Supraglottic Airway Devices — MCQs

10 questions

Patient with BMI 40 presents for emergency surgery. All are correct about airway management EXCEPT:

A patient is admitted following a road traffic accident. He has sustained significant blunt injury to his head, chest and abdomen and has a Glasgow Coma Scale score of 8/15. His saturations are poor at 89% on 15 L of oxygen a rebreathing mask. You note bruising around both eyes and blood-stained fluid issuing from his left ear, which forms concentric circles when dripped on a white sheet. You wish to support his airway to improve oxygenation. The first choice of airway adjunct would be

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

What is the recommended position of a child during an asthmatic attack?

The safest initial approach to open the airway of a patient with maxillofacial trauma is:

Size of the laryngeal mask airway for normal adults-

Which of the following is a second-generation laryngeal mask airway (LMA)?

What is the most reliable indicator to prevent esophageal intubation?

Identify the maneuver being performed.

Q10

All are features of difficult airway except which of the following?

Supraglottic Airway Devices Indian Medical PG Practice Questions and MCQs

Question 1: Patient with BMI 40 presents for emergency surgery. All are correct about airway management EXCEPT:

A. Extended ramping
B. Avoid cricoid pressure (Correct Answer)
C. Rapid sequence induction
D. Avoid preoxygenation

Explanation: ***Avoid cricoid pressure*** - While **cricoid pressure** (Sellick's maneuver) is used to prevent **aspiration** by compressing the esophagus, its effectiveness in **obese patients** is highly debated and often hindered by excess neck tissue. - In obese patients, cricoid pressure can actually worsen the view during laryngoscopy, making intubation more difficult and potentially causing airway trauma. *Extended ramping* - **Ramping** the patient, where the head and shoulders are elevated, is crucial in **obese patients** to align the **oral, pharyngeal, and laryngeal axes**. - This position improves the view during laryngoscopy and facilitates successful intubation by effectively displacing excess tissue. *Rapid sequence induction* - **Rapid sequence induction (RSI)** is often indicated in **obese patients** undergoing emergency surgery due to their increased risk of **gastric reflux** and **pulmonary aspiration**. - RSI involves administering a sedative and a paralytic agent in rapid succession, followed immediately by intubation, to minimize the time the airway is unprotected. *Avoid preoxygenation* - **Preoxygenation** is essential in **obese patients** to maximize their **oxygen reserves** before intubation. - Obese patients have reduced **functional residual capacity (FRC)** and increased **oxygen consumption**, making them desaturate rapidly during apnea, so preoxygenation significantly prolongs safe apnea time.

Question 2: A patient is admitted following a road traffic accident. He has sustained significant blunt injury to his head, chest and abdomen and has a Glasgow Coma Scale score of 8/15. His saturations are poor at 89% on 15 L of oxygen a rebreathing mask. You note bruising around both eyes and blood-stained fluid issuing from his left ear, which forms concentric circles when dripped on a white sheet. You wish to support his airway to improve oxygenation. The first choice of airway adjunct would be

A. Nasopharyngeal tube
B. Intubation
C. Laryngeal mask
D. Oropharyngeal airway (Correct Answer)

Explanation: ***Oropharyngeal airway*** - An **oropharyngeal airway (OPA)** is the most appropriate initial airway adjunct in a patient with a **depressed GCS (8/15)** and poor oxygenation, as it helps to relieve **upper airway obstruction** caused by the tongue falling back. - Given the potential for a **basal skull fracture** (bruising around eyes, blood-stained fluid from ear forming concentric circles), a **nasopharyngeal airway (NPA)** is contraindicated due to the risk of intracranial insertion. *Nasopharyngeal tube* - A **nasopharyngeal airway (NPA)** is contraindicated in this patient due to signs suggestive of a **basal skull fracture**, which include **raccoon eyes (periorbital bruising)** and **Battle's sign (bruising behind the ear)**, as well as the **halo sign (concentric circles of blood and CSF)** from the ear. - Inserting an NPA in such a scenario risks inadvertently entering the **cranial cavity**, leading to further neurological damage or infection. *Intubation* - While **intubation** may eventually be necessary given the patient's low GCS and poor oxygenation, it is not the *first choice* of airway adjunct. - The immediate priority is to establish a **patent airway** quickly and safely, which an OPA can achieve while preparations for definitive intubation are made. *Laryngeal mask* - A **laryngeal mask airway (LMA)** could be considered for airway management, but it is typically a more advanced adjunct than an OPA. - Its insertion requires a certain level of skill and might be more time-consuming than an OPA, which is crucial in an emergency setting.

Question 3: Which of the following is a characteristic of the Supreme Laryngeal Mask Airway (LMA)?

A. Designed specifically for infants
B. Utilizes high pressure, low volume cuff design
C. Includes a built-in drain tube (Correct Answer)
D. Does not have a bite block

Explanation: ***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.

Question 4: What is the recommended position of a child during an asthmatic attack?

A. Supine
B. Semi erect (Correct Answer)
C. Erect
D. Trendelenburg

Explanation: ***Semi erect*** - A **semi-erect or sitting position** (also called the orthopneic position) is the recommended position for children during an asthmatic attack. - This position optimizes **lung expansion**, facilitates use of accessory muscles of respiration, and reduces the work of breathing. - The forward-leaning posture helps to **relieve dyspnea** and is the position most children naturally adopt during respiratory distress. *Supine* - Lying flat on the back **worsens breathing difficulty** by allowing abdominal contents to push against the diaphragm, restricting lung expansion. - This position increases respiratory effort and may worsen **hypoxemia**. - It also increases the risk of **aspiration** if the child coughs or vomits. *Erect* - While a fully upright sitting position is also helpful for breathing, the term **"semi-erect"** or **"sitting"** is more commonly used in clinical guidelines and textbooks when describing the optimal position for acute asthma. - Both positions are acceptable in practice, but "semi-erect" is the preferred terminology as it encompasses the natural forward-leaning posture children adopt during respiratory distress. *Trendelenburg* - In the **Trendelenburg position**, the head is lower than the feet, which **significantly worsens respiratory distress** by increasing pressure on the diaphragm. - This position is contraindicated in asthma and is used for specific conditions such as **hypotensive shock** or during certain surgical procedures, not for respiratory compromise.

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

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.

Question 6: Size of the laryngeal mask airway for normal adults-

A. 2.5
B. 4
C. 1.5
D. 3 (Correct Answer)

Explanation: ***3*** - A size **3 LMA** is generally recommended for an average adult, especially adult females, weighing approximately 30-50 kg. - This size provides an adequate seal for ventilating normal adult airways when a larger LMA (size 4 or 5) may not be suitable based on patient size or anatomy. *2.5* - A size **2.5 LMA** is typically used for older children (ages 6-12 years) or smaller pediatric patients, not normal adults. - Using a size 2.5 in an adult would likely result in an inadequate seal and poor ventilation. *4* - A size **4 LMA** is commonly used for larger adult males weighing approximately 50-70 kg or more. - While suitable for some adults, it may be too large for an "average" adult, potentially causing pharyngeal trauma or poor positioning. *1.5* - A size **1.5 LMA** is designed for infants or very small children, typically those weighing 5-10 kg. - This size is much too small for any adult and would provide no effective airway management.

Question 7: Which of the following is a second-generation laryngeal mask airway (LMA)?

A. Ambu
B. Classic LMA
C. LMA Flexible
D. LMA Proseal (Correct Answer)

Explanation: ***LMA Proseal*** - The **LMA Proseal** is classified as a second-generation LMA because it incorporates features like a **gastric access channel** (drain tube) to allow for suctioning of gastric contents and a **higher seal pressure** around the glottis. - These advancements improve **airway protection** and ventilation efficacy compared to first-generation devices. *Ambu* - The term "Ambu" primarily refers to the company that manufactures various medical devices, including LMAs, but does not specify a particular LMA model that is exclusively second-generation. - Ambu has produced both first and second-generation supraglottic airway devices. *Classic LMA* - The **Classic LMA** is considered a **first-generation** laryngeal mask airway. - It lacks features such as a gastric access channel and typically provides a lower seal pressure, offering less protection against aspiration. *LMA Flexible* - The **LMA Flexible** is also a **first-generation** laryngeal mask airway, distinguished by its wire-reinforced, flexible tube allowing for surgical access to the head and neck. - While it has a specialized design, it does not possess the inherent safety features (e.g., gastric access) that define second-generation devices.

Question 8: What is the most reliable indicator to prevent esophageal intubation?

A. Oxygen saturation on pulse oximeter
B. Direct visualization of passing tube beneath vocal cords
C. Auscultation over chest
D. Measurement of CO2 in exhaled air (EtCO2). (Correct Answer)

Explanation: ***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.

Question 9: Identify the maneuver being performed.

A. Head tilt, chin lift (Correct Answer)
B. Jaw thrust maneuver
C. Head extension technique
D. In-line manual stabilization

Explanation: ***Head tilt, chin lift*** - This maneuver is performed by placing one hand on the patient's forehead and tilting the head back while simultaneously using the fingers of the other hand to lift the chin, thereby opening the airway. - It is a primary technique to establish an **open airway** in an unconscious patient who does not have suspected cervical spine injury. *Jaw thrust maneuver* - The jaw thrust maneuvers involves placing fingers behind the angles of the patient's mandible and displacing the jaw forward, which can be done without extending the neck. - This maneuver is preferred for patients with suspected **cervical spine injuries** to open the airway while minimizing neck movement. *Head extension technique* - This term describes the **head tilt component** of the head tilt, chin lift maneuver, but it doesn't encompass the chin lift aspect, making it an incomplete description of the depicted action. - Simply extending the head without lifting the chin might not adequately open the airway by lifting the tongue off the posterior pharynx. *In-line manual stabilization* - This technique involves manually holding the patient's head and neck to prevent movement, typically used when a **cervical spine injury** is suspected. - It is a **supportive measure** often performed *in conjunction* with airway maneuvers like the jaw thrust, not an airway maneuver itself.

Question 10: All are features of difficult airway except which of the following?

A. Miller's sign
B. Micrognathia with macroglossia
C. TMJ ankylosis
D. Increased thyromental distance (Correct Answer)

Explanation: ***Increased thyromental distance*** - An **increased thyromental distance** (typically > 6.5 cm) indicates more space between the thyroid cartilage and the mentum (chin), suggesting a **less acute angle for intubation** and often a **straightforward airway**. - This measurement correlates with a **better laryngeal view** during direct laryngoscopy. *Miller's sign* - **Miller's sign** refers to the presence of **subglottic stenosis** or **tracheal narrowing**, which can make intubation and ventilation extremely difficult. - This condition can lead to significant challenges in passing an endotracheal tube and securing the airway. *Micrognathia with macroglossia* - **Micrognathia** (small jaw) reduces the space for the tongue, while **macroglossia** (large tongue) further obstructs the airway. - This combination creates a **severely restricted oral and pharyngeal space**, making visualization of the larynx and intubation very challenging. *TMJ ankylosis* - **Temporomandibular joint (TMJ) ankylosis** significantly **limits mouth opening**, which is critical for successful direct laryngoscopy and intubation. - A restricted mouth opening makes it difficult to insert the laryngoscope blade and visualize the vocal cords.

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