Airway Management in Head and Neck Surgery Indian Medical PG Practice Questions and MCQs
Practice Indian Medical PG questions for Airway Management in Head and Neck Surgery. These multiple choice questions (MCQs) cover important concepts and help you prepare for your exams.
Airway Management in Head and Neck Surgery Indian Medical PG Question 1: Laryngeal mask airway [LMA] is contraindicated in?
- A. Ocular surgeries
- B. Pregnant female (Correct Answer)
- C. Difficult airways
- D. In CPR
Airway Management in Head and Neck Surgery Explanation: ***Pregnant female***
- **Pregnant patients** are at an increased risk of **gastric reflux and aspiration pneumonitis** due to decreased lower esophageal sphincter tone and increased intra-abdominal pressure.
- The LMA does not provide a secure airway seal against aspiration, making it contraindicated in cases where **aspiration risk is high**, such as pregnancy or full stomach.
*Difficult airways*
- The LMA is often considered a **rescue device** in difficult airway algorithms when tracheal intubation fails.
- It can be used as a conduit for **fiberoptic intubation** or as a temporary airway while preparing for a definitive airway.
*Ocular surgeries*
- LMAs are generally suitable for ocular surgeries as they provide a stable airway without the use of a mask, which can obstruct the surgical field.
- They tend to cause **less coughing and straining** upon insertion and maintenance compared to endotracheal tubes, which is beneficial in preventing increases in intraocular pressure.
*In CPR*
- The LMA can be an effective airway device during **cardiopulmonary resuscitation (CPR)** when endotracheal intubation is not immediately feasible.
- It provides a relatively quick and easy way to establish an airway, facilitate ventilation, and reduce the risk of gastric insufflation during chest compressions.
Airway Management in Head and Neck Surgery Indian Medical PG Question 2: A man takes peanut and develops tongue swelling, neck swelling, stridor, hoarseness of voice. What is the probable diagnosis?
- A. FB in larynx
- B. Angioneurotic edema (Correct Answer)
- C. Parapharyngeal abscess
- D. FB bronchus
Airway Management in Head and Neck Surgery Explanation: Andioneurotic edema
- The combination of **tongue swelling**, **neck swelling**, **stridor**, and **hoarseness of voice** following peanut ingestion is highly suggestive of **angioneurotic edema**, a severe allergic reaction that can lead to airway obstruction [1].
- This is a life-threatening condition requiring immediate medical intervention, often associated with generalized **anaphylaxis** when triggered by allergens [2].
*FB in larynx*
- While a **foreign body (FB) in the larynx** can cause stridor and hoarseness, the widespread swelling of the tongue and neck points away from a localized laryngeal obstruction [3].
- A laryngeal FB would typically be associated with a more sudden onset of choking and coughing, not diffuse edema [3].
*Parapharyngeal abscess*
- A **parapharyngeal abscess** would typically present with **fever**, **severe throat pain**, and **trismus** (difficulty opening the mouth), which are not mentioned in this scenario.
- The acute, rapid onset of symptoms after peanut consumption is inconsistent with the slower progression of an abscess.
*FB bronchus*
- A **foreign body in the bronchus** would primarily cause **coughing**, **wheezing**, and possibly **respiratory distress**, often unilateral, rather than severe global swelling of the tongue and neck.
- Inspiratory stridor and hoarseness are more indicative of upper airway involvement than bronchial obstruction.
Airway Management in Head and Neck Surgery Indian Medical PG Question 3: A Patient in medical intensive care unit who is intubated, suddenly removes the endotracheal tube. What should be done next?
- A. Sedate and reintubate
- B. Make him sit and do physiotherapy
- C. Assess the patient and give bag and mask ventilation and look for spontaneous breathing (Correct Answer)
- D. Give bag and mask ventilation and intubate
Airway Management in Head and Neck Surgery Explanation: ***Assess the patient and give bag and mask ventilation and look for spontaneous breathing***
- Upon accidental extubation, the immediate priority is to **assess the patient's airway, breathing, and circulation (ABCs)** and ensure oxygenation via **bag-mask ventilation** if needed, while observing for spontaneous breathing efforts.
- This step allows for a controlled re-evaluation of the patient's respiratory status and provides time to plan for reintubation if indicated, without rushing into sedating or reintubating a potentially stable patient.
*Sedate and reintubate*
- While reintubation may ultimately be necessary, sedating and immediately attempting reintubation without prior assessment can be dangerous if the patient has **stable spontaneous breathing** or if there are other contributing factors like **airway swelling** that need to be addressed first.
- Rushing to sedate and intubate could lead to complications if the patient's physiology is not fully understood post-extubation.
*Make him sit and do physiotherapy*
- This option is inappropriate for an intubated patient who has just accidentally self-extubated, as their airway and breathing status are of immediate concern.
- Positioning for physiotherapy or performing chest physiotherapy is a secondary concern after ensuring **adequate oxygenation and ventilation** and confirming a stable airway.
*Give bag and mask ventilation and intubate*
- While bag-mask ventilation is an appropriate immediate step to maintain oxygenation, automatically proceeding to intubation without fully **assessing the patient's spontaneous breathing status** and overall stability is premature.
- Some patients might tolerate extubation and breathe adequately on their own, negating the need for immediate reintubation.
Airway Management in Head and Neck Surgery Indian Medical PG Question 4: Modified Mallampati grading is used in assessment of -
- A. Difficulty of intubation (Correct Answer)
- B. Obstruction of the airway
- C. Aspiration-related death
- D. Endotracheal intubation procedure
Airway Management in Head and Neck Surgery Explanation: ***Difficulty of intubation***
- The **Modified Mallampati score** assesses the visibility of pharyngeal structures, which directly correlates with the ease or difficulty of performing **direct laryngoscopy** and **endotracheal intubation**.
- A higher Mallampati class (e.g., III or IV) indicates less visibility of the soft palate, uvula, and pillars, suggesting a more difficult airway and increased likelihood of a challenging intubation.
*Obstruction of the airway*
- While a high Mallampati score might indirectly indicate potential for **airway obstruction** during anesthesia due to anatomical features, its primary purpose is not to diagnose or quantify existing airway obstruction.
- Airway obstruction is more directly assessed by monitoring breathing sounds, respiratory effort, and oxygen saturation.
*Aspiration-related death*
- The **Mallampati score** helps predict the difficulty of securing the airway but does not directly assess the risk of **aspiration**.
- Aspiration risk is evaluated based on factors like gastric contents, gag reflex, and patient positioning.
*Endotracheal intubation procedure*
- The **Modified Mallampati score** helps in **planning the intubation procedure** by identifying potential difficulties but is not a measure of the intubation procedure itself.
- It is a **pre-procedure assessment tool** to gauge airway anatomy, not a description or evaluation of the steps involved in endotracheal intubation.
Airway Management in Head and Neck Surgery Indian Medical PG Question 5: The safest initial approach to open the airway of a patient with maxillofacial trauma is:
- A. Head tilt-chin lift
- B. Jaw thrust technique (Correct Answer)
- C. Head lift-neck lift
- D. Heimlich procedure
Airway Management in Head and Neck Surgery Explanation: ***Jaw thrust technique***
- This technique is preferred in cases of **maxillofacial or suspected cervical spine trauma** as it minimizes neck movement, thereby reducing the risk of further injury.
- It involves grasping the angles of the mandible and **lifting the jaw anteriorly**, which moves the tongue away from the posterior pharynx to clear the airway.
*Head tilt-chin lift*
- This maneuver is contraindicated in trauma settings where a **cervical spine injury** is suspected, as it can extend the neck and exacerbate spinal cord damage.
- While effective for opening the airway in non-trauma patients, it involves **significant neck movement** which is unsafe in maxillofacial trauma.
*Head lift-neck lift*
- This is not a recognized or safe technique for airway management, especially in trauma patients, as it would cause **unnecessary and potentially harmful movement** of the head and neck.
- There is no clinical scenario where this technique would be recommended over established airway maneuvers.
*Heimlich procedure*
- The Heimlich procedure (abdominal thrusts) is used to relieve **severe foreign body airway obstruction** and is not an initial approach to open an airway due to general trauma.
- It is an intervention for choking, not for managing an airway in a patient with maxillofacial trauma where the primary concern is often **tongue prolapse** or significant structural injury causing obstruction.
Airway Management in Head and Neck Surgery Indian Medical PG Question 6: Emergency tracheostomy is not indicated in
- A. Bilateral vocal cord paralysis
- B. Foreign body larynx
- C. Acute severe asthma (Correct Answer)
- D. Stridor due to laryngeal growth
Airway Management in Head and Neck Surgery Explanation: ***Acute severe asthma***
- While life-threatening, acute severe asthma is primarily managed with **bronchodilators**, **steroids**, and potentially **non-invasive or invasive ventilation**.
- **Tracheostomy** is generally reserved for situations involving upper airway obstruction that cannot be managed by other means, which is not the primary issue in asthma.
*Bilateral vocal cord paralysis*
- This condition can cause severe **upper airway obstruction** due to the adduction of both vocal cords.
- In an emergency setting, a tracheostomy may be life-saving to bypass the obstructed larynx.
*Foreign body larynx*
- An obstructing **foreign body in the larynx** can lead to immediate and complete airway compromise.
- If efforts like the **Heimlich maneuver** or direct laryngoscopy with removal fail, an emergency tracheostomy might be necessary.
*Stridor due to laryngeal growth*
- A laryngeal growth causing **stridor** indicates significant airway narrowing, which can acutely worsen and lead to respiratory distress.
- In cases of severe or rapidly progressive obstruction, an **emergency tracheostomy** is needed to secure the airway below the level of the growth.
Airway Management in Head and Neck Surgery Indian Medical PG Question 7: What is the most common indication for performing a tracheostomy?
- A. Severe obstructive sleep apnea
- B. Tracheal stenosis
- C. Vocal cord paralysis
- D. Prolonged mechanical ventilation (Correct Answer)
Airway Management in Head and Neck Surgery Explanation: ***Prolonged mechanical ventilation***
- Maintaining an **endotracheal tube** for an extended period carries risks like **tracheal injury**, **vocal cord damage**, and difficulty with oral intake.
- A tracheostomy provides a more comfortable and stable airway for **long-term respiratory support**, facilitates weaning from the ventilator, and reduces the risk of **ventilator-associated pneumonia**.
*Severe obstructive sleep apnea*
- While tracheostomy can effectively treat severe OSA by bypassing the upper airway obstruction, it is generally considered a **last resort** after less invasive treatments have failed.
- The most common initial treatments for OSA include **CPAP**, weight loss, and oral appliances.
*Tracheal stenosis*
- Tracheal stenosis itself is a **structural narrowing** of the trachea that may or may not require tracheostomy, depending on its severity and location.
- While a tracheostomy can bypass a severe stenosis, surgical repair of the trachea is often the definitive treatment for **severe tracheal stenosis**.
*Vocal cord paralysis*
- Unilateral vocal cord paralysis typically causes **hoarseness** and may not always necessitate a tracheostomy.
- Bilateral vocal cord paralysis can lead to **airway obstruction**, but intervention usually involves vocal cord lateralization procedures or, in severe cases, a tracheostomy for airway patency.
Airway Management in Head and Neck Surgery Indian Medical PG Question 8: Treatment of resectable T4N0M0 stage of head and neck carcinoma is?
- A. Radiotherapy alone
- B. Surgery and Radiotherapy (Correct Answer)
- C. Chemoradiation
- D. Surgery alone
Airway Management in Head and Neck Surgery Explanation: ***Surgery and Radiotherapy***
- For **resectable T4N0M0 head and neck carcinoma**, the standard treatment is **surgical resection** of the primary tumor followed by **adjuvant radiotherapy**.
- This approach achieves optimal **local control** for advanced primary tumors without nodal involvement.
- **Adjuvant radiotherapy** is essential for T4 tumors due to high risk of microscopic residual disease and local recurrence.
- Surgery allows for complete tumor removal with negative margins, while radiotherapy addresses subclinical disease.
*Radiotherapy alone*
- Radiotherapy alone is **insufficient as monotherapy** for T4 tumors due to the large tumor burden and extensive local invasion.
- Single modality radiation cannot reliably achieve adequate tumor control for advanced primary lesions.
- Generally reserved for early-stage disease or patients unfit for surgery.
*Chemoradiation*
- **Definitive chemoradiation** is an alternative for **unresectable T4 tumors** or when organ preservation is desired (e.g., laryngeal cancer).
- For **resectable** T4N0M0 disease, surgery with adjuvant RT is preferred as it provides better local control and allows pathological staging.
- Chemoradiation may be used postoperatively if high-risk features are found (positive margins, perineural invasion, extranodal extension).
- In this **N0 case with resectable tumor**, upfront surgery is the preferred initial approach.
*Surgery alone*
- While surgical resection is crucial for T4 tumors, **surgery alone is inadequate** due to high risk of locoregional recurrence.
- T4 classification indicates extensive local invasion, necessitating **adjuvant radiotherapy** to eradicate microscopic disease.
- Combined modality treatment (surgery + RT) significantly improves local control and survival compared to surgery alone.
Airway Management in Head and Neck Surgery Indian Medical PG Question 9: N3a TNM staging of head and neck tumors (AJCC 8th edition) shows:
- A. Metastasis in a lymph node >6 cm (Correct Answer)
- B. Metastasis in lymph nodes >2 cm
- C. Metastasis in lymph nodes >5 cm
- D. None of the options
Airway Management in Head and Neck Surgery Explanation: ***Metastasis in a lymph node >6 cm***
- **N3a disease** in head and neck cancer staging (AJCC 8th edition) specifically refers to metastasis in a single lymph node larger than 6 cm in greatest dimension **without extranodal extension (ENE)**.
- This applies to oral cavity, oropharynx (HPV-negative), hypopharynx, and larynx cancers.
- **Note:** N3 staging also includes **N3b** (metastasis in any node with clinically overt ENE), but this question specifically asks about N3a criteria.
*Metastasis in lymph nodes >2 cm*
- Lymph nodes in the 2-3 cm range typically fall within **N1 or N2a categories**, depending on laterality and number of involved nodes.
- **N3a disease** requires a single lymph node to exceed 6 cm in greatest dimension without ENE.
*Metastasis in lymph nodes >5 cm*
- A lymph node between 3-6 cm is usually classified as **N2 disease** (N2a if single ipsilateral ≤6 cm, N2b if multiple ipsilateral ≤6 cm, N2c if bilateral or contralateral ≤6 cm).
- To be classified as **N3a**, the lymph node must be **>6 cm** without extranodal extension.
*None of the options*
- This option is incorrect because the first option accurately describes the size criterion for **N3a TNM staging** in head and neck tumors according to AJCC 8th edition guidelines.
- While N3 staging has two subcategories (N3a and N3b), the size criterion of >6 cm correctly defines N3a disease.
Airway Management in Head and Neck Surgery Indian Medical PG Question 10: Supraomohyoid dissection is a type of?
- A. Selective neck dissection (Correct Answer)
- B. Modified radical neck dissection
- C. Radical neck dissection
- D. Posterolateral dissection
Airway Management in Head and Neck Surgery Explanation: ***Selective neck dissection***
- **Supraomohyoid dissection** specifically refers to a type of selective neck dissection, characterized by the removal of lymph node levels **I, II, and III**.
- This procedure is commonly performed for early-stage oral cavity cancers due to their typical lymphatic spread patterns.
*Modified radical neck dissection*
- This dissection preserves one or more **non-lymphatic structures** (e.g., sternocleidomastoid muscle, internal jugular vein, spinal accessory nerve) that are typically removed in a radical neck dissection.
- It involves a broader range of lymph node levels (typically **I-V**) compared to a supraomohyoid dissection.
*Radical neck dissection*
- This is a more extensive procedure involving the removal of all lymph node groups (levels **I-V**), along with the **sternocleidomastoid muscle**, **internal jugular vein**, and **spinal accessory nerve**.
- It is reserved for advanced neck disease due to its significant morbidity.
*Posterolateral dissection*
- **Posterolateral neck dissection** is a term not commonly used within the standard classification of neck dissections (radical, modified radical, selective).
- Lymphatic dissection is typically categorized based on anatomical levels rather than a general directional term like posterolateral.
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