Respiratory and Airway Management Practice Questions

Q: What is the first step in cardiopulmonary resuscitation (CPR)?

Maintain the airway. **Explanation:** In the management of a collapsed patient, the fundamental priority follows the **ABC (Airway, Breathing, Circulation)** algorithm. The first step in cardiopulmonary resuscitation (CPR) is to ensure a patent **Airway**. Without a clear airway, subsequent steps like rescue breathing or pharmacological interventions are ineffective because oxygen cannot reach the lungs and bloodstream. **Analysis of Options:** * **Option C (Correct):** Maintaining the airway (via head-tilt/chin-lift or jaw-thrust maneuvers) is the prerequisite for all resuscitative efforts. It ensures that the tongue or foreign bodies do not obstruct the passage of air. * **Option A:** Adrenaline is the drug of choice in CPR, but it is administered only after establishing an airway, starting chest compressions, and confirming the cardiac rhythm. It is part of Advanced Life Support (ALS), not the initial step. * **Option B:** Intracardiac injections are obsolete and no longer recommended in modern ACLS protocols due to the risk of coronary artery laceration and pneumothorax. Atropine is also no longer routinely used for asystole or PEA. * **Option D:** This is clinically irrelevant to the immediate management of a cardiac arrest. **High-Yield Clinical Pearls for NEET-PG:** * **Sequence Change:** While the traditional sequence is ABC, the **AHA guidelines** for healthcare providers emphasize **C-A-B** (Compressions-Airway-Breathing) to minimize delays in starting chest compressions. However, in the context of "establishing" the resuscitation process, airway management remains the primary foundational step. * **Maneuver of Choice:** Use the **Head-tilt, Chin-lift** for most patients; use the **Jaw-thrust** if a cervical spine injury is suspected. * **Golden Rule:** In basic life support, always "Look, Listen, and Feel" for breathing only *after* ensuring the airway is open.

Q: Diffusion hypoxia is seen during which phase of anesthesia?

Recovery from anesthesia. **Explanation:** **Diffusion Hypoxia** (also known as the **Fink Effect**) occurs due to the rapid movement of **Nitrous Oxide ($N_2O$)** from the blood back into the alveoli once the administration is stopped. 1. **Why "Recovery from anesthesia" is correct:** $N_2O$ is highly insoluble in blood but is administered in high concentrations (up to 70%). At the end of anesthesia (recovery phase), when the patient starts breathing room air, the large volume of $N_2O$ dissolved in the blood rushes into the alveoli. This massive influx of $N_2O$ **dilutes the alveolar oxygen ($O_2$) and carbon dioxide ($CO_2$)**. The dilution of $O_2$ leads to hypoxia, while the dilution of $CO_2$ reduces the respiratory drive, further worsening the condition. 2. **Why other options are incorrect:** * **Induction of anesthesia:** During induction, the "Second Gas Effect" occurs. $N_2O$ moves rapidly from the alveoli into the blood, increasing the concentration of the co-administered volatile anesthetic, which speeds up induction rather than causing hypoxia. * **Preoperative/Postoperative period:** These periods refer to times before anesthesia starts or long after the patient has left the operating room. Diffusion hypoxia is a transient phenomenon occurring specifically at the moment of discontinuation. **High-Yield Clinical Pearls for NEET-PG:** * **Prevention:** To prevent diffusion hypoxia, the patient should be administered **100% Oxygen for 3–5 minutes** after $N_2O$ is discontinued. * **Second Gas Effect:** Occurs during induction (opposite of diffusion hypoxia). * **Concentration Effect:** The higher the concentration of $N_2O$ inhaled, the faster the arterial tension of a companion gas increases.

Q: Which intravenous anesthetic is a potent bronchodilator and the choice of agent in an asthmatic patient?

Ketamine. **Explanation:** **Ketamine** is the intravenous anesthetic of choice for patients with reactive airway disease (asthma or COPD) due to its potent **bronchodilatory properties**. It achieves this through two primary mechanisms: 1. **Sympathomimetic effect:** It increases the release of endogenous catecholamines, which stimulate $\beta_2$ receptors. 2. **Direct action:** It exerts a direct relaxant effect on the bronchial smooth muscle. Additionally, Ketamine maintains functional residual capacity (FRC) and does not significantly depress the respiratory drive compared to other agents. **Analysis of Incorrect Options:** * **Propofol (A):** While Propofol does possess some bronchodilatory properties and is generally safe for asthmatics, it is not as potent as Ketamine in reversing bronchospasm. It can also cause significant hypotension. * **Thiopentone (B):** This is **contraindicated** in asthmatics. It does not prevent (and may even trigger) histamine release. Furthermore, it fails to suppress airway reflexes, which can lead to life-threatening laryngospasm or bronchospasm during intubation. * **Midazolam (D):** A benzodiazepine used primarily for sedation and anxiolysis. It has a neutral effect on bronchial smooth muscle tone and offers no specific therapeutic benefit for bronchospasm. **NEET-PG High-Yield Pearls:** * **Drug of Choice:** Ketamine is the preferred induction agent for patients in **Status Asthmaticus**. * **Side Effect:** While it bronchodilates, Ketamine increases **salivary secretions** (sialagogue effect), which may necessitate the co-administration of an anticholinergic like Glycopyrrolate to prevent laryngospasm. * **Avoid:** Thiopentone is the "classic" wrong answer for asthma questions due to the risk of histamine release.

Q: Which of the following is considered a definitive airway?

Nasotracheal airway. ### **Explanation** A **definitive airway** is defined as a tube placed in the **trachea** with the **cuff inflated below the vocal cords**, connected to a form of oxygen-enriched ventilation, and secured in place with tape or a commercial device. **Why Nasotracheal Airway is Correct:** A nasotracheal tube is a type of **endotracheal tube (ETT)**. Because it passes through the larynx and into the trachea, and features an inflatable cuff that provides a reliable seal against aspiration while ensuring positive pressure ventilation, it meets all criteria for a definitive airway. **Analysis of Incorrect Options:** * **Orotracheal Airway (Guedel Airway):** This is a **simple airway adjunct**. It merely prevents the tongue from obstructing the posterior pharynx in an unconscious patient. It does not enter the trachea or protect against aspiration. * **Nasopharyngeal Airway (Nasal Trumpet):** Similar to the oropharyngeal airway, this is an **adjunct** used to bypass upper airway obstruction. It terminates in the pharynx, not the trachea. * **Laryngeal Mask Airway (LMA):** This is a **Supraglottic Airway Device (SAD)**. While it provides an effective channel for ventilation, it sits above the vocal cords. It does not provide a definitive seal against gastric aspiration and is therefore not considered a definitive airway. ### **High-Yield Clinical Pearls for NEET-PG:** 1. **Three types of definitive airways:** * Orotracheal tube (most common). * Nasotracheal tube. * Surgical airway (Cricothyroidotomy or Tracheostomy). 2. **Gold Standard for Confirmation:** The most reliable clinical method to confirm definitive airway placement is **Continuous Waveform Capnography (EtCO2)**. 3. **Indication:** A definitive airway is mandatory if the patient has a **GCS ≤ 8** ("8, terminate/intubate"), impending airway obstruction, or severe respiratory failure.

Question 1

Which of the following is NOT true regarding type-III respiratory failure?

Accepted Answer

There is impaired central nervous system drive to breathe.

Answer

It is also known as perioperative respiratory failure.

Answer

It occurs as a result of atelectasis.

Answer

It can be managed conservatively.

Question 2

What is the first step in cardiopulmonary resuscitation (CPR)?

Accepted Answer

Maintain the airway

Answer

Administer intravenous adrenaline

Answer

Administer intracardiac atropine

Answer

Perform a hysterectomy

Question 3

Which of the following always indicates obstruction to the airway?

Accepted Answer

Strenuous breathing

Answer

Slow pounding pulse

Answer

Increase in pulse rate

Answer

Decrease in blood pressure

Question 4

Diffusion hypoxia is seen during which phase of anesthesia?

Accepted Answer

Recovery from anesthesia

Answer

Induction of anesthesia

Answer

Preoperative period

Answer

Postoperative period

Question 5

All of the following are true about the Laryngeal Mask Airway (LMA) except:

Accepted Answer

A cuff pressure of 60 cm H2O for the laryngeal mask can adequately prevent aspiration.

Answer

The device was invented by Dr. Archie Brain.

Answer

It consists of a mask designed to fit in the hypopharynx.

Answer

It allows positive-pressure ventilation with up to 20 cm H2O.

Question 6

What is a laser tube?

Accepted Answer

A tube made up of PVC wrapped in two layers, one metallic and another non-reflective layer.

Answer

A tube made up of red rubber.

Answer

A metallic tube to prevent any airway fire.

Answer

A tube made up of laser-resistant material.

Question 7

Which intravenous anesthetic is a potent bronchodilator and the choice of agent in an asthmatic patient?

Accepted Answer

Ketamine

Answer

Propofol

Answer

Thiopentone

Answer

Midazolam

Question 8

What would be the first line of treatment if a patient develops ventricular fibrillation after intravenous injection of potassium chloride?

Accepted Answer

Defibrillation

Answer

Cardiac massage

Answer

Intravenous adrenaline

Answer

Intermittent positive-pressure ventilation (IPPV)

Question 9

Intubation-induced laryngeal spasm cannot be prevented by which of the following?

Accepted Answer

Promethazine

Answer

Local anesthesia spray

Answer

Fentanyl

Answer

Diltiazem

Question 10

Which of the following is considered a definitive airway?

Accepted Answer

Nasotracheal airway

Answer

Orotracheal airway

Answer

Nasopharyngeal airway

Answer

Laryngeal mask airway (LMA)

Respiratory and Airway Management — MCQs

Respiratory and Airway Management — MCQs

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