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Bone marrow depression is seen with.
B i.e. N2O
2
Halothene
N20
Ether
Isoflurane
Anaesthesia
null
34dd629e-5386-4dd0-8caf-a804e6fd0607
single
The regional anaesthesia technique that would not be expected to provide appropriate analgesic benefit during the first stage of labor is
Pudendal nerve block during delivery mitigates somatic pain during second stage of labor.
2
Lumbar epidural
Pudendal nerve block
Lumbar sympathetic block
Paracervical block
Anaesthesia
null
d43682d6-da0b-4579-a51b-0fb3cee61dc7
single
Recommended maximum dose of Lignocaine + adrenaline for peripheral nerve shock.
Local Anesthetic Maximum dose Over 24 hours Plain With Adrenaline Lidocaine 300mg 4.5mg/kg 500mg 7mg/kg Mepivacaine 300mg 4.5mg/kg 500mg 7mg/kg Prilocaine 600mg 8mg/kg 600mg 2-chloroprocaine 800mg 12mg/kg 1000mg Bupivacaine 175mg 3mg/kg 225mg 400mg Levobupivacaine 150mg 400mg Ropivacaine 225mg 3mg/kg 800mg maximum dose of plain lidocaine is mentioned differently in different anesthesia books - 3mg/kg BW ( Miller TEXT BOOK of Anesthesia) or 4.5 mg/kg BW (Morgan and Mikhail's Clinical Anesthesiology)
1
7 mg/kg bw
4.5 mg/kg bw
2 mg/ kg bw
3 mg/kg bw
Anaesthesia
Regional Anesthesia
5920aa93-772c-4582-bded-9eed0f6a33eb
single
Local anaesthetic with prolonged action
Dibucaine is the longest acting local anaestheticChlorprocaine is the shoest acting local anaestheticDecreasing order of duration: Dibucaine >Bupivacine= Tetracaine = Ropivacaine=Etidocaine > Prilocaine = lignocaine =Mepivacaine = Cocaine >Procaine >Chloprocaine(Refer: stoelting's pharmacology and physiology in anaesthetic practice, 5th edition, pg no.290,304)
4
Procaine
Cocaine
Lidocaine
Dibucaine
Anaesthesia
All India exam
0b66813d-89c4-4089-8a81-9c5163907a66
single
In venturi mask maximum O2 concentration attained is
Maximum concentration delivered by ventimask (venturimask) is 60%.
3
90%
100%
60%
80%
Anaesthesia
null
cf4ca71d-373b-4e97-a5d1-758bf63b2ed1
single
Percentage of lidocaine in eutectic mixture
Eutectic mixture of local AnaestheticsThis is unique topical preparation which can anaesthetize the intact skinIt is a mixture of 2.5% lidocaine and 2.5 prilocaineIt acts slowly and the cream must held in contact with skin for at least 1 hourEMLA is used: to make venepuncture painless especially in children, and for the procedure like skin grafting & circumcision As systemic absorption of prilocaine can cause methemoglobinemia, EMLA should not be used on mucocutaneous membrane or in the very small child.(Refer: Morgan and Mikhail's Clinical Anaesthesiology, 5th edition, pg no. 754, 856)
2
1%
2.55
5%
10%
Anaesthesia
All India exam
b1184e2d-1dc9-4997-907f-8fadece6bfe5
single
Following group of drugs is not the first line in the management of chronic
null
3
Opioids
Antiepileptics
Dopamine antagonist
Serotonergic drugs
Anaesthesia
null
be576689-98e0-4e4f-9fed-08eea325798b
single
Most commonly used nerve for neuromuscular monitoring under anesthesia is
Monitoring of Neuromuscular block Done by nerve stimulator Different stimulation - Single Twitch Tetanus Train of four stimulus (most common) Double burst stimulation Post - tetanic count Nerves used - ulnar nerve (most common) (Adductor pollicis muscle ) Facial nerve Posterior tibial nerve External peroneal nerve Response of stimulation
2
Radial
Ulnar
Glossopharyngeal
Vagus
Anaesthesia
Monitoring in Anesthesia
7ca524c7-8c12-4671-b59b-6eb9db002fc7
single
Anaesthesia used in microlaryngoscopy is
C i.e. Pollarad tube with infiltration block When fire breaks out during laser vocal cord surgery, oxygen should be turned off, ventilation stopped, tracheal tube removed and submerged in water and the patient should be ventilated with facemasK. Airway damage is assessed with bronchoscopy and bronchial lavage, steroids, can be used for treatment. Anesthesia for Endoscopic Surgeries of Airway Endoscopy includes laryngoscopy, microlaryngoscopy (i.e. aided by an operating microscope), bronchoscopy & oesophagoscopy. These procedures may be accompanied by laser surgery. Microlaryngoscopic surgeries include biopsy / surgery of laryngeal malignancy, vocal cord polyps etc. It is associated with some specific problems as - common field for anesthetist & surgeon, already reduced glottic opening d/t growth, laryngospasm (mediated by superior laryngeal nerve) d/t laryngeal stimulation, very high chances of aspiration and myocardial ischemia (- 4% due to sympethetic stimulation). Preoperative Considerations - Sedative premedication is contraindicated in any patient with any significant degree of upper airway obstructionQ, d/t fear of aspiration. Glycopyrrolate, 1 hour before surgery minimize secretions, thereby facilitate ventilation. Pethidine & promethazine are only given if there is no airway obstruction. Laser Precautions General laser precautions include wearing protective spectacles to prevent retinal damage and evacuation of toxic fumes (laser plume) from tissue vaporization which may have potential to transmit microbacterial diseases. Greatest fear during laser airway surgery is a tracheal tube fire. This can be avoided by using a technique of ventilation that does not involve a flammable tube or catheter (eg intermittent apnea or jet ventilation through the laryngoscope side po). The potential fuel source should have laser resistant propeies (laser tubes or wrapping a tracheal tube with metallic tape) or be removed (supraglottic jet ventilation technique). The only non inflammable, laser proof tube is the all metal. Noon tube, which has no cuff. Most laser tubes have laser resistant propeies around the shaft, but the cuff is not protected and can ignite. So there are double cuffs to seal the airway- if upper cuff is struck by laser and saline escapes, the lower cuff will continue to seal the airway. No cuffed tracheal tube, or any currently available tube protection is completely laser proof. Therefore, whenever laser airway surgery is being performed with a tracheal tube in place, the following precaution should be observed. - Inspired 02 conc. should be as low as possible may be upto 21% - N20 suppo combustion & should be replaced with air (N2) or heliumQ - Tracheal tube cuffs should be filled with saline dyed with methylene blue to dessipate heat & signal cuff rupture - A cuffed tube will minimize 02 conc. in the parynx. The addition of 2% lidocaine jelly (1:2 mixture with saline) can seal small laser induced cuff leaks, potentially preventing combustion - Laser intensity & duration should be limited as much as possible. - Saline soaked pledgets (completely saturated) should be placed in the airway to limit risk of ignition. - A source of water (60 ml) should be immediately available in case of fire. Muscle Relaxation Profound muscle relaxation is the aim to provide masseter muscle relaxation for introduction of suspension laryngoscope & an immobile surgical field. - Anesthesia is induced with IV induction agent followed by a non depolarizing muscle relaxant; the vocal cords are sprayed with 3 ml lidocaine 4% to assist smooth anesthesia & to minimize the possibility of postextubation laryngospasmQ - Alternatively the cords may be painted with 3% cocaine at the end of procedure, which has the added advantage of reducing bleeding from operative site. Oxygentation & Ventilation - Microlaryngoscopy tubes are long, have a small internal and external diameter, and are designed specifically for endoscopic procedures (but not suitable for laser surgery). Typically 4 to 5 mm internal diameter tubes with high volume, low pressure cuffs are used in nasal or oral versions. The most popular anesthetic technique use a Coplan's microlaryngoscopy tube (5mm ID, 31cm long, 10m1 cuff volume and constructed from soft plastic). It is designed for micro laryngeal surgery or for patient whose airway has been narrowed to such an extent that a normal sized tracheal tube cannot be inseed. The small tube diameter provides better visibility and access to surgical field but may lit incomplete exhalation and occlusion. - Most commonly the patients are intubated with small diameter (4 - 6 mm) tracheal tubesQ; - Standandard tracheal tubes of this size, however, are designed for pediatric patients. They tend to be too sho for adult trachea (in length)Q with a low volume cuff that will exe high pressure against it - A 4 - 6 mm microlaryngea tracheal (MLT) tubes (Mallinckrodt critical Care) is the same length as the adult tube, has dispropoionately large high volume low pressure cuff, and is stiffer and less prone to compression than a regular tracheal tube. - The advantages of intubation include - protection against aspiration, and the ability to administer inhalational anesthetics and enable monitoring of ventilation by capnography and spirometry, by measuring end tidal CO2Q - In some cases (eg those involving posterior commissure), intubation may interfere with surgeon's visualization and then alternatives are: 1.Insufflation of high flows of oxygen through small catheter placed in the trachea 2. Intermittent apnea technique. Jet ventilation through laryngoscope High frequency positive pressure ventilation (HFPPV)
3
Pollarad tube of 10 mm diameter with heavy sedation
Pollarad tube of 15 mm diameter with topical xylocaine
Pollarad tube with infiltration block
Heavy sedation on and Endotracheal intubation
Anaesthesia
null
11b27d26-0b05-4dfe-bf68-4f8999b7192c
single
Shortest acting muscle relaxant is
Ans) aSuccinylcholine is the only available depolarizing neuromuscular blocker. It is characterized by rapid onset of effect and ultrashort duration of ac-tion because of its rapid hydrolysis by butyryl cholinesterase.Classification of nondepolarizing neuromuscular blockers according to duration of action (time to T1 = 25% of control) after twice the ED95Class of BlockerLong-Acting (>50 min)Intermediate- Acting (20-50 min)Short-Acting (15-12 min)Ultrashort- acting (<10-12min)Steroidal compoundPancuronium pipecuroniumVecuronium Rocuronium Benzylisoquinolinium compoundsd-Tubocurarine Metocurine DoxacuriumAtracurium CisatrucuriumMivacurium Others Asymmetrical mixed-onium chlorofumarates GantacuriumPhenolic etherGallamine Diallyl derivative of toxiferineAlcuromum
1
Succinylcholine
Vecuronium
Pancuronium
Atracurium
Anaesthesia
Muscle Relaxant
d953d978-03c3-4903-87dd-e87b92319971
single
Muscle relaxant with ganglion blocker action are A/E
D i.e. Halothane
4
Pancuronium
Trimethaphan
Curare
Halothane
Anaesthesia
null
4e8372ea-a052-4b14-b269-d86cd4d5a45a
single
Anaesthetic without epileptogenic potential
Ans:A.)Desflurane. Sevoflurane,Enflurane and Isoflurane have Epileptogenic potential.
1
Desflurane
Sevoflurane
Isoflurane
Enflurane
Anaesthesia
null
813ac636-730a-49c3-b348-f9a514cc77bb
single
Induction agent of choice in day care surgery is
(Propofol) 585 - Lee's 13th) (375-KDT6th)* Geneal anaesthesia for day surgery should use agents that are rapidly eliminated and titratable* Most of those in common use are appropriate intravenous propofol or inhalation sevoflurane are both highly suitable for induction of anaesthesia in adults and childrenAdvantages of propofol over Thiopentone1. Rapid and smooth recovery2. Completely eliminated from body in 4 hours so patient is ambulatory early3. Antiemetic4. Antipruritic5. BronchodilatorDisadvantages of Day Surgery* Where day surgery is not well established, it may promote an over cautions attitude* May encourage poor management of operating list order* Surplus overnight capacity can attract emergency out liers and block beds* Antisocial hours may deter - day care nursing staff
2
Ketamine
Propofol
Methohexitone
Thiopentone sodium
Pharmacology
Anaesthesia
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single
Most appropriate mode of ventilation for head injury patient
null
3
CPAP
SIMV
CMV
AMV
Anaesthesia
null
e25d6843-1d97-458a-b2de-4a3d5a5ab58a
single
Clayton is used in a close breathing system for the purpose of
D i.e. As an indicator
4
As a hardner
As an absorbent
As a softner
As an indicator
Anaesthesia
null
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single
Least soluble anaesthetic agent is
Blood-gas paition coefficient, also known as Ostwald coefficient for blood-gas, is a term used in pharmacology to describe the solubility of inhaled general anesthetics in blood. The coefficient is defined as the ratio of the concentration in blood to the concentration in gas that is in contact with that blood when the paial pressure in both compaments is equal. Newer anesthetics (such as desflurane) typically have smaller blood-gas paition coefficients than older ones (such as ether); these are preferred because they lead to faster onset of anesthesia and faster emergence from anesthesia once application of the anesthetic is stopped. If an anesthetic has a high coefficient, then a large amount of it will have to be taken up in the body's blood before being passed on to the fatty (lipid) tissues of the brain where it can exe its effect. Ref: Miller's anesthesia 8th edition Ref: Morgan & Mikhail's clinical anesthesiology 6e
1
Desflurane
Sevoflurane
Halothane
Methoxyflurane
Anaesthesia
General anaesthesia
228a9c90-d6e9-4c90-ad11-b2c70b74d43b
single
Supreme LMA characteristic is
LMA Supreme is one of the most advanced laryngeal mask airway (LMA)It has features of usual LMA with additional Built-in drain tube and a bite blockIt has high volume/ low-pressure cuff which generates higher seal pressureIt also provides a conduit for active suctioning of stomachIt can be used in infants as well as in adults.(Refer: Morgan and Mikhail's Clinical Anaesthesiology, 5th edition, pg no. 317, 318)
4
Has no bite block
Used in infants
High pressure, low volume
Has built in drain tube
Anaesthesia
All India exam
8213f07f-ec90-4a1e-935e-020e96fadc90
single
A 65 year old man is scheduled for emergency laparoscopic appendectomy. He is a chronic smoker with history of severe COPD, diabetic and hypertensive, on insulin, metformin and antihypertensive medications, not on regular follow up. He also complains of dyspnea on walking more than a few meters. This patient would be assigned
Elderly male patient –poorly controlled diabetic and hypertensive, known smoker with COPD. His co-morbidities are constant threat to life.  And since emergency appendectomy is done, it falls under ASA 4E.
3
ASA 3E
ASA 3
ASA 4E
ASA 4
Anaesthesia
null
7fcf03e0-da09-4c53-895d-2f73171e69b7
single
Capnography is used for assessment of
Capnography is the method of determining CO2 levels in exhaled gases (PACO2) but NOT blood.It is the ideal confirmatory method of endotracheal intubation(VENTILATION OF LUNG AFTER INTUBATION) Aeral blood gas analysis is used to measure CO2 levels in Blood (PaCO2) Pulse oxymetry is used to measure oxygen saturation of blood and hea rate.
3
Oxygen saturation of blood
Amount of CO2 transpoed in blood
Ventilation of lung after intubation
Myocardial perfusion
Anaesthesia
Preoperative assessment and monitoring in anaesthesia
875eb259-41a6-46a4-8b93-504ce23c7caa
single
Contraindication for laryngeal mask airway is
LMA INDICATIONS : .Sho procedures where endotracheal tube is not necessary,Difficult airway , Cardiac arrest ,conduit for intubation, Contraindications Absolute :Complete Upper airway obstruction,Locked jaw relative : increased risk of aspiration like in full stomach, 2nd n 3rd trimester of pregnancy ,morbid obesity,Upper GI bleed, Hiatus hernia, Suspected or known Supraglottic anatomical abnormalities
2
Empty stomach
Hiatus hernia
Minor surgery
Young age
Anaesthesia
Anaesthetic equipments
f0251eb0-f3b6-4281-98c4-8494811a913d
single
Most cardiostable among the following is
Thiopentone, propofol, ketamine cardio unstable Etomidate cardio stable Etomidate is the most cardiac stable intravenous agent due to its lack of effect on the sympathetic nervous system and on the function of the baroreceptor. The myocardial oxygen supply-to-demand ratio is well maintained. Hence, etomidate is the intravenous agent of choice in patients with coronary aery disease, cardiomyopathy and cerebral vascular disease.
4
Thiopentone sodium
Ketamine
Propofol
Etomidate
Anaesthesia
Intravenous Anesthetic Agents
ac20506a-ad14-451a-8623-b55f455b160d
single
Hyperbaric Oxygen is not useful in
Hyperbaric oxygen is not useful in veigo.
2
CO poisining
Veigo
Gas gangrene
compament syndrome
Anaesthesia
Anaesthetic equipments
e3fff86a-f185-4175-8bea-3920f3a9b8fe
single
Most common complication of celiac plexus block
Postural hypotension : due to lumbar sympathetic chain blockade leading to upper abdominal vessel dilation and venous pooling. So intravenous fluids are required preblock
2
Pneumothorax
Postural hypotention
Retroperitoneal hamorrhage
Intra_aerial injection
Anaesthesia
Regional anaesthesia
69310e44-16fe-4022-9aee-2f27a81ccb0b
single
The physiological dead space is decreased by
Dead space is defined as the volume of the airway that doesnot paicipate in gas exchange (It is nothing but ventilation occurs but perfusion doesnot occur) Anatomical Dead Space : from nasopharynx to respiratory bronchioles.average adult,normally 150ml Alveolar dead space : Alveoli that are ventilated but not perfused.usually it is absent Physiological or total dead space : Anatomical + Alveolar dead space Factors that increase dead space : upright position neck extension advanced age positive pressure ventilation decreased pulmonary perfusion (pulmonary emboli or pulmonary hypeension) lung diseases (emphysema or cystic fibrosis ) FACTORS THAT DECREASE DEAD SPACE : supine position , neck flexion , intubation Anatomical dead space is measured by single breath nitrogen test , physiological dead space is measured by modified bohr's equation.
3
Upright position
positive pressure ventilation
Neck flexion
Emphysema
Anaesthesia
Complications of anaesthesia
b22c2620-2de2-4a64-be80-6fab640e0360
single
In spinal anaesthesia the drug is deposited between
Ans. is 'b' i.e., Pia and arachnoid matter Spinal anaesthesia In spinal anaesthesia LA is injected into subarachnoid space (space between pia matter and arachnoid matter). Structure pierced during SA (from outside in) - Skin - Subcutaneous tissue --> Supraspinous & intraspinous ligament --> Ligamentum falvum --> Duramater -->Arachnoidmater. Site of spinal anaesthesia L2_3 or L3_4 interveebral space in adult (In adult spinal cord ends at lower border of Ll veebrae). L4_5 interveebral space in children (spinal cord ends at lower border of L3 veebrae in children). Spinal anaesthesia leads to creation of a zone of differential blockade, ie motor fibres are blocked two levels lower and autonomic fibres are blocked two levels higher than the sensory blockade due to different sensitivity of different fibres.
2
Dura and arachnoid
Pia and arachnoid
Dura and veebra
Into the cord substance
Anaesthesia
null
88cc204a-0e34-4c91-b342-9bdf12e7d692
single
Muscle relaxant with ganglion blocker action is
Curare is an example of a non-depolarizing muscle relaxant that blocks the nicotinic acetylcholine receptor (nAChR), one of the two types of acetylcholine (ACh) receptors, at the neuromuscular junction
3
Pancuronium
Trimethoprim
Curare
Halothane
Anaesthesia
Muscle relaxants
58d5b370-4d36-4a39-9034-b61aa5b454ac
single
In Phrenic nerve block, it is best to infiltrate near
Phrenic nerve is blocked 3 cm above the clavicle at the posterior border of sternomastoid. Used for intractable hiccups
3
Scalenus anterior
Scalenus posterior
Posterior border of sternomastoid
Anterior border of sternomastoid
Anaesthesia
Anaesthesia of special situations
73ee2bf3-4428-426a-9a06-97862a8e0f46
single
Pulse oximetry monitors
Pulse oxymetry monitors hea rate, oxygen saturation of hemoglobin and gives aerial waveform. It works on the principle of transmission spectrophotometry and optical plethysmography. It has 2light emitting diodes.one is red with the wavelength of 660nm and other one is infrared with the wavelength of 940nm.
1
Oxygen saturation of hemoglobin
Oxygen content of blood
Pulse pressure
Oxygen paial pressure
Anaesthesia
Anaesthetic equipments
b6fde986-dade-4aa6-8a36-3340a25c4f8e
single
Most cardiotoxic local anesthetic
Bupivacaine is the most cardiotoxic LA (Ropivacaine is a newer bupivacaine congenial with less cardiotoxicity).(Refer: stoelting's pharmacology and physiology in anaesthetic practice, 5th edition, pg no.294)
2
Procaine
Bupivacaine
Cocaine
Lidocaine
Anaesthesia
All India exam
a533029b-defe-42ad-a7b5-946411f5111a
single
Characteristic of an ideal gas is
D i.e. Obeys Charles, boyle's & avogadro's laws
4
Volume is directly propoional to change in pressure
Volume is inversely propoional to change in temperature
At absolute temp. volume of gas is 1
Obeys Carles, Byles and Avagadro' laws
Anaesthesia
null
60c041e8-c11a-4a39-b55c-3303aa1f4a6c
single
For Foreign bodies are retained in the larynx causing choking, first line of management is
Hemilich manouvere
2
Airway inseion
Hemilich manouvere
Hemilich valve
Tracheostomy
Anaesthesia
null
10b873ef-f50c-4ab5-8bda-4ba832d785ff
single
Not a sign of stellate ganglion block
Horner syndrome is a sign of stellate ganglion block (miosis, enopthalmos,ptosis, anhydrosis and absence of cliospinal reflex
2
Miosis
exopthalomoss
Nasal congestion
Conjunctival redness
Anaesthesia
Regional anaesthesia
d2f82b22-2fc7-4ede-aa46-9b887e241002
single
This manouver helps to
This is BURP manouver . here thyroid cartilage is pushed back up with right pressure to improve laryngoscopic view.
2
Decrease risk of aspiration
Improve laryngoscopic view
Open the airway
Stabilize ET tube position
Anaesthesia
null
08958bd9-ccd0-473d-b34c-cc6f2ead9b83
single
Arrange following according to increasing order of their total body water as percentage of body weight 1. 6 month baby 2. neonate 3. young female 4. young male
Age Total body water (%) ECF(%) Blood volume(%) Neonate 80 45 9 6 mo old 70 35 1 yr 60 28 5 yr 65 25 8 Young male 60 22 7 Young female 50 20 7 Elderly 50 20
3
1<2<3<4
1<3<4<2
3<4<1<2
4<3<2<1
Anaesthesia
Anaesthesia Q Bank
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single
Ether was first used by
Ether was used for frivolous purposes ("ether frolics"), but not as an anesthetic agent in humans until 1842, when Crawford W. Long and William E. Clark independently used it on patients for surgery and dental extraction, respectively. However, neither Long nor Clark publicized his discovery. Four years later, in Boston, on October 16, 1846, William T.G. Moon conducted the first publicized demonstration of general anesthesia for surgical operation using ether. The dramatic success of that exhibition led the operating surgeon to exclaim to a skeptical audience: "Gentlemen, this is no humbug!" Joseph Priestley produced nitrous oxide in 1772, and Humphry Davy first noted its analgesic propeies in 1800. Gardner Colton and Horace Wells are credited with having first used nitrous oxide as an anesthetic for dental extractions in humans in 1844. Ref: Miller's anesthesia 8th edition Ref: Morgan & Mikhail's clinical anesthesiology 6e
2
Priestley
Moon
Wells
Simpson
Anaesthesia
General anaesthesia
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single
High airway resistance is seen in
Resistance impedes airflow into (and out of) the lung. The major component of resistance is the resistance exeed by the airways (large and small), and a minor component is the sliding of the lung and the chest wall tissue elements during inspiration (and expiration). Resistance is overcome by (driving) pressure. In spontaneous breathing, Resistance (R) is calculated as driving pressure (DP) divided by the resultant gas flow (F): R = DP/F The value of airway resistance is approximately 1 cm H2O/L/sec, and is higher in obstructive lung disease (e.g., COPD, asthma); in severe asthma, it is elevated approximately tenfold. The presence of an endotracheal tube adds a resistance of 5 (or 8) cm H2O/L/min for a tube with an internal diameter of size 8 (or 7) cm. For any tube for which the airflow is laminar (smooth, streamlined), the resistance increases in direct propoion to the tube length and increases dramatically (to the fouh power) as the diameter of the tube is reduced. Two factors explain why most (approximately 80%) of the impedance to gas flow occurs in the large airways. First, as bronchi progressively branch, the resistances are arranged in parallel and the total cross-sectional area at the level of the terminal bronchioles adds up to almost tenfold that at the trachea. Second, in tubes that are large, irregular or branched, the flow is often turbulent, not laminar. When flow is laminar: F(lam) = DP/R In contrast, when the flow is turbulent: F(turb) = DP/R2 Therefore, for a given radius, far more pressure is required to achieve comparable flow where the flow is turbulent; thus, the effo required is greater, and if prolonged or severe, respiratory failure is more likely. Ref: Miller's anesthesia 8th edition Ref: Morgan & Mikhail's clinical anesthesiology 6e
4
Respiratory bronchiole
Intermediate bronchiole
Terminal bronchiole
Main bronchus
Anaesthesia
Fundamental concepts
cfdb0644-0572-4bb3-92de-499607ec1305
single
Secondary action of Superior Rectus Muscle is
Ans. is c i.e., Adduction & intorsion Muscle Primary ction Secondary Action Superior rectus Elevation Adduction and intorsion Inferior rectus Depression Adduction and extorsion Medial rectus Adduction Lateral rectus Abduction Superior oblique Intorsion Abduction and depression Inferior oblique Extorsion Abduction and elevation
3
Abduction & extorsion
Adduction & extorsion
Adduction & intorsion
Adduction & extorsion
Anaesthesia
null
46f092cd-fbd3-4389-b6d3-d186d528e8fe
single
Optimum oxygenation is maintained by adjusting following parameters a — Tidal volume,b — PEEP,c — FiO2,d — respiratory rate
PEEP and FiO2 determine optimum oxygenation.
2
a, b
b, c
c, d
d, a
Anaesthesia
null
86c8c8c5-5db2-48c7-9d4f-3f2399e901df
single
No effect on hea
B i.e. Ether
2
Chloroform
Ether
Methoxyflurane
Halothane
Anaesthesia
null
1d9fb803-31b6-4c88-b8a3-ec2a7a806839
single
Local anaesthesia causing methemoglobinemia
Prilocaine Prilocaine is an amide local anaesthetic that is metabolized to ohotolidine. Ohotolidine is an oxidizing compound capable of conveing hemoglobin to methemoglobin. As methemoglobinemia reduces the amount of hemoglobin that is available for oxygen transpo this side effect is potentially life threatening. Therefore dose limits for prilocaine should be strictly observed. Drugs causing methemoglobinemia Anilines Aminophenois Aminoph enon es Chlorates/dapsone Prilocaine/benzocaine Nitrates/nitrites/naphthalene Nitrobenzene Phenazopyridine Primaquine and related antimalarials Sulfonamides
2
Procaine
Prilocaine
Etiodicaine
Ropivacaine
Anaesthesia
null
81eac16b-f72a-4838-9262-272b0df14a2a
single
The most potent synthetic opioid is
Sufentanil has a high affinity for the mu receptor, higher than that of any other opioid.
2
Remifentanil
Sufentanil
Alfentanil
Fentanyl
Anaesthesia
General anaesthesia
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single
Modality best utilized for neuromuscular monitoring during maintenance of anaesthesia is
Neuromuscular monitoring, also known as a train of four monitoring, is a technique used during recovery from the application of general anaesthesia to objectively determine how well a patient&;s muscles are able to function.
1
Train of four
Single twitch
Tetanic stimulation
Post-tetanic stimulation
Anaesthesia
General anaesthesia
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single
In a patient with fixed respiratory obstruction Helium is used along with Oxygen instead of plain oxygen because
B i.e. It decreases turbulence
2
It increases the absorption of oxygen
It decreases turbulence
It decreases the dead space
For analgesia
Anaesthesia
null
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single
100 % Oxygen therapy used in
(A) Cluster headache # CLUSTER HEADACHES are rare, extremely painful, & debilitating headaches that occur in groups or clusters.> These headaches affect one side of the head (unilateral) & may involve tearing of the eyes & a stuffy nose.> Unlike migraines, more men experience this type of headache than women.> They can affect people of any age, but are most common between adolescence & middle age.> No discernable pattern can be found among families in the development of cluster headaches.> While no specific cause has been found for the disorder, it appears to be related to a sudden release of histamine or serotonin by the body tissue.> Onset is sudden & most commonly happens during the dreaming (REM) phase of sleep.> Headaches may occur daily for months, alternating with periods without the headaches (episodic), or they can recur for a year or more without stopping (chronic).> A person may experience alternating chronic & episodic phases.> Some people who experience cluster headaches are heavy smokers.> Alcohol, glare, stress, or certain foods may trigger an attack.> The goal of treatment is to relieve the symptoms.> Smoking, alcohol use, specific foods, and other factors that seem to trigger cluster headaches should be avoided.> A headache diary may be helpful in identifying triggers.> When a headache occurs, record the date and time it starts.> In addition, list all activities, substances used, and food/drink consumed within the previous 24 hours, as well as any other factors that seem significant.> HBOT seems to be useful in the treatment of cluster headaches, particularly for frequent headaches that occur at night.> Side effects of mild ear and sinus pressure have been reported
1
Cluster headache
Migraine
Congenital spherocytosis
COPD
Anaesthesia
Miscellaneous
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single
Intravenous anaesthetic agent of choice in status epilepticus
Propofol produces coical EEG changes. Propofol appears to possess profound anticonvulsant propeies. CBF ICP CMRO2 Seizure Thiopentone ||| ||| ||| ||| Ketamine || || | | Halothane || || | | Nitrous oxide | | | | Previously thiopentone was used nowerdays propofol is used.
1
Propofol
Thiopentone
Ketamine
Etomidate
Anaesthesia
Intravenous Anesthetic Agents
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Critical temperature for liquid nitrogen is
Critical temperature (Tc) of substance is the temperature at and above which vapor of that substance cannot be liquefied, no matter how much pressure is applied (Note: Below critical temperature a substance can exist as a liquid or gas depending on pressure).Critical temperature of N2 is-146.9degC; that means N2 can b3e liquefied below -146.9degC - So, liquid nitrogen must be stored below -146.9degC(Refer: Morgan and Mikhail's Clinical Anaesthesiology, 5th edition, pg no 11 -12)
3
36.5degC
-20degC
-147degC
-242degC
Anaesthesia
All India exam
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single
Hepatotoxic inhalational agent
All inhalational agent cause maild hepatotoxicity by decreasing hepatic blood flowIsoflurane is the agent of choice in liver disease as it has least effect on Hepatic blood flowDirect hepatotoxicity (Hepatitis, hepatic necrosis) is caused by- halothane, chloroform, trilene, methoxyflurane(Refer: Morgan and Mikhail's Clinical Anaesthesiology, 5th edition, pg no. 167-169)
1
Halothane
Enflurane
Desflurane
Sevoflurane
Anaesthesia
All India exam
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single
Shoest acting non depolarizing muscle relaxant is
Suxamethonium (succinylcholine) is the shoest acting skeletal muscle relaxantMivacurium is the shoest acting nondepolarizing skeletal muscle relaxant.(Refer: stoelting's pharmacology and physiology in anaesthetic practice, 5th edition, pg no.139)
1
Mivacurium
Doxacuronium
Pipecurium
Vecuronium
Anaesthesia
All India exam
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single
Anesthesia agent with least analgesic propey
B i.e. Halothane
2
N20
Halothane
Ether
Propane
Anaesthesia
null
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single
Laudanosine is metabolic end product of
Laudanosine is metabolic end product of atracurium.
4
Mivacurium
Doxacurium
Rocuronium
Atracurium
Anaesthesia
null
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single
Not compatible with soda lime
C i.e. Trielene
3
Ether
Halothene
Trilene
N20
Anaesthesia
null
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single
Flat capnogram found in A/E
in bronchospasm,there is prolonged expiratory upstroke(abscence of phase 3 plateau). in tube displacement,disconnection,accidental extubation,ventilation failure,it is flat.
4
Disconnection of anesthetic tubing
Accidental extubation
Mechanjca1 ventilation failure
Bronchospasm
Anaesthesia
Preoperative assessment and monitoring in anaesthesia
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single
Spinal anesthesia should be injected into the space between
Spinal anesthesia is usually injected at L3-L4, L2-L3
3
T12-L1
L1-L2
L3-L4
L5-S1
Anaesthesia
Regional anaesthesia
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Maximum vital capacity decreased in
C i.e. Trendelenberg Trendelenburg (head down) position causes cephalad shift of abdominal viscera and diaphragm leading to marked decrease in lung capacities (i.e. vital capacity, functional residual capacity, total lung volume, lung compliance) Q Respiratory rate is not affected in any position.Q Physiological effects of patient position Trendelenburg Horizontal Lithotomy Prone Lateral decubitus * Cardiac : Activation of * Cardiac * Cardiac * Cardiac * Cardiac baroreceptors produce - Decreased hea rate - Increase in - Decrease - Cardiac output unchanged decrease in - Decreased peripheral circulating preload, cardiac unless venous return - Cardiac output resistance blood volume output, blood obstructed. - Hea output - Equalization of and preload. pressure due to - Aerial blood pressure - B.P. pressure through out - Effect on peripheral may fall as a result of - Peripheral vascular resistance the aerial system blood pooling of blood. decreased vascular * Respiratory : Cephalad shift of - Increased right sided pressure and * Respiratory resistance. abdominal viscera produces filling & cardiac cardiac - Decreases total * Respiratory - Marked decrease in lung output. output lung compliance - Decreased volume of capacities (VC, FRC, Total * Respiratory depends on and increases dependent lung. lung volume, lung - Diaphragm is volume work of - Increased perfusion of compliance)Q displaced cephalad status. breathing. dependent lung. - Atelactasis by abdominal viscus * Respiratory - Increased ventilation of - Increase ventilation perfusion - Increase perfusion of - Decreased dependent lung in awake mismatch dependent vital capacity. patient (No v/q mismatch) - Increase likelihood of (posterior) segment - Increase - Decreased ventilation of regurgitation - Functional residual likelihood of dependent lung in * Others - Increase intraocular pressure in glaucoma - Increase in intracranial Pressure & decrease in cerebral blood flow. capacity decreases aspiration anaesthetized patient (v/q mismatch) - Fuher decrease in dependent lung ventilation with paralysis and open chest.
3
Prone
Supine
Trendelenberg
Left lateral
Anaesthesia
null
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single
The term "balanced anaesthesia" has been given by
Term 'balanced anaesthesia' was introduced by Lundy in 1926Balanced anaestesiaThe cardinal feature of general anaesthetics are:-Loss of all sensations, especially painSleep (unconsciousness) and amnesiaImmobility and muscle relaxationAbolition of reflexesIn the modern practice of balanced anaesthesia these modalities are achieved by using the combination of inhaled and i.v. drugs.
3
Simpson
Fischer
Lundy
Moan
Anaesthesia
All India exam
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single
Shoest acting nondepolarising muscle relaxant
Suxamethonium (succinylcholine) is the shoest acting skeletal muscle relaxantMivacurium is the shoest acting nondepolarizing skeletal muscle relaxant(Refer: Morgan and Mikhail's Clinical Anaesthesiology, 5th edition, pg no.214,218,219 )
2
Succinylcholine
Mivacurium
Atracurium
Vecuronium
Anaesthesia
All India exam
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single
Modern monitors to measure ETCO2 make use of
Measurements of variations in the respiratory cycle of expired carbon dioxide by displayed waveform and by absolute numerical values is defined as Capnography and Capnometry respectivelyMeasurement of the exhaled CO2 at the level of upper airway at the end of expiration (when CO2 is at its maximum) is referred to as 3end tidal CO2 (EtCO2)Modern monitors used to measure EtCO2 in the exhaled air make use of infrared absorption spectroscopy(Refer: Morgan and Mikhail's Clinical Anaesthesiology, 5th edition, pg no. 126)
1
Infrared absorption spectroscopy
Ultra violet rays
Laser technology
Scatter technology
Anaesthesia
All India exam
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single
Propofol infusion syndrome is characterized by
Propofol infusion syndrome occurs when propofol infusion is continued for more than 48 hours Severe metabolic acidosis Acute cardiacfailure Hyperkalemia Hyperlipidemia Skeletal myopathy Refractory bradycardia.
3
Hypokalemia
Hypolipidemia
Bradycardia
Tachycardia
Anaesthesia
null
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Fixed performance device is
venturi mask is a device used to deliver designated oxygen concentration to patients on controlled oxygen therapy. It is designed with wide bore tubes with various colour adapters. Each colour code responds to the precise oxygen concentration and specific litre flow.
1
Ventury mask
Nasal cannula
Simple mask
Non rebreathing mask
Anaesthesia
Anaesthetic equipments
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single
A 25 year old male is undergoing incision and drainage of abscess under general anaesthesia with Spontaneous respiration. The most efficient anaesthetic circuit is
Mapelson breathing systems are classified as Mapelson A, B, C, D, E, F Mapelson A also known as Magill&;s circuit. Ranking of Mapelson&;s systems based on superiority as follows : Spontaneous ventilation : A>D,F,E>C,B Controlled ventilation : D, F, E>B,C>A Mapelson A is more efficient in spontaneous ventilation Mapelson D is more efficient in Controlled ventilation
1
Maplelson A
Mapleson B
Mapleson C
Mapleson D
Anaesthesia
Anaesthetic equipments
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single
Sciatic nerve blockade provides sensory loss of the
Sciatic nerve blockade results in sensory loss to the posterior thigh by blocking the posterior cutaneous nerve along with everything below the knee, except for the medial lower leg, which is innervated by the saphenous nerve.
2
Anterior and lateral thigh
Posterior thigh and majority of the leg below the knee
Medial and posterior thigh
Medial leg below the knee
Anaesthesia
Regional anaesthesia
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A 23 years old male presents with ingrown nail. The ingrown nail was removed after administering a ring block. The mechanism of action of the local anesthetic used is
Answer: b) Blockage of activated sodium channelsLOCAL ANESTHETICSInterfere with the excitation process in a nerve membrane in one or more of the following ways:Altering the basic resting potential of the nerve membraneAltering the threshold potential (firing level)Decreasing the rate of depolarizationProlonging the rate of repolarizationLA's are weak bases carrying a positive charge at the tertiary amine group at physiological pH.MOA: Blocks voltage gated Na+ channels from inside of cell membrane by binding to a-subunit.Nerve block produced by local anesthetics is called a nondepolarizing nerve block.LA's are weak bases; they act by penetrating the axonal membrane in the unionized form.After penetration, they get ionized and block the activated sodium channels from within, thereby preventing the propagation of action potentials.
2
Opening of sodium channels
Blockage of activated sodium channels
Increased frequency of GABA activated chloride channels
Increased duration of GABA activated chloride channels
Anaesthesia
Local and Regional Anesthesia
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% of thiopentone used in induction
C i.e. 2.5%
3
0.50%
1.50%
2.50%
4.50%
Anaesthesia
null
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single
Emergency oxygen flush in anaesthetic machine provides
Emergency oxygen flush delivers more than normal amount of oxygen at higher pressure to stabilize the patient.
1
35-75L/min oxygen at 55 to 60 Psi pressure
25-35L/min oxygen at 10 to 12 Psi pressure
55-75L/min oxygen at 55 to 60 Psi pressure
10-20L/min oxygen at 10 to 12Psi pressure
Anaesthesia
null
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single
Best anaesthetic agent for out patient anasthesia is
C i.e. Alfentanyl
3
Fentanyl
Morphine
Alfentanyl
Penthidine
Anaesthesia
null
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single
Pseudocholinesterase acts on
Mivacurium is metabolised by pseudocholinesterase. Rest all are metabolisedby non specific esterase.
3
Esmolol
Atracurium
Mivacurium
Remifentanil
Anaesthesia
null
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single
Commonly used in narcoanalysis
D i.e. Thiopentone
4
Atropine
Scopolamine
Opium
Thiopentone
Anaesthesia
null
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single
Least absorbed from mucous membrane are
Hydrophobicity is a primary determinant of intrinsic anesthetic potency because the anesthetic molecule must penetrate into the nerve membrane and bind at a paially hydrophobic site on the Na+ channel. Clinically, however, the correlation between hydrophobicity and anesthetic potency is not as precise as in an isolated nerve. Differences between in vitro and in vivo potency may be related to a number of factors, including local anesthetic charge and hydrophobicity (which influence paitioning into and transverse diffusion across biologic membranes) and vasodilator or vasoconstrictor propeies (which influence the initial rate of vascular uptake from injection sites into the central circulation). Ref: Miller's anesthesia 8th edition Ref: Morgan & Mikhail's clinical anesthesiology 6e
3
Lidocaine
Tetracaine
Procaine
Cocaine
Anaesthesia
General anaesthesia
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single
Mac Intosh curved blade laryngoscope is a type of
The Macintosh laryngoscope has a curved blade which allows exposure of the larynx by positioning the tip in the vallecula, anterior to the epiglottis, lifting it out of view. This laryngoscope is designed to lessen the difficulty of exposing the larynx to pass an endotracheal tube
2
Indirect laryngoscope
Direct laryngoscopc
Bronchoscope
Video laryngoscope
Anaesthesia
Anaesthetic equipments
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For a 78 yr old man for trans urethral resection of prostate, ideal anesthetic method is spinal anesthesia, this is because
TURP syndrome may occur at any time perioperatively and has been observed as early as few minutes after surgery has staed and as late as several hours after surgery has been completed. When under regional anesthesia, the patient characteristically complains of Dizziness Headache Nausea Tight feeling in the chest and throat Shoness of breath Restlessness Confusion Retching Abdominal paint thus regional anaesthesia is preferred.
2
General anesthesia causes more bleeding than spinal
Signs of hyponatremia can easily be detected under spinal
Spinal anesthesia abolishes the obturator nerve stimulation by electro cautery
Obstructive uropathy and renal failure may be associated with prostatic enlargement
Anaesthesia
Central Neuraxial Blockade
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In relation to the drug Sugammadex
There is currently no data available regarding the use of sugammadex for the 'immediate reversal' of vecuronium. However, sugammadex is recommended for reversal of vecuronium once spontaneous T2 twitch has been achieved, using a dose of 4mg/kg to reverse 0.1mg/kg of vecuronium.Sugammadex is not effective against benzyl-isoquinolinium muscle relaxants (e.g. cisatracurium and mivacurium).Phase I-IV trials have shown sugammadex to be effective for rapid reversal of rocuronium-induced neuromuscular blockade (16mg/kg).Sugammadex is a member of the g-cyclodextrin family, which encapsulates aminosteroid neuromuscular blocking agents (rocuronium, vecuronium, pancuronium).
3
It is recommended for immediate reversal of Vecuronium
It can effectively reverse Cisatracurium
16mg/kg is recommended intravenously for the immediate reversal of Rocuronium
It is an a-cyclodextrin that encapsulates amino-steroid neuromuscular blocking agents
Anaesthesia
Miscellaneous
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Index of potency of general anaesthesia
A i.e. Minimum alveolar concentration
1
Minimum alveolar concentration
Diffusion coefficient
Dead space concentration
Alveolar blood concentration
Anaesthesia
null
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Induction agent of choice in bronchial asthma
Ketamine is a bronchial smooth muscle relaxant. When it is given to patients with reactive airway disease and bronchospasm, pulmonary compliance is improved. Ketamine is as effective as halothane or enflurane in preventing experimentally induced bronchospasm. The mechanism for this effect is probably a result of the sympathomimetic response to ketamine, but isolated bronchial smooth muscle studies showed that ketamine can directly antagonize the spasmogenic effects of carbachol and histamine. Because of its broncho-dilating effect, the administration of ketamine can treat status asthmaticus unresponsive to conventional therapy. A potential respiratory problem, especially in children, is the increased salivation that follows ketamine administration; this effect can be modulated by an anticholinergic drug such as atropine or glycopyrrolate. Racemic ketamine is a potent bronchodilator, making it a good induction agent for asthmatic patients; however, S(+) ketamine produces minimal bronchodilation. Ref: Miller's anesthesia 8th edition Ref: Morgan & Mikhail's clinical anesthesiology 6e
3
Thiopentone
Methhexitone
Ketamine
Propofol
Anaesthesia
General anaesthesia
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single
Day care anesthesia is best achieved with
Propofol
3
Enflurane
Isoflurane
Propofol
Methoxyflurane
Anaesthesia
null
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single
Vasponstricator L.A. is
All local anaesthetics are vasodilators except cociane which is a vasoconstrictor
1
Cocaine
Procaine
Lidocaine
Chlorprocain
Anaesthesia
Preoperative assessment and monitoring in anaesthesia
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The recommended size of endotracheal tube for 1 year old child is
Tube diameter in mm = Age in years/4 + 4 = 1/4 + 4 = 17/4 = 4.2
3
2.5
3
4
5
Anaesthesia
null
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single
Nasal intubation is contra indicated in
A i.e. CSF Rhinorrhea Nasal (naso-tracheal) intubation is required when oral (orotracheal) tube will interfere with surgery (eg intraoral surgery) and may be indicated when oral intubation is difficult (eg inability to open month). It provides good oral hygiene and more secure fixation with less chances of displacement and extubation. But it is more commonly a/w significant nasaVmucosal bleeding, submucosal placement, transient bacteremia (infection), sinusitis and otitis mediaQ. These side effects make nasotracheal intubation contraindicated in base of skull fracture, CSF rhinorrheaQ, nasal abnormalities and trauma and coagulopathy.
1
CSF Rhinorrhea
Fracture cervical spine
Fracture mandible
Sho neck
Anaesthesia
null
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Visual analogue scale most widely used to measure
null
4
Sleep
Sedation
Depth of anaesthesia
Pain intensity
Anaesthesia
null
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Arrange following pas of Anesthesia machine according increasing pressure system wise i) Vaporize mounting devices ii) Hanger yoke assembly iii) Flow indicators iv) Pipe line indicator
Anesthesia machine according increasing pressure system iii) Flow indicators i) Vaporize mounting devices iv) Pipe line indicator ii) Hanger yoke assembly
1
(iii), (i), (iv), (ii)
(i), (iv), (iii), (ii)
(ii), (i), (iii), (iv)
(iii), (iv), (ii), (i)
Anaesthesia
Anesthesia Machine
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Intubation dose of pancuronium
D i.e. 0.08 mg/Kg Pancuronium is commonly used MR. d/t lack of S/E like flushing, bronchospasm as it causes less histamine release. It causes hypeension by releasing Noradrenaline and is safe in malignant hyperpyrexia. Dose for intubation is 0.08-0.12 mg/kgQ
4
0.02 mg/Kg
0.04 mg/Kg
0.06 mg/Kg
0.08 mg/Kg
Anaesthesia
null
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single
Drug of choice for treating malignant hypehermia
Dantrolene sodiumis thedrug of choicefor malignant hypehermia but it is to be reconstituted withsterile distilled water, not saline as it can precipitate in saline or other salt solutions. It is given at a dose of2.5 mg/ kgintravenously and can be repeated every 5-10 minutes (upto 10mg/kg) till the attack subsides. All anesthetic agents should be cut off and the patient is given 100% oxygen. Bicarbonate at a dose of 1 to 4 mEq/kg IV can be used to treat metabolic acidosis. If the body temperature is high, it should be brought down using cold intravenous fluids, cooling body cavities with sterile iced fluids, surface cooling with ice packs and cooling blankets.
1
Dantrolene
Nikethamide
Baclofene
Propofol
Anaesthesia
Inhalational Anesthetic Agents
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After hyperventilation for some time holding the breath is dangerous since
B i.e. Due to lack of stimulation by CO2, anoxia can go into dangerous level
2
It can lead to CO2 narcosis
due to lack of stimulation by CO2, anoxia can go into dangerous level
I-0O2 shift 0 dissociation curve to left.
Alkalosis can lead to tetany
Anaesthesia
null
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Size in < 6 years old child, of endotracheal tube is
A i.e. Age +3.5/3.5
1
Age +3.5/3.5
Age +2.5/2.5
Age + 4.5/4.5
Age -4.5/4.5
Anaesthesia
null
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single
Least soluble anesthetic agent is
Blood-gas paition coefficient, also known as Ostwald coefficient for blood-gas, is a term used in pharmacology to describe the solubility of inhaled general anesthetics in blood. The coefficient is defined as the ratio of the concentration in blood to the concentration in gas that is in contact with that blood when the paial pressure in both compaments is equal. It is inversely propoional to the induction rate. It determines the onset of induction and recovery. anesthetic blood gas solubility Nitrous oxide 0.47 Halothane 2.4 Isoflurane 1.4 Sevoflurane 0.65 Desflurane 0.45 Methoxyflurane 12 Enflurane 1.9
1
Desflurane
Sevoflurane
Halothane
Methoxyflurane
Anaesthesia
General anaesthesia
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single
Sodalime in breathing circuit is contraindicated with
Chloroform produces phosphogene gas with soda lime, so soda lime is contraindicated with it.
2
Sevoflurane
Chloroform
Desflurane
Methoxyflurane
Anaesthesia
null
cb2323ae-61d9-47c3-9955-47373f679cb0
single
Ketamine is useful as an anesthetic agent in
Ketamine is a potent bronchodilator and relieves bronchospasm -Intravenous anaesthetic agent of choice in asthmatic Ketamine increases ICT, IOP and cardiac oxygen demand, therefore contraindicated in other three conditionsNote-Inhalation anaesthetic agent of choice in asthmatics is halothane.(Refer: Morgan and Mikhail's Clinical Anaesthesiology, 5th edition, pg no. 182 - 184)
3
Ischemic hea disease
Intracranial hemorrhage
Hyperactive airways
Glaucoma
Anaesthesia
All India exam
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single
Coronary steal syndrome is associated with
Coronary steal phenomenonInpatient with coronary aery stenosis, isoflurane causes coronary aery vasodilatation in non-ischemic area, thereby diveing the blood away from ischemic zone.(Refer: Morgan and Mikhail's Clinical Anaesthesiology, 5th edition, pg no.169)
3
Desflurane
Sevoflurane
Isoflurane
Halothane
Anaesthesia
All India exam
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single
The proseal LMA has advantage over normal LMA
Advantage of proseal LMA over classical LMA is that it is comparable to ETT in preventing aspiration. The PLMA shows several modifications from the cLMA: The drain tube runs through the device from the tip to the proximal end. When the PLMA is correctly positioned, the tip of the device forms a high-pressure seal with the oesophageal inlet and the drain tube runs in continuity with the oesophageal lumen . oesophageal drain tube posterior inflatable cuff reinforced airway tube integral bite block introducer this reduces the risk of aspiration and hence may be suitable in non-supine positions (e.g., lateral, prone), in laparoscopic surgery (e.g., cholecystectomy, gynecological surgery), and in patients who are obese.
2
In being more easy to inse
Comparable to endotracheal tube in preventing aspiration
Can be inseed in concious patient.
Can be used for pulmonary toileting
Anaesthesia
Airway
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single
Pudendal Nerve Block Involve
D i.e. S2 S3 S4
4
LiL2L3
L2L3L4
SiS2S3
S2S3S4
Anaesthesia
null
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single
Minimal mandatory Percentage of oxygen used in general anaesthesia is
minimum mandatory is 30% oxygen. Less than 30 % can only is allowed in surgeries with high risk of fire hazard. There we decrease oxygen under strict monitoring.
2
33%
30%
21%
66%
Anaesthesia
Inhalational Anesthetic Agents
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single
Most common complication of spinal anesthesia is
A i.e. Hypotension
1
Hypotension
Headache
Meningitis
Arrythmia
Anaesthesia
null
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single
Preclampsia patient at 38 weeks of gestation is started on oxytocin to augment her labor and the patient is now requesting for epidural analgesia. Anaesthetic considerations include
Always ensure adequate hemostasis prior to epidural anaesthesia. Platelet count less than <50000/microliter is contraindicated to neuroxial interventions due to high risk epidural hematoma.
2
No work up is required prior to performing epidural anaesthesia, as this will treat her hypertension
The presence of hypertension and oedema requires further workup before proceeding.
Neuraxial anaesthesia should be avoided, as there is increased risk of bleeding
Avoid systemic opiates, as the risk of respiratory depression is too high
Anaesthesia
null
81e1a070-0b0c-4237-bf0d-96ca842f24e0
single
Pain rating index is provided by
C i.e. Mc Gill questionnaire
3
Faces scale
Visual analogue scale
Mc Gill questionniare
CHEOP scale
Anaesthesia
null
3e9dbc59-226d-4b33-b6d6-4d9faaee0200
single
During cesarean section under general endotracheal anaesthesia, venous air embolism
Expired Nitrogen is the most sensitive venous-air embolism detection method, as the largest component of air is nitrogen.
3
Is associated with high end-tidal CO2
Should be treated with nitrous oxide
Is associated with expired nitrogen
Induces severe hypertension
Anaesthesia
null
501c7143-2635-45e9-a370-40d908dfd2ba
single
Most common complication of central venous catheter
C i.e. Catheter related infection
3
Local bleeding
Thrombosis
Catheter related infection
Pneumotherax
Anaesthesia
null
e0ef736f-4115-4fa1-9b48-3891bb54be93
single
If thiopentone is injected accidently into an aery the first symptom is
D i.e. Pain
4
Analgesia
Paralysis
Skin ulceration
Pain
Anaesthesia
null
86799b51-64da-4c55-a02f-ab32d1504ec0
single
Percentage of adrenaline with lignocaine for local infilteration is
The most common concentrations of epinephrine combined with local anaesthetics are 1:50000 (0.02 mg/ml), 1:100,000 (0.01mg/ml) and 1:20000 (0.005 mg/dml)The 1:50000 concentration is manufactured in combination with 2% lidocaineThe 1:100,000 concentration is manufactured in combination with 2% lidocaine and 4% aicaineThe 1:200,000 concentration is manufacture in combination with 4% prilocaine, 4% aicaine and 0.5% bupivacaine.(Refer: stoelting's pharmacology and physiology in anaesthetic practice, 5th edition, pg no.523,126,127)
4
0.736111111
1:10000
0.111111111
1:50000
Anaesthesia
All India exam
f6cb2e92-cb6d-4dfb-af1c-62ecf4693f68
single
Semiclosed circuit system
Semiclose breathing circuit is less economical, causes more environmental pollution. It is simple portable and no need of advanced monitoring.
3
Needs advanced monitoring
Complex
More environmental pollution
More economical
Anaesthesia
null
32ec269a-db55-4f15-afc1-6910b6d77ff1
single
Post dural (spinal) puncture headache is due to
(Seepage of CSF) (517 - Lee's 13th) (360-KDT 6th)* Post spinal headache is due to seepage of CSF: can be minimised by using smaller bore needle (KDT)* Typical location is bifrontal and / or occipital* It is more common in Young pregnant patients and with accidental dural puncture rate during epidural anaesthesia using Touhyneedle (60 - 80%) Reduced by introduction of size 25 G and 27 - G whitacre pencil point needles. Which replaced cutting needles* Paralysis of cranial nerve. All cranial nerves except 1st, 9, 10th can be involved after spinal Anaesthesia. Most commonly (90%) 6th nerve is involved (Because of the longest course of 6th nerve)
1
Seepage of CSF
Fine needle
Toxic effects of the drugs
Traumatic damage to nerve roots
Pharmacology
Anaesthesia
89f2b9da-cbe5-4816-a4c2-7ac6b11e26d7
single
Most common injection site infection in spinal anaesthesia
Streptococcal infection is most common in spinal anaesthesia.
2
Staphylococcus
Streptococcus
Pseudomonas
Bacteroides
Anaesthesia
null
d79211c5-f256-4296-9c01-8874aaa68c5d
single

Domain Adaptation of Large Language Models

This repo contains the Biomedicine Knowledge Probing dataset used in our ICLR 2024 paper Adapting Large Language Models via Reading Comprehension.

We explore continued pre-training on domain-specific corpora for large language models. While this approach enriches LLMs with domain knowledge, it significantly hurts their prompting ability for question answering. Inspired by human learning via reading comprehension, we propose a simple method to transform large-scale pre-training corpora into reading comprehension texts, consistently improving prompting performance across tasks in biomedicine, finance, and law domains. Our 7B model competes with much larger domain-specific models like BloombergGPT-50B.

🤗 We are currently working hard on developing models across different domains, scales and architectures! Please stay tuned! 🤗

**************************** Updates ****************************

Domain-Specific LLMs

LLaMA-1-7B

In our paper, we develop three domain-specific models from LLaMA-1-7B, which are also available in Huggingface: Biomedicine-LLM, Finance-LLM and Law-LLM, the performances of our AdaptLLM compared to other domain-specific LLMs are:

LLaMA-1-13B

Moreover, we scale up our base model to LLaMA-1-13B to see if our method is similarly effective for larger-scale models, and the results are consistently positive too: Biomedicine-LLM-13B, Finance-LLM-13B and Law-LLM-13B.

Domain-Specific LLaMA-2-Chat

Our method is also effective for aligned models! LLaMA-2-Chat requires a specific data format, and our reading comprehension can perfectly fit the data format by transforming the reading comprehension into a multi-turn conversation. We have also open-sourced chat models in different domains: Biomedicine-Chat, Finance-Chat and Law-Chat

Domain-Specific Tasks

Pre-templatized/Formatted Testing Splits

To easily reproduce our prompting results, we have uploaded the filled-in zero/few-shot input instructions and output completions of the test each domain-specific task: biomedicine-tasks, finance-tasks, and law-tasks.

Note: those filled-in instructions are specifically tailored for models before alignment and do NOT fit for the specific data format required for chat models.

Raw Datasets

We have also uploaded the raw training and testing splits, for facilitating fine-tuning or other usages: ChemProt, RCT, ConvFinQA, FiQA_SA, Headline, NER, FPB

The other datasets used in our paper have already been available in huggingface.

Domain Knowledge Probing

Our pre-processed knowledge probing datasets are available at: med_knowledge_prob and law_knowledge_prob

Citation

If you find our work helpful, please cite us:

@inproceedings{
cheng2024adapting,
title={Adapting Large Language Models via Reading Comprehension},
author={Daixuan Cheng and Shaohan Huang and Furu Wei},
booktitle={The Twelfth International Conference on Learning Representations},
year={2024},
url={https://openreview.net/forum?id=y886UXPEZ0}
}

and the original dataset:

@inproceedings{MedMCQA,
  author       = {Ankit Pal and
                  Logesh Kumar Umapathi and
                  Malaikannan Sankarasubbu},
  title        = {MedMCQA: {A} Large-scale Multi-Subject Multi-Choice Dataset for Medical
                  domain Question Answering},
  booktitle    = {{CHIL}},
  series       = {Proceedings of Machine Learning Research},
  volume       = {174},
  pages        = {248--260},
  publisher    = {{PMLR}},
  year         = {2022}
}
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