General Anesthesia Practice Questions

Q: The reversal by sugammadex is possible with all the following neuromuscular blocker except-

Atracurium. ***Atracurium*** - **Sugammadex** is a modified gamma-cyclodextrin that specifically encapsulates and inactivates **aminosteroid neuromuscular blocking agents**. - **Atracurium** is a **benzylisoquinolinium** agent, not an aminosteroid, therefore it cannot be reversed by sugammadex. *Vecuronium* - **Vecuronium** is an **aminosteroid neuromuscular blocker**, which means it can be effectively encapsulated and reversed by **sugammadex**. - Its chemical structure allows for a high affinity binding with sugammadex, leading to rapid reversal of neuromuscular blockade. *Pancuronium* - **Pancuronium** is an **aminosteroid neuromuscular blocker** that can be effectively reversed by **sugammadex**. - Although sugammadex has a lower affinity for pancuronium compared to rocuronium, it can still effectively reverse its blockade. *Rocuronium* - **Rocuronium** is an **aminosteroid neuromuscular blocker** with the **highest affinity for sugammadex**, making it the most rapidly and effectively reversed by this agent. - The strong, non-covalent binding between sugammadex and rocuronium forms a stable complex, preventing rocuronium from interacting with acetylcholine receptors.

Q: What is the typical pH of Hartmann's solution?

Has a pH of approximately 6.5. Everything mentioned here pertains to pH values of biological fluids and intravenous solutions. ***Has a pH of approximately 6.5*** - Hartmann's solution, also known as **Lactated Ringer's solution**, typically has a pH of about **6.0 to 7.5**, with 6.5 being a good approximation. - Its slightly acidic nature, compared to physiological pH, is due to the presence of **lactic acid** which is later metabolized to bicarbonate. *Has a pH of approximately 5.5* - A pH of 5.5 is more **acidic** than typical Hartmann's solution and might be found in some other IV fluids like **0.9% normal saline**. - While Hartmann's is slightly acidic, it's generally not as acidic as 5.5. *Has a pH of approximately 7.4* - A pH of 7.4 is the **physiological pH of blood** [1]. - While Hartmann's solution is designed to be **isotonic** and help correct acidosis, its pH is not exactly 7.4 before infusion and metabolism. *Has a pH of approximately 8.0* - A pH of 8.0 is **alkaline** and significantly higher than the typical pH of Hartmann's solution. - Such a high pH would not be safe for routine intravenous administration. *Has a pH of approximately 4.5* - A pH of 4.5 is quite **acidic** and would be much more acidic than Hartmann's solution. - Infusion of a solution with such a low pH could lead to significant **acidosis** and other adverse effects in a patient.

Q: Anaesthesia contraindicated In volvulus of gut is

Nitrous oxide. ***Nitrous oxide*** - **Nitrous oxide** diffuses rapidly into gas-filled spaces, which can exacerbate bowel distension in cases of volvulus, increasing the risk of perforation or tension pneumoperitoneum. - Its use can lead to a significant increase in bowel volume and pressure, which is particularly dangerous when the gut is already obstructed and potentially ischemic. *Pancuronium* - **Pancuronium** is a non-depolarizing muscle relaxant that provides good muscle relaxation for surgery, which is often beneficial during abdominal procedures like volvulus repair. - It does not significantly affect bowel volume or blood flow, making it a safe choice for muscle paralysis. *Halothane* - **Halothane** is an inhaled anesthetic that causes general anesthesia and muscle relaxation. - While it can cause some myocardial depression and arrhythmias, it does not directly expand bowel gas and can be used safely in volvulus if cardiovascular status is stable. *Ketamine* - **Ketamine** is a dissociative anesthetic that can be used for induction and maintenance of anesthesia. - It does not cause gas expansion within the bowel and can be a suitable choice, especially in hypotensive patients due to its sympathomimetic effects which help maintain cardiovascular stability.

Q: Anaesthetic agent causing analgesia?

Ketamine. ***Ketamine*** - Ketamine provides excellent **analgesia** by acting as an **NMDA receptor antagonist**, making it unique among commonly used intravenous anesthetics [1]. - It induces a state of **dissociative anesthesia**, where the patient is conscious but detached from painful stimuli, maintaining cardiovascular stability [1]. *Thiopentone* - Thiopentone is a **barbiturate** that causes rapid **induction of anesthesia** and profound **sedation** but has no analgesic properties. - Its primary action is through potentiation of GABA-A receptor activity, leading to central nervous system depression. *Propofol* - Propofol is a widely used intravenous anesthetic known for its rapid onset and short duration of action, but it lacks significant **analgesic effects** [3]. - It primarily works by enhancing GABA-A receptor function, leading to **sedation** and hypnosis. *Etomidate* - Etomidate is an intravenous anesthetic characterized by its minimal cardiovascular depression, making it suitable for patients with **hemodynamic instability**, but it provides **no analgesia** [1], [2]. - Its anesthetic effect is mediated through GABA-A receptor potentiation, resulting in rapid loss of consciousness.

Q: The anesthetic agent which can cause massive hepatic necrosis?

Halothane. ***Halothane*** - Halothane can be metabolized into toxic intermediates through oxidative pathways, leading to **halothane hepatitis** or fulminant hepatic necrosis. - This idiosyncratic reaction is more likely after repeated exposures and presents as severe liver injury, possibly due to **immune-mediated mechanisms** triggered by trifluoroacetylated proteins. *N 2 O* - **Nitrous oxide** (N2O) is generally considered very safe regarding hepatic effects and does not cause massive hepatic necrosis. - Its primary metabolism involves no significant liver pathways that would generate toxic metabolites affecting hepatocytes. *Methoxyflurane* - Methoxyflurane is known to cause **nephrotoxicity** due to its metabolism to fluoride ions, which can impair renal concentrating ability. - While it can be hepatotoxic, its effects are generally less severe and less common than halothane-induced necrosis, with **renal toxicity** being its most prominent adverse effect. *Isoflurane* - Isoflurane is a commonly used volatile anesthetic with a **very low incidence of hepatotoxicity** compared to halothane. - It undergoes minimal metabolism, reducing the likelihood of producing toxic metabolites that could harm the liver.

Q: All are used to produce controlled hypotension except

Propofol. ***Propofol*** - While propofol can cause hypotension, it is primarily used as an **intravenous anesthetic** for induction and maintenance and for sedation. - Its hypotensive effect is a common side effect due to **vasodilation** and decreased cardiac output, but it is not typically optimized or used as a primary agent for controlled hypotension in a surgical setting. *Nitroglycerine* - **Nitroglycerine** is a potent vasodilator, primarily acting on veins, and is commonly used to induce **controlled hypotension** during surgery by reducing preload and afterload. - Its rapid onset and short duration of action make it suitable for titrating blood pressure. *Isoflurane* - **Isoflurane** is an inhaled anesthetic that causes dose-dependent myocardial depression and vasodilation, leading to a decrease in blood pressure. - It is frequently used to provide **controlled hypotension** during surgical procedures. *Esmolol* - **Esmolol** is a rapid-acting, ultra-short-acting beta-blocker that can reduce blood pressure by decreasing heart rate and myocardial contractility. - It is often used to manage **hypertension** and to induce controlled hypotension, especially when a rapid and reversible effect is desired.

Q: In Jorgenson technique drugs given by IV routes are:

Pethidine, Pentobarbital, and Scopolamine. ***Pethidine, Pentobarbital, and Scopolamine*** - The Jorgensen technique, a method of intravenous (IV) sedation for dental procedures, typically involves a combination of **Pethidine (Meperidine)**, a short-acting **barbiturate** like **Pentobarbital**, and an **anticholinergic** agent like **Scopolamine (Hyoscine)**. - This specific drug cocktail provides a synergistic effect, offering **analgesia**, **sedation**, and **amnesia** while reducing secretions. *Scopalamine (Hyoscine)* - While Scopolamine is a component, it is usually administered as part of a **drug combination** with an opioid and a sedative/hypnotic in the Jorgensen technique, not as a sole agent. - Its primary role in this technique is to induce **amnesia** and reduce salivation, contributing to patient comfort. *Pentobarbitol* - Pentobarbital is a key sedative in the Jorgensen technique, providing **hypnotic and anxiolytic effects**. - However, it is typically combined with an opioid like Pethidine and an anticholinergic like Scopolamine to achieve the full desired sedation profile. *Mepiridine* - Meperidine, also known as **Pethidine**, is indeed a component of the Jorgensen cocktail, providing **analgesia and sedation**. - This option is partially correct but does not represent the complete combination of drugs used in the technique. *Pethidine* - Pethidine is an **opioid analgesic** that is a crucial part of the Jorgensen sedative regimen, contributing to pain relief and sedation. - However, the Jorgensen technique utilizes a **multi-drug approach**, making this option incomplete as it excludes the sedative and anticholinergic components.

Q: Bone marrow depression is seen with:

N2O. ***N2O*** - **Nitrous oxide (N2O)** can cause **bone marrow depression** due to its interference with **vitamin B12 metabolism**. - Prolonged or repeated exposure to N2O **inactivates methionine synthase**, an enzyme crucial for **DNA synthesis** and **erythropoiesis**. *Ether* - **Ether** is an older anesthetic agent known for its **cardiovascular depression** and **irritating effects** on the respiratory tract. - It does not typically cause direct **bone marrow depression**. *Isoflurane* - **Isoflurane** is a volatile anesthetic that primarily affects the **cardiovascular system** by causing **vasodilation** and **myocardial depression**. - It is not associated with **bone marrow suppression**. *Halothane* - **Halothane** is a potent anesthetic that can cause **dose-dependent myocardial depression** and is known for its potential to induce **halothane hepatitis**. - **Bone marrow depression** is not a characteristic side effect of halothane.

Q: Emergence Delirium is characteristic of?

Ketamine. ***Ketamine*** - **Emergence delirium**, characterized by vivid dreams, hallucinations, and confusion upon recovery from anesthesia, is a known side effect of **ketamine**, particularly in adults. - This effect is attributed to ketamine's action on **NMDA receptors** and can be attenuated by co-administration of benzodiazepines. *Midazolam* - **Midazolam** is a benzodiazepine often used for sedation and anxiolysis, and it typically causes amnesia and relaxation rather than a delirious state upon emergence. - While it can cause paradoxical agitation in some patients, it does not characteristically lead to emergence delirium similar to ketamine. *Thiopentone* - **Thiopentone** is a short-acting barbiturate used for induction of anesthesia, known for rapid onset and offset, leading to smooth emergence without significant delirium. - Its primary effect is general central nervous system depression, not dissociative anesthesia associated with emergence phenomena. *Opioids* - **Opioids** are potent analgesics that, at higher doses, can cause respiratory depression, nausea, and somnolence; however, they do not characteristically cause emergence delirium. - While they can contribute to postoperative cognitive dysfunction, it is distinct from the dissociative emergence state seen with ketamine.

Q: Which of the following is most cardio depressant

Halothane. ***Halothane*** - **Halothane** is known for causing significant **myocardial depression** by directly reducing myocardial contractility and stroke volume. - It also **sensitizes the myocardium to catecholamines**, increasing the risk of arrhythmias. *Sevoflurane* - **Sevoflurane** causes less **myocardial depression** and is often preferred in patients with compromised cardiac function. - Its effects on heart rate and blood pressure are generally moderate compared to halothane. *Isoflurane* - **Isoflurane** can cause **systemic vasodilation** and a dose-dependent decrease in blood pressure but is generally less cardio-depressant than halothane. - It maintains **cardiac output** better than halothane, sometimes increasing heart rate to compensate for vasodilation. *Desflurane* - **Desflurane** typically causes a **lesser degree of myocardial depression** and tends to preserve cardiac output. - It can, however, lead to transient increases in heart rate and blood pressure upon rapid increases in concentration due to **sympathetic stimulation**.

Question 1

The reversal by sugammadex is possible with all the following neuromuscular blocker except-

Accepted Answer

Atracurium

Answer

Vecuronium

Answer

Pancuronium

Answer

Rocuronium

Question 2

What is the typical pH of Hartmann's solution?

Accepted Answer

Has a pH of approximately 6.5

Answer

Has a pH of approximately 5.5

Answer

Has a pH of approximately 7.4

Answer

Has a pH of approximately 8.0

Answer

Has a pH of approximately 4.5

Question 3

Anaesthesia contraindicated In volvulus of gut is

Accepted Answer

Nitrous oxide

Answer

Pancuronium

Answer

Halothane

Answer

Ketamine

Question 4

Anaesthetic agent causing analgesia?

Accepted Answer

Ketamine

Answer

Thiopentone

Answer

Propofol

Answer

Etomidate

Question 5

The anesthetic agent which can cause massive hepatic necrosis?

Accepted Answer

Halothane

Answer

N 2 O

Answer

Methoxyflurane

Answer

Isoflurane

Question 6

All are used to produce controlled hypotension except

Accepted Answer

Propofol

Answer

Nitroglycerine

Answer

Isoflurane

Answer

Esmolol

Question 7

In Jorgenson technique drugs given by IV routes are:

Accepted Answer

Pethidine, Pentobarbital, and Scopolamine

Answer

Scopalamine (Hyoscine)

Answer

Pentobarbitol

Answer

Mepiridine

Answer

Pethidine

Question 8

Bone marrow depression is seen with:

Accepted Answer

N2O

Answer

Ether

Answer

Isoflurane

Answer

Halothane

Question 9

Emergence Delirium is characteristic of?

Accepted Answer

Ketamine

Answer

Midazolam

Answer

Thiopentone

Answer

Opioids

Question 10

Which of the following is most cardio depressant

Accepted Answer

Halothane

Answer

Sevoflurane

Answer

Isoflurane

Answer

Desflurane

General Anesthesia — MCQs

General Anesthesia — MCQs

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