PAPER : ALL INDIA 2005 (AIPGE 2005 January, Answers, Explanation and Notes)

Page -4

Q.76 The laryngeal mask airway used for securing the airway of a patient in all of the following conditions except:
1 In a difficult intubation.
2 In cardiopulmonary resuscitation.
3 In a child undergoing an elective routine eye surgery.
4 In a patient with a large tumor in the oral cavity.
Answer is 4

Clinical anesthesiology Lange - Appleton 3rd/P-65
The laryngeal mask airway provides an alternative to ventilation through a
Face mask or ETT.
Contraindication to LMA
- Patient with pharyngeal pathology (e.g. abscess)
- Patient with pharyngeal obstruction. (Large tumor)
- Full stomach (e.g. pregnancy, hiatus hernia)
- Low pulmonary compliance (e.g. obesity) requiring peak inspiratory
Pressure greater than 20 cm H2O.

Q.77 The following are used for treatment of postoperative nausea and vomiting following squint surgery in children except:
1 Ketamine.
2 Ondansetron.
3 Propofol.
6 Dexamethasone.
Lange clinical anaesthesiology 3rd Ed, pg-940
Postoperative nausea & vomiting

1) Increased incidence of nausea has been reported with -
. following opiods . N2O anaesthesia
. after laparoscopy . after strabismus surgery

2) Highest incidence appears to be in young women, studies suggest that nausea is more common during menstruation.
3) Propofol anaesthesia decreases the incidence of postoperative nausea and vomiting.
4) Intravenous droperidol and metoclopramide also decreases postoperative nausea.
5) Drugs used in postoperative nausea.
• 5HT3 antagonists (ondansetron, granisetron and dolasetron) are extremely effective. No dystonia and No dysphoria occur with use of these agent.
• Ondansetron may be more effective than other agent in children.
• Dexamethasone when combined with another antiemetic is especially effective for refractory nausea and vomiting.
• Low dose propofol has been reported to be effective for postoperative nausea and vomiting.

Q.78 Which one of the following anaesthetic agents causes a rise in the Intracranial pressure:
1 Sevoflurane.
2 Thiopentone sodium.
3 Lignocaine.
4 Propofol.
Lange clinical anaesthesiology 3rd Ed, pg-145
Answer is (1) 

Sevoflurane -
• Similar to isoflurane and desflurane, sevoflurane causes slight increase in cerebral blood flow and intracranial pressure at normo carbia.
• High concentration of Sevoflurane (> 1.5 MAC) may impair autoregulation of C.B.LF. and thus allowing a drop in C.B.F. during ihemorrhagic hypotension. This effect on CBF is less pronounced
than isoflurane.
• Property of sevoflurane -. non purgent and rapid increase in alveolar anesthetic concentration make seroflurane an excellent choice for smooth and rapid inhalation induction in pediatric or adult patient.
• Contraindication of seroflurane are
1) Severe hypovolemia 2) Susceptibility to malignant hyperthermia 3) intracranial hypertension.

Q.79 The following modes of ventilation may be used for weaning off patients from mechanical ventilation except:
1 Controlled Mechanical ventilation (CMV).
2 Synchronized intermittent mandatory ventilation (SIMV).
3 Pressure support ventilation (PSV).
4 Assist - control ventilation (ACV).

Lange clinical anaesthesiology 3rd Ed, pg-962
Points about Ventilatory modes -
CMV - Controlled mode venteilation
AC - Assist control.
IMV - Intermittent mandatory ventilation
SIMV - Synchronized intermittent mandatory ventilation.
PSV - Pressure support ventilation
PCV - Pressure Control Ventilation
MMV - Mandatory minute ventilation
IRV - Inverse I:E ratio ventilation
APRV - Airway pressure release ventilation
HFJV - High frequency jet ventilation.
The modes that don’t allow spontaneous ventilation
                CMV
                PCV
                PC-IRV
The weaning modes are
            IMV
            SIMV
            PSV
AC can also be used during weaning but CMV is never used as weaning mode.

Q.80 The most common pathogens responsible for nosocomial pneumonias in the ICU are:
1 Gram positive organisms.
2 Gram negative organisms.
3 Mycoplasma.
4 Virus infections.
Lange clinical anaesthesiology 3rd Ed, pg-981
Nosocomial pneumonias are usually caused by gram negative organisms,and are leading cause of death in many ICUs
® GI bacterial overgrowth
                 ¯
Translocation into the portal circulation
                 ¯
Retrograde colonization of the upper airways from GI tract
                 ¯
Aspiration
®Most nosocomial infection arise from endogenous bacterial flora
®Urinary tract accounts for upto 35-40% of nosocomial infection
®Urinary inf are usually due gram negative bacteria and associated with indwelling catheter
®Wound inf are 2nd most common cause,25-30%
®Pneumonia accounts for another ,20-25%
®Intravascular catheter inf are responsible for 5-10%of ICU inf
Hence the Answer is 2

Q.81 A Lower Segment Caesarean Section (LSCS) can be carried out under all the following
techniques of anaesthesia except:
1 General anaesthesia.
2 Spinal anaesthesia.
3 Caudal anaesthesia.
4 Combined Spinal Epidural anaesthesia.

Lange clinical anaesthesiology 3rd Ed, p-828.
Anasthesia for cesarean section-
-80% are performes under regional ansthesia
40% spinal
40% epidural

-Epidural anasthesia is preferred over spinal anasthesia because of more gradual decrease in B.P.
-Continuous epidural anasthesia also allows better control the sensory level.
-CSE anasthesia – it is called combined spinal epidural anasthesia.
It combines benefit of both type of anasthesia.
1. rapid and reliable and intense block of spinal anasthesia.
2. flexibility of epidural catheter.

-Advantage of general anasthesia.
1. rapid, reliable.
2. control of airway & ventilation.
3. potentially less hypotension.

Important facts:
1. Cesarean section requires a T4 sensory level.
2. Measures to prevent hypotension during spinal anastheasia.
-1500-2000 ml bolus of Ringer lactate injection prior to block (crystalloid are not effective).
-phenylephrine if hypotension occurs.
-ephedrine prior to block.
-trendlenberg position
3. Epidural anasthesia is most satisfactory when an epidural catheter is used.
4. Epidural morphine, 5mg, at the end of surgery provides good to excellent pain relief
post-operatively.

Q.82 The most appropriate circuit for ventilating a spontaneously breathing infant during anaesthesia is:
e. Jackson Rees’ modification of Ayres’ T Piece.
f. Mapleson A or Magill’s circuit.
g. Mapleson C or Waters’ to and fro canister.
h. Bains circuit.

Lange clinical anaesthesiology 3rd Ed, pg

Q.83 The abnormal preoperative pulmonary function test in a patient with severe kyphoscoliosis includes:
i. Increased RV/TLC.
j. Reduced FEV1/FVC
k. Reduced FEV25-75
l. Increased FRC.
m.

Q. 84 Which one of the following drugs has been shown to offer protection from gastric aspiration syndrome in a patient with symptoms of reflux?
1 Ondansetron.
2 Metoclopramide.
3 Sodium citrate.
4 Atropine.

Lange clinical anaesthesiology 3rd Ed, p830
Prophylaxis against aspiration pneumonia:
1. 30 ml of .3M sodium citrate 30-445 min prior to induction given routinely.
2. Patient with risk factors like morbid obesity, gastro-esophageal reflux, potentially difficult airway, emergent delivery should also receive Ranitidine and/or
Metoclopramide.
3. High risk patient- 40mg omeprazole in night is most effective.
4. anticholenergic like Glycopyrrolate (.1mg) reduce the risk of aspiration only theoretically.

Q.85 Which one of the following is true of adrenal suppression due to steroid therapy?
1 It is not associated with atrophy of the adrenal glands.
2 It does not occur in patients receiving inhaled steroids.
3 It should be expected in anyone receiving > 5 mg. Prednisolone Daily
4 Following cessation, the stress response normalizes after 8 weeks.
Answer is 3

Q.86 The carpal tunnel contains all of the following important structures except:
1 Median Nerve.
2 Flexor pollicis longus.
3 Flexor carpi radialis.
4 Flexor digitorum superficialis.
Answer is 3

B. D. Chaurasia vol. ii 3rd Ed pg-99

Q.87 The femoral ring is bounded by the following structures except:
1 Femoral vein
2 Inguinal ligament.
3 Femoral artery.
4 Lacunars ligament.
Answer is 3

B. D. Chaurasia vol. ii 3rd Ed pg-44-45
Femoral vein makes the lateral wall of femoral ring. Femoral artery lies lateral to the
femoral vein so how can it make boundary of femoral ring.
B. D. Chaurasia vol. ii 3rd Ed pg-44-45

Q.88 All of the following statements regarding vas deference are true except:
1 The terminal part is dilated to form ampulla.
2 It crosses ureter in the region of Ischial spine.
3 It passes lateral to inferior epigastric artery at deep inguinal ring.
4 It is separated from the base of bladder by the peritoneum.
Answer is 4

B. D. Chaurasia vol. ii 3rd Ed pg-325 -327
The base of bladder is not covered by the peritoneum so how can it separate the ureter from the base of bladder by the peritoneum.

Q.89 The following statements concerning chorda tympani nerve are true except that it:
1 Carries secretomotor fibers to slubmandibular gland.
2 Joins lingual nerve in infratemporal fossa.
3 Is a branch of facial nerve.
4 Contains postganglionic parasympathetic fibers.
Answer is 4

B. D. Chaurasia vol. III 3rd Ed pg-113
        It Carries secretomotor fibers to slubmandibular gland, which are preganglionic parasympathetic fibers not postganglionic parasympathetic
It should be noted that any major nerve in body cannot Contains postganglionic parasympathetic fibers. Because parasympathetic ganglia lie in the effector organ itself, so how is it possible?

Q.90 A woman with infertility receives an ovary transplant from her sister who is an identical Twin. What type of graft it is?
1 Xenograft.
2 Autograft.
3 Allograft.
4 Isograft.
Answer is 4

Panikar microbiology PG 164
                                                TYPES OF GRAFTS  

Allograft:	Transplant from one individual to another with a different genetic make- up, within the same species, e.g. kidney transplant from one person to any other (except an identical twin).
Isograft or  Syngeneic graft	Transplant between genetically identical, monozygotic twins, or between members of an inbred strain of animals.
Autograft	Transplant from one site to another on the same individual, e.g. transplanting a blood vessel from the leg to the heart during cardiac bypass surgery. This type of transplant does not require immunosuppressive therapy.
Xenograft	Transplant across species barriers, e.g., transplanting a heart from a baboon to a human. Have a very poor prognosis because of the presence of cross-species reactive antibodies that will induce hyperacute rejection.

Q.91 The type of joint between the sacrum and the coccyx is a:
1 Symphysis.
2 Synostosis.
3 Synchondrosis.
4 Syndesmosis.
Answer is 1

Q.92 The Prostatic urethra is characterized by all of the following features, except that it:
1 It is the widest and most dilatable part
2 Presents a concavity posteriorly
3 Lies closer to anterior surface of prostate.
4 Receives Prostatic ductules along its posterior wall.
Answer is 2

B.D. Chaurasia Vol. 2/Page 308
Moore & Dalley, Clinically oriented anatomy 4th Ed Pg –363

PROSTATIC URETHRA
1 Semi-lunar on transverse section with its convexity directed forwards.
2 Widest and most dilatable part of the male urethra.
3 Receive Prostatic ductules along its posterior wall.
4 Forms a gentle curve, that is concave anteriorly
5 Lies closer to anterior surface of prostate.
6 Prostatic sinuses lies on side of Prostatic utricle and each sinus Presents the opening of about 20-30 Prostatic glands
7 Slit like opening of ejaculatory duct on or just within the orifice to the Prostatic utricle
- The membranous part is star shaped (stellate) and it is least dilatable part of the male
urethra.
- The spongy part is in the form of a transverse slit.
- External urethral orifice is in the form of a vertical slit.

Q.93 All of the following areas are commonly involved sites in pelvic fracture except:
1 Pubic rami.
2 Alae of ileum.
3 Acetabula.
4 Ischial tuberosities.
Answer is 4

Moore & Dalley Clinically oriented anatomy 4th Ed PG –338

Pelvic fractures can result from - direct trauma to the pelvic bones as in automobile accidents or caused by forces transmitted to these bones from the lower limbs during fall on feet The areas of fractures in ? ing order of frequency are
1 Pubic rami
2 Acetabula (or the area immediately surrounding them
3 Region of sacroiliac joint
4 Alae of ileum
These are the weak areas of the pelvis

Q.94 The following group of lymph nodes receives lymphatics from the uterus except:
1 External iliac.
2 Internal iliac.
3 Superficial inguinal.
4 Deep inguinal.
Answer is 4

B.D. Chaurasia Vol. II page 319.
                            Lymphatic drainage of uterus –

Fundus and upper part of body	Aortic nodes partly to the superficial inguinal nodes along the round ligament of the uterus
Cervix	- External iliac, internal iliac and sacral nodes.
Middle lymphatics and lower part	External iliac nodes

Q.95 All of the following physiological processes occur during the growth at the epiphyseal plate except:
1 Proliferation and hypertrophy.
2 Calcification and ossification.
3 Vasculogenesis and erosion.
4 Replacement of red bone marrow with yellow marrow.
Answer is 4

Tortora & Grabowski, Principles of Anatomy & Physiology 9th Ed, Pg 168-170
The epiphyseal plate is a layer of hyaline cartilage in the metaphysic of a growing bone that consists of four zones

Resting Zone	No function in bone growth, they anchor the epiphyseal plate to the bone of epiphysis
Proliferating Zone	The chondrocytes divide to replace those that die at the diaphyseal side of epiphyseal plate
Hypertrophic Zone	The chondrocytes are even larger. The lengthening of the diaphysis is the result of cell division in the zone of proliferating cartilage and the maturation of the cells in the zone of Hypertrophic cartilage
Calcified Zone	Consists mostly of dead chondrocytes because the matrix around them has calcified. This calcified cartilage is dissolved by osteoclastic erosion and increased vascularisation. This area is invaded by osteoblasts and capillaries from the diaphysis

Q.96 Benign Prostatic hypertrophy results in obstruction of the urinary tract. The specific condition is associated with enlargement of the:
1 Entire prostate gland.
2 Lateral lobes.
3 Median lobe.
4 Posterior lobes.
Answer is 3

Moore & Dalley Clinically oriented anatomy 4th Ed Pg-369

Middle lobe (median lobe) often enlarges in the most peoples and obstructs the internal urethral orifice; the more the Person strains, the more the Prostate occlude the urethra enlargement of this lobe give rise to symptom of bladder outflow obstruction even in absence of Prostatic enlargement.

Q.97 In an adult male, on per rectal examination, the following structures can be felt anteriorly except:
1 Internal iliac lymph nodes.
2 Bulb of the penis.
3 Prostate.
4 Seminal vesicle when enlarged.
Answer is 1

Moore & Daley’s Clinically Oriented Anatomy 4th Ed, Pg-388
Many structures related to the antero-inferior part of the rectum may be palpated through its walls on per rectal examination. These are-
- Prostate & seminal vesicles in males
- Cervix in females
- In both sexes, pelvic surface of sacrum& coccyx, Ischial space & tuberosities may also be palpated
- Bulb of penis specially when urethra is catheterized.
- Enlarged internal iliac LN felt on lateral wall, pathological thickening of the Ureters
swelling in ischiorectal fossa, or ischiorectal abscess and abnormal contents in recto-vesical pouch in male & recto-uterine pouch in females
- Tenderness of inflamed appendix can also be detected per rectally in case of pelvic appendix.

Q.98 While doing thoracocentesis, it is advisable to introduce needle along:
1 Upper border of the rib.
2 lower border of the rib.
3 In the center of the inter-costal space.
4 In anterior part of inter-costal space.
Answer is 1

Clinically oriented anatomy Keith L. Moore 4th edi/87.
In Thoracocentesis, to avoid damage to the inter-costal nerve and vessels, the needle is
inserted superior to the rib, in plane of mid axillary’s line, High enough to avoid the
collateral branches. It is not inserted along lower border of rib because neuro-vascular bundle lies there.

TRIANGLE OF SAFETY
Anterior border of latissimus dorsi
The posterior border of the Pectoralis major and
The superior border of the fifth rib

Q.99. Virus mediated transfer of host DNA from one cell to another is known as:
1. Transduction.
2. Transformation.
3. Transcription.
4. Integration.
Answer is 1

Panikar microbiology 6th Ed PG 51-53
Harrison principle of internal medicine 15th ed/ chapter 69 Table 69-3
Two major classes of vectors are used for transferring nucleic acids into cells for the purposes of gene therapy: viral and non-viral vectors. Viral vectors have been genetically engineered so that the viruses transfer exogenous (therapeutic) nucleic acids into cells through a process called transduction.

Q.100 Barr body is found in the following phase of the cell cycle:
1. Interphase.
2. Metaphase.
3. GI phase
4. Telophase.
Answer is 1

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