Mobitz type 1 block .
What is the most appropriate management?
A) Wait and watch
B) Inj. atropine 0.5mg iv stat
C)Transvenous pacing
D)Inj. dopamine infusion @5-20mcg/kg/min
• ANS- D)Inj dopamine infusion
@5-20mcg/kg/min
3. According to the ILCOR ACLS Provider
Manual, which of the following Hs and Ts
should always be considered in paediatric
emergencies where cardiac arrest or altered
mental status is noted?
– A.Hydrogen ion (acidosis)
– B.Hypoglycemia
– C.Toxins
– D.Tension pneumothorax
ANS – B. Hypoglycemia
• REVERSIBLE CAUSES
• Hypovolemia
• Hypoxia
• Hydrogen ion (Acidosis)
• Hypoglycemia
• Hypo-hyperkalemia
• Hypothermia
• Tension pneumothorax
• Cardiac Tamponade
• Toxins
• Thrombosis (Pulmonary / Coronary )
 4. 28yr old G3P2L2 posted for elective LSCS,
baby delivered suddenly. Pt developed
bradycardia followed by cardiac arrest . All the
following modification are done in this patient
compared to non pregnant cardiac arrest
patient except
– A. If no ROSC in 4 min consider perimortem
ceserian delivery
– B.Place IV access above diaphragm
– C.If receiving iv magnesium stop and give calcium
gluconate
– D. Provide continuous lateral uterine displacement
• Ans A.
If no ROSC in 4 min consider perimortem ceaserian
delivery
 5. What is the most common presenting
rhythm in children experiencing cardiac
arrest?
A)Third-degree AV block
B)PEA/asystole
C)Ventricular fibrillation
D)Pulseless ventricular tachycardia
• Ans B PEA/ASYSTOLE
ANAESTHESIOLOGY
This round consists of 8questions in total
 1.A 22-year-old parturient is anesthetized for an
emergency laparoscopic cholecystectomy. She is in the
twenty-fourth week of gestation and receives general
anesthesia with sevoflurane and has received
rocuronium for muscle relaxation. Just before
emergence, muscle relaxation is reversed with
glycopyrrolate and neostigmine. Three minutes later,
the fetal heart rate falls to
88 beats/min. The MOST likely cause of this is
A)Fetal head compression
B)Uteroplacental insufficiency
C)Fetal hypoxia
D)Reversal agents
• ANS – D Reversal agents
2. 68yr Male scheduled for Lumbar
discectomy. At the Pre assessment clinic, we
suspected Obstructive sleep apnea in this
patient. Identify the Preanaesthetic scoring
tool for this patient
• STOP- BANG Scoring tool.

S- Do you SNORE loudly?

T- Do you feel TIRED during the day, most days
O- anyone OBSERVED you stop breathing during sleep
P- history of high BLOOD PRESSURE
B-BMI>35
A- AGE over 50
N- NECK circumference >40cm
G- GENDER male
High risk for OSA if >3 Criteria
3. All are true regarding perioperative
management of patients on antiplatelet
therapy EXCEPT
A)Continue aspirin throughout the perioperative
period in high cardiac risk patients
B) Clopidogrel throughout the perioperative
period in high cardiac risk patients
C)Discontinue clopidogrel 5 days before the
procedure in elective surgery
D)Postpone the elective surgery for 6 months in
drug eluting stents
• ANS B
CONTINUE CLOPIDOGREL THROUGHOUT THE
PERIOPERATIVE PERIOD IN HIGH CARDIAC
RISK PATIENTS
4.A 42-year-old woman is anesthetized for resection of a large
(22-kg), highly vascular sarcoma in the abdomen. During the
resection, 20 units of RBCs, 6 units of platelets, 10 units of
cryoprecipitate, 5 units of FFP, and 1 L of albumin are
administered. At the conclusion of the operation, the patient’s
vital signs are stable, and she is transported to the intensive care
unit. Three and a half hours later, a diagnosis of sepsis is made,
and antibiotic therapy is started. Which of the blood products
below would be the most likely cause of sepsis in this patient?
A. Packed RBCs
B. Cryoprecipitate
C. Platelets
D. FFP
ANS – C Platelets
 5. ALL ARE TRUE REGARDING Propofol
Infusion Syndrome EXCEPT
A. HYPOKALEMIA
B. BRUGADA LIKE ECG CHANGES
C. LACTIC ACIDOSIS
D. BRADYCARDIA
ANS A Hypokalemia
 6.Doloplus-2 scale used for
• A. Assesment of pyrexia
• B.Assesment of pain
• C.Assesment of difficult airway
• d.Assesment of Post operative cognitive
dysfunction (POCD)
• ANS D Assesment of POCD
7. IDENTIFY THIS PICTURE
ANS
VORTEX - IMPLEMENTATION TOOL FOR
DIFFICULT AIRWAY
8. Which of the following volatile is
contraindicated in chronic renal failure
A)Isoflurane
B)Sevoflurane
C)Enflurane
D)Halothane
ANS C Enflurane
• 9. An 18-year-old woman involved in an MVA is brought to the
emergency room in shock. She is transfused with 10 units of type
O, Rh-negative whole blood over 30 minutes. After infusion of the
first 5 units, bleeding is controlled, and her blood pressure rises to
85/51 mm Hg. During the next 15 minutes, as the remaining 5
units are infused, her blood pressure slowly falls to 60 mm Hg
systolic. The patient remains in sinus tachycardia at 120
beats/min, but the QT interval is noted to increase from 310 to
470 msec, and the central venous pressure increases from 9 to 20
mm Hg. Her breathing is rapid and shallow. The most likely cause
of this scenario is
• A. Citrate toxicity
• B. Hyperkalemia
• C. Hemolytic transfusion reaction
• D. Tension pneumothorax
• ANS – A Citrate Toxicity
•
PAIN
1.A 24yr old Volleyball player for repair of Rotator
cuff in his right shoulder. He weighs 120kg and is
185cm tall.
Nerves that need to be blocked to provide
analgesia for Rotator cuff Repair are all except

1.Supraclavicular Nerve
2.Axillary Nerve
3. Suprascapular Nerve
4.Medial pectoral Nerve
Ans D Medial pectoral Nerve
2.A 56-year-old man presented to his primary care
physician with a complaint of right buttock and right
leg pain along with numbness and tingling sensations.
He was subsequently diagnosed with a piriformis
syndrome (trapped nerve). The nerve(s) responsible
for this diagnosis is/are
• A. Femoral and saphenous nerves
• B. Ilioinguinal nerve
• C. Sciatic nerve
• D. Obturator and femoral nerves
• ANS C Sciatic nerve
• Piriformis syndrome is a neuromuscular disorder
that occurs when the sciatic nerve is compressed
causing pain, tingling, and numbness in the
buttocks and along the path of the sciatic nerve
descending down the posterior lower thigh and
into the leg. The sciatic nerve can be trapped at
the sciatic notch and cause impingement
syndromes (buttocks and leg pain).
3.Incorrect statement regarding treatment of complex
regional pain syndrome (CRPS) is
• A. Efficacious treatment with multimodal therapy
early in the diagnosis (within 1 month of symptom)
is most effective
• B. It responds well to sympathetic blockade
• C. If not treated properly and in a timely fashion,
CRPS can result in functional disability
• D. Patients need to refrain from physical therapy
until the pain syndrome is resolved
• ANS D Patients need to refrain from physical
therapy until the pain syndrome is resolved
• The general strategy in CRPS treatment is often
multidisciplinary. Physical therapy plays a central role in
the multimodal treatment of CRPS which is facilitated
with sympathetic blockade or intravenous regional
blocks. Physical therapy typically consists of active
movement without weights and desensitization therapy.
4.Chronic pain indications for insertion of a
spinal cord stimulator include all of the
following, except
• A. Phantom pain
• B. Complex regional pain syndrome
• C. Chronic visceral pelvic pain
• D. Compartment syndrome pain
 ANS D . Compartment syndrome pain

• A spinal cord stimulator is a device used to exert

pulsed electrical signals to the spinal cord to control
chronic pain, and in some motor disorders. Spinal cord
stimulation is most effective for neuropathic pain, of
which some common indications include
sympathetically mediated pain, phantom limb pain,
ischemic pain due to peripheral vascular disease,
peripheral neuropathies, and visceral pain.
Compartment syndrome pain often requires urgent
evaluation and possible need for emergency
fasciotomy.
5.All the following are inhibitory
neurotransmitters in the pain pathway, except
A. Norepinephrine
B. Adenosine
C. Serotonin
D. Calcitonin gene-related peptide
• ANS D. Calcitonin gene-related peptide
• Norepinephrine, adenosine, and serotonin are
among the major inhibitory neurotransmitters
in the pain cascade.
REGIONAL ANAESTHESIA
1.IDENTIFY THE BLOCK AND THE
STRUCTURE
• PENG BLOCK
• PSOAS TENDON
2.IDENTIFY THE BLOCK AND THE
STRUCTURE
• Ans -
BRACHIAL PLEXUS – AXILLARY APPROACH
MUSCULO CUTANEOUS NERVE
3.WHAT IS SHAMROCK SIGN, NAME THE MUSCLE INVOLVED , IN
ORDER
Shammrock Sign – The
quadratus lumborum muscle is
seen as darker triangular
shape attaching to the apex of
the transverse process of L4.
Three leaves
• PSOAS MAJOR
• ERECTOR SPINAE
• QUADRATUS LUMBORUM
Stem - TP
4.IDENTIFY THE BLOCK RELATED TO THIS SONOANATOMY AND
NAME THE LANDMARK BLOOD VESSEL IN THIS BLOCK
• SUPRAINGUINAL FASCIA ILIACA BLOCK (SIFI)
• DEEP CIRCUMFLEX ILIAC ARTERY
 5. WHAT IS THE VASCULAR STRUCTURE COMMONLY
ENCOUNTERED IN PATH OF THE NEEDLE WHILE PERFORMING
CONVENTIONAL INFRACLAVICULAR BLOCK
• THORACOACROMIAL ARTERY
• INFRA CLAVICULAR APPROACH TO BRACHIAL
PLEXUS
• ALTERNATIVE TO THIS BLOCK IS RAPTIR (Retro
Clavicular approach to Infraclavicular region)
 6.IDENTITY THE MARKED MUSCLE AND THE
PROCEDURE INTENDED FOR THIS SONOANANTOMY
• ANS –
• Longis Collis muscle.
• Stellate ganglion block