- DESCRIBE THE MANAGEMENT OF NEAR DROWNING
- ANAESTHESIA FOR ECT
- ORGANOPHOSPHOROUS POISONING MX
- WITH THE HELP OF DIAGRAMS DESCRIBE CELIAC GANGLION BLOCK
- INTRA AORTIC BALLOON COUNTER PULSATION
- LEVOBUPIVACAINE
- COMPARE ISOFLURANE AND SEVOFLURANE
- CAUSES FOR DELAYED RECOVERY, INVESTIGATIONS MX
- MYASTHENIC SYNDROME
- ANAESTHESIA FOR LASER SURGERY
- PULSE OXIMETRY PRINCIPLES AND USES
- SAFETY FEATURES IN ANAESTHESIA MACHINE, DESCRIBE ORMC
- PHANTOM LIMB PAIN
- RENAL REGULATION OF ACID BASE
- PERCUTANEOUS TRACHEOSTOMY
- CRITERIA FOR WEANING FROM VENTILATOR
- TURP SYNDROME DIAGNOSIS AND MANAGEMENT
- ANAESTHETIC CONSIDERATION IN SCOLIOSIS SURGERY
- INTRATHECAL OPIOIDS
- MEDICAL MANAGEMENTOF HEAD INJURY
- CLASSIFY INOTROPS, COMPARE DOPAMINE AND DOBUTAMINE
- TETRALOGY OF FALLO ANAESTHESIA MANAGEMENT
- MORBID OBESITY
- LAPAROSCOPY ANAESTHETIC CONSIDERATION
- MAJOR SURGERY IN POST CABG PATIENT, PREOP ASSESSMENT AND INTRAOP MANAGEMENT
- CONTRIBUTION BY JOHN SNOW
- ANESTHETIC CONSIDERATION IN PACEMAKER
- INTRA OP BRONCHOSPASM
- POST OP PULM COMPLICATIONS
- MALIGNANT HYPERTHERMIA CAUSES DIAGNOSIS AND MANAGEMENT
- PHEOCHROMOCYTOMA
- BRONCHOPLEURAL FISTULA ANAESTHETIC MX
- PAIN MANAGEMENT IN SICKLE CELL DISEASE
- RECENT RESUSCITATION GUIDELINES
- HOW TO SET UP ACUTE PAIN SERVICE CLINIC
- LABOUR ANALGESIA METHODS
- BRACHIAL PLEXUS BLOCK AXILLARY APPROACH
- AIRWAY PRESSURE RELEASE VENTILATION
- OXYGEN DISS CURVE
- EXPLAIN TRANSPORT OF CARBON DIOXIDE IN BLOOD
- BAIN CIRCUIT WITH THE HELP OF DIAGRAM
- ASSESSMENT OF DIFFICULT AIRWAY
- VOCAL CORD PALSIES WITH THE HELP OF DIAGRAM
- BRAIN DEAD DONOR FOR TRANSPLANTATION, ASSESSMENT,MX
- NOSOCOMIAL INFECTIONS IN ICU
- PATHOPHYSIOLOGY OF PREECLAMPSIA, MX OF A PRIMI GRAVIDA WITH ECLAMPSIA FOR CAESAREAN
- AWARENESS METHODS TO DETECT PREVENTION
- POST OP NAUSEA AND VOMITING
- PROBLEMS IN DENTAL CHAIR
- MITRAL STENOSIS PATIENT FOR CAESAREAN
- ICP MONITORING
- BIPAP MODE
- WEANING MODES DESCRIBE SIMV
- 2 YR CHILD WITH FOREIGN BODY AIRWAY
- SUPRAGLOTTIC AIRWAY DEVICES, DESCRIBE FASTRACH
- HYPOXIC PULM VASOCONSTRICTION
- ONELUNG VENTILATION MANAGEMENT
- MANAGEMENT OF ACUTE BURNS, FLUID MANAGEMENT
- APPENDICECTOMY FOR A PREG PATIENT
- DRUG INTERACTIONS
- REMIFENTANYL
- ASSESSMENT OF DIFFICULT AIRWAY
- CAPNOGRAM PRINCIPLE DRAW DIAGRAM IN COPD
- METABOLIC ACIDOSIS CAUSES MX
- HYPERKALEMIA,ECG CHANGES, MX
- MINIMUM ALVEOLAR CONCENTRATION
- POST ANAESTHESIA CARE UNIT
- 70 YR OLD PATIENT FOR TOTAL HIP REPLACEMENT
- PATHOPHYSIOLOGY OF SEPTIC SHOCK MX
- MASSIVE BLOOD TRANSFUSION
- ANAESTHESIA FOR CATARACT SURGERY WHAT IS MAC?
- PONV
Thursday, February 25, 2010
PREVIOUS YEAR QUESTIONS
Friday, February 5, 2010
PHYSIOLOGICAL CHANGES IN PREGNANCY
CVS CHANGES
Intravascular volume increases by 35% (about 1000ml) – plasma volume 45%, RBC – 20%. So relative anaemia of pregnancy occurs
Anaemia – Hb < 11 gm/dl, PCV < 33% Blood loss up to 1500 ml need no blood transfusion.
Plasma protein decreases to 5 gm/dl due to dilution and decreased colloid oncotic pressure.
Cardiac output – increases by 40%. Stroke volume 30% and heart rate 15%. Maximum CO at the 32nd week. (Due to steroids). Cardiac output increases by 15% during latent phase, 30% during active phase, 45% during expulsive phase, Post partum – 60% increase of cardiac output
Peripheral circulation -SVR decreases. Diastolic BP decreases by 15%.
supine hypotension syndrome: on supine position bp decreases by 10 % leading to nausea vomiting and vomiting and changes in cerebration due to compression of IVC by the uterus leading to decreased venous return and decreased CO and decreased BP. Compensated by collateral supply via azygous and paravertebral veins. Increased sympathetic nerve activity leads to increased SVR and increased BP. Aortic compression also occurs which leads to decreased lower blood flow and decreased uterine blood flow and foetal compromise. Treatment is given if systolic BP less than 100 or with Bradycardia with 20 – 30% decreased. Treatment – left lateral position, fluids, wedge, and ephedrine.
RESPIRATORY SYSTEM
Upper airway – oedema, capillary engorgement of the mucosal lining, difficult intubation, small sized tube, increased bleeding.
Minute ventilation – increased by 50%, of that 40% by tidal volume due to progesterone, less by respiratory rate. Due to increased minute ventilation PaCO2 decreases from 40 to 30mm of Hg. PaO2 increases. PH is normal. PaCO2 compensated by decrease in HCO3 from 26 to 22 meq/l. 4 meq/L by renal excretion of sodium HCO3.
Lung volume – decreased ERV plus RV. So decreased FRC. 20% decrease. Other volumes normal. So with increased minute ventilation and decreased FRC, the change in alveolar concentration of anaesthetics occur very fast and so decreased dose is required and fast onset is seen. So make the parturient susceptible to overdose.
Arterial oxygenation – PaO2 falls very fast with apnoea. Decreased FRC and 20% increase in O2 consumption. So pre oxygenation for 6 minutes is given. This also increases umbilical vein O2 concentration. Also contributors are aorto caval compression plus early closure of small arteries leading to V/Q mismatch. So O2 supplemented with all regional anaesthesia technique used.
CNS
-Engorgement of epidural veins (due to IVC compression plus collateral by paravertebral plexus) leads to decreased epidural space. Compress CSF in subarachnoid space – pumping effect by the epidural veins more spread to upper levels.
- Exaggerated lordosis
- High pressure in epidural space
RENAL
renal blod flow is increased gfr increased by 50%
renal glycosuria
proteinuria 300 mg/day
Increased SGOT, LDH, alkaline phosphatase and Cholesterol
decreased total protein and albumin
cholinesterase activity is reduced but usually immaterial due to large volume of distriubution
GIT
abolition of go angle due to upward displacement of stomach, so the punch coch effect
lost, increased chance of aspiration
Delayed gastric emptying
COAGULATION SYSTEM
Hypercoagulable state with increased clotting factors mainly VII, VIII, X and fibrinogen
METABOLISM
BMR – decrease in 3rd and 4th month. Increase by term. 5-40%.Insulinase produced by plasma also cause degradation of insulin. HPL antagonizes insulin at periphery and also increase FFA So in pregnancy a diabetogenic state exists.
Increased FFA, increased cholesterol, increased phospholipids,Increased FFA as in accelerated starvation state could lead to ketonemia, ketonuria in presence of diabetes
Protein content increase with pregnancy (500gm – foetus, 500gm – uterus.) Haemodilution will lead to decrease in albumin concentration. A:G ratio reversed.
ACID BASE
Increase minute ventilation leads to decreased PaCO2 from 40 to 30 mm of Hg (Respiratory alkalosis) and is compensated by increased sodium bicarbonate excretion and decreasee bicarbonate from 26 to 22 meq/l. so this causes shift of ODC to left and decreased release of oxygen. But increased pH leads to increased 2,3 DPG release and shift of ODC to right and increased release of O2. PaCO2 is decreased so that release of CO2 from foetus occurs.
ENDOCRINE
Pituitary – no change,Thyroid – increased thyroid binding globulin. Increased thyroid stimulating factors. increased T3/T4. Adrenal – cortisol level increases.Aldosteone level increases.
OTHERS
calcium, iron, and magnesium content are decreased.
Intravascular volume increases by 35% (about 1000ml) – plasma volume 45%, RBC – 20%. So relative anaemia of pregnancy occurs
Anaemia – Hb < 11 gm/dl, PCV < 33% Blood loss up to 1500 ml need no blood transfusion.
Plasma protein decreases to 5 gm/dl due to dilution and decreased colloid oncotic pressure.
Cardiac output – increases by 40%. Stroke volume 30% and heart rate 15%. Maximum CO at the 32nd week. (Due to steroids). Cardiac output increases by 15% during latent phase, 30% during active phase, 45% during expulsive phase, Post partum – 60% increase of cardiac output
Peripheral circulation -SVR decreases. Diastolic BP decreases by 15%.
supine hypotension syndrome: on supine position bp decreases by 10 % leading to nausea vomiting and vomiting and changes in cerebration due to compression of IVC by the uterus leading to decreased venous return and decreased CO and decreased BP. Compensated by collateral supply via azygous and paravertebral veins. Increased sympathetic nerve activity leads to increased SVR and increased BP. Aortic compression also occurs which leads to decreased lower blood flow and decreased uterine blood flow and foetal compromise. Treatment is given if systolic BP less than 100 or with Bradycardia with 20 – 30% decreased. Treatment – left lateral position, fluids, wedge, and ephedrine.
RESPIRATORY SYSTEM
Upper airway – oedema, capillary engorgement of the mucosal lining, difficult intubation, small sized tube, increased bleeding.
Minute ventilation – increased by 50%, of that 40% by tidal volume due to progesterone, less by respiratory rate. Due to increased minute ventilation PaCO2 decreases from 40 to 30mm of Hg. PaO2 increases. PH is normal. PaCO2 compensated by decrease in HCO3 from 26 to 22 meq/l. 4 meq/L by renal excretion of sodium HCO3.
Lung volume – decreased ERV plus RV. So decreased FRC. 20% decrease. Other volumes normal. So with increased minute ventilation and decreased FRC, the change in alveolar concentration of anaesthetics occur very fast and so decreased dose is required and fast onset is seen. So make the parturient susceptible to overdose.
Arterial oxygenation – PaO2 falls very fast with apnoea. Decreased FRC and 20% increase in O2 consumption. So pre oxygenation for 6 minutes is given. This also increases umbilical vein O2 concentration. Also contributors are aorto caval compression plus early closure of small arteries leading to V/Q mismatch. So O2 supplemented with all regional anaesthesia technique used.
CNS
-Engorgement of epidural veins (due to IVC compression plus collateral by paravertebral plexus) leads to decreased epidural space. Compress CSF in subarachnoid space – pumping effect by the epidural veins more spread to upper levels.
- Exaggerated lordosis
- High pressure in epidural space
RENAL
renal blod flow is increased gfr increased by 50%
renal glycosuria
proteinuria 300 mg/day
Increased SGOT, LDH, alkaline phosphatase and Cholesterol
decreased total protein and albumin
cholinesterase activity is reduced but usually immaterial due to large volume of distriubution
GIT
abolition of go angle due to upward displacement of stomach, so the punch coch effect
lost, increased chance of aspiration
Delayed gastric emptying
COAGULATION SYSTEM
Hypercoagulable state with increased clotting factors mainly VII, VIII, X and fibrinogen
METABOLISM
BMR – decrease in 3rd and 4th month. Increase by term. 5-40%.Insulinase produced by plasma also cause degradation of insulin. HPL antagonizes insulin at periphery and also increase FFA So in pregnancy a diabetogenic state exists.
Increased FFA, increased cholesterol, increased phospholipids,Increased FFA as in accelerated starvation state could lead to ketonemia, ketonuria in presence of diabetes
Protein content increase with pregnancy (500gm – foetus, 500gm – uterus.) Haemodilution will lead to decrease in albumin concentration. A:G ratio reversed.
ACID BASE
Increase minute ventilation leads to decreased PaCO2 from 40 to 30 mm of Hg (Respiratory alkalosis) and is compensated by increased sodium bicarbonate excretion and decreasee bicarbonate from 26 to 22 meq/l. so this causes shift of ODC to left and decreased release of oxygen. But increased pH leads to increased 2,3 DPG release and shift of ODC to right and increased release of O2. PaCO2 is decreased so that release of CO2 from foetus occurs.
ENDOCRINE
Pituitary – no change,Thyroid – increased thyroid binding globulin. Increased thyroid stimulating factors. increased T3/T4. Adrenal – cortisol level increases.Aldosteone level increases.
OTHERS
calcium, iron, and magnesium content are decreased.
PREPARE FOR THE EXAM
THEORY TOPIC QUESTIONS FOR SIX MONTHLY ASSESSMENTS
Minimum mandatory monitoring of anaesthesia
Anatomy of larynx
Pulmonary functions tests
Safety in anaesthesia equipment
Management of unconscious patient
Neonatal Resuscitation
Physiology and Mangament of Pain
Trigeminal Neuralgia
Oxygen therapy
Recovery from Anaesthesia
Effect of Positioning
Characteristic and functional specification of vaporizers
Acid base and electrolyte balance
Measurement of Intracranial pressure
Hypotensive Anaestheisa
Obstetric Analgesia
Day Care Anaestheisa
Anaesthesia and Pacemaker
Resuscitation of Trauma patient and Mass Casuality
Anaesthesia implication in Phecochromocytoma
Co-agulation disorders and Anaesthesia
Cardioplegia
Management of Shock
Chronic pain therapy
Neonatal ventilation
Principles of one lung anaesthesia
Anaesthesia in a patient with burns
Sterilization of Anaesthesia equipment
Therapeutic nerve blocks
Organ Harvestation
Cardiac output monitoring
BOOKS AND JOURNALS WHICH THE CANDIDATE MUST READ
List of Books
Must read:
1. Lee.s Synopsis of Anaesthesia
2. Clinical Anaesthesia Practice by Kirby and Gravenstein
3. Clinical Anesthesiology by Morgan
4. Anaesthesia by Nimmo, Rowbotham and Smith
5. Physics for Anaesthetists by Sir Robert macintosh
6. Physics applied to Anaesthesia by Hill
7. Scientific foundations in Anaesthesia by Stanley Feldman and Cyril Scurr
8. Cardiac Anaesthesia By Joel Kaplan
9. Clinical Anaesthesia by Barash, Cullen and Stoelting
10. Anaesthesia and perioperative complications by Benumoff and Saidman
11. Textbook of Anaesthesia by Aitkenhead Rowbotham and Smith
12. Paediatric Anaesthesia by Gregory
13. Medicine by Anaesthetists by Vickers
14. Pharmacology and Physiology for Anaesthetists by Stoelting
15. Principles of Obstetric Anaesthesia by Selwin Craford
16. Thoracic Anaesthesia byW.Mushin
17. Automatic Ventilation by Mushin
18. Miller RD, ed Anesthesia
19. Wylie, Churchill, Davidson: Practice of Anaesthesia
20. Nunn & Utting; Anaesthesia
21. Stoelting RK, Miller Rd, eds, Basics of Anaesthesia
22. ICU Book, Paul Marino
23. Critical Care, Joseph Civetta & Taylor
24. Critical Care, Schoemaker
25. Regional Anaesthesia, Moore
26. Regional Anaesthesia, P Prithviraj
27. The Management of Pain, Bonica
28. Neural Blockade in Pain Management, Cousins
29. Practical Management of Pain, Raj
30. Stoelting & Dierdorf: Anaesthesia and Co-existing Disease
31. ABG: Shapiro
32. Dorsch and Dorsch: Understanding Anaesthesia Equipments
33. ECG by Shamroth/Goldman
34. Anatomy for Anaesthetists by Harold Ellis
Must refer:
1. J Benumof: Anaesthesia for Thoracic Surgery
2. Cucchiara and Michenfelder: Clinical Neuroanaesthesia
3. Cottrell & Smith: Anaesthesia and Neurosurgery
4. Smith : Pediatric Anesthesia
5. Steward D: Handbook of Peadiatric Anaesthesia
6. Complications in Anaesthesiology by Orkin
7. Complications in Anaesthesia by Raven
8. Airway management by JL Benumof
9. Obstetric Anaesthesia by Chestnut
List of Journals:
1. Indian Journal of Anaesthesia
2. Journal of Anaesthesiology and Clinical pharmacology
3. Anaesthesia
4. British Journal of Anaesthesia
5. Anesthesia and Analgesia
6. Anesthesiology
7. Anaesthesia and Intensive Care
8. Canadian Anaesthesia Society Journal
9. Acta Anaesthesia Scandanavia
10. Regional Anesthsia and Pain Medicine
Year Books:
1. Anesthesia Clinic of North America
2. International Anesthesiology Clinics
3. Year Book of Anaesthesia
4. Recent Advances in Anaesthesia
5. Anaesthesia Review
Minimum mandatory monitoring of anaesthesia
Anatomy of larynx
Pulmonary functions tests
Safety in anaesthesia equipment
Management of unconscious patient
Neonatal Resuscitation
Physiology and Mangament of Pain
Trigeminal Neuralgia
Oxygen therapy
Recovery from Anaesthesia
Effect of Positioning
Characteristic and functional specification of vaporizers
Acid base and electrolyte balance
Measurement of Intracranial pressure
Hypotensive Anaestheisa
Obstetric Analgesia
Day Care Anaestheisa
Anaesthesia and Pacemaker
Resuscitation of Trauma patient and Mass Casuality
Anaesthesia implication in Phecochromocytoma
Co-agulation disorders and Anaesthesia
Cardioplegia
Management of Shock
Chronic pain therapy
Neonatal ventilation
Principles of one lung anaesthesia
Anaesthesia in a patient with burns
Sterilization of Anaesthesia equipment
Therapeutic nerve blocks
Organ Harvestation
Cardiac output monitoring
BOOKS AND JOURNALS WHICH THE CANDIDATE MUST READ
List of Books
Must read:
1. Lee.s Synopsis of Anaesthesia
2. Clinical Anaesthesia Practice by Kirby and Gravenstein
3. Clinical Anesthesiology by Morgan
4. Anaesthesia by Nimmo, Rowbotham and Smith
5. Physics for Anaesthetists by Sir Robert macintosh
6. Physics applied to Anaesthesia by Hill
7. Scientific foundations in Anaesthesia by Stanley Feldman and Cyril Scurr
8. Cardiac Anaesthesia By Joel Kaplan
9. Clinical Anaesthesia by Barash, Cullen and Stoelting
10. Anaesthesia and perioperative complications by Benumoff and Saidman
11. Textbook of Anaesthesia by Aitkenhead Rowbotham and Smith
12. Paediatric Anaesthesia by Gregory
13. Medicine by Anaesthetists by Vickers
14. Pharmacology and Physiology for Anaesthetists by Stoelting
15. Principles of Obstetric Anaesthesia by Selwin Craford
16. Thoracic Anaesthesia byW.Mushin
17. Automatic Ventilation by Mushin
18. Miller RD, ed Anesthesia
19. Wylie, Churchill, Davidson: Practice of Anaesthesia
20. Nunn & Utting; Anaesthesia
21. Stoelting RK, Miller Rd, eds, Basics of Anaesthesia
22. ICU Book, Paul Marino
23. Critical Care, Joseph Civetta & Taylor
24. Critical Care, Schoemaker
25. Regional Anaesthesia, Moore
26. Regional Anaesthesia, P Prithviraj
27. The Management of Pain, Bonica
28. Neural Blockade in Pain Management, Cousins
29. Practical Management of Pain, Raj
30. Stoelting & Dierdorf: Anaesthesia and Co-existing Disease
31. ABG: Shapiro
32. Dorsch and Dorsch: Understanding Anaesthesia Equipments
33. ECG by Shamroth/Goldman
34. Anatomy for Anaesthetists by Harold Ellis
Must refer:
1. J Benumof: Anaesthesia for Thoracic Surgery
2. Cucchiara and Michenfelder: Clinical Neuroanaesthesia
3. Cottrell & Smith: Anaesthesia and Neurosurgery
4. Smith : Pediatric Anesthesia
5. Steward D: Handbook of Peadiatric Anaesthesia
6. Complications in Anaesthesiology by Orkin
7. Complications in Anaesthesia by Raven
8. Airway management by JL Benumof
9. Obstetric Anaesthesia by Chestnut
List of Journals:
1. Indian Journal of Anaesthesia
2. Journal of Anaesthesiology and Clinical pharmacology
3. Anaesthesia
4. British Journal of Anaesthesia
5. Anesthesia and Analgesia
6. Anesthesiology
7. Anaesthesia and Intensive Care
8. Canadian Anaesthesia Society Journal
9. Acta Anaesthesia Scandanavia
10. Regional Anesthsia and Pain Medicine
Year Books:
1. Anesthesia Clinic of North America
2. International Anesthesiology Clinics
3. Year Book of Anaesthesia
4. Recent Advances in Anaesthesia
5. Anaesthesia Review
Saturday, January 16, 2010
DNB ANAESTHESIOLOGY
HAI ALL
WELCOME TO THIS SITE DEDICATED TO DNB STUDENTS. YOU CAN HAVE PREVIOUS YEARS QUESTIONS TOPICS AND OTHER INFORMATION ON DNB ANAESTHESIOLOGY. YOUR COMMENTS AND SUGGESTIONS ARE MOST WELCOME. GIVE YOUR FEED BACK FOR IMPROVEMENT. THANKS. BLOGGER
WELCOME TO THIS SITE DEDICATED TO DNB STUDENTS. YOU CAN HAVE PREVIOUS YEARS QUESTIONS TOPICS AND OTHER INFORMATION ON DNB ANAESTHESIOLOGY. YOUR COMMENTS AND SUGGESTIONS ARE MOST WELCOME. GIVE YOUR FEED BACK FOR IMPROVEMENT. THANKS. BLOGGER
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