MCPS Anesthesia

Oct 2021 Recall

2
36 weeks pregnant presents in emergency, epigastric pain, headache, peripheral edema, BP
150/90, Albumin 2g/dl, Platelets 60000, AST and ALT increased...
a. Magnesium for convulsion prophylaxis
b. Early Delivery
c. Cesarean section

3
Patient for elective chole, thyroidectomy performed previously, on levothyroxine. Which test to
see euthyroid status
a. T4
b. TSH
c. Thyroid binding globulin
d. T3

4
Patient with diarrhoea, HCO3 reduced from 24 to 14. If initial PaCO2 was 40mmHg… What will
be the PaCO2 with fully compensated..
a. 28
b. 35
c. 100

5
Fascia Iliaca block. Which nerves are blocked.
a. Obturator and femoral
b. Femoral nerve
c. Lat. cutaneous and femoral

6
Patient primigravida, did not attend pre op anesthetic clinic. She is worried from spinal and
wants full sedation. You are counselling her for regional anesthesia. Which advantage will be
most important
 a. Inc peri-op blood loss
b. Aspiration
c. Awareness during GA

7
Allowalbe blood loss calculation. 40 kg child, hematocrit to fall from 40% to 30%. How much is
allowable blood loss?
a. 450ml
b. 350ml
c. 750ml
d. 550ml

8
Laser surgery, airway fire. Immediate action
a. Remove ETT
b. Pour saline through ETT

9
Laser surgery, ETT is laser compatible. Airway fire. Immediate action
a. Stop oxygen and disconnect circuit from machine
b.

10
To prevent airway fire during laser surgery, what to do?
a. Methylene blue in ETT cuff
b. Saline soaked guazes
c. Minimum FiO2
d. Smoke suctioning

11
Superior hypogastric plexus ganglion is present at bifurcation of aorta. You will perform block at
which level?
a. Left of L4 vertebral body
b. Left of L4 transverse process
c. Right of L4 vertebral body
d. Left of L5 vertebral body
e. Right of L5 vertebral body

12
Cholecystectitis patient complains of shoulder pain. Which dermatome is involved?
a. C3-C5
b. C6-C8
c. C2-C3
 d. T1-T3
e. T6-T8

13
Patient of depression… taking treatment. Complaint of dry mouth, tachycardia etc…
Which drug is responsible?
a. Imipramine
b. Amitryptyline
c. SSRI
d. MAO Inhibitor
e. Diazepam

14
Cerebral blood flow raised most by which of following?
a. O2
b. PaCO2 30mmHg
c. PaCO2 60mmHg
d. pH…

15
Patient of depression on drugs. Came for ECT… She has prolonged QRS complex. Which
drugs responsible?
a. Amytriptyline
b. Doxapram
c. Diazepam

16
At rest most blood is in?
a. Venous system
b. Capillary bed
c. Pulmonary vessels
d. Arterial system

17
Patient with renal failure. Reason for coaugulopathy?
a. Platelet dysfunction
b. Von Wiilebrand deficiency

18
Infraclavicular nerve block level?
a. Roots
b. Trucks
 c. Divisions
d. Cords
e. Branches

19
Patient of asthma. Intra-op develops raised airway pressure and SO2 85%. Reason?
a. Pneumothorax
b. Airway obstruction
c. Bronchoconstriction
d. Allergy

20
Patient of aortic stenosis. Intra-op management.
a. Normal rate and rhythm
b. SVR
c. Decrease heart rate

21
Patient develops wheeze intra-op. Management?
a. Bronchodilator
b. Deepen anesthesia with volatile
c. Steroid

22
Patient with PIH and asthma. Induction of choice?
a. Propofol
b. Thiopentone
c. Ketamine
d. Etomidate

23
Pregnant patient advised cholecystectomy, When is best time to perform surgery?
a. 3rd trimester
b. Delay elective surgery till after delivery
c. 2nd trimester
d. …

24
Hemodynamically stable patient for D&C. Best anesthetic option?
a. Spinal
b. GA with mask
c. GA with LMA
25
Intrathecal opioids for epidural labour analgesia. Most common side effect?
a. Pruritis
b. Respiratory depression

26
Intrathecal opioid which causes most delayed respiratory depression
a. Morphine sulfate
b. Fentanyl
27
Patient with uterine rupture during labour. BP 80/40. Immediate management?
a. Laparatomy with GA
b. Fluid resuscitation before surgery

28
Retained placenta, obstetrician brought patient for removal. Which will be best anesthesia
choice?
a. Spinal
b. GA with mask
c. GA with LMA

29
Patient child for lumbar puncture and some elective diagnostic procedure. Parents are in sialkot.
Elder brother 17 yrs old is with him. He has understood the risks and given consent. What will
you do?
a. Cancel the case
b. Proceed
c. Wait for parental consent

30
Female patient comes for surgery under GA. She has many questions in pre-op clinic. Informed
consent is taken? Why is it important for anesthesiologist to take consent?
a. Patient is unaware during surgery and anesthesiologist is responsible for her dignity

31
Patient found in garage with car engine running. Cherry red appearance. GCS 12/15.
Management options?
a. Intubate and ventilate
b. Transfer for hyperbaric oxygen therapy
c. Give O2 via NRB at 15L/min

32
Patient with pre eclampsia. Labetalol 5-20mg given for BP control. Still BP is 170/90. Now what
to do next?
 a. Magnesium with loading dose
b. Magnesium infusion without loading dose
c. Hydralazine

33
Patient with preeclampsia for LSCS under GA. How to blunt laryngoscopy response?
a. Lignocaine
b. Labetalol
c. Hydralazine
d. GTN
e. Fentanyl

34
Patient with Pyloric stenosis. Vomiting for 2 weeks. Anesthetic management?
a. Immediate RSI induction
b. Resuscitate medically before surgery

35
Patient had bare metal stent 6 weeks back. Now came for elective surgery. What to do?
a. Stop clopidogrel and aspirin
b. Stop clopidogrel continue aspirin
c. Continue both
d. Cardiologist opinion
e. Stop aspirin continue clopidogrel

36
Patient with mitral valve disease. Came for mastectomy. Which antibiotic to be given?
a. Ceftriaxone
b. Vancomycin
c. Ampicillin
d. Clindamycin

37
Interscalene block given.. Patient starts coughing and desats…?
a. Pneumothorax
b. Other options

38
Massive transfusion given… which electrolyte abnormality expected?
a. Hypocalcemia
b. Hyperkalemia
c. Hypernatremia
d. Hypercalcemia
39
Patient oliguric 24 hours post op after TURP. CVP 8-10, BP and heart rate normal.
Management?
a. Lasix 40mg
b. Lasix 180mg
c. 2 L Normal saline challenge in 2 hours
d. 500ml colloid in 30 min
e. Manitol
40
Laryngoscope blade used on Hepatitis patient. After washing with water, what next step in
disinfection?
a. Gluteraldehyde
b. Autoclave
c. Ethylene oxide
d. Peracetic acid

41
Calculate fluid requirement for burn patient. First 8 hours. 70kg, burn on chest, abdomen and
back, and right arm.
a. 7000ml
b. 6300ml
c. 4000ml

42
Calculate fluid requirement for burn patient in 24 hours. 40kg weight, 50% burn.
a. 6L
b. 7L
c. 8L

43
Flow in a vessel increases with radius by square of?
a. 2
b. 16
c. 4
d. 8

44
Patient of parkinsons disease. Which will be best anti-emetic?
a. Metoclopramide
b. Ondansetron
c. Diphenhydramine

45
Emergency surgery performed of a pregnant full stomach patient. After extubation patient sats
drop to 75%. Reason?
a. Aspiration
b. Amniotic Fluid Embolism
c. VAE
d. MI

46
Patient of A positive blood group. Undergoing surgery with massive blood loss. No blood
arranged or crossmatched before. Hospital blood bank does not have O negative blood in stock.
What other blood group can be given to this patient?
a. AB positive
b. AB Negative
c. O Positive
d. …

47
MAC changes with aging per dacade?
a. Decreases 6% per decade
b. Decreases 12% per decade
c. Increases 6% per decade
d. Increases

48
Complication of celiac plexus block?
a. Diarrhoea
b. Hypertension
c. Hypotension
d. Constipation

49
23 weeks pregnant patient for non pregnant surgery. Just after induction of anesthesia patient
BP falls to 70/50mmHg. Reason?
a. Propofol
b. Thiopentone
c. Aortocaval compression

50
 Paper 2
1
During Lap chole in tredelenberg position… suddenly SO2 drops and raised airway pressure.
one side chest has hyperresonant and reduced breath sounds?
a. Pneumothorax
b. Endobronchial
c.
d.

2
Patient post surgery 3 months, pain in arm.. Diagnosed with Reflex sympathetic dystrophy.
Clinical features will include
a. Temperature change
b. Brittle nails

3
How to diagnose tension pneumothrax intraoperative
a. ECG
b. Xray
c. Auscultation
d. CO2

4
Patient for elective chole, thyroidectomy performed previously, on levothyroxine. Which test to
see euthyroid status
a. T4
b. TSH
c. Thyroid binding globulin
d. T3

5
Patient with spinal cord transection at C6 level. He is on antihypertensive meds. In previous
surgery he had episode of hypertension, bradycardia, diaphoresis. Came for some elective
surgery now. What will be preferred anesthesia choice?
a. GA with suxa and ETT
b. GA with LMA
c. Spinal

6
Phantom limb patient… below knee amputation. Complaint of pain despite simple analgesics.
What proven treatment will you offer?
a. Gabapentin
b. Mirror box therapy
c. Spinal cord stimulation

7
Patient with post herpetic neuralgia. Which treatment will help in acute herpes zoster phase?
a. Repeated sympathetic blocks
b. Opioids
c. Anticonvulsants
d. Anti depressants
e. NSAIDs

8
During basic life support, what will be indicator for good neurological outcome?
a. Systolic more than 100mmHg
b. Mixed venous sats more than 75%
c. pH < 7.3

9
During Basic life support, what will be indicator of good chest compressions?
a. EtCO2 > 30mmHg
b. EtCO2 > 20mmHg
c. EtCO2 < 45mmHG
d. EtCO2 > 40mmHG
e. PaO2 100%

10
Patient 100kg with sodium 110mEq… how much sodium will be required to raise level to
120mEq?
a. 300mEq
b. 500mEq
c. 600mEq

11
Patient with IHD taking beta blockers. During surgery, BP drops. SO2 drops. CXR interstitial
shadows B/L, Chest clear on auscultation. ECG shows ST elevation 2mm on anterior leads.
What will be diagnosis?
a. Myocardial infarction
b. Pulmonary embolism

12
Patient with diarrhoea history, develops weakness in both distal upper and lower limbs,
respiratory difficulty, getting drowsy. Vital capacity is 1.5L. Next step?
a. IVIG
b. Plasmaphoresis
c. Intubate ventilate
d. Steroids

13
How to measure plateau pressure..?
a. At end of inspiration
b. Inspiratory pause
c. Expiratory pause
d. At end of expiration

14
OLV… patient on FiO2 1.0… and SO2 drops to 75%. How to improve refractory hypoxemia?
a. CPAP to non dependant lung
b. PEEP to dependant lung

15
OLV… patient on FiO2 1.0… and SO2 drops to 75%. How to improve refractory hypoxemia?
a. CPAP to non dependant lung
b. PEEP non dependant lung

16
Bronchopleural fistula surgery, How will you isolate the lung?
a. Double lumen tube
b. Single lumen tube with bronchial blocker
c. Single lumen tube

17
Ruptured Cerebral aneurysm surgery in progress. PaCO2 30mmHg… effective way to decrease
ICP?
a. Hyperventilate
b. Mannitol bolus
c. Mannitol infusion

18
Cerebral surgery… surgery not happy with ICP after dura opening. How to immediately
decrease ICP?
d. Hyperventilate
e. Mannitol bolus
f. Mannitol infusion
19
Patient in ICU after neurosurgery. Effective way to decrease ICP?
a. Hyperventilation
b. Manitol
c. Ferusemide

20
Patient with penetrating eye injury. Which drug will increase IOP?
a. N2O
b. Nitrogen
c. Oxygen
d. Air
e. CO2
21
Patient with penetrating eye injury. What will increase IOP?
a. Raised MAP
b. Raised CO2
c. Hypoxia
d. Raised CVP

22
Which of following can be done as day case?
a. Paeds patient for appendectomy
b. Patient with angina
c. Patient with Asthma controlled on bronchodilators

23
Patient on beta blockers. Develops wheeze intra-op. Reason?
a. Allergy
b. Bronchoconstriction
c. Pulmonary edema
d. Mechanical airway obstruction

24
Patient on beta blocker, Laparoscopic cystoscopy. Develops sudden bradycardia. Reason?
a. Beta blocker use
b. Insufflation of CO2

25
Patient with IHD, rales, SO2 85% on sitting position, Shortness of breath. Came for elective non
cardiac surgery. How to proceed?
a. Cancel the surgery
 b. GA
c. Spinal

26
Lap chole… after gas insufflation, patient airway pressure rises suddenly. Decreased breath
sounds on left side.
a. Endobronchial
b. Pneumothorax
c. bronchospasm

27
Child 4 yrs. for emergency fracture surgery, full stomach. passed 4.0 non cuffed ETT, and throat
packed. air leak is persistent. Using Mapelson F circuit with adjustable valve attached to bag.
And bag is not being inflated adequately. Options?
a. Change ETT to one size larger
b. Increase fresh gas flow

28
Posterior cranial fossa surgery. CO2 ddrops, BP drops, Sts drop.?
a. VAE

29
Renal failure patient for AV fistula repair. Bleeding time 18, APTT 32... Oozy… How to treat?
a. Cryoprecipitate
b. Platelets
c. FFPs
d. Factor VIII concentrates

30
Patient transfused one unit RCC during surgery. Develops hypotension, rash on body.
Treatment?
a. Epinephrine
b. Ephedrine

31
Patient for repeated dressings. Options?
a. Epidural
b. Ketamine
c. GA with LMA

32
Child with Type 1 diabetes and Renal failure. Came for appendectomy. Pre-op. BSR 250, pH
7.2, HCO3 12, Na 145, K 5.6, Cl: 122. Diagnosis?
a. Diabetic ketoacidosis
 b. Renal tubular acidosis
c. Lactic acidosis

33
Patient given 5 RCC and 6 Litre Normal saline in surgery. Later findings pH 7.1, HCO3 12, Na
155, Cl 115, Reason?
a. Lactic acidosis
b. Normal saline infusion

34
Patient given 10 units RCC and 1 litre of colloid in surgery. Still oozing from anastomoses.
Reason?
a. Dilutional thrombocytopenia
b. Low fibrinogen
c. …

35
End point of damage control resuscitation is?
a. Systolic more than 100
b. ScVO2 for than 75%
c. Carotid pulse palpable and BP more than 80
d. Radial pulse palpable and BP more than 80
e. Femoral palpable and BP…..

36
Patient with von willebrand disease. How to correct his coagulopathy preoperatively?
a. Vit K
b. DDAVP
c. FFP
d. Cryoprecipitate

37
Patient undergoing cholecystectomy under GA. now unable to opposition of left thumb and little
finger. Which nerve?
a. Radial
b. Ulnar
c. Median
d. Median cutaneous nerve

38
Patient previous history of CVA, with power of 1/5 in Right upper and lower limbs. Cranial
surgery. Induction done with propofol and Atracurium 50mg. You want to see nerve monitoring
for muscle relaxation? Which muscle to see?
a. Right orbicularis occuli
 b. Left orbicularis occuli
c. Left adductor pollicis
d. Right adductor pollicis
e. Orbicularis oris

39
Patient of pheochromocytoma. How to control his BP pre-operatively?
a. Phenoxybenzamine
b. Metoprolol
c. Atenolol
d. GTN

40
Patient for small bowel tumor resection. Has flushing, High BP, sweating on hands. Diagnosis?
a. Carcinoid
b. Zollinger ellison syndrome

41
Crescendo decrescendo murmur mid systolic. Which condition?
a. Aortic regurgitation
b. Aortic stenosis
c. Mitral stenosis

42
Patient on Reserpine. Develops hypotension intra-op. What to give?
a. Epinephrine
b. Phenylephrine
c. Ephedrine
d. Dopamine
e. Noradrenaline

43
Patient given spinal. No sepsis or hemorrhage. Develops hypotension intra-op. Treatment?
a. 2 litre normal saline
b. Phenylephrine
c. Ephedrine
d. Epinephrine

44
Of the following, which one is dynamic method of fluid responsiveness assessment?
a. Pulse pressure variation
b. CVP
c. Echo findings
45
Patient with hip fracture in ward. develops signs of pulmonary embolism. Which most reliable
method to make diagnosis of P.E?
a. Pulmonary angiogram
b. CXR
c. ECG
d. V/Q scan

46
COPD patient. How to assess post op morbidity?
a. FEV1
b. FVC
c. Other options

47
Patient underwent cystoscopy. Post op few hours later he develops, tachycardia, tachypnea,
rigid tender distended abdomen. Diagnosis?
a. Bladder perforation
b. Congestive heart failure
c. Other options

48
Cobra snake bite patient on neck. Patient develops difficulty breathing, drooling, SO2 75%.
Heart rate 60, BP 100/70. Most immediate management?
a. Intubate ventilate
b. Snake venom
c. Epinephrine + 100mg Hydrocortisone
d. …

49
Epiglottitis child… how to perform induction?
a. Inhalational induction
b. Propofol induction with rocuronium
c. Propofl induction with suxa

50
Child with vomitings. Olive shaped mass palpable in abdomen. What will be metabolic
abnormality seen?
a. Hypochloremic Metabolic alkalosis
b. Hypochloremic Metabolic acidosis
c. hyperchloremic Metabolic alkalosis
d. Hyperchloremic metabolic acidosis

51
2 weeks old, delivered at 34 weeks neonate for inguinal hernia repair. Best anesthesia plan?
a. Caudal with GA
b. Spinal
c. GA with epidural

52
Child with Rhinorrhoa, dry cough, and temp 37.5C. Came for tonsillectomy. How will you
proceed?
a. Postpone the surgery
b. Proceed if chest is clear and no history of asthma
c. Perform CXR

53
Child with upper respiratory tract infection. Came for elective surgery. How long to postpone?
a. 2-3 weeks
b. 3-4 weeks
c. 4-6 weeks
d. Do not postpone

54
Patient on warfarin due to previous CVA. Warfarin stopped 2 weeks back. Now on which
investigation will you proceed for epidural?
a. PT 14/14, APTT 34/34, INR 1.0
b. PT 16/14, APTT 34/34, INR 1.5
c. INR 2.5
d. INR 2.0

55
APGAR score calculation. New born is cyanotic, Heart rate of 80/min. No respiration, no
movement.
a. 0
b. 1
c. 2
d. 3
e. 4

56
GCS calculation. Patient of RTA. Does not open eyes, no movement and no voice.
a. 0
b. 1
c. 2
d. 3
e. 4
57
Which ETT is best for strabismus surgery?
a. Normal PVC tube
b. RAE tube
c. Armoured tube
d. Norton tube

58
Cleft palate surgery. Which position?
a. Trendelenberg
b. Supine with hyperextended neck
c. Neck flexed
d. Tonsillectomy position

59
Surgeon wants to do Forced duction test. Which drugs offers limitation for its performance?
a. Suxa
b. Atracurium
c. Propofol
d. Thiopentone
e. Atropine

60
Strabismus surgery. Bradycardia develops. Best management?
a. Stop the surgeon and give atropine
b. Continue surgery and give atropine
c. Atropine only

61
Advantage of hetastarch on dextran, is that it does not?
a. Interfere with type and crossmatch
b. Allergic reaction
c. Hypervolemia
d. Coagulopathy
e. Micron filter is used

62
Obese Patient came for lung biopsy. What option for DVT prophylaxis?
a. Early mobilization
b. Compression stockings
c. Heparin 60mg TDS SQ
d. Enoxaparin
63
Obese patient which marker will tell difficulty intubation?
a. Short neck with normal circumference
b. Inter incisor distance >3.5 cm
c. Inability to protrude lower incisors from upper incisors
d. Receding maxillary incisors
e. Receding mandible

64
Patient with OSA. Which are predictors for OSA risk.
a. Neck circumference
b. BMI
c. Other options.

65
Best and economical method for pain relief that has most patient satisfaction?
a. PCA
b. Continuous morphine infusion
c. Intermittent nalbin doses

66
PCIA given to patient. PCIA was with fentanyl 10mics background infusion, 10 mics bolus, 10
minutes lockout time.Which factor influence it?
a. Weight and age
b. Lockout time
c. Background infusion
d. Bolus dose

67
Epidural test dose of lignocaine is given to test?
a. Intravascular and sub arachnoid
b. Intravascular only
c. Intrathecal only
d. Intravascular and epidural dose

68
COPD patient… airway pressure rise and SO2 fall…
a. Pneumothorax
b. Mainstem intubation

69
Patient with base of skull fracture will have which findings?
a. Xray air fluid level frontal sinus
b. Tympanic membrane tear
 c. Infra alveolar paraesthesia

70
Patient with trauma… blood in airway.. GCS 7/15. Induction method?
a. Inhalational induction with direct laryngoscopy
b. Fiber optic intubation

71
Patient for Laryngeal tumor biopsy… and has stridor… best method?
a. Microlaryngeal tube
b. Intermittent mask ventilation

72
Patient in recovery. Sats down, crow like voice, BP, and pulse were normal…Management?
a. Racemic epinephrine
b. Steroid
c. Intubate
d. Von invasive ventilation

73
Spinal cord transection… Hypotension, CVP 1mmHg. Reason for hypotension?
a. Dec myocardial contractility
b. Increased venous capacitance
c. …

74
Level for orchidopexy
a. T10
b. L1
c. S1-S2

75
Patient with fracture. How to make fat embolism diagnosis?
a. Petichie, SOB and ….
b. …

76
Hyperkalemia with ECG changes… .treatment?
a. Calcium gluconate
b. Calcium chloride
c. Glucose insulin

77.
Femoral nerve block

78
Cardiac contusion. Findings?
a. Elevated cardiac enzymes
b. ST elevation
c. …

79
ASA status of following patient. Patient has HTN controlled with meds. IHD, CHF with EF of
35%. He becomes short of breath climbing one flight of stairs.
a. 5
b. 4
c. 3
d. 2
e. 1

80
How much blood is needed for epidural blood patch?
a. 10-15ml
b. 15-20ml
c. 20-25ml
d. 20-30ml

81
Patient with RTA. cervical spine injury not ruled out. Blood in oral cavity. How to intubate?
a. Manual in line stabilization with direct laryngoscopy
b. MILS with hard collar on and laryngoscopy
c. Fiber optic
d. …

82
Baby has taken cow’s milk. How long to wait before GA case.
a. 2 hours
b. 4 hours
c. 6 hours
d. 8 hours

83
When will you do synchronized cardioversion?
a. Ventricular fibrillation
b. Atrial fibrillation
c. Asystole
d. Pulseless VT
84
When will you do unsynchronized defibrillation?
a. After failed pericardial thump
b. After establishing ventricular fibrillation
c. Asystole
d. After 5 cycles of CPR
e. After 2 cycles of CPR

85
Nitroglycerine dose to control BP?
a. 5-10 mcg/min
b. 10-20 mcg/min
c. 0.5-1 mcg/kg/min
d. …

86
Metal object is stuck in MRI and engineers want to remove it. What will effect the patient most?
a. Cold
b. Heat
c. Hypoxia

87
Patient with Parkinson’s disease. Which antiemetic to avoid?
a. Droperidol
b. Dexamethasone
c. …

88
Which organ will have vasoconstriction hypoxia?
a. Heart
b. Liver
c. Kidney
d. Lungs

89