1
Q
Guedel’s oropharyngeal airway - indications?
A
Used in unconscious patients; Prevents tongue fall
2
Q
LMA size: Child, Female, Male?
A
Child: 3; Female: 4; Male: 5
3
Q
LMA generations and types?
A
1st Gen: Classical (inflation port); 2nd Gen: Proseal (inflation port); 3rd Gen: iGel (no inflation port, adapts to thermal heat of larynx)
4
Q
Laryngoscope blades: Adults vs Children?
A
Adults: McIntosh, McCoy’s; Children: Miller’s
5
Q
Most common injury during laryngoscopy?
A
Upper Central Incisor
6
Q
ET tube optimal position from carina?
A
2-5 cm from Carina
7
Q
ET tube size: Male vs Female vs Child?
A
Male: 8-9 mm; Female: 7-8 mm; Child: 3-4 mm (Uncuffed preferred; cuffed may lead to tracheomalacia and subglottic stenosis)
8
Q
IOC to confirm ET tube position?
A
ETCO₂ (capnography)
9
Q
ET tube cuff type and function?
A
Low-pressure, high-volume cuff; Function: Prevents aspiration
10
Q
Optimal intubation position: Normal vs Obese?
A
Normal: Sniffing position (Flexion of cervical spine + Extension of atlanto-occipital joint); Obese: Ramp position/HELP (Head Elevated Laryngoscopy Position)
11
Q
Sellick’s maneuver indication?
A
Rapid sequence intubation; Cricoid pressure to prevent aspiration
12
Q
Larson’s maneuver indication?
A
To prevent laryngospasm
13
Q
Double lumen ET tube indication?
A
For single lung ventilation
14
Q
Mallampati classification grades?
A
Grade I: Complete uvula seen; Grade II: Uvula tip not visualized; Grade III: Uvula not visualized; Grade IV: Only base visualized
15
Q
Cormack-Lehane grading during laryngoscopy?
A
Grade 1: Complete vocal cords visible; Grade 2: Partial cords visible; Grade 3: Only epiglottis base visible; Grade 4: No glottic structures visible
16
Q
Risk factors for difficult airway (mnemonic: OBESE)?
A
Obese, Bearded, Edentulous, Snorer, Elderly; Also: Neck circumference >40 cm
17
Q
Normal Thyromental distance and Sternomental distance?
A
Thyromental distance: >6.5 cm; Sternomental distance: >13 cm; TMJ (Finger breadth): 3 fingers
18
Q
Failed intubation algorithm: Plan A to D?
A
Plan A: Facemask ventilation + tracheal intubation (direct/video laryngoscopy - max 3+1 attempts); Plan B: 2nd generation SAD insertion (max 3 attempts); Plan C: Facemask ventilation; Plan D: Front-of-neck-access (Scalpel Cricothyroidotomy)
19
Q
Most common vein for central line?
A
Internal Jugular Vein (IJV)
20
Q
Most common vein for TPN?
A
Subclavian Vein (SCV)
21
Q
Maximum risk of pneumothorax in central line?
A
Subclavian Vein (SCV) → Increased risk of pneumothorax
22
Q
Maximum risk of infection and thrombosis in central line?
A
Femoral Vein (maximum risk for both infection and thrombosis)
23
Q
Best method to confirm central line placement?
A
CXR; Tip should be at SVC-Right atrium junction
24
Q
Types of central catheters and their uses?
A
Chemoport/Portacath (self-sealing silicon port - chemotherapy, decreased infections/exposure/handling); Tunneled catheter/Hickman’s/Permacath (Chemotherapy, TPN, Dialysis)
25
Swan Ganz catheter uses?
Pulmonary arterial catheter; Best to measure PCWP and Core temperature; Ideal site to measure core temp: Pulmonary artery; Most common site: Distal end of esophagus
26
BIS (Bispectral Index) range and adequate anesthesia level?
Range: 0-100 (0 = Coma, 100 = Fully awake); Adequate anesthesia: 40-60
27
BIS monitoring principle?
Frontal processed EEG; Used to measure level of consciousness (Depth of anesthesia)
28
Pulse oximetry principle and false readings?
Based on Beer-Lambert law; OxyHb: IR rays, DeoxyHb: Red light; Falsely Low (85%): MetHb; Falsely High (100%): COHb (use co-oximetry)
29
Neuromuscular monitoring: Most common nerve and stimulus?
Most common nerve: Ulnar nerve → Adductor pollicis; 2nd most common: Facial nerve → Orbicularis oculi; Most common stimulus: Train of Four (TOF) - 4 stimuli @ 2 Hz, 0.5 sec apart
30
TOF ratio for extubation?
TOF ratio >0.9
31
TOF patterns: No drug vs Depolarizing vs Non-depolarizing?
No drug: TOF-R = 1.0, No fade; Depolarizing block Phase I: TOF-R = 1.0, Constant but diminished, No fade; Phase II: TOF-R = 0.4, Fade; Non-depolarizing block: TOF-R = 0.4, Fade
32
Most common circuit in spontaneous vs controlled ventilation?
Spontaneous: Mapleson A (Magill's); Controlled: Mapleson D (Bain's circuit - coaxial, APL distant from patient)
33
Mapleson circuits for children?
Mapleson E (Ayre's - No APL, No bag); Mapleson F (Jackson Rees - No APL, has bag)
34
Mapleson A characteristics?
APL adjacent to patient; Best for spontaneous ventilation
35
Mapleson D (Bain's) characteristics?
Co-axial circuit; APL distant from Fresh Gas Flow (FGF); Best for controlled ventilation
36
Nasal prongs: Max flow rate and saturation?
Max flow rate: 5 L/min; Max saturation: 40%
37
Hudson's mask: Max flow rate and saturation?
Max flow rate: 10 L/min; Max saturation: 60%
38
Simple face mask: Max flow rate and saturation?
Max flow rate: 15 L/min; Max saturation: 60%
39
Non-rebreathing mask (NRBM): Max flow rate and saturation?
Max flow rate: 15 L/min; Max saturation: 85-90%
40
High flow nasal cannula: Max flow rate and saturation?
Max flow rate: 60 L/min; Max saturation: 100%; Provides humidification and PEEP; May delay intubation
41
Venturi mask characteristics?
Precise O₂ delivery; Max flow rate: 15 L/min; Max saturation: 60%
42
Pin index for O₂, N₂O, Air, CO₂, Entonox?
O₂: 2,5; N₂O: 3,5; Air: 1,5; CO₂: 1,6/2,6; Entonox (N₂O+O₂ 50:50): 7
43
Minimum size cannula for trauma patient?
18G
44
IV cannula color codes and flow rates (mnemonic: GORY FROM PUNJAB)?
Orange 14G (270 mL/min), Gray 16G (210-240), White 17G (130-180), Green 18G (80-90), Pink 20G (50-60), Blue 22G (30), Yellow 24G (20), Violet 26G (10)
45
NG tube length measurement?
NEX: Nose-Ear-Xiphoid; NEMU: Nose-Ear-Midpoint between xiphoid & umbilicus (Children)
46
Foley's catheter sizing?
1 fr = 0.3 mm
47
MAC (Minimum Alveolar Concentration) values?
MAC = 1/potency; Halothane: 0.75; Isoflurane: 1; Sevoflurane: 2; Desflurane: 6; N₂O: 104
48
Blood-gas solubility coefficients?
Halothane: 2.5; Isoflurane: 1; Sevoflurane: 0.65; Desflurane: 0.45; N₂O: 0.47 (Lower solubility = Faster onset)
49
Fastest acting inhalational agent and why not used for induction?
Desflurane; Not used for induction because it is irritant
50
Inhalational agent of choice and why?
Sevoflurane; Non-irritant, Fruity odor, Used for induction in children
51
Best maintenance agent?
Isoflurane
52
Best inhalational agent for renal surgery and obese patients?
Sevoflurane (produces Compound A with desiccated soda lime, but best for renal surgery and obese)
53
Agent of choice in asthmatics?
Halothane (most potent bronchodilator); Also: All inhalational agents
54
Nephrotoxic inhalational agent?
Methoxyflurane (most nephrotoxic - not used now)
55
Effects of inhalational agents on cerebral and cardiovascular parameters?
All inhalational agents: ↓Cerebral metabolic O₂, ↑CBF/ICP, ↑CVS/HR, ↓Respiratory drive; They are uncouplers
56
Halothane specific side effects?
Most potent bronchodilator; Causes hepatitis; Used for induction in asthmatics
57
Sevoflurane specific characteristics?
Compound A production with CO and desiccated soda lime; Fruity odor; Agent of choice for induction
58
Isoflurane specific feature?
Coronary steal phenomenon (controversial); Best maintenance agent
59
Desflurane vaporizer?
Tec-6 vaporizer (because very low boiling point)
60
N₂O specific effects?
Concentration effect, Second gas effect, Diffusion hypoxia; Highest MAC (104); Lowest potency
61
Effects of IV anesthetics on cerebral and cardiovascular parameters?
All IV agents: ↓Cerebral metabolic O₂, ↓CBF/ICP, ↓CVS/HR, ↓Respiratory drive; EXCEPT Ketamine
62
DOC for induction in various scenarios?
Day care/Liver/Kidney/NeuroSx/TIVA/Malignant hyperthermia/Porphyria: Propofol
63
Propofol characteristics and side effects?
Soybean oil, Egg lecithin; Painful injection; Infusion syndrome
64
Ketamine characteristics?
NMDA antagonist; Dissociative anesthesia; DOC in asthma/COPD, Cyanotic heart disease, Shock; C/I: Hypertension, Epilepsy, Glaucoma
65
Etomidate characteristics?
DOC in cardiac surgery; S/E: Adrenal suppression (11β-hydroxylase inhibition); Most cardiostable
66
Thiopentone characteristics?
DOC in hyperthyroidism, Seizures, Narcoanalysis; Causes intra-arterial vasospasm
67
Depolarizing muscle relaxant and characteristics?
Succinylcholine (Sch); Best for RSI; Causes: Hyperkalemia, Bradycardia
68
Most cardiostable muscle relaxant?
Atracurium (Hoffman elimination - safe in RF/LF/Pediatrics); Byproduct: Laudanosine
69
Shortest acting muscle relaxant?
Mivacurium
70
Reversal agents for muscle relaxants?
Non-depolarizing: Neostigmine, Sugammadex (for Rocuronium/Vecuronium)
71
MOA of local anesthetics?
Block Na+ channels
72
Local anesthetic causing hypertension?
Cocaine
73
Most cardiotoxic local anesthetic and dose?
Bupivacaine; Dose: 2 mg/kg (max 175 mg)
74
Maximum dose of lignocaine: Plain vs with adrenaline?
Plain: 3 mg/kg (max 300 mg); With adrenaline: 7 mg/kg (max 500 mg)
75
Proparacaine duration?
15 minutes (shortest acting topical LA for ophthalmology)
76
DOC for LAST (Local Anesthetic Systemic Toxicity)?
20% Lipid emulsion (Intralipid)
77
Local anesthetic causing methemoglobinemia?
Prilocaine, Benzocaine
78
Adrenaline doses in different scenarios?
Anaphylactic shock/Status asthmaticus: 1:1000 SC/IM; Cardiac arrest: 1:10,000 IV/IO; Vasoconstriction: 1:100,000; With LA for vasoconstriction: 1:200,000 (1:2 Lakh); Labour epidural: 1:400,000 (1:4 Lakh)
79
Full agonist opioids?
Morphine, Pethidine, Heroin, Meperidine, Methadone, Codeine, Fentanyl
80
Partial agonist opioid?
Buprenorphine
81
Mixed agonist-antagonist opioids?
Nalbuphine, Pentazocine, Butorphanol
82
Opioid antagonists?
Naloxone, Naltrexone
83
Opioid contraindications?
Head injuries, Bile obstruction (Sphincter of Oddi dysfunction)
84
Shortest acting opioid for day care?
Remifentanil
85
Opioid causing mydriasis?
Meperidine (all others cause miosis)
86
Opioid side effects requiring special mention?
Pruritus (Histamine release → Vasodilation/↓BP); No tolerance to: Constipation and Miosis; Serotonin syndrome: Tramadol; Wooden chest syndrome: Fentanyl; Prolonged QTc: Methadone
87
Pethidine metabolism and significant metabolite?
MAO-A demethylase → 99% Pethidinic acid (inactive) + 1% Norpethidine (CNS stimulant, causes seizures, tendency to accumulate)
88
Caudal anesthesia age limit and puncture site?
Age <5 years (open sacral hiatus); Puncture @ S3-S4 (sacrococcygeal ligament is pierced)
89
Interscalene block level and area covered?
Level: Roots & trunks of brachial plexus; Area: Shoulder & upper arm region
90
Supraclavicular block level and area?
Level: Trunks/Divisions of brachial plexus; Area: Upper arm
91
TPN composition ratio?
20:30:50 → Protein:Fat:Carbohydrate
92
TPN fluid overload indicator?
>1 kg/day weight gain; Weight gain after 6 days indicates fluid overload
93
TPN refeeding syndrome?
↓K+, ↓Mg, ↓PO₄, Zn deficiency, B12 deficiency
94
Most common metabolic complication of TPN?
Insulin Resistance
95
Normal EtCO₂ value?
35-45 mmHg
96
Capnography principle?
Infrared spectroscopy
97
Shark fin pattern in capnography?
COPD (loss of plateau, delayed emptying)
98
Curare cleft in capnography?
Indicates spontaneous breathing efforts during controlled ventilation
99
Sudden loss of waveform in capnography?
Circuit disconnection, Cardiac arrest, Air embolism (sitting neuro surgery/neck surgery)
100
EtCO₂ >20 mmHg in CPR indicates?
Adequate chest compressions
101
Rebreathing circuit pattern in capnography?
Respiratory baseline >0 mmHg (should be 0); Replace soda lime
102
Esophageal intubation pattern?
EtCO₂ rises gradually, no sustained waveform
103
Sudden increase in EtCO₂?
Malignant hyperthermia
104
Malignant hyperthermia triggers?
Succinylcholine, Inhalational anesthetics
105
Malignant hyperthermia clinical features?
Fever + Tachycardia + Rigidity; Earliest sign: ↑EtCO₂; Late sign: Fever
106
Malignant hyperthermia genetic mutation?
RYR/DHPR (Chromosome 19)
107
DOC for malignant hyperthermia?
Dantrolene Sodium
108
Position for air embolism during sitting neurosurgery?
Durant position (Left lateral decubitus + Trendelenburg position)
109
ASA PS I definition?
Normal healthy patient; Healthy, non-smoking, no or minimal alcohol use
110
ASA PS II definition?
Mild systemic disease without substantive functional limitations; Examples: Current smoker, social alcohol drinker, pregnancy, obesity (30
111
ASA PS III definition?
Severe systemic disease with substantive functional limitations; Examples: Poorly controlled DM or HTN, COPD, morbid obesity (BMI≥40), active hepatitis, alcohol dependence, pacemaker, moderate ↓EF, ESRD on dialysis, history (>3 months) of MI/CVA/TIA/CAD/stents
112
ASA PS IV definition?
Severe systemic disease that is constant threat to life; Examples: Recent (<3 months) MI/CVA/TIA/CAD/stents, ongoing cardiac ischemia or severe valve dysfunction, severe ↓EF, sepsis, DIC, ARD or ESRD not on dialysis
113
ASA PS V definition?
Moribund patient not expected to survive without operation; Examples: Ruptured abdominal/thoracic aneurysm, massive trauma, intracranial bleed with mass effect, ischemic bowel with significant cardiac pathology or multiple organ dysfunction
114
ASA PS VI definition?
Declared brain-dead patient whose organs are being removed for donor purposes
115
Pre-op drug DOC to reduce anxiety?
Midazolam
116
Pre-op drug DOC to reduce secretions?
Glycopyrrolate
117
Pre-op antibiotic timing?
Cefazolin: 30 min - 1 hour prior to incision
118
Most common nerve injured intra-operatively?
Ulnar nerve
119
Most common intra-operative ophthalmic complication?
Corneal abrasions
120
DOC for PONV (Post-operative nausea and vomiting)?
Ondansetron
121
Most common cause of POVL (Post-operative vision loss)?
Ischemic Optic Neuropathy
122
Most common cause of intra-operative anaphylaxis?
Antibiotics > Muscle relaxants
123
When to stop anticoagulants before surgery?
Clopidogrel: 7 days; Warfarin: 5 days; LMWH: 12-24 hours; UFH: 4 hours; Lithium: 48 hours
124
Drugs to omit morning dose on day of surgery?
ACE inhibitors, ARBs, Oral hypoglycemic agents, Insulin
125
NPO guidelines?
Solid food: 8 hours; Liquids: 6 hours; Breast milk: 4 hours; Clear liquids: 2 hours
126
Mendelson syndrome?
Aspiration pneumonitis; Rule out aspiration in perioperative period
127
Anesthesia of choice in pregnancy complications?
PIH, Heart disease in pregnancy: Epidural > GA; EXCEPT: Coarctation of aorta/Eisenmenger/Uncorrected TOF: GA
128
Aldrete score components and use?
Components: Activity, BP, Consciousness, Respiration, O₂ saturation; Use: Discharge criteria for day care surgery patients; Score ≥9 for discharge
129
Dibucaine number significance?
<30: Atypical pseudocholinesterase → Prolonged action of succinylcholine
130
Volume-controlled modes?
CMV (Controlled Mechanical Ventilation), ACV (Assist-Controlled Ventilation), SIMV (Synchronized Intermittent Mandatory Ventilation)
131
Pressure-controlled mode?
PSV (Pressure Support Ventilation) - triggered by patient's inspiration only
132
Volume and pressure-controlled mode?
PS/SIMV - spontaneous breaths in SIMV receive pressure assist
133
Best mode for weaning?
PS/SIMV
134
Mode NOT for weaning?
CMV
135
RSBI (Rapid Shallow Breathing Index) formula and interpretation?
RSBI = Respiratory Rate / Tidal Volume; RSBI <105: Successful weaning predicted; RSBI ≥105: Weaning failure predicted
136
PEEP (Positive End-Expiratory Pressure) benefits and risks?
Benefits: Prevents collapse, Increases recruitment, Reduces work of breathing; Risks: Barotrauma, Low CO, Raised ICP; Normal: 3-5 cm; ARDS: 8-12 cm
137
CPR compression depth and rate?
Depth: 5-6 cm (1/3 AP diameter); Rate: 100-120/min; Allow complete recoil
138
CPR compression to ventilation ratio?
30:2 (compressions:breaths)
139
Rate of breathing in CPR: Adults vs Children vs Neonates?
Adults: 10 breaths/min; Children: 20-30 breaths/min; Neonates: 40-60 breaths/min
140
Shockable vs Non-shockable cardiac rhythms?
Shockable: VF (Ventricular Fibrillation), pVT (pulseless Ventricular Tachycardia); Non-shockable: Asystole, PEA (Pulseless Electrical Activity)
141
ACLS drug doses: Epinephrine and Amiodarone?
Epinephrine: 1 mg IV/IO every 3-5 minutes; Amiodarone: 1st dose 300 mg bolus, 2nd dose 150 mg; Alternative: Lidocaine: 1st dose 1-1.5 mg/kg, 2nd dose 0.5-0.75 mg/kg
142
Reversible causes of cardiac arrest (5H/5T)?
5H: Hypovolemia, Hypoxia, H+ ions (acidosis), Hypo/Hyperkalemia, Hypothermia; 5T: Tension pneumothorax, Tamponade (cardiac), Thrombosis (myocardial infarction), Thrombosis (pulmonary), Toxins
143
Perimortem cesarean delivery timing in pregnant cardiac arrest?
If no ROSC in 5 minutes, consider immediate perimortem cesarean delivery; NOT in OT, NOT Pfannenstiel, NOT LSCS - immediate bedside procedure
144
Initial steps in neonatal resuscitation (within 1 minute)?
Warm, dry, stimulate, position airway, suction if needed
145
When to start PPV in neonate?
If: Apnea or gasping, OR HR <100 bpm
146
When to start chest compressions in neonate?
HR <60 bpm despite adequate PPV
147
NRP chest compression technique?
2-thumb technique; Lower 1/3rd of sternum; Midline; 1/3rd depth of AP diameter; CC:PPV = 3:1
148
NRP vascular access of choice?
Umbilical Venous Catheter (UVC)
149
NRP saturation monitoring site?
Right upper limb (pre-ductal saturation)
150
Initial oxygen concentration for PPV in neonate?
≥35 weeks GA: 21% oxygen; <35 weeks GA: 21-30% oxygen
151
NRP order of suction?
Mouth first, then Nose
152
Room temperature for neonatal resuscitation?
25°C
153
Target oxygen saturation in NRP?
1 min: 60-65%; 2 min: 65-70%; 3 min: 70-75%; 4 min: 75-80%; 5 min: 80-85%; 10 min: 85-95%
154
Contraindications for bag-valve-mask in neonate?
Congenital Diaphragmatic Hernia, Tracheo-Esophageal Fistula
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