FMGE Anesthesia previous year questions

1. Q1. A day-case patient needs the most rapid emergence possible once the vaporiser is switched off at the end of a 20-minute procedure. Which property of the inhalational agent best predicts how quickly he will wake?

   • A. A high oil-gas partition coefficient
   • B. A high minimum alveolar concentration
   • C. A low blood-gas partition coefficient
   • D. A high saturated vapour pressure

   Answer: C. A low blood-gas partition coefficient

2. Q2. An anaesthetist sites a lumbar epidural using the loss-of-resistance technique. Which structure does the needle tip traverse immediately before it enters the epidural space?

   • A. Interspinous ligament
   • B. Ligamentum flavum
   • C. Supraspinous ligament
   • D. Dura mater

   Answer: B. Ligamentum flavum

1. Q1. Before elective surgery an anaesthetist asks the patient to sit upright, open the mouth and protrude the tongue without phonating, then assigns a grade. What is being assessed?

   • A. The view of the glottis obtained at direct laryngoscopy
   • B. The patient's systemic fitness for anaesthesia
   • C. The pharyngeal structures visible, to predict difficult laryngoscopy
   • D. The thyromental distance, to predict difficult mask ventilation

   Answer: C. The pharyngeal structures visible, to predict difficult laryngoscopy

2. Q2. Which anaesthetic technique for cataract surgery uses no needle at all, and so carries no risk of globe perforation or retrobulbar haemorrhage?

   • A. Peribulbar block
   • B. Topical anaesthesia with proparacaine drops
   • C. Retrobulbar block
   • D. Facial nerve block

   Answer: B. Topical anaesthesia with proparacaine drops

1. Q1. A Bier block is planned for forearm surgery. Which local anaesthetic is used, and which is specifically avoided?

   • A. Bupivacaine is used; lidocaine is avoided for its short duration
   • B. Procaine is used; lidocaine is avoided for allergy risk
   • C. Lidocaine is used; bupivacaine is avoided because of cardiotoxicity if the cuff fails
   • D. Ropivacaine is used; all other amides are avoided

   Answer: C. Lidocaine is used; bupivacaine is avoided because of cardiotoxicity if the cuff fails

2. Q2. A patient with COPD needs a precisely controlled inspired oxygen concentration that does not vary with his breathing pattern. Which device delivers this, and on what principle?

   • A. A simple face mask, which dilutes oxygen with room air
   • B. Nasal cannulae, which deliver a fixed flow
   • C. A non-rebreathing mask, which prevents any air entrainment
   • D. A Venturi mask, which entrains air in a fixed ratio by jet entrainment

   Answer: D. A Venturi mask, which entrains air in a fixed ratio by jet entrainment

1. Q1. Which method of monitoring neuromuscular blockade gives a reliable measure of the depth of block without needing a pre-paralysis baseline, and how is it read?

   • A. Tetanic stimulation, judged by the presence of fade
   • B. Train-of-four, read as the ratio of the fourth twitch to the first
   • C. Single twitch height, compared with a control twitch
   • D. Post-tetanic count, used only in shallow block

   Answer: B. Train-of-four, read as the ratio of the fourth twitch to the first

1. Q1. A fixed-performance oxygen mask draws in a constant proportion of room air as oxygen passes through a narrow jet. Which physical principle governs this entrainment?

   • A. The Bohr effect
   • B. Boyle's law
   • C. The Bernoulli principle, where a fast jet creates a fall in lateral pressure
   • D. Dalton's law of partial pressures

   Answer: C. The Bernoulli principle, where a fast jet creates a fall in lateral pressure

2. Q2. Immediately after a right subclavian vein cannulation attempt the patient desaturates, and the right upper chest is hyperresonant with reduced breath sounds. What has happened, and what is the immediate action?

   • A. Arterial puncture, needing direct pressure
   • B. Cardiac tamponade, needing pericardiocentesis
   • C. Chylothorax, needing conservative management
   • D. Pneumothorax, needing urgent decompression and a chest drain

   Answer: D. Pneumothorax, needing urgent decompression and a chest drain

1. Q1. Which intravenous induction agent is preferred for day-case surgery, and what property makes it so?

   • A. Thiopentone, because of its rapid redistribution
   • B. Etomidate, because of cardiovascular stability
   • C. Ketamine, because it preserves airway reflexes
   • D. Propofol, because rapid clearance gives a clear-headed recovery with antiemetic effect

   Answer: D. Propofol, because rapid clearance gives a clear-headed recovery with antiemetic effect

2. Q2. A patient emerging from anaesthesia is agitated, with vivid unpleasant dreams and hallucinations. Which agent is responsible, and how is the reaction reduced?

   • A. Propofol, reduced by slower injection
   • B. Etomidate, reduced by premedication with steroid
   • C. Ketamine, reduced by co-administration of a benzodiazepine
   • D. Thiopentone, reduced by using a lower dose

   Answer: C. Ketamine, reduced by co-administration of a benzodiazepine

1. Q1. Which intravenous induction agent must be avoided in acute intermittent porphyria, and why?

   • A. Propofol, because it inhibits haem synthesis
   • B. Ketamine, because it raises porphyrin excretion
   • C. Thiopentone, because barbiturates induce ALA synthase and precipitate an attack
   • D. Etomidate, because it suppresses adrenal steroidogenesis

   Answer: C. Thiopentone, because barbiturates induce ALA synthase and precipitate an attack

2. Q2. Why is laparoscopic surgery hazardous in a patient with severe cardiac disease?

   • A. Carbon dioxide is absorbed, causing a respiratory alkalosis
   • B. Pneumoperitoneum raises intra-abdominal pressure, reducing venous return while systemic vascular resistance rises
   • C. Reverse Trendelenburg increases preload excessively
   • D. The absence of a laparotomy wound prevents adequate analgesia

   Answer: B. Pneumoperitoneum raises intra-abdominal pressure, reducing venous return while systemic vascular resistance rises

1. Q1. Entonox is a 50:50 mixture of nitrous oxide and oxygen. What is its pin index position, and why does the pin index system exist?

   • A. Position 7, to prevent a cylinder being connected to the wrong yoke
   • B. Position 5, to identify the cylinder by colour
   • C. Position 2 and 5, to allow interchange with oxygen
   • D. Position 3 and 5, to indicate a medical gas mixture

   Answer: A. Position 7, to prevent a cylinder being connected to the wrong yoke

2. Q2. Under the Indian colour coding for medical gas cylinders, what colour is a nitrous oxide cylinder?

   • A. Black body with a white shoulder
   • B. Grey body with a black and white shoulder
   • C. White throughout
   • D. Blue throughout

   Answer: D. Blue throughout

1. Q1. During adult cardiopulmonary resuscitation, what rate and depth of chest compression are recommended?

   • A. 100 to 120 per minute, 5 to 6 cm deep
   • B. 60 to 80 per minute, 3 cm deep
   • C. 80 to 100 per minute, 4 cm deep
   • D. 140 to 160 per minute, 7 cm deep

   Answer: A. 100 to 120 per minute, 5 to 6 cm deep

2. Q2. At which interspace is subarachnoid block performed in an adult, and why not higher?

   • A. L3 to L4, because the spinal cord ends at about L1 to L2 and the needle meets only cauda equina fibres
   • B. T12 to L1, above the artery of Adamkiewicz
   • C. L1 to L2, at the conus
   • D. L5 to S1, to avoid the epidural veins

   Answer: A. L3 to L4, because the spinal cord ends at about L1 to L2 and the needle meets only cauda equina fibres

1. Q1. A patient's larynx is graded at direct laryngoscopy according to how much of the glottis is visible. Which grading system is this, and how does it differ from an airway assessment made before induction?

   • A. The Cormack-Lehane grade, made at laryngoscopy, whereas the Mallampati score is a bedside prediction made beforehand
   • B. The Mallampati score, made after induction
   • C. The ASA grade, made preoperatively
   • D. The Wilson score, made at laryngoscopy

   Answer: A. The Cormack-Lehane grade, made at laryngoscopy, whereas the Mallampati score is a bedside prediction made beforehand

2. Q2. Which inhalational agent is associated with immune-mediated hepatitis on repeat exposure, and what is the mechanism?

   • A. Halothane, through trifluoroacetylated liver proteins acting as neoantigens
   • B. Sevoflurane, through compound A formation
   • C. Isoflurane, through carbon monoxide production
   • D. Nitrous oxide, through methionine synthase inhibition

   Answer: A. Halothane, through trifluoroacetylated liver proteins acting as neoantigens

Every FMGE session paper, all 19 subjects together, is on our previous year questions page.