NEET-PG 2012 - Anesthesiology PYQs Practice Questions

Q: Which of the following is true about coeliac plexus block?

Most common side effects include diarrhea and hypotension. ***Most common side effects include diarrhea and hypotension*** - A coeliac plexus block interrupts **sympathetic innervation** to the upper abdominal organs, which can lead to parasympathetic dominance. - This imbalance often results in **increased gastrointestinal motility (diarrhea)** and **vasodilation (hypotension)** as common side effects. *Located retroperitoneally at the level of L3* - The coeliac plexus is typically located **retroperitoneally** at the level of the **T12-L1 vertebrae**, not L3. - Its position is generally superior to the renal arteries, which are closer to L1-L2. *Usually done unilaterally* - A coeliac plexus block is almost always performed **bilaterally** or with a single posterior approach aiming for bilateral spread to effectively block the plexus. - The coeliac plexus is an extensive network, and a unilateral block would likely provide inadequate pain relief. *Useful for painful conditions of the lower abdomen* - The coeliac plexus primarily innervates **upper abdominal organs** (e.g., pancreas, liver, stomach, small intestine, kidneys, adrenal glands). - It is therefore generally **ineffective for lower abdominal pain**, which is innervated by different sympathetic plexuses (e.g., superior and inferior hypogastric plexuses). [Practice more Anesthesiology PYQs on OnCourse]

Q: What is the potential respiratory complication associated with the use of Trilene in combination with Sodalime?

Airway irritation and inflammation. ***Airway irritation and inflammation*** - The interaction between **Trilene (trichloroethylene)** and **soda lime** in a closed anesthetic circuit can produce **dichloroacetylene**. - **Dichloroacetylene** is a highly toxic compound that can cause severe airway irritation, inflammation, and even **necrosis** of the respiratory tract. *Renal toxicity* - While some halogenated anesthetics (e.g., methoxyflurane) are associated with **renal toxicity** due to fluoride ion release, this is not the primary or most severe respiratory complication of Trilene with soda lime. - The main concern with Trilene and soda lime is the formation of a **toxic airway irritant**. *Hepatotoxicity* - **Halothane** is more classically associated with **hepatotoxicity** (halothane hepatitis) due to metabolism into toxic intermediates. - **Trilene** itself is not primarily known for causing severe hepatotoxicity, and the interaction with soda lime does not specifically target the liver for toxicity. *Myocardial depression* - Many inhaled anesthetics, including Trilene, can cause some degree of **myocardial depression**. - However, this is a general effect of the anesthetic on cardiac function and is not a unique or specific complication arising from the **interaction with soda lime** that produces dichloroacetylene. [Practice more Anesthesiology PYQs on OnCourse]

Q: Calcium homeostasis disturbance is the predominant pathophysiological mechanism in

Malignant hyperthermia. ***Malignant hyperthermia*** - Malignant hyperthermia is caused by a genetic defect in the **ryanodine receptor (RYR1)** in skeletal muscle, leading to an uncontrolled release of **intracellular calcium** from the sarcoplasmic reticulum. - This excessive calcium release results in sustained muscle contraction, increased metabolism, and a rapid rise in body temperature. *Duchenne Muscular Dystrophy (DMD)* - DMD is primarily caused by a mutation in the **dystrophin gene**, which leads to the absence or severe deficiency of the **dystrophin protein**. - This deficiency results in muscle fiber fragility, cycles of degeneration and regeneration, and eventual replacement of muscle with fibrous and fatty tissue, rather than a primary calcium homeostasis disturbance. *Limb Girdle Muscular Dystrophy* - This group of disorders is characterized by progressive weakness and wasting of muscles, primarily affecting the **shoulders and hips**. - The pathophysiology involves genetic defects in various proteins that are crucial for muscle function and integrity, such as **sarcoglycans** or **calpain-3**, not primarily calcium dysregulation. *Tibial Muscular Dystrophy* - Tibial muscular dystrophy is a rare, late-onset disorder characterized by progressive weakness of the **anterior tibial muscles**. - It is typically caused by mutations in the **TTN gene**, encoding for the protein **titin**, which plays a vital role in muscle elasticity and structural integrity, rather than a primary calcium imbalance. [Practice more Anesthesiology PYQs on OnCourse]

Q: Who is known for demonstrating the levels of ether anesthesia?

Guedel. ***Guedel*** - Arthur Guedel developed and refined the **stages and planes of ether anesthesia** based on clinical observations of respiratory patterns, eye signs, and muscle tone. - His classification system, known as the **Guedel stages**, provided a systematic approach to monitoring anesthetic depth, especially useful before the advent of modern anesthetic agents and monitoring equipment. *Morton* - **William T.G. Morton** is credited with the first successful public demonstration of sulfuric ether as a surgical anesthetic in 1846 during a tooth extraction. - While he pioneered the use of ether for anesthesia, he did not develop the classic stages of anesthetic depth. *Thompson* - There is no widely recognized historical figure named Thompson who is primarily known for defining the **levels or stages of ether anesthesia**. - This name is not associated with the primary discovery or classification of anesthetic depth. *None of the options* - This option is incorrect because **Guedel** is specifically known for his work in defining the stages of ether anesthesia. - Guedel's contributions were significant in standardizing anesthetic practice for many years. [Practice more Anesthesiology PYQs on OnCourse]

Q: What does the Dibucaine number indicate in clinical practice?

Atypical acetylcholinesterase activity. ***Atypical acetylcholinesterase activity*** - The **Dibucaine number** quantifies the inhibition of **pseudocholinesterase (butyrylcholinesterase)** by the local anesthetic dibucaine. - A low Dibucaine number (e.g., < 20-30) indicates a genetically determined **atypical variant** of pseudocholinesterase, leading to prolonged duration of action of drugs like succinylcholine. *Potency of muscle relaxants* - The potency of muscle relaxants is typically assessed by the **ED95**, which is the dose required to produce 95% suppression of twitch response. - While Dibucaine is a local anesthetic that can cause muscle relaxation, the **Dibucaine number** specifically evaluates an enzyme's activity, not the strength of the relaxant itself. *Potency of general anesthetics* - The potency of general anesthetics is primarily measured by the **Minimum Alveolar Concentration (MAC)** required to prevent movement in 50% of patients in response to a noxious stimulus. - The Dibucaine number is unrelated to the mechanism or potency of general anesthetic agents. *None of the options* - This option is incorrect because **Atypical acetylcholinesterase activity** accurately describes what the Dibucaine number indicates. - The Dibucaine number is a specific laboratory test used to identify genetic variations in butyrylcholinesterase, which has significant clinical implications for drug metabolism. [Practice more Anesthesiology PYQs on OnCourse]

Question 1

Which of the following is true about coeliac plexus block?

Accepted Answer

Most common side effects include diarrhea and hypotension

Answer

Usually done unilaterally

Answer

Located retroperitoneally at the level of L3

Answer

Useful for painful conditions of the lower abdomen

Question 2

What is the potential respiratory complication associated with the use of Trilene in combination with Sodalime?

Accepted Answer

Airway irritation and inflammation

Answer

Renal toxicity

Answer

Hepatotoxicity

Answer

Myocardial depression

Question 3

Calcium homeostasis disturbance is the predominant pathophysiological mechanism in

Accepted Answer

Malignant hyperthermia

Answer

Duchenne Muscular Dystrophy (DMD)

Answer

Limb Girdle Muscular Dystrophy

Answer

Tibial Muscular Dystrophy

Question 4

Who is known for demonstrating the levels of ether anesthesia?

Accepted Answer

Guedel

Answer

Morton

Answer

Thompson

Answer

None of the options

Question 5

What does the Dibucaine number indicate in clinical practice?

Accepted Answer

Atypical acetylcholinesterase activity

Answer

Potency of muscle relaxants

Answer

Potency of general anesthetics

Answer

None of the options

Question 6

All of the following cause myocardial depression except:

Accepted Answer

Etomidate

Answer

Halothane

Answer

Thiopentone

Answer

Ketamine

Question 7

What is the critical temperature of Nitrous Oxide (N2O)?

Accepted Answer

-36.5°C

Answer

-118°C

Answer

-36°C

Answer

-30°C

Question 8

Cocaine was first used as a local anesthetic by?

Accepted Answer

Carl Koller

Answer

Holmer Wells

Answer

Morton

Answer

None of the options

Question 9

Which anaesthetic agent is neither metabolised by liver nor by kidney?

Accepted Answer

Atracurium

Answer

Vecuronium

Answer

Pancuronium

Answer

Rocuronium

Question 10

Which of the following is NOT a contraindication for spinal anaesthesia?

Accepted Answer

Hypertension

Answer

Raised intracranial tension

Answer

Bleeding disorder

Answer

Infection at injection site

NEET-PG 2012 — Anesthesiology