NEET PG Anesthasia Flashcards

24 sample cards from the Anesthasia deck

Sampled from the end of the deck, so these are different cards from the ones shown on the syllabus page.

1. Compare spinal and epidural anesthesia in terms of injection site, onset, and dose.

   Spinal: small dose injected into subarachnoid (intrathecal) space below L2, rapid dense onset, single shot. Epidural: larger dose into epidural space (any level), slower segmental onset, catheter allows continuous/titrated dosing. Spinal carries higher risk of post-dural puncture headache.

2. What are the standard ASA basic intraoperative monitors required during anesthesia?

   Oxygenation (pulse oximetry, inspired O2 analyzer), ventilation (capnography/EtCO2), circulation (ECG, blood pressure at least every 5 min), and temperature. A qualified anesthesia provider must be present throughout.

3. What is the gold-standard confirmation of correct endotracheal tube placement?

   Sustained waveform capnography showing exhaled CO2 over several breaths confirms tracheal (not esophageal) placement; bilateral chest auscultation and chest rise are supportive.

4. What are the laryngoscopic (Cormack-Lehane) grades of glottic view?

   Grade 1: full glottis visible; Grade 2: posterior glottis/arytenoids; Grade 3: only epiglottis; Grade 4: no glottic structures (only soft palate). Grades 3-4 predict difficult intubation.

5. What is a supraglottic airway device, and give a common example with a key limitation.

   A device (e.g., laryngeal mask airway, LMA) that sits above the glottis to provide ventilation without tracheal intubation. It is fast and less stimulating but does not fully protect against aspiration of gastric contents.

6. What is the most critical priority in the ASA Difficult Airway Algorithm when a 'cannot intubate, cannot oxygenate' (CICO) situation occurs?

   Emergency invasive airway access (cricothyrotomy) to restore oxygenation. Throughout, the priority is maintaining oxygenation and calling for help, with options including LMA, video laryngoscopy, and awake intubation.

7. What is rapid sequence induction (RSI) and its purpose?

   RSI is induction with preoxygenation, a rapid-acting induction agent plus a fast-onset paralytic (succinylcholine or high-dose rocuronium), and immediate intubation, to minimize the apneic interval and aspiration risk in patients with full stomachs. Cricoid pressure may be applied.

8. List four common causes of intraoperative hypotension under anesthesia.

   Decreased preload (hypovolemia/hemorrhage, vena caval compression), decreased afterload/vasodilation (anesthetic agents, anaphylaxis, sepsis, neuraxial block), decreased contractility (myocardial depression/ischemia), and decreased heart rate/arrhythmia.

9. Define hypoxemia by SpO2/PaO2 and list the five main physiologic causes.

   Hypoxemia = PaO2 < 60 mmHg or SpO2 < 90%. Causes: hypoventilation, V/Q mismatch, right-to-left shunt, diffusion limitation, and low inspired oxygen (FiO2). Shunt responds poorly to supplemental O2.

10. What is malignant hyperthermia, its triggers, and the genetic defect involved?

    A hypermetabolic crisis of skeletal muscle triggered by volatile anesthetics and succinylcholine, caused by mutations in the ryanodine receptor (RYR1), leading to uncontrolled sarcoplasmic calcium release. It is autosomal dominant.

11. List the early clinical signs of malignant hyperthermia and the specific drug treatment.

    Earliest sign: rising EtCO2 (hypercarbia); also tachycardia, masseter/generalized rigidity, hyperthermia (late), acidosis, hyperkalemia. Treatment: stop triggers, give dantrolene (2.5 mg/kg IV, repeat to 10 mg/kg), hyperventilate with 100% O2, cool, and treat hyperkalemia/arrhythmias.

12. What is the role of the PACU (post-anesthesia care unit), and what scoring system gauges discharge readiness?

    The PACU provides close monitoring during recovery from anesthesia (airway, hemodynamics, pain, nausea). The modified Aldrete score (activity, respiration, circulation, consciousness, oxygen saturation; each 0-2) assesses discharge readiness, typically a score >=9.

13. What are the most common risk factors and first-line prophylaxis for postoperative nausea and vomiting (PONV)?

    Apfel risk factors: female sex, non-smoker, history of PONV/motion sickness, postoperative opioids. Prophylaxis: ondansetron (5-HT3 antagonist), dexamethasone, droperidol; use multimodal combinations for high-risk patients.

14. Describe the WHO analgesic ladder for pain management.

    Step 1: non-opioids (paracetamol/NSAIDs) +/- adjuvants for mild pain; Step 2: weak opioids (codeine/tramadol) + non-opioids for moderate pain; Step 3: strong opioids (morphine) + non-opioids for severe pain. Adjuvants added at any step.

15. What is multimodal analgesia and why is it preferred?

    Combining analgesics with different mechanisms (e.g., paracetamol, NSAIDs, opioids, regional blocks, gabapentinoids, ketamine) to achieve additive/synergistic pain relief while minimizing the dose and side effects of any single agent, especially opioids.

16. What is the formula for an uncuffed endotracheal tube internal diameter and tube length in children over 2 years?

    Uncuffed ETT internal diameter (mm) = (age/4) + 4; tube depth at lips (cm) = (age/2) + 12, or 3 x tube ID. For cuffed tubes, subtract 0.5 from the diameter formula.

17. What is the formula for maintenance fluid in children (Holliday-Segar / 4-2-1 rule)?

    4 mL/kg/hr for the first 10 kg, plus 2 mL/kg/hr for the next 10 kg, plus 1 mL/kg/hr for each kg above 20 kg.

18. Why are infants more prone to rapid desaturation during apnea than adults?

    Infants have higher oxygen consumption per kg, lower functional residual capacity (FRC) relative to closing capacity, and proportionally smaller oxygen reserves, leading to faster desaturation during apnea.

19. What physiological changes of pregnancy increase aspiration risk and reduce apnea tolerance during obstetric anesthesia?

    Decreased lower esophageal sphincter tone and delayed gastric emptying increase aspiration risk; reduced FRC plus increased oxygen consumption cause rapid desaturation. MAC is reduced ~30-40% and there is greater sensitivity to local anesthetics.

20. What is aortocaval compression (supine hypotension syndrome) in pregnancy and how is it prevented?

    In the supine position after ~20 weeks, the gravid uterus compresses the inferior vena cava and aorta, reducing venous return and causing hypotension. Prevented by left uterine displacement (left lateral tilt of ~15 degrees).

21. Name three key physiologic changes in geriatric patients that affect anesthetic management.

    Decreased MAC and anesthetic requirement, reduced cardiac/renal/hepatic reserve and drug clearance, decreased lung elasticity and impaired thermoregulation, and increased sensitivity to sedatives. Doses should be reduced and titrated.

22. In neurosurgical anesthesia, state the cerebral perfusion pressure (CPP) formula and the normal target range.

    CPP = MAP - ICP (or CVP, whichever is higher). Normal CPP is ~60-80 mmHg; maintaining adequate CPP while controlling ICP is a key anesthetic goal.

23. What are the core principles of Enhanced Recovery After Surgery (ERAS) protocols?

    Preoperative counseling and carbohydrate loading (avoid prolonged fasting), multimodal opioid-sparing analgesia, regional/minimally invasive techniques, normothermia and euvolemia, early removal of drains/catheters, and early postoperative mobilization and feeding to speed recovery.

24. What is Point-of-Care Ultrasound (POCUS) used for in anesthesia, and name two common applications?

    POCUS is bedside ultrasound for real-time diagnosis and procedural guidance. Applications: ultrasound-guided vascular access and regional nerve blocks, gastric content/aspiration risk assessment, focused cardiac (FoCUS) and lung assessment, and airway evaluation.

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