ANAESTHESIA

PROMETRIC
EXAM
PRACTICE

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01. This set of Clinical Science Multiple Choice Questions & Answers (MCQs) focuses on “General
Anaesthesia”.
1. What mixture of gases are used in anesthesia?
a) O2 and N2O
b) O2 and CO2
c) CO2 and N2O
d) O2 , CO2 and N2O
Answer: a
Explanation: In general anesthesia, the gases are given through a face mask. Oxygen is given to allow normal
breathing while nitrous oxide is given to anesthise the patient. However, in major operations, nitrous oxide
is used more as a carrier gas as it alone is not powerful enough to anesthise the patient.

02. The oxygen flush system provides a higher flow of oxygen of ________ L/min when the patient’s need
for oxygen is greater than the amount the breathing circuit can provide.
a) 25-50
b) 35-75
c) 55-95
d) 65-105
Answer: b
Explanation: The ventilator monitors the amount of oxygen being inhaled and exhaled by the body. At times,
there can arise a situation where even under the normal settings of the ventilator the person can feel
shortness of breath. In such cases, oxygen flush is given in which more than normal amount of oxygen is
given at a higher pressure to stabilize the person.

03. One of the methods to measure changes in the levels of consciousness during anesthesia is ________
a) Auditory Evoked Potential
b) Visual Evoked Potential
c) Tactile Evoked Potential
d) Speech Evoked Potential
Answer: a
Explanation: One of the methods to measure changes in the levels of consciousness during anesthesia is
Auditory Evoked Potential (AEP) which is a neuro-physiological indicator of the changes in the level of
consciousness during anesthesia. In this, the person is given an auditory stimulus and the EEG response of
the person is noted. This allows the doctor to realize the level of consciousness of the person.
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04. AEP stands for ________

a) Auditory Evoked Potential
b) Auxiliary Evoked Potential
c) Audiovisual Evoked Potential
d) Ambulatory Evoked Potential
Answer: a

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Explanation: Auditory Evoked Potential is a type of test done to look into the response of a person to an
auditory stimulus. The brain waves are recorded with the help of an EEG. This test is also used for a patient
under general anesthesia to keep a track of the level of consciousness of the person.

05. What causes the pre-selected volume of air to flow into the patient by communicating directly with a
breathing circuit?
a) Nebulizer
b) Microcontroller
c) Bellows
d) Humidifier
Answer: c
Explanation: The bellows are like pumps that send in the air to the patient. They hold a certain volume of air
and gives it to the patient at a certain pressure. They work like a normal pump, they suck air from the supply
tank in a proportionate ratio and allow it to mix. Then, they force the air out from a tube and it is received
by the patient.
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06. What is the function of a nebulizer?

a) To supply moisture in the form of droplets
b) To maintain temperature
c) To maintain the gas levels of individual gases
d) To check the safety of valves
Answer: a
Explanation: Nebulizers are used to convert the liquids into gaseous form and is sent on the respiratory
path. This is also a method to deliver medicines in case of asthma attack, COPD etc. If the air does not
contain a sufficient amount of moisture in it, it can cause a drying and desiccation of the respiratory track
and pathway. This can cause problems like bleeding and injury. Thus, nebulizers are used to maintain
moisture levels of the air.

07. What is one of the crucial reasons for lung compliance to fall?
a) Wet gases
b) Dry gases
c) High temperature gases
d) Low temperature gases
Answer: b
Explanation: Our body is made of almost 60% of water and maintaining the water balance in the body is
important. The lining of the respiratory tract contains mucus to trap any unwanted particles in the air. Even
the lungs contain some percentage of water in form of moisture to better facilitate the exchange of gases in
the body. Thus, when the air that is sent into the body has a low moisture content, it starts taking in
moisture from the body which in the long run can desiccate the cells and cause bleeding. This causes the
lung compliance the fall as well.

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08. _______ is the most commonly used material for vapourizer.
a) Steel
b) Cast iron
c) copper
d) Brass
Answer: c
Explanation: A vapourizer is a machine that heats water and converts it into steam. This instrument is used
to maintain the humidity of the room and is often used to give steam to a patient. Of all the three materials,
copper has the best conductivity for heat and it helps the water heat up faster. Thus, copper coils or copper
based vessel is used in a vapourizer.

099. The gas pressure supplied by the hospital is maintained at the wall outlet at______ kPa.
a) 275-345
b) 245-325
c) 266-376
d) 225-315
Answer: a
Explanation: The gas that is refined in the air treatment plant and then sent to the patients via the wall
fittings or to the ventilator, it has to maintain a higher pressure so that the gas can travel long distances with
a good velocity. If the pressure is low, the velocity of the gases will be less and then the gases which have
regulated temperature and moisture may loose their heat and water content.

10. Which of the following is known as laughing gas?

a) CO2
b) N2O
c) NO2
d) B2O
Answer: b
Explanation: N2O is also known as laughing gas. It is also used as a mild anesthetic. It is used in dentistry and
as a carrier gas during general anesthesia. It is administered via inhalation, absorbed through diffusion and
removed via the normal respiration process.

11. After oxygenation of blood, what is the percentage of oxygen carried by hemoglobin?
a) 70 %
b) 75 %
c) 87 %
d) 97 %
Answer: d
Explanation: After oxygenation, the partial pressure of oxygen increases. At this point, arterial blood has
0.29 ml oxygen in 5 ml of blood and veins have 0.12 ml of oxygen in 5 ml of blood. This way, we find that 3%
oxygen is carried dissolved in the blood and 97% in a hemoglobin.

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12. What is the pressure of gases maintained in medical air supply?
a) 300 – 345 kPa
b) 345 – 380 kPa
c) 380 – 400 kPa
d) 400 – 425 kPa
Answer: b
Explanation: The gases are usually under a higher pressure to allow more filling up of the cylinder and better
control of the temperature. Also, it helps them travel long distances more easily.

13. What is the residual capacity of the lungs?

a) 2000 ml
b) 2300 ml
c) 2500 ml
d) 2700 ml
Answer: b
Explanation: Residual Lung capacity is the amount of air that stays in the lungs after normal expiration.
Lungs normally have 2800 ml is a normal volume in which the tidal volume is 500 ml. This is the amount of
air taken in and given out normally. Since the left side of the lung is little smaller to accommodate the heart,
there are some minor volume differences between the two lungs.
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14. What all modes exist in ventilator?

a) Neonatal mode, normal mode
b) Normal mode, geriatric mode
c) Neonatal mode, normal mode, geriatric mode
d) Neonatal mode, pediatric mode, normal mode, geriatric mode
Answer: a
Explanation: A neonate has very delicate lungs so they need special care during ventilation. Thus, they have
a separate mode. In modern ventilators, there is separate kind of ventilators, especially for the neonates. All
the other population is kept on the normal mode.

15. The operation which allows air to be given directly in the trachea is called ________
a) Tracheotomy
b) Vasectomy
c) Disc Prolapse
d) Clog Removing
Answer: a
Explanation: Tracheotomy is a process in which an incision is made on the throat and the respiratory
passage is accessed. A tube is directly inserted in the passage and the ventilator is used to send air into the
tube. Thus, the air is given directly in the trachea and lungs. This happens in very severe cases when the
person is not able to breathe by themselves.
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16. The pump used to pump air mechanically into the respiratory tract __________
a) Mechanical Pump
b) Ventilator
c) Ambulatory Bag
d) CPR
Answer: c
Explanation: An ambulatory bag has a mouth piece which is placed in the mouth of the patient and a rubber
bulb which is used to pump air. It is a self-inflating bag and so it keeps getting air. Once the bulb is
compressed, the air is sent back to the patient in their respiratory tract.

17. A ventilator can sometimes cause a disruption in the normal breathing pattern.
a) True
b) False
Answer: a
Explanation: Ventilator is supposed to ensure proper oxygen supply during operation. Depending on
parameters like heart rate, weight, etc ventilation pattern is selected and adjusted for the patient and the
ventilator follows that. Often times, this ventilator pattern may clash with the normal breathing of the
person. It may send in oxygen when the person is trying to exhale or the breathing of the device may not be
synchronized.

18. Prolonged bed rest can lead to which problem?

a) Tuberculosis
b) Diarrhea
c) Cholera
d) Hyper Tension
Answer: a
Explanation: When a person is lying down for long periods of time, the most commonly known problem that
occurs is bed sores. However, long periods of bed rest also causes water to be slowly accumulated in the
lungs. Due to the horizontal posture of the body, the body is not able to expel microorganisms as properly
as it does in the vertical posture. The existing and accumulated water in the lungs becomes their breeding
ground and the person suffers from tuberculosis.

19. The first anesthesia used was ___________

a) polyvinyl chloride
b) trichloro methane
c) chlorofluorocarbon
d) tetra fluorocarbon
Answer: b
Explanation: Trichloro Methane, more popularly known as chloroform was the first known and widely used
anesthetic. It was used to numb the area, or inhaled as general anesthesia. It was used as a pain reliever and
an anesthetic. However, it was found harmful for the kidneys.

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20. Which of the following parameters does not affect anesthesia?
a) Blood pressure
b) Blood sugar
c) Temperature
d) Moisture content of the exhaled air
Answer: d
Explanation: When a person goes for surgery, certain conditions need to be maintained. They include the
blood pressure, blood sugar, pulse oximetry, electrocardiography etc. The moisture content of the exhaled
air, though important, but it does not affect anesthesia. If the moisture content falls below, the ventilator
adjusts it automatically but the other parameters all need to be monitored by the doctors.

21. Obesity can pose a risk of anesthesia.

a) True
b) False
Answer: a
Explanation: An obese person is the one whose body mass index is high and they are overweight. Obesity
can cause a condition called sleep apnea in which a person snores due to trouble in breathing. Under
anesthesia, a person may stop breathing at all for a few seconds which is dangerous for the patient. Thus, if
the surgery is not a life saving one, a person is recommended to lose weight before they are operated upon.
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4. What is epidural?
a) A type of anesthesia used during childbirth
b) A type of anesthesia used for implants
c) A type of anesthesia used for rheumatic surgery
d) A type of anesthesia used for renal transplant
View Answer

Answer: a
Explanation: Epidural is when anesthesia is administered in the epidural space of the spinal chord. During a
normal childbirth, it is used as a relaxant and dilator. During cesarian, an increased dose is used as
anesthesia. Epidural is commonly known for childbirth but is used in many other cases. Sometimes, a
catheter is used to continuously administer the drug to prolong the numbing sensation.
5. The anesthesia applied directly to the skin is ___________
a) Topical Anesthesia
b) Caudal Anesthesia
c) Local Blocks
d) General Anesthesia
View Answer

Answer: a

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Explanation: When anything is applied externally on the skin, it is called a topical application. Thus, the
anesthesia that is applied directly on the skin is called as topical anesthesia. It numbs a certain region of the
skin and allows surgical procedures to happen.
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7. In a caudal block, where is the anesthesia injected?
a) Thoracic Canal
b) Lumbar Canal
c) Sacral Canal
d) Coccyx Canal
View Answer

Answer: c
Explanation: Caudal means the posterior thus the caudal block anesthetizes the lower parts of the body.
Since the sacral canal has nerves that supply to the lower regions, thus injecting anesthesia in the sacral
region numbs the lower extremities.
8. In this type of anesthesia, all the impulses from a nerve are blocked.
a) Nerve Blocks
b) Spinal Anesthesia
c) Topical Anesthesia
d) Epidural Blocks
View Answer

Answer: a
Explanation: In a nerve block, the anesthesia is injected in the nerves that supply to the system. When the
particular nerve is anesthetized, it becomes paralyzed for the duration of the operation and the whole area
where the nerve supplied becomes numb as there is no exchange of information between that area and the
brain.
9. In a spinal anesthesia, where all is the anesthetic injected?
a) 1st and 2nd thoracic space, 11th and 12th thoracic space
b) 3rd and 4th Lumbar space, 5th lumbar and 1st sacral space
c) 7th cervical and 1st thoracic space, 12th thoracic and 1st lumbar space
d) 1st and 2nd lumbar space, 4th and 5th lumbar space
View Answer

Answer: b
Explanation: A spinal anesthesia is given when the lower body is being operated upon. The lumbar region
can numb the abdominal areas and allows the operation of the GI track and the sacral area numbs the lower
extremities. Since the sacral and coccyx bones are almost fused together, 1st sacral space is the only
accessible space.
10. In which of these sub cutaneous infiltration with a desensitizing agent is done?
a) Saddle Blocks

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b) Epidural Blocks
c) Local Blocks
d) General Anesthesia
View Answer

Answer: c
Explanation: In a local anesthesia, the anesthetic or the desensitizing agent is injected in the sub cutaneous
region of the skin. This allows a certain region of the body to become numb and the doctors are able to
perform the operation. This is done when the area of operation is small or the time needed for the
operation is small.

1. Immediately after the surgery, the patient is usually shifted to _____________

a) ICU
b) PACU
c) CCU
d) Recovery room
View Answer

Answer: b
Explanation: After the surgery, a patient is shifted to PACU (Post Anesthesia Care Unit). After a surgical
procedure, anesthesia reversal is done and if needed, it is followed by extubation. The patient is monitored
here for a duration which depends upon factors like the surgery performed, length of the surgery, type of
anesthesia administered and the level of consciousness of the patient.
2. In the usual preparation for general surgery, the client may be __________
a) Given specifically ordered oral medications with small amounts of water
b) Given ice chips
c) NPO for 12 to 14 hours before
d) Allowed regular diet
View Answer

Answer: a
Explanation: General Anesthesia is the process in which the whole body becomes numb and the mind is
unconscious. In such cases, the mind has no control over the bladder or the sphincter muscles. The GI track
is usually kept empty before the procedure to avoid any urinary or faecal discharges. It is also best kept
empty to avoid any discharges of the GI track from leaking in the abdominal, which may end up causing
infections after the surgery.
3. If a nurse finds that a patient’s abdominal wound has eviscerated, she should ________
a) Administer antibiotics
b) Position the patient sideways and call for help
c) Attempt to drain the site
d) Cover the site with saline-soaked sterile gauze
View Answer

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Answer: d
Explanation: When an abdominal wound eviscerates, the organs actually have shifted and come out. In such
cases, emergency medicine must be applied first. Using a saline soaked sterile gauze will control any
infection and keep the wound as clean and harmless as possible. Keeping the bandage well soaked will
ensure that the bandage does not stick to the wound and is easily removable otherwise pulling the bandage
off can cause other complications. The further procedures are taken care of by the doctors.
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4. After surgery, an incentive spirometer is used to prevent _________

a) Lung collapse
b) Gastric and intestinal problems
c) Elevated blood pressure
d) Blood Clotting
View Answer

Answer: a
Explanation: A spirometer is used to help the lungs regain their strength. After a surgery, due to the use of
the ventilator, the lungs may feel a little abnormal and may have a weakness. This is also possible due to
age. The person is made to breathe into the spirometer to exercise their lungs and regain normal lung
function. Normally, 10 to 15 breaths with the spirometer every 1 to 2 hours is prescribed, or as often as
instructed by your nurse or doctor.
5. What is the ideal time interval for patient monitoring in the Postanesthesia care unit?
a) Every hour
b) Every 15 mins
c) Every 30 mins
d) Every 10 mins
View Answer

Answer: b
Explanation: Usually the patient remains in PACU for 60-90 minutes after surgery depending upon patient
response. Vitals like heart rate, body temperature, oxygen levels, ensuring airways need to be constantly
monitored in the immediate post-op period.
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6. Spinal Anaesthesia used on a patient needs monitoring for ________
a) Oxygen levels
b) Hyper tension
c) Renal Function
d) Brain activity
View Answer

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Answer: c
Explanation: All the toxins and the administered medicines are removed by the kidney. Thus, when
anesthesia is given in the spine, it is usually a local anesthesia and numbs the lower part of the body. Since
the lower part of the body had been anesthetized, kidney which is also supplied to by these nerves may also
be affected thus monitoring renal function becomes important.
7. To be approved for discharge from PACU, the patient should exhibit:
a) Normal breathing
b) No bleeding and swelling
c) Oxygen saturation of min 90
d)Temperature greater than 96.8
View Answer

Answer: d
Explanation: Patients recovering from surgery and anesthesia have lost physiologic homeostasis. They’re at
risk for respiratory and circulatory deficits, reduced physical activity and alterations in core body
temperature and level of consciousness. It is an essential condition for discharge to possess a core body
temperature of not less than 36° C (96.8° F).
8. A preoperative assessment should include all of the following except:
a) Current medication and drugs
b) Psychological aspects
c) Patient knowledge of rehabilitation
d) Age, Weight, Height
View Answer

Answer: c
Explanation: The main goal of preoperative care is to reduce the patients surgical and anaesthetic
perioperative morbidity or mortality and to allow the patient to get back to their original state as soon as
possible. Thus, it is important to know the medical history of the patient. This also helps to guide the patient
better for post operation rehabilitation.
9. A patient with a history of heart disease can be put on a prophylactic antibiotic.
a) True
b) False
View Answer

Answer: a
Explanation: During surgery, high levels of sterility is maintained, be it the instruments used, the operation
theatre or even the operation table. However, the risk of infections always exists. Thus, people with a
history of a heart disease may have a weaker heart and so they are put on a prophylactic antibiotic to
prevent bacterial endocarditis.
10. Paralytic ileus is a possible postoperative complication. To check for it, which of the following should be
done?

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a) Monitor renal function
b) Auscultate for bowel sounds every 4 hours
c) Administer antibiotics
d) Observe and monitor patient heart rate
View Answer

Answer: b
Explanation: Paralytic ileus is an obstruction of the intestine due to paralysis of the intestinal muscles. The
paralysis does not need to be complete to cause ileus, but the intestinal muscles must be so inactive that it
prevents the passage of food and leads to a functional blockage of the intestine. It inhibits propulsive bowel
movement and hence frequently needs to be assessed.

1. Before reaching the operation theater, how many zones exist?

a) 1
b) 3
c) 5
d) 7
View Answer

Answer: b
Explanation: Before entering an OT, normally there will be three zones. The outermost zone is a waiting
zone, until where the patient may be accompanied by a family member. Here is also a nursing management
station where the nurses and doctors go through the final paperwork for operation. The next zone is the
changing zone. The changing rooms are right next to the entry so that the doctors, nurses, and technicians
can immediately change into their OT scrubs. Even the shoes need to have a covering or normally they have
different pairs of shoes and slippers in the changing room. Beyond that is the anesthesia room where the
vitals are monitored for one last time and anesthesia is administered. Finally comes the operation theater.
Within the zones, there are often resting chambers for the OT staff, offices of the surgeons, pharmacy and
supply door to C.S.S.D.
2. How many sections are there in the operation table?
a) 1 – 3
b) 4 – 5
c) 6 – 7
d) 7 – 8
View Answer

Answer: b
Explanation: The table is divided in such a way that during an operation a certain area of the body can be
elevated and it allows better access to the area to the surgeon. The main four divisions of the bed are for
the head, thorax, thigh and then legs. Sometimes, there is a support for the waist in the abdomen and leg
pelvic region.
3. What kind of lights exists in the OT?

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a) Fluorescent Lamps
b) LED lights
c) Tungsten Light
d) LCD
View Answer

Answer: b
Explanation: LED lights are also called shadow less lights. This is the reason they are widely used in
operations as the shadow of the surgeon and nurse is not cast on the patient then. They can also produce
an illumination of 70,000 – 1,20,000 lumen which ensures sufficient brightness in the theater.
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4. When a baby is born, why are they placed under UV lamps?

a) To reduce the possibility of skin disease
b) To reduce the possibility of jaundice
c) To ensure proper blood flow
d) To allow the bones to absorb nutrients
View Answer

Answer: b
Explanation: After birth, the liver of an infant becomes very active. This is because the environment of the
child changes completely and to ensure that the body is under no harm, the activity of the liver increases.
This increased activity causes a rise in the production of bile pigments and causes jaundice. To ensure that
jaundice does not harm the baby, a baby after birth is placed under mild UV light and kept for monitoring.

5. What is all usually present in an OT trolley?

i. Bandages ii.Basic Medicines iii. Disinfectants iv. Antiseptic v. Cannula vi. Syringe vii. Catheter
a) i, ii, iii, iv
b) i, ii, iii, iv, v, vi, vii
c) ii, iii, iv
d) iii, iv, vi
View Answer

Answer: b
Explanation: An OT trolley is used to carry all the things that are needed in surgery. Most of the products are
brought in from the CSSD but some like medicines, antiseptics etc are already there in the trolley.
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6. What is the ratio of the gases in medical air?
a) 78% Nitrogen, 21 % oxygen
b) 75 % Oxygen, 25 % Carbon dioxide
c) 60% Nitrogen, 20% Oxygen, 20% Carbon Di oxide
d) 50% Nitrogen, 50% Oxygen

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View Answer

Answer: a
Explanation: Medical air is like normal air, but has been treated in air plants. It is used to provide air to the
patients during or after surgery and maintain the normal respiratory functions.

7. How are the OT ventilated?

a) Air is blown in from the lower part of the wall
b) Air is sucked out from the upper region of the wall
c) Air is blown in from the lower part and sucked out from the upper part
d) Air is blown in from the upper part and sucked out from the lower part
View Answer

Answer: d
Explanation: This kind of ventilation system should actually exist throughout the hospital. The air which
passes through various filters is pumped in and the air in the room is pulled out from the lower regions. This
forms a steady air current and fresh, treated air is constantly circulated. This reduces the chances of
nosocomial infections and wound festering.
8. What is the general equipment found in OT?
i) OT Trolley ii) Heart Lung Machine iii) Pendant iv) Ventilator v) Electron Microscope vi) Medical Air Tank vii)
Intubation Equipment viii) Fire Extinguisher
a) i, iii, iv, vi, vii
b) i, ii, iii, iv, v, vi, vii, viii
c) ii, iii, vi, vii
d) i, iii, iv, vii, viii
View Answer

Answer: a
Explanation: In a general OT room, there is a trolley, a pendant (it sockets for connections and shelves to
hold things) a ventilator, medical air tank and intubation equipment. Sophisticated machines like the heart
lung machine or the electron microscope are present in OTs that specialize in cardiac surgery or
neurosurgery. A fire extinguisher may be found outside in the hallways but not necessarily in an OT.
9. What is the resolution of the microscopes used in neurosurgery?
a) 1 μm
b) 1 nm
c) 1 Åm
d) 1 pm
View Answer

Answer: b

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Explanation: A scanning electron microscope (SEM) is used in neurosurgery. It can give a good resolution up
to 1 nm. Neurosurgery deals with nerves and neurons and it needs good magnification and resolution to
look into the structures properly.
10. For how long can a heart lung machine be used?
a) 4 hours
b) 6 hours
c) 8 hours
d) 10 hours
View Answer

Answer: b
Explanation: A heart lung machine or rather a cardiopulmonary bypass machine is used during a cardiac
surgery. The machine acts like the heart, it receives oxygenated blood from the lungs and sends it to the
body. It receives deoxygenated blood from the body and sends it to the lungs. However, since its a machine,
various problems like clotting, leakage, air bubble etc may happen so it is recommended that the machine is
not used for more than six hours. Under extreme precautions and severely critical cases, it can be used for
ten hours.

11. In which of the following is not used for suturing?

a) Silk
b) Nylon
c) Polyester
d) Bakelite
View Answer

Answer: d
Explanation: Suturing is the process of closing the wound. It is either stitched back or stapled back. Various
different materials are used to suture the wound. Bakelite is hard, non flexible material so it cannot be used
as a suture thread but recent trials are being made to develop a suturing needle from Bakelite.
12. What are all precautions taken for a patient directly out of surgery?
a) The injury should not be infected
b) The person must take a bath
c) The blood pressure should go down
d) The blood sugar should go up
View Answer

Answer: a
Explanation: For a person directly out of surgery, the main concern is that the site of operation and injury
should not be infected. An operated person is given a sponge bath if the need arises but mostly after
surgery, they should keep away from water. The parameters that were observed before and during the
surgery, the same parameters are monitored even after the surgery.

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13. The following steps are for _______
i. Alcohol with Chlorhexidine ii. Alcohol without Chlorhexidine iii. Chlorhexadine 2% iv. Chlorhexadine 4% v.
Povidone with Iodine 7.5% – 10% vi. Triclosan 1% vii. Phenolics viii. Quarternary Ammonium Compound ix.
3% hexachlorophane
a) sterilization
b) disinfection
c) antiseptic
d) hand washing
View Answer

Answer: d
Explanation: Before and after surgery it is important to wash hands properly. The above given steps are used
to wash hands properly with procedure and chemicals that are used. The movements of washing the hands
also need to be followed carefully.
14. What are the temperature and humidity maintained in an OT?
a) T = 20 – 26 ℃, H = 20% – 30% air exchanges = 7 – 8 per hour
b) T = 18 – 22 ℃, H = 40% – 50% air exchanges = 10 – 12 per hour
c) T = 10 – 12 ℃, H = 10% – 30% air exchanges = 9 – 10 per hour
d) T = 30 – 35 ℃, H = 50% – 60% air exchanges = 15 – 20 per hour
View Answer

Answer: b
Explanation: An OT is normally cool without being cold. The humidity and temperature need to be
maintained so that the body does not go into any other kind of shock. Once under anaesthesia, the normal
functions like homeostasis of the body can also get disrupted thus an external maintenance is needed. It is
important for fresh air to keep circulating in the room so that the risk of infection goes down. The number of
exchanges can’t be too high to avoid cooling nor can they be too low or else infectious particles may settle
down.

1. What is the purpose of CSSD?

a) storage of clean equipment
b) providing sterile equipment to the operation theater
c) storing sterile equipment
d) pharmacy of the operation theater
View Answer

Answer: b
Explanation: CSSD stands for Central Sterile & Supply Department. All the equipment that is used in the
hospital, especially surgeries, is kept in this store. The area is responsible for disinfecting all the equipment
and preparing it for use again and keeping the disinfected instruments in a sterile environment.
2. Which machine uses the temperature and pressure of the steam for disinfection?
a) Laminar Airflow

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b) Autoclave
c) Oven
d) Water Jet
View Answer

Answer: b
Explanation: An autoclave produces steam at high temperature and maintains great pressure to destroy the
microbes. The autoclave does heat and steam treatment of the instruments at 134℃ for three minutes or at
121℃ for fifteen minutes. This high pressure and high heat treatment help destroy a number of microbes.
3. Which of the following cannot be autoclaved?
a) catheter
b) mes
c) scalpel
d) scissors
View Answer

Answer: a
Explanation: Catheter is a soft instrument, made of polymers rather than any metallic substance. The high
heat and water pressure of the autoclave can cause the polymer to melt or get damaged. Thus, it undergoes
chemical treatment.
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4. Which of the following chemicals are used to treat the instruments made out of polymers?
i) Ethylene Oxide ii) Hydrochloric Acid iii) Silver Cyanide iv) Ozone v) Bleach vi) Saline Solution vii) Sulphuric
Acid viii) Glutaraldehyde and Formaldehyde ix) Phthalaldehyde x) Hydrogen Peroxide xi) Nitric Acid xii)
Peracetic Acid xiii) Silver xiv) Formic Acid xv) Citric Acid
a) i, ii, iii, iv, v, vi
b) ii, iv, vi, viii, x, xii
c) i, iv, v, viii, ix, x, xii, xiii
d) iii, iv, ix, xii, xv
View Answer

Answer: c
Explanation: Instruments made out of polymers cannot be treated with high heat or pressure like autoclaves
because it can cause the instrument to be damaged. Thus, they are treated with chemicals. These chemicals
need to be strong enough to destroy the microorganisms but should not be corrosive or else they will
destroy the instrument.
5. How are the gauze and cotton sterilized?
a) Hot air sterilization
b) Wet Heat Sterilization
c) Sterilization Under High Pressure

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d) Chemical Sterilization
View Answer

Answer: a
Explanation: Gauze and cotton are cloth materials which have their own pores. Using moist sterilization will
cause them to become wet and they may not dry out. Chemical sterilization also poses the same problem,
the chemicals may stay back and adhere to the gauze and cotton. For sterilization under pressure, again
moisture is required. Thus, hot air sterilization is used. Hot air at high temperature and pressure is blown
and the gauze and cotton are sterilized.
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6. What machine is used to package the cotton and gauze?
a) Heat Sealing Machine
b) UV sealing Machine
c) Zip Lock Machine
d) Needle and Thread Sealing
View Answer

Answer: a
Explanation: The gauze and cotton are placed in special pouches which have been sealed from three sides
before hand. After the gauze or the cotton has been placed, the fourth side, which is open is placed in
between the heat sealing tubes and the pouch is sealed.
7. What is sterilized in dry conditions?
a) Implant
b) Gauze
c) Scalpel
d) Cannula
View Answer

Answer: b
Explanation: A gauze is like a bandage that is used to wrap up an injury. Since it is made of cloth, it cannot
undergo wet sterilization as it may not dry out and become a site of infections. Thus, it is sterilized in dry
conditions like in an oven or a microwave or some other heat therapy.
8. How is dry sterilization done?
a) In autoclave
b) In oven
c) In Magnetic Vibrator
d) In Hot Plate
View Answer

Answer: b

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Explanation: The oven is a specialized device that helps in dry sterilization with the help of heat. It may also
use some gases at times to sterilize the object. Dry Air sterilization is also done. Other devices for dry
sterilization are microwaves, hot air sterilization, desiccators etc.
1.
According to the ASA 2008 Recommendations, which of the following machine checks should be completed
before each case?

A.
Test scavenging system function

B.
Verify that there are no leaks in the gas supply lines between the flowmeters and the common gas outlet

C.
Verify that patient suction is adequate to clear the airway

D.
Calibrate the oxygen monitor and check the low oxygen alarm

Correct Answer
C. Verify that patient suction is adequate to clear the airway
Explanation
Of the 15 standard machine checks, the ASA 2008 guidelines advise for all 15 at the start of the day and
then only 8 before each case. Here is the list of tests to be completed before each procedure:

1. Verify that patient suction is adequate to clear the airway

2. Verify the availability of required monitors including alarms
3. Verify that vaporizers are adequately filled and if applicable that the filler ports are tightly closed
4. Verify that the CO2 absorbent is not exhausted
5. Perform breathing system pressure/leak testing
6. Verify that gas flows properly through the breathing circuit during both inspiration and expiration
7. Document completion of checkout procedures
8. Confirm ventilator settings and evaluate readiness to deliver anesthesia care
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2.

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The device on anesthesia machines that most reliably detects delivery of hypoxic gas mixtures is which of
the following?

A.
Fail-safe valve

B.
O2 analyzer

C.
Gas rotamers

D.
Disconnection alarm

E.
Diameter index safety system

Correct Answer
B. O2 analyzer
Explanation
The worst thing an anesthesia machine can do is deliver a hypoxic gas mixture to the patient, so there are
multiple checks to prevent this from happening--including the rotamers, disconnection alarm, and of course
the O2 analyzer. The O2 analyzer is on the inspiratory limb of the breathing circuit immediately before the
gas goes to the patient, which makes it the last line of defense against a hypoxic mixture.
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3.
An incompetent pressure relief valve will result in which of the following?

A.
Hypoxia

B.
Barotrauma

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C.
Hypoventilation

D.
Hyperventilation

E.
A low-circuit pressure signal

Correct Answer
C. Hypoventilation
Explanation
The pressure-relief valve (also known as the pop-off valve or the APL -- Adjustable Pressure Limiting valve) is
designed to release gas when the system pressure exceeds a certain threshold. When this valve fails,
pressure builds within the system as new gas enters each time the machine gives the patient breath. This
new gas will fill the areas of lowest pressure first, so some of the tidal volume is diverted from the patient
into the reservoir bag as it requires lower force to expand than the patient’s lungs.
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4.
The most frequent cause of mechanical failure to deliver adequate FiO2 is which of the following?

A.
Attachment of the wrong compression gas cylinder to the O2 yoke

B.
Crossing the pipelines during daily set-up

C.
Malfunctioning rotamer

D.
Fresh gas line disconnection from the machine to the hospital supply

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E.
Disconnection of the O2 supply system from the patient

Correct Answer
E. Disconnection of the O2 supply system from the patient
Explanation
Failure to oxygenate patients is a leading cause of morbidity in the OR. All of the answer choices can lead to
hypoxic gas mixtures being delivered to the patient, but there are many systems in place such as the
Diameter Index Safety System to prevent incorrect attachment of gas lines (choices A and B). The most
common cause by far is an accidental disconnection between the anesthetic machine and the patient.
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5.
Which of the following explains the monitor reading seen here?

- ProProfs
Which of the following explains the monitor reading seen here?

A.
Incompetent inspiratory valve

B.
Incompetent expiratory valve

C.
Incompetent pop off valve

D.
Breathing circuit air leak

E.
Exhausted CO2 absorbent

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F.
More than one of the above

G.
More than two of the above

H.
None of the above

Correct Answer
F. More than one of the above
Explanation
The capnograph portion of the monitor shows that this patient’s CO2 is above 0 mmHg even after
expiration. The easiest way this can happen is when the CO2 absorbent is exhausted because exhaled CO2
will be able to return to the inspiratory limb of the breathing circuit. This can be corrected by replacing the
soda-lime or increasing the gas flow. CO2 is also elevated when there is an incompetent expiratory valve.
The expiratory valve is supposed to prevent expired air from passing back to the patient, so if it is broken,
the patient’s own previously exhaled CO2 will cause the reading seen on the monitor here.
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6.
Which of the following medical gasses is matched incorrectly with the standard color of its holding canister?

A.
Air : Yellow

B.
Oxygen : Green

C.
Carbon Dioxide : Orange

D.
Nitrous Oxide : Blue

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E.
Nitrogen : Black

Correct Answer
C. Carbon Dioxide : Orange
Explanation

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7.
Which of the following values (in PSI) corresponds with the pressure inside a standard Oxygen canister at
100%, 50%, and 25% volume respectively?

A.
4000, 4000, 4000

B.
4000, 2000, 1000

C.
2200, 2200, 2200

D.
2200, 1100, 550

Correct Answer
D. 2200, 1100, 550
Explanation
Oxygen is stored as a gas under high pressure within the cylinder, so as the gas is released, the pressure
within the container decreases proportionally. This is an example of Boyle's Law.

Medical Gas Supply, Ch 1, available at:

http://elsevierhealth.com/media/us/samplechapters/9780443100871/9780443100871.pdf
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Page 24 of 34
5
0
8.
Which of the following values (in PSI) corresponds with the pressure inside a standard nitrous oxide canister
at 100%, 50%, and 25% volume respectively?

A.
2200, 2200, 2200

B.
2200, 1100, 550

C.
745, 745, 745

D.
745, 373, 187

Correct Answer
C. 745, 745, 745
Explanation
Because nitrous oxide is stored as a liquid, the pressure within the canister is the same until all of the gas is
used. Like any liquid, N2O exists in equilibrium between liquid and gas within the container. Whenever any
of the gas is released to the patient, the momentary drop in pressure from the container gas on the liquid
allows more of the liquid N2O molecules to escape into the gaseous state. This is why the pressure gauge is
not the way to check how much gas is left as it should always be 745 PSI. N2O volume remaining is checked
by weight-- a full canister weighs 8kg, and an empty one weighs 6kg.

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9.
As the surgeon is closing from a laparotomy for small bowel obstruction, the hospital central oxygen line
stops working, and the size E oxygen cylinder comes on automatically. The pressure gauge says 550 psi. If
the patient requires 4L by nasal cannula, how long will the canister last?

A.
36 minutes

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B.
42 minutes

C.
58 minutes

D.
67 minutes

E.
> 75 minutes

Correct Answer
B. 42 minutes
Explanation
A full-size E oxygen cylinder contains 680L O2 at 2200 psi, and as it is stored as a gas, the pressure decreases
proportionally as the volume is released. The pressure here is 550, which is 25% of the original, so the
volume must also be 25% of the starting value. 680 / 4 = 170 L still in the canister. 170 / 4L per minute = 42.5
minutes.
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10.
A healthy 25 yo M is in sitting position for an open craniotomy under general anesthesia when his ETCO2
and HR suddenly drop significantly. Rank the following from most sensitive to least in diagnosing this
patient's most likely problem: 1. Increased HR 2. Decreased CVP 3. Transesophageal Echo 4. Pre-cordial
doppler 5. Decreased ET-CO2

A.
3, 4, 2, 1, 5

B.
4, 3, 5, 2, 1

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C.
4, 3, 5, 2, 1

D.
3, 4, 5, 2, 1

Correct Answer
D. 3, 4, 5, 2, 1
Explanation
As he is in a sitting position and having a craniotomy, this patient is already at high risk for a venous air
embolism (VAE), and his drop in HR and ETCO2 is consistent with this diagnosis. While a large amount of air
is required most often (5ml/kg in some studies), there are case reports of VAE with as little as 20 ml air. The
amount of air required is thought to be a function of the procedure, the speed of air injection, and the
position of the patient.

Transesophageal echo is most sensitive in detecting VAE followed by pre-cordial doppler. Both of these
methods detect VAE before there are any physiologic changes. Decreased ET-CO2 and PAP can detect VAE
when symptoms are still modest. Decreased CVP and CO are able to detect larger emboli. SIgns of
catastrophic VAE are EKG changes (either bradyarrhythmia or ventricular fibrillation), cardiovascular
collapse, and "Millwheel" murmur.
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11.
A 26 yo F with no PMHx is getting a rhinoplasty. As the surgeon is using the bovie, flames start shooting out
of the ET tube. Which of the following is the best next step?

A.
Disconnect the ET tube

B.
Extubate the patient

C.
Cover the area with water

D.

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Use the fire extinguisher

Correct Answer
A. Disconnect the ET tube
Explanation
OR fires can only happen when the triad of ignition source, fuel, and oxidizer all come together. In this case,
the source is the bovie, the fuel is the patient's skin, and the oxidizer is the O2 she is breathing. Stopping
the fire is as simple as removing one part of the triad, so disconnecting the ET tube here will take away the
fire's oxygen supply and it should go out immediately. The patient should then be extubated and the airway
inspected by bronchoscopy.

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12.
What is the end product of the reaction of soda-lime with CO2?

A.
CaCO3 + H2O

B.
NaHCO3 + H2O

C.
NaCO3 + H2O

D.
None of the above

Correct Answer
A. CaCO3 + H2O
Explanation
Think of soda-lime as a base that combines with CO2 to produce CaCO3 and water with some heat. It is
made of: 75% Ca(OH)2, 20% water, 3% NaOH, and 1% KOH. The mechanism of the reaction is:

1) CO2 + H2O → CO2 (aq) (CO2 dissolves in water - slow and rate-determining)
2) CO2 (aq) + NaOH → NaHCO3 (bicarbonate formation at high pH)
3) NaHCO3 + Ca(OH)2 → CaCO3 + H2O + NaOH

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The NaOH and KOH are catalysts as they cancel in the final equation. Now it makes sense that the soda lime
is spent when too much water is in the canister.

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13.
A patient in Denver is going to have an exploratory laparotomy with sevoflurane. When compared to a
patient at sea level with the same setting on the vaporizer, what are the changes in the percentage of
sevoflurane delivered as well as the sevoflurane partial pressure in the gas mixture?

A.
None of the above

B.
Percent sevoflurane delivered will increase, partial pressure of sevoflurane will also increase

C.
Percent sevoflurane delivered will increase, partial pressure of sevoflurane will remain the same

D.
Percent sevoflurane delivered will remain the same, partial pressure of sevoflurane will also remain the
same

E.
Percent sevoflurane delivered will decrease, and partial pressure of sevoflurane will also decrease

Correct Answer
C. Percent sevoflurane delivered will increase, partial pressure of sevoflurane will remain the same
Explanation
Studies of volatile agents at increased altitudes show that while a higher percentage of gas is delivered, the
partial pressure remains roughly the same.
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0
14.
The presence of a bubble in the tubing between the transducer and catheter of an arterial line is which of
the following:

A.
Not significant

B.
Leads to an artificially high reading

C.
Leads to a damping of the tracing

D.
Has the greatest effect on the mean blood pressure

E.
Has a greater effect on the mean blood pressure

Correct Answer
C. Leads to a damping of the tracing
Explanation
An arterial line works by using a fluid column to transfer subtle differences in pressure from the patient's
circulation to a transducer. Bubbles--even small bubbles-- can interrupt the transferring of these waves and
result in a damping of the tracing. Both systolic and diastolic will be affected.
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15.
Which of the following will increase the damping of an arterial line?

A.
Air bubbles between the catheter and transducer

B.

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A kink in the tubing between the catheter and the transducer

C.
A blood clot within the catheter

D.
Using soft tubing

E.
All of the above

Correct Answer
E. All of the above
Explanation
An arterial line works by transferring the patient's pulse pressure through a fluid column against a
transducer, which converts the force it feels into a blood pressure tracing. If the patient's pulse pressure is
removed, there is a short time during which the system will still register pressure. This concept is called
"damping," and the mathematical model for how long the signal lingers is called the "damping coefficient."

Anything that extinguishes the vibration of the pulse pressure within the tubing will increase the damping
coefficient. This includes air bubbles, blood clots, kinks in the line, soft tubing, and an extended line.
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16.
A radial arterial line is zeroed with the transducer level to a position 12 cm posterior to the patient's sternal
border. While positioning the patient, the arm with the arterial line is elevated, and the catheter rests 10
cm above the transducer. The blood pressure currently is measured as 130 / 72. Which of the following is
the actual blood pressure?

A.
118 / 60

B.
130 / 72

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C.
142 / 84

D.
142 / 72

E.
130 / 84

Correct Answer
A. 118 / 60
Explanation
An arterial line works by transferring pressure from the catheter through a fluid-filled tube and against a
transducer that can convert the force into a tracing. When the catheter is elevated as in this case, a fluid
column forms that pushes on the transducer and creates a higher value than is actually present in the
patient.
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17.
Which of the following breathing systems is most efficient for a patient with spontaneous ventilation?

A.
Mapleson A

B.
Mapleson B

C.
Mapleson C

D.
Mapleson D

E.

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Mapleson E

F.
Bain Circuit

Correct Answer
A. Mapleson A
Explanation
A Mapleson A circuit has a pressure valve near the patient, which means that when the patient exhales,
alveolar gas leaves the system. As a result, only a minimum of fresh gas flow is required.

Kaul TK, Mittal G. Mapleson's breathing systems. Indian J Anesthesia, 2013 [cited 2014 Feb 17];57:507-15.
Available from: http://www.ijaweb.org/text.asp?2013/57/5/507/120148

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18.
Which of the following breathing systems is most efficient for a patient with controlled ventilation?

A.
Mapleson A

B.
Mapleson B

C.
Mapleson C

D.
Mapleson D

E.
Mapleson E

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F.
Bain Modification

Correct Answer
D. Mapleson D
Explanation
The Mapleson D circuit places the fresh gas flow next to the patient and a pressure valve near the ventilator.
This means that excess pressure generated by the ventilator will be released by the valve and the patient
will receive the gas flow.

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