Q Myocardial Ischemia Under Anaesthesia 1. Diagnosis and management under GA 2. Ischemia monitoring during anaesthesia Q Cardiac Pt for Non cardiac surgery 1. DES patient for TKR 2. CAD patient for THR 3. IHD patient for laparoscopic cholecystectomy 4. Frail elderly with prior coronary stenting 5. Risk stratification in ischemic heart disease Core areas repeatedly asked • Risk assessment • Timing after stent • Antiplatelets • Beta blockers/statins • Functional capacity • Intraoperative goals Q Mitral Stenosis → Combined from 1. MS pathophysiology 2. Severe MS for LSCS 3. Severe MS for emergency appendicectomy 4. Rheumatic heart disease in pregnancy High-yield focus • Avoid tachycardia • Maintain preload • Avoid pulmonary hypertension • Sinus rhythm importance Q Non-invasive Cardiac Output Monitoring QArrhythmias + ACLS + Cardioversion → Included topics 1. Ventricular tachycardia 2. Ventricular fibrillation ACLS 3. Atrial fibrillation 4. Cardioversion 5. CCLS guidelines + good-quality CPR Q Post-cardiac Arrest Care / CPR Included 1. Post-cardiac arrest care 2. Temperature management after cardiac arrest 3. Infant vs adult CPR Q Pacemaker / ICD → Combined from 1. Permanent pacemaker for TURP 2. Classification + perioperative management of pacemaker/ICD Q ECMO → Included 1. ECMO basics 2. Role in COVID 3. General indications Q Venous Air Embolism → 2 repetitions Included 1. VAE causes/diagnosis/management 2. Air embolism + paradoxical embolism + capnography Q Hypertension / Blood Pressure → Included 1. BP definition and measurement 2. Types of hypertension 3. Hypertensive patient for surgery Q Cardiac Risk Stratification / Preoperative Evaluation → Combined from 1. Chronic smoker + HTN for THR 2. Elderly frail patient with CAD 3. CAD with DES 4. IHD for laparoscopic surgery Q Coronary Circulation / MVO₂ Included 1. Coronary circulation + ischemia monitoring 2. Regulation of coronary blood flow + determinants of myocardial oxygen consumption Answer these question for dnb practical exam from millers and latest guidelines of cpr provide consise and scoring answer for 10 marks question
You are helping prepare DNB Anaesthesia practical exam answers. Search the medical textbook library database for content on the following topics, then write concise high-scoring 10-mark exam answers: 1. **Myocardial Ischemia Under Anaesthesia** - Diagnosis and management under GA, ischemia monitoring during anaesthesia 2. **Non-invasive Cardiac Output Monitoring** - all methods, principles, clinical use 3. **Coronary Circulation and MVO2** - coronary blood flow regulation, determinants of myocardial oxygen consumption, ischemia monitoring SEARCH INSTRUCTIONS: - First read /skills/readonly/medical-library/SKILL.md (limit=1000) - Use query_library_db with headings_fts and paragraphs_fts to find relevant sections - Search terms to use: "myocardial ischemia anaesthesia", "ischemia monitoring", "ST segment monitoring", "coronary circulation", "myocardial oxygen consumption", "cardiac output monitoring", "non-invasive cardiac output" - Read the relevant file sections using read_file with the paths returned - Also search paragraphs_fts for: "ischemia perioperative", "coronary blood flow", "MVO2", "esophageal Doppler", "pulse contour", "bioimpedance cardiac output" FORMAT REQUIRED: For each question, write a DNB exam answer structured as: - Brief intro (1-2 lines) - Numbered/bulleted points covering all key areas - Tables where appropriate - Each answer should be self-contained and score-worthy for 10 marks Return the complete text of all 3 answers.
"noncardiac surgery" AND "coronary stent" AND "antiplatelet"
2024 AHA ACC guidelines perioperative cardiac risk assessment noncardiac surgery DES timing antiplatelet
EXAM ANSWER NAVIGATOR
| Q | Topic | Key Scoring Points |
|---|---|---|
| Q1 | Myocardial Ischemia Under GA | ECG lead sensitivity table (II+V4+V5=98%), TEE most sensitive, hemodynamic goals table, GTN/beta-blocker/volatile agents |
| Q2 | Cardiac Pt for Non-Cardiac Surgery | ACC/AHA stepwise algorithm, RCRI 6-point table, DES timing (new-gen 6 months), antiplatelet bridging, each scenario covered |
| Q3 | Mitral Stenosis | MVA severity table, "avoid tachycardia" goals table, epidural preferred for LSCS, modified RSI for emergency, avoid ergometrine |
| Q4 | Arrhythmias + ACLS + CPR | AHA 2020 VF algorithm, high-quality CPR parameters, amiodarone 300+150 mg, TTM at 32–36°C, infant vs adult CPR comparison table |
| Q5 | Pacemaker/ICD for TURP | NBG code, VOO/DOO programming, bipolar diathermy preference, magnet effect, ICD suspension protocol |
| Q6 | ECMO | VV vs VA table, indications, ECPR, COVID role, ELSO criteria |
| Q7 | Venous Air Embolism | Monitoring sensitivity table (Doppler most sensitive, EtCO₂ most practical), Durant manoeuvre, N₂O must stop, paradoxical embolism via PFO |
| Q8 | Hypertension | BP classification, ACEi/ARB morning-of decision, laryngoscopy response management, SNP for emergencies |
| Q9 | Non-invasive CO Monitoring | 6 methods, oesophageal Doppler (FTc/PV), FloTrac/PiCCO, SVV >13% = fluid responsive, bioreactance, comparison table |
| Q10 | Coronary Circulation + MVO₂ | CPP formula, 70-80% diastolic flow, LaPlace's law, MVO₂ components (pressure work 64%), RPP threshold >12,000, ischemic preconditioning via KATP |
- Always open with a crisp definition/intro (2 lines)
- Include at least one table per answer — examiners reward structured organisation
- End with "anaesthetic goals" or "monitoring targets" — ties everything together
- For scenario questions (DES/MS/frail elderly), explicitly state what you would avoid — this demonstrates depth