Respiratory and Airway Management Practice Questions

Q: Sallick's maneuver is used for what purpose?

To prevent gastric aspiration. **Explanation:** **Sellick’s Maneuver**, also known as **Cricoid Pressure**, is a technique used during Rapid Sequence Induction (RSI) to prevent the passive regurgitation of gastric contents into the pharynx, thereby **preventing pulmonary aspiration**. 1. **Why Option A is correct:** The maneuver involves applying firm downward pressure on the cricoid cartilage. Since the cricoid is the only complete cartilaginous ring in the larynx, pressing it posteriorly compresses the esophagus against the body of the fifth or sixth cervical vertebra. This physical occlusion prevents stomach contents from reaching the glottis during the period between the loss of consciousness and successful tracheal intubation. 2. **Why other options are incorrect:** * **Option B & D:** Sellick’s maneuver does not facilitate respiration or prevent alveolar collapse; in fact, excessive pressure can sometimes distort the laryngeal anatomy, making ventilation or intubation more difficult. * **Option C:** Reducing dead space is typically achieved through specialized breathing circuits or tracheostomy, not manual airway maneuvers. **High-Yield Clinical Pearls for NEET-PG:** * **Force Required:** Approximately **10 Newtons (1kg)** of pressure is applied while the patient is awake, increasing to **30 Newtons (3kg)** once consciousness is lost. * **BURP Maneuver vs. Sellick’s:** Do not confuse Sellick’s with the **BURP maneuver** (Backwards, Upwards, Rightwards Pressure), which is applied to the *thyroid* cartilage specifically to improve the *view of the glottis* during laryngoscopy. * **Contraindications:** Suspected cricotracheal transition injury, active vomiting (risk of esophageal rupture), or unstable cervical spine fractures.

Q: Which of the following is NOT a side effect of oxygen therapy?

Increased pulmonary compliance. Oxygen therapy, while life-saving, can lead to **Oxygen Toxicity** (the Lorrain Smith effect) when high concentrations are administered for prolonged periods. ### **Why "Increased Pulmonary Compliance" is the Correct Answer** Oxygen toxicity actually **decreases** pulmonary compliance. High concentrations of oxygen (FiO2 > 0.6) lead to the formation of Reactive Oxygen Species (ROS), which damage the alveolar-capillary membrane and inhibit surfactant production. This results in "stiff lungs," making them harder to inflate, thereby decreasing compliance. ### **Analysis of Incorrect Options** * **A. Absorption Atelectasis:** Normally, nitrogen (an inert gas) stays in the alveoli and keeps them splinted open. When 100% oxygen is given, nitrogen is "washed out." Since oxygen is rapidly absorbed into the blood, the alveoli collapse. * **C. Decreased Vital Capacity:** This is one of the earliest signs of pulmonary oxygen toxicity. It occurs due to a combination of airway congestion, alveolar edema, and the aforementioned atelectasis. * **D. Endothelial Damage:** ROS directly damage the pulmonary capillary endothelium, leading to increased permeability, protein leakage into the alveoli, and eventually a picture similar to ARDS (Acute Respiratory Distress Syndrome). ### **High-Yield Clinical Pearls for NEET-PG** * **Safe Limit:** To avoid toxicity, the FiO2 should ideally be kept below **0.5 to 0.6 (50-60%)** for long-term therapy. * **Retinopathy of Prematurity (ROP):** In neonates, hyperoxia causes vasoconstriction followed by abnormal vascular proliferation in the retina. * **CO2 Narcosis:** In patients with chronic hypercapnia (e.g., COPD), high-flow oxygen can abolish the **hypoxic drive**, leading to respiratory depression. * **Paul Bert Effect:** Refers to Central Nervous System oxygen toxicity (seizures) occurring under hyperbaric conditions.

Q: What is the recommended treatment for post-intubation croup in a child who has undergone adenoidectomy?

All of the above. **Explanation:** Post-intubation croup (post-extubation subglottic edema) is a common pediatric complication caused by mucosal edema at the level of the cricoid cartilage, the narrowest part of a child’s airway. It typically presents within 30–60 minutes of extubation with stridor, barking cough, and respiratory distress. **Why "All of the Above" is Correct:** The management of post-intubation croup is multi-modal, focusing on reducing airway inflammation and improving airflow: * **Steroids (Dexamethasone):** These are the mainstay of treatment. They reduce mucosal inflammation and capillary permeability. Intravenous dexamethasone (0.15–0.6 mg/kg) is highly effective in decreasing the severity of symptoms. * **Racemic Epinephrine:** Administered via nebulization, it causes alpha-adrenergic vasoconstriction of the subglottic mucosa, rapidly reducing edema and providing immediate symptomatic relief. * **Mist/Humidified Oxygen:** While its efficacy is debated in isolation, humidified air/oxygen (mist) helps soothe the airway, prevents drying of secretions, and reduces the work of breathing. * **Re-intubation:** In severe cases refractory to medical management where the airway is compromised, re-intubation with a smaller diameter (usually 0.5 mm smaller) endotracheal tube is necessary. **Clinical Pearls for NEET-PG:** 1. **Risk Factors:** Frequent in children aged 1–4 years, use of oversized/uncuffed tubes, prolonged surgery, and multiple intubation attempts. 2. **Prevention:** The **"Cuff Leak Test"** is a vital bedside predictor; the absence of an air leak at <20 cm H₂O pressure indicates a high risk for post-extubation stridor. 3. **Heliox:** A mixture of Helium and Oxygen (70:30) may be used to reduce turbulent flow through the narrowed subglottic area. 4. **Drug of Choice:** Dexamethasone is the steroid of choice due to its high potency and long duration of action.

Q: What is the reason for difficult intubation in an obese patient?

All of the above. In obesity, anatomical and physiological changes combine to make airway management particularly challenging. **Explanation of the Correct Answer:** The correct answer is **D (All of the above)** because obesity affects every stage of the intubation process: 1. **Difficult Visualization (Option A):** Obese patients often have increased neck circumference, redundant pharyngeal soft tissue, and limited atlanto-occipital extension. These factors lead to a higher Mallampati score and poor visualization of the glottis during direct laryngoscopy. 2. **Decreased Safe Apnea Time (Option B):** This is the most critical physiological challenge. Obesity causes a significant decrease in **Functional Residual Capacity (FRC)** due to the weight of the chest wall and abdomen. Since FRC acts as the body's oxygen reservoir, its reduction—coupled with increased basal oxygen consumption—leads to rapid arterial desaturation during apnea. 3. **Lower Tidal Volume (Option C):** Increased intra-abdominal pressure and reduced chest wall compliance lead to a restrictive lung pattern. This results in lower spontaneous tidal volumes and requires higher airway pressures during mechanical ventilation. **Clinical Pearls for NEET-PG:** * **Positioning:** The **"Ramped Position"** (stacking blankets under the head, neck, and shoulders) is the gold standard for obese patients to align the oral, pharyngeal, and laryngeal axes. * **Pre-oxygenation:** Use of **Head-Up (25-30°)** position and CPAP/BiPAP during pre-oxygenation can help prolong the safe apnea time. * **Predictors:** Neck circumference (>40-43 cm) is often a better predictor of difficult intubation in obese patients than BMI alone. * **Induction:** Always be prepared for a "Cannot Intubate, Cannot Oxygenate" (CICO) scenario; have a video laryngoscope and supraglottic airway devices (SADs) readily available.

Q: Which of the following volatile anesthetic agents are pungent?

Sevoflurane. ### Explanation The pungency of a volatile anesthetic agent refers to its tendency to irritate the airway, which can trigger coughing, breath-holding, or laryngospasm during induction. **Why Sevoflurane is the Correct Answer (in the context of non-pungency):** *Note: There appears to be a discrepancy in the provided key. In clinical practice and standard textbooks (Miller, Morgan & Mikhail), **Sevoflurane is non-pungent** and sweet-smelling. This makes it the gold standard for **inhalational induction**, especially in pediatric patients.* **Analysis of Options:** * **Desflurane & Isoflurane:** These are highly **pungent** agents. They cause significant airway irritation and are generally avoided for mask induction as they can trigger coughing and laryngospasm. Desflurane is the most pungent of all. * **Halothane:** This is a **non-pungent**, sweet-smelling agent. Historically, it was the preferred agent for smooth inhalational induction before Sevoflurane became widely available. * **Sevoflurane:** This is **non-pungent**. It is the agent of choice for smooth induction due to its pleasant odor and lack of airway irritation. **NEET-PG High-Yield Pearls:** 1. **Agent of Choice for Induction:** Sevoflurane (due to non-pungency and rapid onset). 2. **Most Pungent Agent:** Desflurane (causes most airway irritation). 3. **Blood-Gas Partition Coefficient:** Desflurane (0.42) < Sevoflurane (0.65) < Isoflurane (1.4) < Halothane (2.4). Lower coefficient means faster induction/recovery. 4. **Soda Lime Reaction:** Sevoflurane can react with dry soda lime to produce **Compound A** (nephrotoxic in rats), while Desflurane/Isoflurane can produce **Carbon Monoxide**.

Q: Which statement is true regarding cardiopulmonary resuscitation?

Adrenaline is given if cardioversion fails.. ### Explanation **Correct Option: C. Adrenaline is given if cardioversion fails.** In the management of **Shockable Rhythms** (Ventricular Fibrillation/Pulseless Ventricular Tachycardia), the priority is immediate defibrillation. If the initial shocks (cardioversion/defibrillation) fail to restore a perfusing rhythm, **Adrenaline (1 mg IV/IO every 3–5 minutes)** is administered. It acts via alpha-1 adrenergic receptors to cause vasoconstriction, increasing coronary and cerebral perfusion pressure during CPR, thereby improving the chances of successful subsequent shocks. **Analysis of Incorrect Options:** * **A. Most common presentation:** In adult out-of-hospital cardiac arrests (OHCA), the most common initial rhythm is actually **Ventricular Fibrillation (VF)**, not asystole. Asystole is more common in prolonged arrests or pediatric cases. * **B. Compression to ventilation ratio:** According to the latest AHA/ERC guidelines, the universal ratio for adult CPR (one or two rescuers) is **30:2**. A 5:1 ratio is obsolete and no longer recommended. * **D. Calcium gluconate:** Calcium is **not** recommended for routine use in CPR. It is only indicated in specific scenarios such as hyperkalemia, hypocalcemia, or magnesium/calcium channel blocker toxicity. Routine use may cause cerebral reperfusion injury. **High-Yield Clinical Pearls for NEET-PG:** * **Compression Depth:** 5–6 cm (2–2.4 inches) in adults. * **Compression Rate:** 100–120 compressions per minute. * **Amiodarone:** The antiarrhythmic of choice (300 mg bolus) if VF/pVT persists after the 3rd shock. * **Reversible Causes (5Hs & 5Ts):** Always look for Hypovolemia, Hypoxia, Hydrogen ion (acidosis), Hypo/Hyperkalemia, Hypothermia; and Tension pneumothorax, Tamponade, Toxins, Thrombosis (pulmonary/coronary).

Question 1

Difficult oral intubation may be associated with all EXCEPT:

Accepted Answer

Decreased thyromental distance

Answer

Receding lower jaw

Answer

Poor mobility of mandible

Answer

Protruding upper incisor tooth

Question 2

Sallick's maneuver is used for what purpose?

Accepted Answer

To prevent gastric aspiration

Answer

To facilitate respiration

Answer

To reduce dead space

Answer

To prevent alveolar collapse

Question 3

Which of the following is NOT a side effect of oxygen therapy?

Accepted Answer

Increased pulmonary compliance

Answer

Absorption atelectasis

Answer

Decreased vital capacity

Answer

Endothelial damage

Question 4

What is the recommended treatment for post-intubation croup in a child who has undergone adenoidectomy?

Accepted Answer

All of the above

Answer

Intubation with mist

Answer

Steroids

Answer

Racemic epinephrine

Question 5

What is the reason for difficult intubation in an obese patient?

Accepted Answer

All of the above

Answer

Difficult visualization

Answer

Decreased safe apnea time

Answer

Lower tidal volume

Question 6

Placement of a double lumen tube for lung surgery is best confirmed by which method?

Accepted Answer

Bronchoscopy

Answer

End-tidal carbon dioxide (EtCO2) monitoring

Answer

Airway pressure measurement

Answer

Clinical assessment by auscultation

Question 7

Which of the following volatile anesthetic agents are pungent?

Accepted Answer

Sevoflurane

Answer

Halothane

Answer

Isoflurane

Answer

Desflurane

Question 8

What is the standard airway intervention for Ludwig's Angina?

Accepted Answer

Cricothyrotomy

Answer

Tracheostomy

Answer

Nasal intubation

Answer

Oral intubation

Question 9

What difficulty is assessed by the Mallampati classification during intubation?

Accepted Answer

Large tongue

Answer

Inadequate neck movement

Answer

Inadequate mouth opening

Answer

Receding mandible

Question 10

Which statement is true regarding cardiopulmonary resuscitation?

Accepted Answer

Adrenaline is given if cardioversion fails.

Answer

The most common presentation in ECG is asystole.

Answer

The compression to ventilation ratio is 5:1.

Answer

Calcium gluconate is given immediately.

Respiratory and Airway Management — MCQs

Respiratory and Airway Management — MCQs

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