Tuesday, May 1, 2012

MD/DNB ANAESTHESIOLOGY PREVIOUS QUESTIONS THEORY

THESE ARE THE GUN SHOTS....

PAPER 1

1.Draw a labeled diagram of anatomy of brachial plexus. What is the technique
of supraclavicular approach of brachial plexus block.

2.Draw Oxygen dissociation curve and enumerate factors affecting it.

3.Enumerate oxygen delivery devices. Describe Venturi principle
   diagrammatically.

4.Define MAC (Minimum Alveolar Concentration) and its different levels.
  Enumerate various factors affecting MAC value.

5. Outline the principles of Pulse Oximetry, enumerate its pitfalls and solutions
 with brief note on Masimo’s technology

6.Short notes on the following drugs
 a) Propofol
 b) Ropivacaine

7.Define volume of distribution? What is its clinical significance? Give one
   example?

8.What is the nerve supply of to the cricothyroid muscle? Enumerate the sensory
    innervation of larynx? Draw labeled outline diagram of vocal cord position in
   unilateral and bilateral recurrent laryngeal nerve palsy
9.Give classification of Mapleson’s breathing circuits. Describe Bain’s Coxial
   system in detail including its functional analysis.
10.Describe the anatomical differences between adult and infant airway.  Write brief on Upper Lip bite test and its relevance to Airway assessment?

PAPER 2.

1.Define autologous blood transfusion. Enumerate various methods. Describe
intra-operative blood conservation.

2.Enumerate the methods to relieve post operative pain in an adult patient who
has undergone right upper lobe lobectomy. Give details of thoracic epidural
analgesia.

3.Anaesthetic considerations in MRI

4.Describe outline of – Difficult Airway Algorithm.

5.Discuss causes, clinical features, EKG changes and management of
hyperkalemia.

6.Discuss pre-anaesthetic assessment and preparation of patient scheduled for
laparoscopic adrenalectomy

7Discuss the differentials and management of postoperative oxygen
desaturation in postanaesthesia care unit

8.Write short note on “World Anaesthesia Day”

9.Write short note on Anaesthetic considerations for globe (Eye) perforation.

10.Enumerate post operative  complication of thyroid surgery. Write note on managementof thyroid storm.
Curriculum MD (Anaesthesia)

 PAPER 3


1.A 50yr old male patient with history of well controlled hypertension with
 breathlessness on moderate exertion and inferior wall infarction 4 months
back is posted for emergency Laparotomy. Outline pre-anaesthetic
evaluation, risk stratification, preparation and anaesthetic management.

2.What is renal replacement therapy? What are the techniques used?

3.Outline anaesthetic goals with respect to heart rate, rhythm, pre-load, after
   load for a patient with severe mitral stenosis posted for open cholecystectomy
  and describe  achievement of these goals during induction.

4.Describe Low flow anaesthesia – advantages, problems & limitations.

5.Describe Continuous Spinal Epidural Analgesia (CSEA) under the following
 headings:- equipment needed, position of patient, technique, volume and
doses of local anaesthetic agents used, additives and complications.

6.Enumerate methods of confirming correct posturing of Endotracheal Tube.
  Describe complications of malplaced ETT.

7.Tabulate the beneficial effects of cessation of smoking preoperatively with their
   time course. Enumerate pulmonary function tests in patient scheduled for
  pneumonectomy

8.Enumerate perioperative complications of one lung anaesthesia. Outline the
    management intraoperative desaturation in a patient undergoing lobectomy.

9.Describe pre operative evaluation and preparation of an adult patient with burn neck contracture.

10.Define cerebral perfusion pressure. Describe briefly perioperative
 management of cerebral vasospasm following aneurismal leak.
Curriculum MD (Anaesthesia)

PAPER 4



1.Define & outline technique of Percutaneous dilatational tracheotomy. Tabulate
 advantages and disadvantages as compared to traditional Tracheotomy.

2.Enumerate newer modes of mechanical ventilation. Tabulate differences
  between Volume preset and Pressure preset modes.

3.Describe briefly early goal directed therapy of sepsis. Describe role and
   current status of corticosteroids in sepsis management.

4.Describe resuscitation and anaesthetic management of patient who developed
  inversion of uterus after delivery and brought to emergency room in gasping
 state.

5.Define Intra- Cranial Pressure (ICP). Enumerate factors causing an increase in
 ICP and Enumerate ICP lowering drugs and non pharmacological measures to
reduce ICP in post traumatic head injury.

6. Define Cardioversion and Defibrillation. Enumerate indications for both.
  Tabulate differences between Biphasic and Monophasic defibrillation.

7.Describe early resuscitation of 25 years female, who developed second
   degree burns on face, front upper trunk, upper limbs and upper airway after
  suicidal attempt.

8.Describe briefly preanaesthetic evaluation, preparation, anaesthetic
    management of a middle aged male scheduled for lobectomy following
   carcinoma lung. Enumerate postoperative complications.

9. Enumerate different methods of blood conservation in patient under going
  bilateral total knee replacement surgery. Enumerate antifibrinolytic drugs and
 describe dosage schedule of one drug.

10.Discuss briefly role of PEEP with low tidal volume, Inverse Ratio Ventilation,
 Prone ventilation, Permissive hypercapnia and permissible hypoxemia in
ARDS

Sunday, April 29, 2012

ANAESTHESIA MD PREVIOUS YEAR QUESTIONS

ANAESTHESIA PREVIOUS DNB THEORY QUESTIONS 2009

THESE QUESTIONS WERE RECOLLECTED FROM MEMORY BY PREVIOUS CANDIDATES

1.With the help of diagram describe physiology of cerebral circulation and factors affecting

2.Describe in brief the preop preparation and anaesthetic management of leinorenal shunt

3.Guidelines for regional anaesthesia in patients on anticoagulants

4.Technique of caudal epidural anaesthesia in children

5.Anaesthetic management of congenital diaphragmatic hernia in a 1 year old baby

6.Describe the pathophysiology of shivering. outline the management of post op shivering.

7.With the help of diagram  explain the ventilation perfusion ratio in normal lung.

8.Percutaneous dialatational tracheostomy

9.Enumerate the weaning modes of ventilator..describe the process of weaning.

10.role of sedation and analgesia in ICU.Agents used.

11.Hypoxic pulmonary vasoconstriction

12.explain the role of physiotherapy in post surgical patients. enumerate the methods used for chest physiotherapy.

13.What are the nosocomial infections in ICU? write in brief about ventilator associated pneumonia.

14.Describe the pathophysiology of hepatorenal syndrome

15.Management of intracranial hypertension

16.Desribe the management of a case of respiratory failure following COPD

17.Explain venturi principle.what are the applications in anaesthesia?

18.Explain the physiological changes associated with laparoscopic cholecystectomy

20.classify inotrops according to their mechanism of action. compare dopamine and dobutamine

21.Outline the management of a case of severe organophosphorus poisoning.

22.Describe the management and manifestations of thyroid storm.

23.Describe the techniques of chest physiotherapy. describe incentive spirometry.

24.Pathophysiology of hepatorenal syndrome.

25.What are the factors affecting neuro muscular block.Describe train of four pattern of blockade.

26.What is minimum alveolar concentration? what are the factors affecting MAC?

27.30 year old 36 weeks primi with eclampsia for emergency LSCS. Describe the preop evaluation and anaesthetic management.

28.Define massive blood transfusion.What are the complications of massive blood transfusion?

29.Describe the resuscitative measures for a case of acute severe burns.

30.70 year old  patient with CAHD is posted for TURP.Describe the preoperative evaluation.Describe in brief about the management of TURP syndrome.

31.40 year old morbidly obese patient  is posted for gastric banding. describe the anaesthetic management.
 

Saturday, April 28, 2012

PREVIOUS YEAR QUESTIONS DNB THEORY ANAESTHESIA 2006 DECEMBER

THESE QUESTIONS WERE RECOLLECTED FROM MEMORY BY PREVIOUS CANDIDATES


PAPER 1
1. Acute Pain Management Service

2.Modified guidelines of Cardio-pulmonary Brain Resuscitation- 2005

3. Anaesthetic management of Post Tonsillectomy Bleed.

4. Resuscitation of 60% burns in an adult patient

5. Anaesthetic consideration for Magnetic Resonance Imaging (MRI)

6. Post-operative Pulmonary Complications

7.Anaesthesia for Electro Convulsive Therapy

8. Thyrotoxic patient for subtotal thyroidectomy

9. Diabetic patient with Autonomic Neuropathy for Abdominal Hysterectomy

10.Anaesthetic  implications  for Laparoscopy surgery in a pregnant patient

PAPER 2
1. Myasthenic Syndrome

2. Anti-thrombotic Prophylaxis and Neuraxial Anaesthesia

3. Diagnosis and management of an acute attack of Malignant Hyperthermia

4. Artificial Blood (Synthetic oxygen carrying substances)

5. Pulmonary Artery Pressure Monitoring

6. Spinal Anaesthesia in children

7. Pre-operative evaluation and preparation of a patient with Fallot's Tetrology

8. Total Intravenous Anaesthesia

9. Anaesthetic management of a case of Pituitary Adenoma who is planned for
excision of adenoma (transsphenoidal hypophysectomy)

10. Discuss  the Anaesthetic problems in scoliosis, surgery

PAPER 3

1. Discuss the causes   and management of delayed recovery from anaesthesia
2. Complications of Extradural Anaesthesia

3. Regional anaesthesia in pediatrics

4.

5. Discuss the management of an unconscious young patient with history of drowning

6. What do you mean by awareness during anaesthesia? describe  the measurement of the depth of anesthesia

7. Describe the intrathecal and epidural opioids

8. What are the causes of hypercarbia during the intraoperative period. Discuss the physiological effects and management

9. Anaesthetic problems in a patient with extreme obesity

10. Describe the different anaesthetic management of cataract surgery



PAPER 4
 1.What do you mean by the term Golden Hour in Trauma? Discuss the role of
anaesthetist in resuscitation of a trauma patient

2.Stress response to trauma and surgery

3. Describe innervation of Female Genital Tract with a diagram and discuss methods of producing painless labour

4. Lung Compliance

4. Role of Kidney in Acid-base Regulation

5. HELLP Syndrome

6. Adrenergic Agonists

7. Drug Interactions

8. Phantom Limb Pain

9. Hyperkalemia

10.Role of magnesium in anaesthesia and Intensive Care Unit.

BEST ONLINE RESOURCE FOR DNB ANAESTHESIA THEORY

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Thursday, February 25, 2010

PREVIOUS YEAR QUESTIONS

  • 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
watch this link for other interesting topics and cases: http://anaesthesiatoday.blogspot.com/

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.

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