Respiratory and Airway Management Practice Questions

Q: All of the following are examples of definite airways, except?

Laryngeal Mask airway. ### Explanation The concept of a **"Definitive Airway"** is a high-yield topic in emergency medicine and anesthesiology. By definition, a definitive airway requires a tube present in the **trachea** with the **cuff inflated below the vocal cords**, connected to an oxygen-enriched ventilation source, and secured in place. **Why Laryngeal Mask Airway (LMA) is the correct answer:** The LMA is a **supraglottic airway device**. It sits in the hypopharynx and masks the glottic opening but does not enter the trachea. Because it does not provide a physical barrier within the trachea, it does not reliably protect against pulmonary aspiration of gastric contents. Therefore, it is considered an "intermediate" or "temporary" airway, not a definitive one. **Analysis of Incorrect Options:** * **Orotracheal Tube (B) & Nasotracheal Tube (A):** These are the gold standards for definitive airways. The tube passes through the vocal cords into the trachea, and the inflated cuff provides a seal that protects the lungs from aspiration and allows for positive pressure ventilation. * **Cricothyroidotomy (D):** This is a **surgical definitive airway**. Whether performed via needle or surgical incision, the tube is placed directly into the trachea through the cricothyroid membrane, meeting the criteria for a definitive airway. **Clinical Pearls for NEET-PG:** * **Indications for a Definitive Airway:** Apnea, inability to maintain a patent airway by other means, protection from aspiration (blood/vomitus), or significant head injury (GCS ≤ 8). * **The "GCS 8, Intubate" Rule:** A classic mnemonic for when a definitive airway is mandatory. * **Surgical Airway:** If "cannot intubate, cannot ventilate" occurs, a surgical definitive airway (Cricothyroidotomy) is the final step in the difficult airway algorithm. * **Tracheostomy** is also a definitive airway, usually reserved for long-term management rather than acute resuscitation.

Q: What is the preferred method of intubation for patients undergoing oral surgeries with bilateral temporomandibular joint (TMJ) ankylosis?

North pole RAE tube. **Explanation:** In patients with **bilateral temporomandibular joint (TMJ) ankylosis**, the primary anesthetic challenge is a "cannot ventilate, cannot intubate" scenario due to restricted mouth opening. For oral surgeries, the surgeon requires an unobstructed surgical field. **Why North Pole RAE is correct:** The **RAE (Ring-Adair-Elwyn) tube** is a pre-formed, angled endotracheal tube designed to prevent kinking and improve surgical access. The **North Pole RAE tube** is specifically designed for **nasotracheal intubation**. It features a pre-formed bend that directs the tube upward (towards the patient's head/north) after exiting the nostril. This allows the breathing circuit to be positioned away from the mouth, providing the surgeon with an unobstructed view and access to the oral cavity and TMJ. **Why other options are incorrect:** * **South Pole RAE tube:** These are designed for **orotracheal intubation**. The bend directs the tube downward (towards the feet/south) over the chin. In TMJ ankylosis, the mouth cannot open sufficiently for oral intubation, and the tube would obstruct the surgical site. * **Tracheostomy/Cricothyrotomy:** These are invasive surgical airways. While they may be used in emergencies or for long-term ventilation, they are not the "preferred" initial method for elective oral surgery if a fiberoptic-guided nasal intubation is feasible. **High-Yield Clinical Pearls for NEET-PG:** * **Gold Standard for TMJ Ankylosis:** Awake Fiberoptic Intubation (AFOI) via the nasal route is the safest approach. * **RAE Mnemonic:** **N**orth = **N**asal (for oral/dental surgery); **S**outh = **O**ral (for ENT/ophthalmic/cranial surgery). * **Magill Forceps:** Often used during nasal intubation to guide the tube into the glottis, though caution is needed in limited mouth opening.

Q: Which general anesthetic is most likely to cause bronchodilation?

Ketamine. **Explanation:** **Ketamine** is the correct answer because it is a potent bronchodilator. Its mechanism involves a direct relaxant effect on bronchial smooth muscle and an indirect effect via the inhibition of catecholamine reuptake, which increases circulating adrenaline. This makes Ketamine the **induction agent of choice for patients with reactive airway diseases**, such as bronchial asthma or COPD. **Analysis of Incorrect Options:** * **Thiopentone (Option A):** It is known to cause respiratory depression and can trigger **histamine release**. This may lead to bronchospasm, making it contraindicated in asthmatic patients. * **Propofol (Option C):** While Propofol does produce some bronchodilation (by inhibiting vagal tone and calcium signaling), it is less potent than Ketamine in this regard. It is generally safe for asthmatics but is not the "most likely" to be tested for its bronchodilatory properties compared to Ketamine. * **Fentanyl (Option D):** As an opioid, Fentanyl can cause respiratory depression. High doses or rapid administration can lead to **"Chest Wall Rigidity"** (Wooden Chest Syndrome), which severely impairs ventilation. **High-Yield Clinical Pearls for NEET-PG:** * **Ketamine** is also the induction agent of choice for **hypovolemic shock** due to its sympathomimetic effects (increases HR and BP). * **Avoid Ketamine** in patients with hypertension, ischemic heart disease, or increased intracranial/intraocular pressure. * Among volatile (inhalational) anesthetics, **Sevoflurane** is the most potent bronchodilator and is preferred for gas induction in asthmatics. * **Halothane** also causes bronchodilation but sensitizes the myocardium to catecholamines, increasing the risk of arrhythmias.

Q: During an anesthetic procedure, what is the primary purpose of compressing the cricoid cartilage?

To help in preventing regurgitation. **Explanation:** The compression of the cricoid cartilage is known as **Sellick’s Maneuver**. It is a key component of Rapid Sequence Induction (RSI), used primarily in patients with a "full stomach" who are at high risk of aspiration. **1. Why Option B is Correct:** The cricoid cartilage is the only complete cartilaginous ring in the larynx. Applying firm downward pressure (approx. 30 Newtons) compresses the esophagus against the body of the fifth or sixth cervical vertebra. This mechanical occlusion prevents the passive regurgitation of gastric contents into the pharynx, thereby reducing the risk of pulmonary aspiration. **2. Why Other Options are Incorrect:** * **Option A:** Spinal headaches (Post-Dural Puncture Headaches) are complications of neuraxial anesthesia, managed with bed rest, hydration, or an epidural blood patch, not airway maneuvers. * **Option C:** While **BURP** (Backwards, Upwards, Rightwards Pressure) on the *thyroid* cartilage is used to improve the glottic view during intubation, the primary goal of *cricoid* pressure is aspiration prophylaxis, not visualization. * **Option D:** Bronchospasm is a reactive airway issue treated with bronchodilators or deepening the plane of anesthesia; physical compression of the airway would likely worsen the situation. **High-Yield Clinical Pearls for NEET-PG:** * **Timing:** Cricoid pressure should be applied while the patient is awake (before induction) and maintained until the ETT cuff is inflated and position is confirmed. * **Contraindications:** Active vomiting (may cause esophageal rupture), unstable cervical spine fractures, and laryngeal trauma. * **Pressure:** 10N when awake, increasing to 30N once consciousness is lost.

Q: Which of the following devices is most effective in preventing aspiration?

Proseal Laryngeal Mask Airway (LMA). **Explanation:** The **Proseal Laryngeal Mask Airway (PLMA)** is the correct answer because it is a second-generation supraglottic airway device specifically designed to improve safety compared to the classic LMA. Its primary advantage is the inclusion of a **drain tube** (gastric channel) that allows for the passage of a gastric tube to decompress the stomach and provides a bypass for regurgitated fluid, significantly reducing the risk of aspiration. Additionally, it features a larger, deeper cuff that provides a better posterior seal and allows for higher positive pressure ventilation (up to 30 cm H₂O). **Analysis of Incorrect Options:** * **Laryngeal Mask Airway (Classic LMA):** While it maintains a patent airway, it does not protect against aspiration. It sits above the glottis and lacks a gastric drain, meaning regurgitated contents can easily enter the trachea. * **Oropharyngeal Airway (OPA):** This is a simple adjunct used to prevent the tongue from obstructing the posterior pharynx in unconscious patients. It provides no protection for the lower airway against gastric contents. * **Nasopharyngeal Airway (NPA):** Similar to the OPA, this is a conduit to maintain upper airway patency. It does not seal the glottis or isolate the esophagus, offering no protection against aspiration. **High-Yield Clinical Pearls for NEET-PG:** * **Gold Standard:** The **Endotracheal Tube (ETT)** remains the absolute gold standard for preventing aspiration; however, among the *listed* supraglottic/adjunct devices, the Proseal LMA is superior. * **Second-Generation SADs:** Devices like the Proseal LMA, Supreme LMA, and I-gel are characterized by their ability to allow gastric drainage. * **Indication:** PLMA is often preferred in controlled ventilation cases where a higher seal pressure is required compared to a classic LMA.

Q: All are true about armoured endotracheal tubes except?

It has a radiopaque line like a normal ETT.. **Explanation:** Armoured endotracheal tubes (also known as **reinforced** or **anode tubes**) are specialized airways designed for specific clinical scenarios where tube patency is at risk due to positioning. **1. Why Option B is the Correct Answer (The False Statement):** Unlike standard PVC endotracheal tubes, which require a **radiopaque line** (Blue Line) for X-ray visualization, armoured tubes do not need one. The **stainless steel or nylon wire coil** embedded throughout the shaft is inherently radio-dense. Therefore, the entire length of the tube is visible on a chest X-ray, making a separate radiopaque line redundant. **2. Analysis of Other Options:** * **Option A:** This is the defining feature. The wire coil provides structural integrity while maintaining flexibility. * **Option C:** The primary clinical advantage is that they are **kink-resistant**. They are ideal for surgeries involving extreme head/neck flexion (e.g., posterior fossa surgery) or where the surgeon may lean on the tube (e.g., ENT/Maxillofacial surgery). * **Option D:** To accommodate the embedded wire coil within the silicone or PVC matrix, the outer wall is slightly thicker than a standard ETT of the same internal diameter. **High-Yield Clinical Pearls for NEET-PG:** * **The "Floppy" Nature:** While kink-resistant, these tubes are very flexible and usually require a **stylet** for intubation. * **The Danger of Biting:** If a patient bites an armoured tube, the wire coil can deform permanently, **occluding the lumen**. Unlike standard ETTs, it will not "spring back." A bite block is mandatory. * **MRI Safety:** Most modern armoured tubes use non-ferromagnetic materials, but older versions with stainless steel coils are a contraindication for MRI. * **No Shortening:** You cannot cut an armoured tube to shorten it, as this would expose the wire coil.

Question 1

Plan C of anesthetic airway management involves which of the following?

Accepted Answer

Insertion of laryngeal mask airway and fiberoptic bronchoscopy

Answer

Standard laryngoscopy and intubation

Answer

Intubation catheter guided intubation

Answer

Cancel the surgery or perform tracheostomy

Question 2

All of the following are examples of definite airways, except?

Accepted Answer

Laryngeal Mask airway

Answer

Nasotracheal tube

Answer

Orotracheal tube

Answer

Cricothyroidotomy

Question 3

Which of the following maneuvers is NOT performed during laryngoscopy and endotracheal intubation?

Accepted Answer

The laryngoscope is lifted upwards, levering over the upper incisors

Answer

Flexion of the neck

Answer

Extension of the head at the atlanto-occipital joint

Answer

In a straight blade laryngoscope, the epiglottis is lifted by the tip

Question 4

Difficulty in laryngoscopy and intubation is seen in all except:

Accepted Answer

Modified Mallampati class 2

Answer

Cervical joint immobility

Answer

Upper lip bite test negative

Answer

Interincisor gap of <3cm

Question 5

All statements are true about modified rapid sequence induction except?

Accepted Answer

Preoxygenation is not mandatory.

Answer

Rocuronium is used as a neuromuscular blocker.

Answer

Any IV induction agent can be used.

Answer

Positive pressure ventilation with bag and mask is not performed.

Question 6

What is the preferred method of intubation for patients undergoing oral surgeries with bilateral temporomandibular joint (TMJ) ankylosis?

Accepted Answer

North pole RAE tube

Answer

South pole RAE tube

Answer

Tracheostomy

Answer

Cricothyrotomy

Question 7

Which general anesthetic is most likely to cause bronchodilation?

Accepted Answer

Ketamine

Answer

Thiopentone

Answer

Propofol

Answer

Fentanyl

Question 8

During an anesthetic procedure, what is the primary purpose of compressing the cricoid cartilage?

Accepted Answer

To help in preventing regurgitation

Answer

To prevent spinal headache

Answer

To aid in intubation

Answer

To relieve reflex bronchospasm

Question 9

Which of the following devices is most effective in preventing aspiration?

Accepted Answer

Proseal Laryngeal Mask Airway (LMA)

Answer

Laryngeal Mask Airway (LMA)

Answer

Oropharyngeal airway

Answer

Nasopharyngeal airway

Question 10

All are true about armoured endotracheal tubes except?

Accepted Answer

It has a radiopaque line like a normal ETT.

Answer

These are tubes with a metal wire coil embedded in the wall of the tube shaft.

Answer

It is bend resistant.

Answer

It has a slightly thicker outer wall as compared to a normal ETT.

Respiratory and Airway Management — MCQs

Respiratory and Airway Management — MCQs

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