NEET PG High Yield Questions for Anesthesiology

Mastering the NEET PG demands a strategic approach to preparation, with an emphasis on high-yield topics proving to be a successful tactic. This blog zeroes in on exactly that – a curated list of high-yield questions in Anesthesiology that are highly likely to appear on the NEET PG. By acquainting yourself with these questions and their detailed explanations, you'll deepen your understanding of Anesthesiology concepts, enhancing your confidence and readiness for exam day.

1. What does the displayed capnography waveform given below likely indicate in a 32-year-old patient undergoing laparotomy for acute intestinal obstruction under general anesthesia?

A. Bisferiens cleft

B. Servo notch

C. Curare cleft

D. All of the above

Correct Option C - Curare cleft:

• Capnometry is the measurement of expired CO₂ and is the confirmation method of choice in anaesthesia for the proper placement of an endotracheal tube.
• Most CO₂ monitors include a waveform known as a capnograph.
• The shape of the normal waveform is illustrated below.

• Phase 0: inspiratory phase.
• Phase 1: It reflects the inspired gas, which is normally devoid of CO₂. It is the dead space.
• Phase 2 (expiratory upstroke): a mixture of alveolar and dead space gas.
• Phase 3: alveolar plateau, with the peak representing end-expiratory (end-tidal) CO₂.
• Several situations can cause unusual waveforms. One of them is a curare cleft, as asked in this question above.
  • Curare cleft, or notch, is seen during spontaneous ventilation.
  • Patients who are primarily partially paralyzed with muscle relaxants may make respiratory efforts at any time during the respiratory cycle with controlled ventilation.
  • As the muscle relaxant is reversed, the curve becomes normal in shape.
• The aperture is in the last third of the plateau. It is caused by a lack of synchronous action between the intercostal muscles and the diaphragm, most commonly caused by inadequate muscle relaxant reversal.
  • The depth of the aperture is proportional to the degree of muscle paralysis.
  • The position of the cleft is fairly constant in the same patient but is not necessarily present with every breath.
• The notch is also seen in patients with transverse cervical lesions, flail chest, hiccups, pneumothorax, and when a patient tries to breathe during mechanical ventilation.

Incorrect Options:

Option A - Bisferiens cleft:

• It is also a biphasic pulse and aortic waveform with two peaks per cardiac cycle. The smaller peak is followed by a strong and broad one.
• It is a sign of problems with the aorta, including aortic stenosis, aortic regurgitation and hypertrophic cardiomyopathy resulting in aortic stenosis.

Option B - Servo notch:

• Servo motors, or "servos", as they are known, are electronic devices and rotatory or linear actuators that rotate and push parts of a machine with precision.
• Servos are mainly used on angular or linear positions and for specific velocity and acceleration.
• These motors are used in CNS machinery, robotics and automated manufacturing.

Option D - All of the above:

• The diagram in the question above reveals a “curare cleft”, which is represented by a small dip in the alveolar plateau. It indicated a spontaneous respiratory effort during mechanical ventilation.
• The other options do not explain this capnograph.

2. During a surgery, endotracheal intubation is performed, and airway monitoring is done via waveform capnography. The normal waveform is shown in the figure below. Which part of expiration in this figure is represented by phase 1?

A. Dead space ventilation

B. Alveolar ventilation

C. Both

D. None

Correct Option A - Dead space ventilation:

• In a normal capnogram, Phase 1 represents dead space ventilation.
• ASA guidelines for basic anesthetic monitoring state that when a tracheal tube or supraglottic airway device is inserted, its correct positioning must be verified by identifying carbon dioxide in the expired gas.
• Continual end-tidal carbon dioxide (EtCO₂) analysis is performed until the device is removed or the patient is transferred to a postoperative care location.
• CO₂ analysis provides a means for assessing metabolism, circulation, and ventilation and can detect many equipment and patient-related problems.
• Capnometry is the measurement of CO₂ in a gas mixture, and a capnometer is a device that performs the measurement and displays the readings in numerical form.
• Capnography is the recording of CO₂ concentration versus time, while a capnograph is a machine that generates the waveform. 
• The shape of the normal waveform is illustrated in the figure below.

• Phase 1 (inspiratory baseline) reflects inspired gas normally devoid of carbon dioxide. It is the end of inspiration and the early gas expiration from dead space.
• Phase 2 (expiratory upstroke) represents the transition from gas from the dead space that does not participate in gas exchange and alveolar gas that contains carbon dioxide.
• Phase 3 (plateau) represents the partial pressure of CO₂ exchange at the alveoli; the plateau amplitude is referred to as EtCO₂; phase 3 normally has a slight upslope due to physiologic ventilation-perfusion mismatch.
• The angle between phases 2 and 3 is called the alpha angle. Normally, it is between 100^o and 110°. It is decreased with obstructive lung disease, as the dead space volume takes longer to be exhaled.
• In phase 4, the patient inhales. Normally, carbon dioxide falls abruptly to zero and remains at zero until the next exhalation.

Incorrect Options:

Option B - Alveolar ventilation:

• Phase 2 represents gas from late anatomic and alveolar dead space, upsloping as alveolar gas mixes in and raises the CO₂.
  • As exhalation continues, gas from alveoli in regions with relatively short conducting airways appears and mixes with dead space from regions with relatively long conducting airways resulting in an increased CO₂ level.
• Phase 3 shows the alveolar plateau. Because of the uneven emptying of alveoli, the slope continues to rise gently.

Option C - Both:

• Phase 1 represents dead space ventilation, while Phase 2 represents upper alveolar ventilation, and Phase 3 represents middle and lower alveolar ventilation in a normal capnogram. Neither of them can represent Phase 1.

Option D - None:

• Phase 1 represents dead space ventilation, while phase 2 (mainly) and a portion of phase 3 represent alveolar ventilation.

3. A 46-year-old chronic smoker comes to the emergency department with a history of difficulty in breathing & fever for 1 day. Which of the following pin index numbers of a cylinder to be used to connect the facemask in this patient?

A. 1, 5

B. 2, 5

C. 3, 5

D. 2, 6

Correct Option B - 2, 5:

• The pin index number of a cylinder used to connect the face mask in this patient is 2,5 (pin index for oxygen).
• Machines usually have one or two E-type cylinders that hang on specific hanger yokes.
• The medical gas pin-index safety system ensures that the correct medical gas cylinder is hung in the correct yoke.
• The pin index safety system consists of holes on the cylinder valve positioned in an arc below the outlet port.
  • Pins on the yoke or pressure regulator are positioned to fit into these holes.
  • This is one of the safety features of anesthesia machines which prevents the misconnection of the particular gas cylinder to the machine.

Incorrect Options:

Option A - 1, 5:

• This patient should be connected to an oxygen mask, so the pin index system number is 2, 5.
• The pin location of the air is 1, 5

Option C - 3, 5:

• The pin locations of nitrous oxide are 3, 5 and the air is 1, 5.

Option D - 2, 6:

• This patient should be connected to an oxygen mask, so the pin index system number is 2, 5, not 2, 6.
• The pin location of Carbon dioxide(< 7.5%) is 2,6

4. What medical device, depicted below, is most likely recommended for a 56-year-old male with a history of hypertension and myocardial ischemia who is admitted to the cardiology ward due to rhythm issues?

A. Pulse oximeter

B. Sphygmomanometer

C. Manual external defibrillator

D. Automated External Defibrillator

Correct Option D - Automated External Defibrillator:

• The above image is of Automated External Defibrillator.
• Automated External Defibrillator:
  • It is an advanced, microprocessor-based portable device.
  • High specificity and sensitivity in differentiating shockable from non-shockable rhythms. 
  • Delivers an electric shock through the chest to the heart, potentially stopping arrhythmias.
  • Compared with monophasic shocks, biphasic shocks deliver energy in two directions with equivalent efficacy at lower energy levels and possibly with less myocardial injury.
  • When using AEDs, one electrode pad is placed beside the upper right sternal border, just below the clavicle, and the other pad is placed just lateral to the left nipple, with the top of the pad a few inches below the axilla.

Incorrect Options:

Option A - Pulse oximeter:

• It is used to monitor the oxygen saturation.

Option B - Sphygmomanometer:

• It is used to measure blood pressure.

Option C - Manual external defibrillator:

• The manual device for defibrillation does not automatically identify and treat the abnormal rhythm.
• However, the success rates are comparable to the automatic defibrillator

5. What is a potential adverse effect of using a laryngeal mask airway (LMA) during the anesthesia for fibroadenoma removal in a 32-year-old female when Glycopyrrolate, Propofol, fentanyl, and succinylcholine are administered, and oxygen/nitrous oxide and sevoflurane are used for maintenance?

A. Less invasive

B. Less haemodynamic alteration

C. Pulmonary aspiration

D. Lesser time for insertion

Correct Option C - Pulmonary aspiration:

• The endotracheal tube is the best device and definitive airway to prevent aspiration.
• There is an increased incidence of aspiration of gastric contents with a laryngeal mask airway.
• The laryngeal mask airway is a supraglottic airway device which sits in the hypopharynx and forms a seal around the epiglottic tissues.
  • The seal around the laryngeal inlet allows for the delivery of oxygen and volatile agents during spontaneous ventilation and permits positive pressure ventilation at pressures up to 20 cm H₂O.
  • Once positioned, the cuff should be inflated with the minimum air volume, with a target cuff pressure of 60 cm H₂O.

Advantages

Disadvantages

Easy and rapid Less invasive Better hemodynamic stability Very useful in difficult intubations Lack of need for muscle relaxation requires a lesser plane of Anaesthesia Avoidance of risk of some risks of tracheal intubation(trauma to teeth and airway, sore throat, coughing on emergence, bronchospasm) It can be used for ventilation as a primary airway management device, rescue airway device, and a conduit for tracheal intubation.

Supraglottic airway devices have comparatively lesser seal pressures than tracheal tubes, which leads to ineffective ventilation when higher airway pressures required Increased risk of gastrointestinal aspiration when first-generation Supraglottic airway devices used No protection from laryngospasm Less safe in prone or jackknife positions Less secure airway Greater risk of the gas leak and pollution Can cause gastric distention

Incorrect Options:

Option A - Less invasive:

• LMA is a less invasive technique to provide ventilation than the other methods.

Option B - Less haemodynamic alteration:

• It is better hemodynamic stability
• As there is no need for any specific arrangements been needed.

Option D - Lesser time for insertion:

• Its application needs no time as it's a less invasive technique, so less time is required for its insertion.

Also Read: NEET PG Previous Year Question Papers of Last 6 Years

6. A 40-year-old male is brought in by his friend to the Emergency department with a sustained head injury following a road traffic accident. His GCS is 6/15, and he has a blood pressure of 150/100 mmHg, a pulse rate of 50 beats/minute, and SpO2 of 90% at room air. Given poor GCS, his airway is secured in the casualty. Which device, incorporating Murphy's eye, is utilized to secure the airway?

A. Endotracheal tube

B. Laryngeal mask airway

C. Anaesthesia face mask

D. Mapleson circuit

Correct Option A - Endotracheal Tube:

• The above mentioned patient sustained a head injury and is not maintaining saturation at room air. She is intubated with an endotracheal tube with a murphy eye structure.

• The main indications for intubation with an endotracheal tube are airway protection and control of the airway.
• Indications include:
  • General anaesthesia
  • Congenital malformations
  • Diseases of the upper airway
  • Mechanical ventilation
  • Perinatal resuscitation
  • Acute respiratory distress
• Murphy's eye is the part of the endotracheal tube just distal to the proximal opening.
• Size of Endotracheal tube:
  • Adult Male: 8mm ID-9mm ID
  • Adult Female: 7mm ID-8mm ID
• Pediatric size of the endotracheal tube
  • For age > 6 years: ETT size = Age/4 + 4.5 mm ID
  • For age < 6 years: ETT size = Age/3 + 3.5 mm ID

Incorrect Options:

Option B - Laryngeal mask airway:

• Laryngeal mask airways (LMA) are supraglottic airway devices.
• They are used as a quick method to maintain an open airway during anaesthesia induction and as an immediate life-saving procedure for a failed airway patient.
• It does not have Murphy's eye in its structure.

Option C - Anesthesia face mask:

• The face mask does not have Murphy's eye in its structure.

Option D - Mapleson circuit:

• Mapleson has no Murphy's eye in its structure.

7. Which machine from the provided image is used for the further management of a 60-year-old man with acute shortness of breath and respiratory acidosis due to COPD?

A. BiPAP machine

B. Portable Ventilator

C. Mechanical Ventilator

D. ECMO

Correct Option A - BiPAP Machine:

• BiPAP (Bilevel Positive Airway Pressure is technically a CPAP that alternates between two pressure levels (inspiratory positive airway pressure (IPAP) higher pressure and expiratory positive airway pressure (EPAP) lower pressure).
• The principal effect is to increase functional residual capacity and has an added advantage of alveolar recruitment.
• BiPAP therapy is best for short-term use and in patients with the ability to cough and protect their airways.

Incorrect Options:

Option B - Portable Ventilator:

• A portable ventilator provides invasive ventilatory support and is connected via an endotracheal tube or a tracheostomy tube, not a face mask.
• It is used to transport patients who require ventilatory support.

Option C - Mechanical Ventilator:

• An invasive ventilator provides invasive ventilatory support and is connected via an endotracheal tube or a tracheostomy tube, not a face mask.
• It provides respiratory support to patients who cannot breathe independently.
• It has 3 modes of ventilation
  • Pressure Controlled Ventilation
  • Volume Controlled Ventilation
  • Pressure Support Ventilation

Option D - ECMO:

• ECMO stands for extracorporeal membrane oxygenation. The ECMO machine is similar to the heart-lung bypass machine used in open-heart surgery.
• It pumps and oxygenates a patient's blood outside the body, allowing the heart and lungs to rest.
• The main advantage of ECMO is that it can maintain the supply of oxygen to the body while resting the lungs.

8. In a 45-year-old male with established alcoholic liver disease scheduled for open reduction and internal fixation with plating for proximal fractures of the right radius and ulna under brachial plexus block using local anesthetics, which drug can be administered safely without requiring dose adjustment?

A. Lignocaine

B. Bupivacaine

C. Cocaine

D. Procaine

Correct Option D - Procaine:

• This is a case of fracture of the radius and ulna for which the patient is posted for open reduction and internal fixation under the brachial plexus block.
• Ester local anesthetics undergo hydrolysis by cholinesterase enzyme principally in the plasma and, to a lesser extent, in the liver.
• So procaine, a local ester anesthetic, can be given in patients with hepatic dysfunction with little dose adjustment.
• The rate of hydrolysis varies, with chloroprocaine being the most rapid, procaine being intermediate, and tetracaine being the slowest.
• The exception to hydrolysis of ester local anesthetics in the plasma is cocaine, which undergoes significant metabolism in the liver.
• Severe liver disease may slow the clearance of the amino amide local anesthetics, and significant drug levels may accumulate.
• So dose reduction of amino amide local anesthetics is necessary for hepatic dysfunction.

Incorrect Options:

Option A - Lignocaine:

• Lignocaine metabolizes in the liver primarily by oxidative dealkylation, followed by hydrolysis to silicide.
• Lignocaine, an amino amide local anesthetic drug, needs dose adjustment in chronic liver diseases.

Option B - Bupivacaine:

• Metabolism of bupivacaine includes aromatic hydroxylation, N-dealkylation, amide hydrolysis, and conjugation in the liver.
• Bupivacaine is an amino amide local anesthetic and needs dose adjustment in patients with chronic hepatic diseases.

Option C - Cocaine:

• The exception to the hydrolysis of ester local anesthetics in the plasma is cocaine.
• Cocaine undergoes significant metabolism in the liver using hepatic carboxylesterase and is partially excreted unchanged in the urine.

9. A 45-year-old female patient is scheduled for surgery requiring muscle relaxation, and succinylcholine is considered for neuromuscular blockade. The anesthesia team is reviewing potential side effects. Among the listed options, which side effect is not typically associated with the administration of succinylcholine in the context of neuromuscular blockade?

A. Hyperkalemia

B. Bronchospasm

C. Increased IOP

D. Fasciculation

Correct Option B - Bronchospasm:

• Bronchospasm is not commonly associated with succinylcholine, it may primarily result from the administration of a non-depolarizing neuromuscular blocker that induces a higher release of histamine.

Incorrect Options:

Option A - Hyperkalemia:

• Succinylcholine can induce a transient increase in serum potassium levels, particularly in patients with certain risk factors such as burns, denervation, and major trauma.

Option C - Increased IOP:

• Succinylcholine administration may lead to a brief increase in intraocular pressure. This can be a concern in patients with glaucoma or eye injuries.

Option D - Fasciculation:

• Fasciculation, or visible twitching of small muscle fibers, is a common and expected side effect of succinylcholine. It occurs because of the depolarizing action of succinylcholine on muscle fibers.
• Fasciculation lasts for the initial 30 seconds.
• Too many fasciculations involve vigorous muscle contraction, leading to post-operative myalgia.

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