MHMS • 2022 • Paper-IV (Technical)
You are taking care of a 45-year-old patient undergoing a left adrenalectomy for a pheochromocytoma. Intraoperative management includes
A)
Use of ketamine as an induction agent to counteract the effects of preoperative á-adrenergic blockade
B)
Long-acting antihypertensive agents should be available to treat hypertension
C)
Judicious fluid replacement as these patients are usually volume-overloaded
D)
Magnesium sulphate infusion to treat hypertension
Magnesium sulphate infusion to treat hypertension is the preferred standard management for this clinical situation.
MHMS • 2022 • Paper-IV (Technical)
One of the preventive measures of ventilator-associated pneumonia is
A)
Head end elevation by 30-45 degrees
B)
Open suctioning system
C)
Always keep ventilated patients deeply sedated
D)
Gastric over distension need not be avoided
VAP bundle includes head-up 30-45 degrees, closed suction, subglottic drainage, daily sedation vacation and avoiding gastric overdistension.
MHMS • 2022 • Paper-IV (Technical)
A 6-year-old, 20-kg girl develops pulseless ventricular tachycardia after induction of anaesthesia with halothane, nitrous oxide, and oxygen for a tonsillectomy. The anaesthesiologist intubates the child, administers 100% oxygen, and starts chest compressions. When the defibrillator quickly arrives in the OT the defibrillator should be charged to what energy level for the initial shock?
A)
20 joules
B)
40 joules
C)
60 joules
D)
80 joules
40 joules correctly describes the definition or characteristic asked in the question.
MHMS • 2022 • Paper-IV (Technical)
Which of the following intravenous induction agents is the most suitable for day care surgery?
A)
Morphine
B)
Ketamine
C)
Propofol
D)
Diazepam
Propofol correctly describes the definition or characteristic asked in the question.
MHMS • 2022 • Paper-IV (Technical)
Which of the following is the most common reason for the cancellation of paediatric procedures?
A)
Asthma Exacerbation
B)
Upper Respiratory Infections
C)
Non-compliance with NPO requirements
D)
Instability due to illness
Upper Respiratory Infections is the standard/commonest association or the most appropriate choice for this presentation.
MHMS • 2022 • Paper-IV (Technical)
All are predictors of difficult intubation except
A)
Low Cormack and Lehane Scores from past history
B)
High Mallampati Score
C)
Subglottic stenosis
D)
Marfan’s syndrome
Subglottic stenosis is the exception/incorrect statement; the other choices are consistent with the usual finding or principle.
MHMS • 2022 • Paper-IV (Technical)
One of the following is a risk of keeping high PEEP
A)
Hypotension
B)
Hypertension
C)
Hyperthermia
D)
Hypothermia
High PEEP raises intrathoracic pressure, reducing venous return and cardiac output leading to hypotension and barotrauma.
MHMS • 2022 • Paper-IV (Technical)
Which mode of ventilation locks out patient’s effort to breath
A)
Controlled Mandatory Ventilation
B)
Synchronous Intermittent Mandatory Ventilation
C)
Assist Control Mode
D)
Pressure Control Mode
Assist Control Mode is the relevant physiological, anatomical, pharmacological, or anaesthetic principle for this question.
MHMS • 2022 • Paper-IV (Technical)
Which of the following conditions is more likely to be associated with neuropathic pain?
A)
Traumatic nerve injury
B)
Stroke
C)
Syringomyelia
D)
Multiple sclerosis
Traumatic nerve injury correctly describes the definition or characteristic asked in the question.
MHMS • 2022 • Paper-IV (Technical)
All are true of Visual analogue scale (VAS) except
A)
Correlate highly with pain measured on verbal and numerical rating scales
B)
Is minimally intrusive
C)
Assumes that pain is a multidimensional experience
D)
Measures the intensity of pain
Assumes that pain is a multidimensional experience is the exception/incorrect statement; the other choices are consistent with the usual finding or principle.
MHMS • 2022 • Paper-IV (Technical)
Malignant Hyperthermia is a severe reaction which results in ryanodine receptor activation leading primarily to…
A)
Intracellular Hyperkalaemia
B)
Intracellular Hypernatremia
C)
Intracellular Hypercalcemia
D)
Intracellular Hyperglycaemia
Intracellular Hyperkalaemia correctly describes the definition or characteristic asked in the question.
MHMS • 2022 • Paper-IV (Technical)
What type of breathing circuit would you choose for a child weighing less than 10 kg?
A)
Small semi-closed Circuit
B)
Mapleson A
C)
Standard adult semi closed system
D)
Jackson-Rees Circuit
Jackson-Rees Circuit is the correct choice based on the standard clinical or subject-matter fact tested.
MHMS • 2022 • Paper-IV (Technical)
What is an appropriate hourly maintenance fluid rate for a child weighing 18 kg?
A)
68 ml/hour
B)
58 ml/hour
C)
70 ml/hour
D)
45 ml/hour
58 ml/hour correctly describes the definition or characteristic asked in the question.
MHMS • 2022 • Paper-IV (Technical)
What would be an appropriate sized uncuffed ETT for a 3 year old child weighing 18 kgs?
A)
4.5
B)
4
C)
3.5
D)
3
4.5 is the correct choice based on the standard clinical or subject-matter fact tested.
MHMS • 2022 • Paper-IV (Technical)
Endotracheal intubation is a major risk factor for ventilator-associated pneumonia due to the following reasons with the exception of
A)
Endotracheal intubation breaches airway defences
B)
impairs cough and muco-ciliary clearance, and facilitates micro-aspiration of bacteria-laden secretions that pool above the inflated endotracheal tube cuff
C)
Bacteria form a biofilm on and within the endotracheal tube that protects them from antibiotics and host defences
D)
Due to immuno-compromised condition in a ventilated patient
ET tube impairs cough, mucociliary clearance and biofilm formation promoting VAP; immunocompromised state is separate host factor not due to intubation itself.
MHMS • 2022 • Paper-IV (Technical)
One of the following modes of ventilation reduces the work of breathing by overcoming the resistance created by ventilator tubing
A)
Controlled Mandatory Ventilation
B)
Synchronous Intermittent Mandatory Ventilation
C)
Assist Control Mode
D)
Pressure Support Mode
Pressure Support mode assists spontaneous breaths to overcome circuit/endotracheal tube resistance, reducing work of breathing during weaning.
MHMS • 2022 • Paper-IV (Technical)
Which are the Ventilator Parameters adjusted to maintain the optimum oxygenation?
A)
FiO2 and PEEP
B)
Tidal Volume and Respiratory Rate
C)
Tidal Volume and PEEP
D)
FiO2 and Tidal volume
Oxygenation is controlled by FiO2 and PEEP (mean airway pressure) while ventilation/CO2 clearance is controlled by tidal volume and respiratory rate.
MHMS • 2022 • Paper-IV (Technical)
Which is true of pressure support ventilation (PSV) ?
A)
Delivers either volume cycled or time cycled breaths at a preset mandatory rate
B)
Set amount of pressure that is applied augments each patient-triggered breath.
C)
Delivers unassisted ventilator breaths at a pre-set rate
D)
This mode allows patients to contribute to and determine a portion of their ventilatory requirement
Delivers either volume cycled or time cycled breaths at a preset mandatory rate correctly describes the definition or characteristic asked in the question.
MHMS • 2022 • Paper-IV (Technical)
What side effect is commonly associated with fentanyl that we are concerned about during paediatric anaesthesia?
A)
Myocardial depression
B)
Chest Wall Rigidity
C)
Renal Toxicity
D)
Cytochrome P450 induction
Myocardial depression correctly describes the definition or characteristic asked in the question.
MHMS • 2022 • Paper-IV (Technical)
Neonates and infants have less effective ventilation due to all of the following except
A)
Larger tongue and head
B)
Weak intercostals and diaphragmatic musculature
C)
More pliable and horizontal ribs
D)
Protuberant abdomen
Larger tongue and head is the exception/incorrect statement; the other choices are consistent with the usual finding or principle.
MHMS • 2022 • Paper-IV (Technical)
Allodynia is
A)
Neuropathic pain caused by stimuli that are usually not painful
B)
The ‘burning’ sensation of causalgia
C)
Red flare with nerve damage
D)
Due to reflex sympathetic dystrophy
Neuropathic pain caused by stimuli that are usually not painful correctly describes the definition or characteristic asked in the question.
MHMS • 2022 • Paper-IV (Technical)
Appropriate anaesthetic management for ophthalmic surgery requires tight control of intraocular pressure (IOP) before, during, and after the procedure. The accurate effect of an anaesthetic drug on IOP is
A)
Decreased by glycopyrrolate
B)
Increased by hyperventilation
C)
Decreased by nitrous oxide
D)
Increased by nondepolarizing muscle relaxants
Decreased by glycopyrrolate is the preferred standard management for this clinical situation.
MHMS • 2022 • Paper-IV (Technical)
All of the following statements when positioning patients for spine surgery in the prone position are true, except
A)
The neck should be in neutral position (without hyperextension or hyperflexion)
B)
The eyes must be free of pressure and checked periodically
C)
The abdomen must always be supported (never permitted to hang freely)
D)
The arms are kept at less than 90 degrees of extension and flexion
The abdomen must always be supported (never permitted to hang freely) is the exception/incorrect statement; the other choices are consistent with the usual finding or principle.
MHMS • 2022 • Paper-IV (Technical)
The most significant change in maternal lung volume that occurs in the third trimester of pregnancy includes
A)
Decrease in vital capacity
B)
Increase in residual volume
C)
Decrease in functional residual capacity (FRC)
D)
Decrease in closing capacity (CC)
Decrease in functional residual capacity (FRC) is the relevant physiological, anatomical, pharmacological, or anaesthetic principle for this question.
MHMS • 2022 • Paper-IV (Technical)
The mode of ventilation which allows the patient to breathe spontaneously at his or her own respiratory rate and depth between the ventilator breaths is
A)
Controlled Mandatory Ventilation
B)
Synchronous Intermittent Mandatory Ventilation
C)
Assist Control Mode
D)
Pressure Control Mode
SIMV allows spontaneous breathing at own rate between mandatory ventilator breaths.
