Respiratory and Airway Management Practice Questions

Q: Identify the airway device shown in the image.

Laryngeal Mask Airway. ***Laryngeal Mask Airway*** - The image clearly displays a **Laryngeal Mask Airway (LMA)**, characterized by its inflatable, elliptical cuff designed to seal around the laryngeal inlet. - This supraglottic device is used for airway management in anesthesia and emergencies when endotracheal intubation is not required or feasible. *Nasopharyngeal Airway* - A **nasopharyngeal airway** is a soft, flexible tube inserted through the nose into the posterior pharynx. - It does not have an inflatable cuff or the broad, mask-like structure seen in the image. *Cuffed Endotracheal Tube* - A **cuffed endotracheal tube (ETT)** is a long, narrow tube inserted directly into the trachea, featuring a balloon cuff near the distal end for tracheal sealing. - The device in the image has a much broader, mask-like structure designed to sit above the larynx, not within the trachea. *Guedel Airway* - A **Guedel airway** (or oropharyngeal airway) is a rigid, curved device inserted into the mouth to prevent the tongue from obstructing the airway. - It is typically made of plastic and lacks any inflatable components or the sophisticated design of the device shown.

Q: What percentage of oxygen is provided to a victim during mouth-to-mouth respiration?

16%. ***16%*** - Expired air from a rescuer during **mouth-to-mouth resuscitation** contains about **16% oxygen**. - This percentage is sufficient to provide adequate oxygenation to the victim until further medical help is available. *10%* - This percentage is **too low** to be effective in providing life-sustaining oxygen to a victim. - A 10% oxygen concentration would likely lead to or worsen **hypoxia**. *21%* - This represents the approximate percentage of **oxygen in ambient air**, which is what we breathe normally. - Due to oxygen consumption by the rescuer's metabolism, the expired air will have a **lower oxygen concentration**. *100%* - **100% oxygen** is typically delivered via medical equipment, such as an oxygen tank and mask, not through expired air. - Providing 100% oxygen would require specialized **emergency medical services (EMS)** equipment.

Q: Modified Mallampati grading is used in assessment of -

Difficulty of intubation. ***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.

Q: Laryngeal mask airway [LMA] is contraindicated in?

Pregnant female. ***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.

Q: Which of the following is a characteristic of the Supreme Laryngeal Mask Airway (LMA)?

Includes a built-in drain tube. ***Includes a built-in drain tube*** - The **Supreme Laryngeal Mask Airway (LMA)** features an integrated **drain tube** to facilitate gastric decompression and reduce the risk of aspiration. - This design allows for the passage of a gastric tube, which can be useful during longer procedures or in patients with a higher risk of gastric content regurgitation. *Designed specifically for infants* - While LMAs are available in various sizes for all age groups, the **Supreme LMA** is not designed *specifically* for infants; it is a general-purpose LMA available in multiple sizes for different patient populations. - Other LMA types, such as the LMA Unique, are more commonly associated with a broader pediatric application. *Utilizes high pressure, low volume cuff design* - The **Supreme LMA** actually utilizes a **low pressure, high volume cuff** design, which helps contour to the perilaryngeal anatomy and minimizes pressure on mucosal tissues. - A high pressure, low volume cuff is associated with traditional endotracheal tubes and could lead to increased tissue ischemia if used with an LMA. *Does not have a bite block* - The **Supreme LMA** incorporates an **integrated bite block** within its design to prevent occlusion of the airway tube from patient biting. - This feature helps maintain airway patency and protects the LMA from damage, making it a key characteristic.

Q: Which drug is commonly used for emergency intubation?

Etomidate. ***Etomidate*** - Etomidate is a **short-acting nonbenzodiazepine hypnotic** often preferred for rapid sequence intubation (RSI) due to its minimal impact on **hemodynamic stability**. - It induces **rapid unconsciousness** with a quick onset and offset, making it suitable for emergency airway management in patients who are hemodynamically compromised. *Propofol* - Propofol is a **potent intravenous anesthetic** that can cause significant **hypotension** due to vasodilation and myocardial depression. - While it provides rapid onset of sedation and amnesia, its cardiovascular side effects make it less ideal for patients with **unstable hemodynamics** during emergency intubation. *Ketamine* - Ketamine is a **dissociative anesthetic** that causes a cataleptic state, amnesia, and analgesia, often leading to **bronchodilation** and cardiovascular stimulation. - While useful in patients with **reactive airway disease** or hypotension, it can increase intracranial pressure and may induce sympathetic stimulation, which might not be ideal for all emergency intubation scenarios. *None of the options* - This option is incorrect because **Etomidate is a commonly used drug** for emergency intubation, particularly where hemodynamic stability is a concern. - Other agents are also used but Etomidate is a clear clinical choice in many situations.

Q: Which of the following statements is NOT true regarding rapid induction of anesthesia?

Sellick's maneuver is always required.. ***Sellick's maneuver is always required.*** - **Sellick's maneuver**, or cricoid pressure, is applied to compress the esophagus against the vertebrae, aiming to prevent **gastric regurgitation** and aspiration during rapid sequence intubation (RSI). - While historically considered a standard component of RSI, its routine use has been increasingly questioned due to a lack of strong evidence supporting its efficacy and potential to impede glottic visualization and intubation. It is not "always" required; its application is often at the discretion of the anesthetist based on patient factors and risk assessment. *Pre-oxygenation is mandatory* - **Pre-oxygenation** is a critical step in rapid sequence induction, involving administering 100% oxygen for several minutes prior to induction. - This denitrogenates the functional residual capacity (FRC), creating an oxygen reservoir that extends the safe apnea time, thus preventing **hypoxemia** during the intubation attempt. *Suxamethonium is often used.* - **Suxamethonium** (succinylcholine) is a depolarizing neuromuscular blocker primarily used in rapid sequence intubation due to its **ultra-rapid onset** (30-60 seconds) and short duration of action (5-10 minutes). - Its rapid action facilitates quick muscle relaxation for tracheal intubation, which is crucial for minimizing the risk of aspiration in patients with a full stomach or other risk factors. *Mechanical ventilation is typically avoided before intubation.* - During rapid sequence induction, **positive pressure ventilation** with a bag-valve mask is typically avoided before intubation to prevent gastric insufflation. - Gastric insufflation can increase the risk of **regurgitation** and pulmonary aspiration of gastric contents, which is a major concern in patients undergoing RSI.

Q: In which context can helium replace nitrogen as a diluent gas in oxygen mixtures?

None of the options. **None of the options** - This question implies that helium might replace *another noble gas* as a diluent, but the correct application is for helium to replace **nitrogen** in oxygen mixtures, particularly in **diving applications**. This question likely has a flaw in its premise if expecting one of the noble gases listed to be the 'replacement' for nitrogen, as helium *is* the replacement. - Helium is used instead of nitrogen in diving gases (**trimix, heliox**) for deep dives because it is less narcotic than nitrogen under pressure, reducing the risk of **nitrogen narcosis**. *Argon* - **Argon** is denser than nitrogen and has a higher narcotic potential at depth, making it unsuitable as a replacement for nitrogen in diving gases. - It is sometimes used during **dry suit inflation** for insulation due to its low thermal conductivity, but not as a breathing gas diluent. *Xenon* - **Xenon** is a potent anesthetic agent, even at atmospheric pressure, due to its high lipid solubility. - Its use as a diluent would cause severe **narcosis** and render a diver unconscious, making it entirely inappropriate for diving mixtures. *Helium* - While helium is indeed the gas that replaces nitrogen as a diluent in oxygen mixtures for deep diving, it being listed as an option here suggests a misunderstanding of the question's phrasing. The question is asking for **in which context** helium can replace nitrogen, not asking to identify helium itself as the replacement. - Given the other options are noble gases that *cannot* replace nitrogen in this context, "None of the options" is the most accurate answer if the question implies picking from the provided list for a replacement *for helium* or a suitable *alternative* to helium, which isn't the case here.

Q: What is the most reliable indicator to prevent esophageal intubation?

Measurement of CO2 in exhaled air (EtCO2).. ***Measurement of CO2 in exhaled air (EtCO2)*** - The presence of **carbon dioxide** in exhaled air confirms tracheal intubation as the esophagus does not contain CO2. - This method provides a **real-time**, objective assessment of tube placement that is highly reliable because even small amounts of CO2 are detected. *Oxygen saturation on pulse oximeter* - This indicator measures **oxygenation**, which can remain adequate for several minutes after esophageal intubation due to pre-oxygenation. - A **delayed drop in saturation** might indicate esophageal intubation, but it's not immediate and therefore not the most reliable early indicator. *Direct visualization of passing tube beneath vocal cords* - While helpful, **direct visualization** can sometimes be misleading due to difficult airways or poor visibility, where the tube might appear to pass correctly but enter the esophagus. - This method is **operator-dependent** and its reliability can vary based on the intubator's experience and the patient's anatomy. *Auscultation over chest* - **Auscultation** can detect breath sounds; however, sounds can be transmitted from the stomach or surrounding tissues, leading to false positives. - It is also very difficult to reliably distinguish between **esophageal and tracheal sounds**, especially in noisy environments or with inexperienced personnel, making it less reliable than EtCO2.

Q: During preanaesthetic evaluation, an anaesthetist wrote a Mallampati grade 3. What does this signify?

Soft palate and base of uvula visible. **Soft palate and base of uvula visible** - A **Mallampati grade 3** classification indicates that only the **soft palate** and the **base of the uvula** are visible when the patient opens their mouth and protrudes their tongue. - This grade suggests a moderate difficulty for **endotracheal intubation** because the visualization of the glottis may be partially obstructed. *Limited neck extension* - Limited **neck extension** is assessed separately during a preanesthetic evaluation and is not directly indicated by the Mallampati score. - It is a factor that can independently contribute to a difficult airway by limiting the ability to achieve the **sniffing position** for intubation. *An enlarged epiglottis* - The **epiglottis** is not visible during a standard awake Mallampati examination, which assesses oral pharyngeal structures. - Visualization of the epiglottis typically occurs during **laryngoscopy** and an enlarged epiglottis (e.g., in epiglottitis) is a medical emergency, not a Mallampati finding. *Jaw stiffness* - **Jaw stiffness** or limited mouth opening is assessed by measuring the **interincisor distance** and is not directly part of the Mallampati classification process. - Significant jaw stiffness can independently predict a difficult airway by restricting the view during laryngoscopy, even with a favorable Mallampati score.

Question 1

Identify the airway device shown in the image.

Accepted Answer

Laryngeal Mask Airway

Answer

Nasopharyngeal Airway

Answer

Cuffed Endotracheal Tube

Answer

Guedel Airway

Question 2

What percentage of oxygen is provided to a victim during mouth-to-mouth respiration?

Accepted Answer

16%

Answer

10%

Answer

21%

Answer

100%

Question 3

Modified Mallampati grading is used in assessment of -

Accepted Answer

Difficulty of intubation

Answer

Obstruction of the airway

Answer

Aspiration-related death

Answer

Endotracheal intubation procedure

Question 4

Laryngeal mask airway [LMA] is contraindicated in?

Accepted Answer

Pregnant female

Answer

Ocular surgeries

Answer

Difficult airways

Answer

In CPR

Question 5

Which of the following is a characteristic of the Supreme Laryngeal Mask Airway (LMA)?

Accepted Answer

Includes a built-in drain tube

Answer

Designed specifically for infants

Answer

Utilizes high pressure, low volume cuff design

Answer

Does not have a bite block

Question 6

Which drug is commonly used for emergency intubation?

Accepted Answer

Etomidate

Answer

None of the options

Answer

Propofol

Answer

Ketamine

Question 7

Which of the following statements is NOT true regarding rapid induction of anesthesia?

Accepted Answer

Sellick's maneuver is always required.

Answer

Suxamethonium is often used.

Answer

Mechanical ventilation is typically avoided before intubation.

Answer

Pre-oxygenation is mandatory

Question 8

In which context can helium replace nitrogen as a diluent gas in oxygen mixtures?

Accepted Answer

None of the options

Answer

Argon

Answer

Xenon

Answer

Helium

Question 9

What is the most reliable indicator to prevent esophageal intubation?

Accepted Answer

Measurement of CO2 in exhaled air (EtCO2).

Answer

Oxygen saturation on pulse oximeter

Answer

Direct visualization of passing tube beneath vocal cords

Answer

Auscultation over chest

Question 10

During preanaesthetic evaluation, an anaesthetist wrote a Mallampati grade 3. What does this signify?

Accepted Answer

Soft palate and base of uvula visible

Answer

Limited neck extension

Answer

An enlarged epiglottis

Answer

Jaw stiffness

Respiratory and Airway Management — MCQs

Respiratory and Airway Management — MCQs

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