Q1) All of the following are used for Nutritional Assessment except
Answer: d) PT/INR
Visceral protein measurement (e.g., albumin, transferrin, prealbumin) are used for nutritional assessment. Serum albumin < 3.5 g/dL (35 g/L) in a stable, hydrated patient suggests depletion; half-life 14–20 days. Serum prealbumin reflects acute changes: 10–17 mg/dL = mild depletion, 5–10 mg/dL = moderate, <5 mg/dL = severe; half-life 2–3 days. Serum transferrin < 200 mg/dL; half-life 8–10 days. Indirect calorimetry / predictive equations (Fick, Harris–Benedict, Estimated REE) estimate calorie needs and are not markers of previous nutritional status.Teaching point: Use prealbumin for short-term changes and albumin for chronic protein status; PT/INR assesses coagulation, not nutrition.
Q2) IV fluid of choice to increase calories to provide parenteral nutrition by peripheral route is:
Answer: b) Lipid Emulsions
Lipid emulsions can be administered peripherally; they are energy-dense and reduce reliance on high-concentration dextrose which can cause thrombophlebitis if given peripherally. 25% dextrose has high osmolarity — generally for central lines; DNS/arginine additions are less efficient for calories.Teaching point: For peripheral parenteral nutrition prioritize lipid-based components to provide calories while avoiding high dextrose osmolarity.
Q3) Best indicator to assess short term nutritional status is
Answer: b) Prealbumin
Half-life: albumin ~18–21 days, transferrin ~8–10 days, prealbumin ~2 days — prealbumin is best for short-term assessment.Teaching point: For tracking rapid nutritional response (days), prealbumin is preferred; albumin reflects longer-term status.
Q4) Harris Benedict equation components are all except?
Answer: d) BMI
Harris–Benedict estimates resting energy expenditure (REE). Example formulas:Men: REE = 66.5 + 13.75×Weight(kg) + 5.003×Height(cm) − 6.755×Age(years).
Women: REE = 655.1 + 9.563×Weight(kg) + 1.85×Height(cm) − 4.676×Age(years).
Teaching point: BMI is an index (weight/height²), not a direct variable in the Harris–Benedict formula used for BMR/REE.
Q5) In which situation is enteral nutrition best suited?
Answer: b) Ileostomy with output 700 ml
Enteral nutrition is preferred whenever the gut is functional. Contraindications include mechanical obstruction, uncontrolled GI bleeding, and high-dose vasopressors. Ileostomy outputs under ~800 ml are usually compatible with enteral feeding.Teaching point: Start enteral feeds early when feasible — it preserves mucosal integrity and lowers infectious complications.
Q6) Things to do to decrease stress in surgery — all except?
Answer: c) 8 hours fasting
Minimally invasive surgery, regional/afferent blocks, and early mobilization reduce surgical stress. Prolonged fasting increases insulin resistance — modern protocols recommend shorter fasting times (clear fluids up to 2 hours, solids 6 hours).Teaching point: ERAS principles reduce physiologic stress: limit fasting, use multimodal analgesia, and encourage early activity.
Q7) In a critically ill patient the best way to monitor cardiac output is by:
Answer: a) Pulmonary artery catheter
Pulmonary artery (Swan–Ganz) catheters measure cardiac output (thermodilution), cardiac index, and mixed venous oxygen saturation — but are invasive and carry risks (arrhythmia, thrombosis, rare PA rupture).Teaching point: Reserve invasive CO monitoring for patients where noninvasive methods are insufficient or when guided hemodynamic therapy is planned.
Q8) False statement about emergency airway management
Answer: d) Airway is prepared before cricothyroidotomy
Emergency cricothyroidotomy is performed when rapid airway access is needed (cannot intubate/cannot ventilate); there is usually no time for formal airway preparation.Teaching point: Know the landmarks and practice timed technique — cricothyroidotomy is life-saving in airway emergencies.
Q9) Restrictive strategy of transfusion in acute GI bleed — all are true except?
Answer: b) Will not alter the risk of re-bleed (this is false)
A restrictive transfusion threshold (Hb <7 g/dL) reduces further bleeding risk compared with liberal transfusion. In cirrhotic patients (Child–Pugh A/B) restrictive strategy lowered risk; effect in Child–Pugh C was similar between groups. (NEJM study).Teaching point: Use restrictive transfusion thresholds in acute GI bleed unless there are specific cardiac or ischemic indications.
Q10) Commonest cause of breathing difficulty in unconscious patient is
Answer: b) Tongue
In unconscious patients the tongue falls back and obstructs the airway. Positioning (lateral or semi-prone), airway adjuncts, and suction are important.Teaching point: Airway patency is the first priority — simple maneuvers (jaw thrust, airway adjuncts) often restore ventilation.
Q11) Which of the following is a clinical marker of myocardial ischemia?
Answer: a) Troponin I
Troponin I is the most sensitive and specific marker for myocardial injury (peaks within ~9 hours). CK-MB is useful to detect reinfarction; LDH and ALP are non-specific.Teaching point: Use troponins for diagnosis of MI; CK-MB may help detect re-infarction due to faster clearance.
Q12) Which trace element deficiency causes impaired glucose tolerance, anemia, neutropenia and leukopenia?
Answer: b) Copper
Copper deficiency causes hematologic abnormalities (anemia, neutropenia), impaired glucose tolerance, skin/hair changes, and can be linked to arrhythmias. Copper is important for collagen/elastin crosslinking and antioxidant function.Teaching point: Consider trace element deficiencies in malnourished patients or those on long-term TPN without trace element supplementation.
Q13) Which does not form a part of Virchow's triad?
Answer: c) Platelet defects
Virchow's triad: endothelial injury, stasis (slow flow), and hypercoagulability — these describe venous thrombosis risk. Platelet defects are more relevant to arterial thrombosis.Teaching point: Venous and arterial thromboses have different dominant mechanisms — manage and prophylax accordingly.
Q14) Which of the following parameters will be of least worry to the anesthetist due to chronic kidney disease?
Answer: d) Pulmonary
CKD patients have increased perioperative risk largely from cardiac disease, fluid/electrolyte disturbances, and uremic bleeding diathesis. Pulmonary issues occur but are often secondary to fluid imbalance.Teaching point: Optimize cardiac status, correct electrolytes, and address coagulopathy before major surgery in CKD patients.
Q15) Which of the following is not true for malignant hyperthermia?
Answer: b) Rhabdomyolysis and hypokalemia are common (this is false)
Malignant hyperthermia typically causes rhabdomyolysis and hyperkalemia (not hypokalemia). Early sign: rising end-tidal CO2 despite increased ventilation. Treat with IV dantrolene.Teaching point: Recognize early signs (ETCO2 rise, tachycardia) and give dantrolene promptly; monitor potassium and treat hyperkalemia if present.
Q16) What should be done to prevent refeeding syndrome in a 70-year-old on TPN?
Answer: b) Slowly increase calories
Refeeding syndrome causes hypophosphatemia, hypocalcemia, hypomagnesemia and should be prevented by gradual calorie increases, adequate vitamin (thiamine) supplementation and monitoring.Teaching point: Identify high-risk patients (prolonged fasting/malnutrition) and start feeds slowly with electrolyte/vitamin monitoring.
Q17) Which is not a complication of TPN given through central line?
Answer: a) Aspiration
Aspiration is mainly a risk with enteral feeding. Central line TPN complications include line-related pneumothorax, infection, metabolic complications and bone demineralization with long-term use. Refeeding can occur with both enteral and parenteral routes.Teaching point: Prevent central line complications with sterile technique and monitor metabolic/bone health with prolonged TPN.
Q18) 48-year-old male: on mouth opening only hard palate is seen. Which modified Mallampati grade is this?
Answer: d) Grade IV
Modified Mallampati (Samsoon & Young): Grade I = faucial pillars, soft palate, uvula visible; Grade II = soft palate & part uvula; Grade III = soft palate only; Grade IV = only hard palate visible.Teaching point: Higher Mallampati grade predicts more difficult intubation — prepare airway strategy accordingly.
Q19) Which of the following is an absolute contraindication to percutaneous endoscopic gastrostomy (PEG) placement?
Answer: a) INR 3.1
INR >1.5, PTT >50 s, platelets <50,000/mm³ are contraindications due to high bleeding risk. Other absolute contraindications: hemodynamic instability, peritonitis, severe ascites, lack of safe tract, gastric outlet obstruction in some contexts.Teaching point: Correct coagulopathy and assess abdominal wall anatomy before PEG placement; multidisciplinary decision-making is essential.
Q20) Which of the following components are used in the Harris–Benedict equation to calculate Basal Metabolic Rate (BMR)?
Answer: a) Age, weight, height, and gender
The original Harris–Benedict equations use age, weight, height and sex to estimate BMR/REE. Activity factor is applied separately to estimate total daily energy expenditure (TDEE).Teaching point: Use REE × activity/stress factors to estimate total needs; monitor and adjust by clinical response.