MHMS • 2022 • Paper-III (Technical)
A fifty year old woman presents with two year history of recurrent abdominal pain with radiation to her back. Pain is severe and refractory to simple analgesics. Ultrasound and CECT confirm the diagnosis and show a dilated pancreatic duct. Which of the following is the likely recommended surgical procedure of choice-
A)
Whipple’s procedure
B)
Longitudinal pancreatico-jejunostomy
C)
Vagotomy with antrectomy
D)
Vagotomy and gastrojejunostomy
Longitudinal pancreatico-jejunostomy is the preferred standard management for this clinical situation.
MHMS • 2022 • Paper-III (Technical)
5 days after CBD surgery there is a small leak. What will be the best treatment-
A)
Ultrasound guided aspiration
B)
ERCP and stenting
C)
Re-explorationn and hepaticojejunostomy
D)
Re-exploration and primary repair
ERCP and stenting is the preferred standard management for this clinical situation.
MHMS • 2022 • Paper-III (Technical)
The following condition is indicative of surgery in acute pancreatitis-
A)
Acute fluid collection
B)
Persistent psudocyst pancreas
C)
Pancreatic abscess
D)
Infective pancreatic necrosis
Infective pancreatic necrosis correctly describes the definition or characteristic asked in the question.
MHMS • 2022 • Paper-IV (Technical)
A patient with a history of uncontrolled hypertension, diabetes, and angina who is to undergo a laparoscopic cholecystectomy, will be classified as an
A)
ASA II
B)
ASA III
C)
ASA IV
D)
ASA V
ASA II correctly describes the definition or characteristic asked in the question.
MHMS • 2022 • Paper-IV (Technical)
ASA classification for risk stratification is validated for predicting preoperative morbidity associated with the following, except
A)
General or regional anaesthesia
B)
Conscious sedation
C)
Monitored anaesthesia care
D)
Surgical procedure
Conscious sedation is the exception/incorrect statement; the other choices are consistent with the usual finding or principle.
MHMS • 2022 • Paper-IV (Technical)
Which of the following is not helpful in preventing laryngospasm?
A)
Suction secretions immediately after extubation
B)
Extubate deep
C)
Extubate totally awake
D)
Immediately after extubation, stretch the larynx
Immediately after extubation, stretch the larynx correctly describes the definition or characteristic asked in the question.
MHMS • 2022 • Paper-IV (Technical)
For pressure-preset ventilation (also known as “pressure-control ventilation”), the independent variable and dependent variable, respectively, are
A)
Tidal volume and FIO2
B)
Tidal volume and frequency
C)
SpO2 and airway pressure
D)
Airway pressure and tidal volume
Airway pressure and tidal volume is the relevant physiological, anatomical, pharmacological, or anaesthetic principle for this question.
MHMS • 2022 • Paper-IV (Technical)
A patient is undergoing craniotomy for subdural hematoma. During the procedure, the surgeon requests lowering the intracranial pressure. All the following can be used, except
A)
Mannitol
B)
Hyperventilation
C)
Steroids
D)
Furosemide
Mannitol is the exception/incorrect statement; the other choices are consistent with the usual finding or principle.
MHMS • 2022 • Paper-IV (Technical)
The desired level of PaCO2 in a neurosurgical patient is
A)
30 to 35 mm Hg
B)
25 to 30 mm Hg
C)
20 to 25 mm Hg
D)
15 to 25 mm Hg
20 to 25 mm Hg correctly describes the definition or characteristic asked in the question.
MHMS • 2022 • Paper-IV (Technical)
The most incorrect statement regarding postoperative vision loss (POVL) that may occur during prone positioning in spine surgery patients is
A)
Ischemic optic neuropathy accounts for the highest incidence of POVL
B)
Ischemic optic neuropathy is associated with decreased ocular perfusion pressure
C)
Prone positioning, greater than 1 L intraoperative blood loss, and surgery lasting greater than 6 hours represent the highest risk
D)
POVL due to central retinal artery occlusion (CRAO) tends to be bilateral
POVL due to central retinal artery occlusion (CRAO) tends to be bilateral is the exception/incorrect statement; the other choices are consistent with the usual finding or principle.
MHMS • 2022 • Paper-IV (Technical)
During pregnancy, hepatic changes contribute to
A)
Decreased albumin levels contributing to higher free blood levels of highly protein-bound drugs
B)
Decreased liver function tests due to decreased blood flow
C)
Decreased concentration levels of coagulation factors leading to easy bruisability
D)
Decreased activity of plasma cholinesterase resulting in significantly longer duration of action of succinylcholine
Decreased liver function tests due to decreased blood flow is the correct choice based on the standard clinical or subject-matter fact tested.
MHMS • 2022 • Paper-IV (Technical)
Major excitatory neurotransmitters responsible for pain modulation include all the following, except
A)
Substance P
B)
Glutamate
C)
Somatostatin
D)
Aspartate
Somatostatin is the exception/incorrect statement; the other choices are consistent with the usual finding or principle.
MHMS • 2022 • Paper-IV (Technical)
CPAP and BiPAP modes are usually used
A)
In conjunction with sedation
B)
to delay intubation
C)
In unconscious patients
D)
In uncooperative patients
CPAP/BiPAP are non-invasive ventilation modes used in alert cooperative patients to avoid or delay endotracheal intubation in respiratory failure.
MHMS • 2022 • Paper-IV (Technical)
An air bubble is injected into the posterior chamber at the conclusion of retinal surgery (pneumatic retinopexy) to facilitate anatomically correct healing. The most appropriate anaesthetic management, before the air bubble is injected, is
A)
Increase depth of anaesthesia
B)
Discontinue nitrous oxide (N2O)
C)
Ensure adequate muscle relaxation
D)
Hyperventilate the patient
Hyperventilate the patient is the preferred standard management for this clinical situation.
MHMS • 2022 • Paper-IV (Technical)
Potential adverse effect from high inspiratory pressures include
A)
Barotrauma
B)
Hypertension
C)
Hypercapnia
D)
Respiratory acidosis
Barotrauma is the relevant physiological, anatomical, pharmacological, or anaesthetic principle for this question.
MHMS • 2022 • Paper-IV (Technical)
When NPPV is used inspiratory pressures greater than 20 cm H2O should be avoided to prevent
A)
Barotrauma
B)
CO retention
C)
Gastric distension
D)
Hypoxia
Pressures >20 cm H2O exceed lower esophageal sphincter tone causing gastric insufflation, vomiting and aspiration during NPPV.
MHMS • 2022 • Paper-IV (Technical)
Which of the following is not a risk factor associated with cardiac arrests in the paediatric patient?
A)
Emergency Surgery
B)
ASA 3-5
C)
Congenital Airway Deformities
D)
Children 1-4 years old
ASA 3-5 is the exception/incorrect statement; the other choices are consistent with the usual finding or principle.
MHMS • 2022 • Paper-IV (Technical)
Weaning from mechanical ventilation is expedited by
A)
Daily spontaneous breathing trials
B)
Synchronized intermittent mandatory ventilation (SIMV)
C)
Administration of bronchodilating medications around the clock
D)
Daily bronchoscopy
Daily spontaneous breathing trials correctly describes the definition or characteristic asked in the question.
MHMS • 2022 • Paper-IV (Technical)
Nonsteroidal anti-inflammatory drugs (NSAIDs) are often used as part of “multimodal” analgesic therapy, some of the potential advantages include all of the following, except
A)
Decreases opioid requirements
B)
Can decrease postoperative pain intensity
C)
Indirect effect of decreasing opioid-related side effects
D)
Can improve wound healing
Can improve wound healing is the exception/incorrect statement; the other choices are consistent with the usual finding or principle.
MHMS • 2022 • Paper-IV (Technical)
Which of the following is not associated with oxytocin administration?
A)
Myocardial ischemia
B)
Respiratory depression
C)
Hypotension
D)
Tachycardia
Respiratory depression is the exception/incorrect statement; the other choices are consistent with the usual finding or principle.
MHMS • 2022 • Paper-IV (Technical)
Which of the following inhalational anaesthetic agents may cause bradycardia, vasodilation and myocardial depression in infants?
A)
Desflurane
B)
Isoflurane
C)
Sevoflurane
D)
Opioids
Isoflurane is the relevant physiological, anatomical, pharmacological, or anaesthetic principle for this question.
MHMS • 2022 • Paper-IV (Technical)
Which of the following children is the best candidate for a deep extubation?
A)
An 18 month old child who just had a minor procedure, no past HX and spontaneous ventilation for whole case.
B)
A 9 year old healthy child with asthma (no attacks in one year and no wheezes) having a minor elective procedure, spontaneous ventilation maintained throughout procedure
C)
An 5 year old healthy child with no medical history, needed paralysis during procedure but has now been fully reversed.
D)
A 7 year old child who came for emergency appendectomy
A 7 year old child who came for emergency appendectomy correctly describes the definition or characteristic asked in the question.
MHMS • 2022 • Paper-IV (Technical)
Incorrect statement regarding neuraxial anaesthesia and deep-vein thrombosis/pulmonary embolism (DVT/PE) in orthopaedic surgical procedures is
A)
Neuraxial anaesthesia may reduce thromboembolic complications
B)
Neuraxial anaesthesia may reduce blood loss
C)
Neuraxial anaesthesia may decrease platelet reactivity
D)
Neuraxial anaesthesia may increase activity of both factor VIII and von Willebrand factor
Neuraxial anaesthesia may reduce blood loss is the exception/incorrect statement; the other choices are consistent with the usual finding or principle.
MHMS • 2022 • Paper-IV (Technical)
A 10-year-old girl with hoarseness presents for laser microsurgery to address laryngeal papillomas. She is otherwise healthy. The surgeon is requesting a general endotracheal anaesthetic (GETA). The gas mixture least likely to support combustion is
A)
Oxygen 35%, air 65%
B)
Oxygen 30%, helium 70%
C)
Oxygen 20%, nitrous oxide (N2O) 80%
D)
Oxygen 30%, nitrogen (N2 ) 70%
Oxygen 35%, air 65% is the exception/incorrect statement; the other choices are consistent with the usual finding or principle.
MHMS • 2022 • Paper-IV (Technical)
The benzodiazepine which is used to treat various neuropathic pain syndromes is
A)
Diazepam
B)
Clonazepam
C)
Flunazepam
D)
Lorazepam
Clonazepam correctly describes the definition or characteristic asked in the question.
