Video Laryngoscopy — MCQs

10 questions

All of the following are advantages of LMA except:

Endotracheal tube in the esophagus is best assessed by:

Which of these is the most life-threatening injury that can be identified by assessing the breathing component of the patient?

Identify the instrument shown in the image:

What is the correct sequence of management in a patient who presents to the casualty with an RTA? 1. Cervical spine stabilization 2. Intubation 3. IV cannulation 4. CECT

The position adopted for tonsillectomy is also adopted for this procedure.

Steps of intubation - arrange in sequence:- a. Head extension and flexion of neck b. Introduction of laryngoscope c. Inflation of cuff d. Check breath sounds with stethoscope e. fixation of the tube to prevent dislodgement

In correct positioning the tip of the instrument shown in the image should lie at:

All are correct about the procedure being performed except: (Recent NEET Pattern 2016-17)

Q10Medium

Which of the following indicates anticipated difficult bag-mask ventilation?

Video Laryngoscopy Indian Medical PG Practice Questions and MCQs

Question 1: All of the following are advantages of LMA except:

A. Alternative to Endotracheal intubation
B. Prevent aspiration (Correct Answer)
C. More reliable than face mask
D. Does not require laryngoscope & Visualization

Explanation: ***Prevent aspiration*** - While the **LMA** provides a seal for ventilation, it does not fully isolate the trachea from the esophagus, making it **less effective** than an endotracheal tube in preventing aspiration of gastric contents. - Patients at high risk for aspiration (e.g., non-fasted, pregnant, or with reflux) are generally **contraindicated** for LMA use. *Alternative to Endotracheal intubation* - The **LMA** is a recognized alternative for airway management in many surgical procedures, especially those of **short duration** or when tracheal intubation is difficult. - It provides an effective seal for ventilation and oxygenation in situations where a secure endotracheal tube is not immediately feasible or desired. *More reliable than face mask* - The **LMA** creates a much more reliable and consistent seal around the laryngeal inlet compared to a face mask, reducing the need for continuous manual jaw lift and improving ventilation. - This improved seal minimizes gas leak and allows for more effective positive pressure ventilation. *Does not require laryngoscope & Visualization* - Inserrtion of an **LMA** is performed blindly, relying on anatomical landmarks rather than direct visualization of the vocal cords with a laryngoscope. - This simplifies the insertion process and can be advantageous in difficult airway scenarios or when equipment for direct laryngoscopy is unavailable.

Question 2: Endotracheal tube in the esophagus is best assessed by:

A. Direct laryngoscopy
B. Auscultation
C. CO2 Exhalation (Correct Answer)
D. Chest wall movement

Explanation: ***CO2 Exhalation*** - Measuring **CO2 exhalation** (capnography) is the most reliable method to confirm endotracheal tube placement, as CO2 is present in the trachea but not in the esophagus. - A persistent **waveform on the capnograph** indicates proper tracheal intubation. *Direct laryngoscopy* - While helpful for initial visualization during intubation, **direct laryngoscopy** cannot confirm continuous tracheal placement after the tube is advanced. - It only confirms the tube passing through the vocal cords, not its final position in the trachea versus esophagus. *Auscultation* - **Auscultation** can be misleading because stomach sounds can be transmitted to the chest, and breath sounds can be heard in the epigastrium even with esophageal intubation. - It relies on subjective interpretation and is less definitive than capnography. *Chest wall movement* - Observing **chest wall movement** is not a definitive sign, as the chest can still rise with esophageal intubation due to air entering the stomach. - This method is unreliable and can be mistaken for proper ventilation, leading to dangerous delays in correcting tube misplacement.

Question 3: Which of these is the most life-threatening injury that can be identified by assessing the breathing component of the patient?

A. Blunt cardiac injury
B. Tension pneumothorax (Correct Answer)
C. Cervical spine injury
D. Laryngotracheal injury

Explanation: ***Tension pneumothorax*** - A tension pneumothorax is a **life-threatening condition** identified during the breathing assessment, as it severely impairs ventilation and causes **hemodynamic instability** by compressing major vessels. - Key signs include absent breath sounds on the affected side, **tracheal deviation**, and **hypotension** due to mediastinal shift. *Blunt cardiac injury* - While serious, blunt cardiac injury is typically identified during the **circulation assessment**, with signs like arrhythmias, hypotension, or cardiac tamponade. - Its direct impact on breathing is less immediate compared to a tension pneumothorax. *Cervical spine injury* - A cervical spine injury can affect breathing if it involves the **phrenic nerve** (C3-C5), leading to respiratory paralysis, but this is assessed during the **disability component** or secondary survey for neurological deficits. - It does not directly cause an acute, life-threatening compromise of lung function discernible primarily through a breathing assessment like a tension pneumothorax. *Laryngotracheal injury* - A laryngotracheal injury primarily affects the **airway component** (A in ABCDE), leading to immediate obstruction or stridor. - While critical, it is distinct from problems with the lungs' ability to expand or perform gas exchange, which are assessed under breathing.

Question 4: Identify the instrument shown in the image:

A. Nasogastric tube
B. Uncuffed endotracheal (ET) tube (Correct Answer)
C. Oropharyngeal tube
D. Tracheostomy tube

Explanation: ***Uncuffed endotracheal (ET) tube*** - This image displays a transparent, flexible tube with a distinct connector at one end and no inflated cuff near the distal tip, which is characteristic of an **uncuffed endotracheal tube**. - Uncuffed ET tubes are commonly used in **pediatric patients** where a cuff could potentially damage the narrower, cone-shaped trachea. *Nasogastric tube* - A nasogastric tube typically has a much **smaller diameter** and a distinctly different tip design, often with multiple side ports for fluid aspiration or administration. - It does not feature the large, universal connector seen on endotracheal tubes. *Oropharyngeal tube* - An oropharyngeal (Guedel) airway is a **rigid, curved device** inserted into the mouth to maintain an open airway, and it looks distinctly different from the flexible tube shown. - It does not extend into the trachea like an ET tube. *Tracheostomy tube* - A tracheostomy tube is typically shorter, often with a curved neck flange for securement to the neck, and frequently made with an outer and inner cannula, which are absent in the image. - While it helps maintain an airway, its design is specific for insertion directly into a tracheostomy stoma, unlike the longer tube for oral/nasal intubation.

Question 5: What is the correct sequence of management in a patient who presents to the casualty with an RTA? 1. Cervical spine stabilization 2. Intubation 3. IV cannulation 4. CECT

A. 2,1,4,3
B. 1,3,2,4
C. 2,1,3,4
D. 1,2,3,4 (Correct Answer)

Explanation: ***1,2,3,4*** - This sequence follows the **ATLS (Advanced Trauma Life Support)** protocol, prioritizing immediate life threats in order. - **Cervical spine stabilization** is the **first action upon patient contact** to prevent secondary neurological injury in any trauma patient. - **Airway management (intubation)** is then performed **with maintained in-line c-spine stabilization** - these occur nearly simultaneously but c-spine protection is instituted first. - **IV cannulation (circulation)** follows to establish vascular access for resuscitation and medications. - **CECT (imaging)** is performed last, once the patient is stabilized after addressing immediate life threats. - This follows the **ATLS Primary Survey: Airway (with c-spine protection) → Breathing → Circulation → Disability → Exposure**. *2,1,4,3* - This incorrectly places intubation **before** cervical spine stabilization is initiated. - In ATLS, **c-spine protection must be applied immediately upon patient contact** before any airway manipulation. - Delaying IV cannulation until after CECT is inappropriate as circulatory access is critical for early resuscitation. *1,3,2,4* - While this correctly starts with cervical spine stabilization, it incorrectly places **IV cannulation before intubation**. - In the ATLS primary survey, **Airway comes before Circulation** - securing the airway takes priority over establishing IV access. - This sequence could delay critical airway management in a patient with respiratory compromise. *2,1,3,4* - This sequence places **intubation before cervical spine stabilization**, which violates ATLS principles. - **C-spine stabilization must be the first action** upon approaching any trauma patient to prevent secondary spinal cord injury. - While intubation with in-line stabilization is possible, the c-spine protection must be instituted first, not after beginning airway manipulation.

Question 6: The position adopted for tonsillectomy is also adopted for this procedure.

A. Indirect laryngoscopy
B. Tracheostomy (Correct Answer)
C. Bronchoscopy
D. Direct laryngoscopy

Explanation: ***Tracheostomy*** - For a **tracheostomy**, the patient is typically positioned supine with the neck extended (often with a shoulder roll) to expose the trachea, similar to the Rose position used for tonsillectomy. - This position optimizes surgical access to the neck and upper airway, allowing for safe incision and tube placement. *Indirect laryngoscopy* - This procedure usually involves the patient sitting upright with the neck slightly flexed and the head extended, using a mirror to visualize the larynx. - It specifically avoids surgical intervention and thus does not require the same deep neck extension as tonsillectomy or tracheostomy. *Bronchoscopy* - While patient positioning may vary, bronchoscopy is primarily an endoscopic procedure that involves inserting a bronchoscope through the mouth or nose into the airways. - It does not require a surgical approach to the anterior neck and therefore does not use the tonsillectomy position. *Direct laryngoscopy* - Though it provides a direct view of the larynx, the patient is usually supine with the head extended (sniffing position) to align the oral, pharyngeal, and laryngeal axes. - While there is some neck extension, it differs from the more pronounced extension used for direct surgical access to the neck, as in tracheostomy or tonsillectomy.

Question 7: Steps of intubation - arrange in sequence:- a. Head extension and flexion of neck b. Introduction of laryngoscope c. Inflation of cuff d. Check breath sounds with stethoscope e. fixation of the tube to prevent dislodgement

A. CBAED
B. ACBED
C. DBCEA
D. ABCDE (Correct Answer)

Explanation: **ABCDE** - The correct sequence for intubation starts with proper patient positioning (**A. Head extension and flexion of neck**) followed by insertion of the laryngoscope (**B. Introduction of laryngoscope**). - After visualizing the glottis and inserting the endotracheal tube, the cuff is inflated (**C. Inflation of cuff**), tube placement is confirmed by checking breath sounds (**D. Check breath sounds with stethoscope**), and finally, the tube is secured (**E. Fixation of the tube to prevent dislodgement**). *CBAED* - This sequence is incorrect because inflating the cuff (C) and introducing the laryngoscope (B) occur before head positioning (A), and checking breath sounds (E) and fixation (D) are not in the correct order after intubation. - Proper patient positioning is the critical first step to align the oral, pharyngeal, and laryngeal axes for optimal visualization. *ACBED* - This sequence incorrectly places the inflation of the cuff (C) before the introduction of the laryngoscope (B) and confirmation steps (E and D). - The cuff is inflated only after the tube is properly placed in the trachea, and confirmation of placement always precedes fixation. *DBCEA* - This sequence is incorrect as it begins with checking breath sounds (D), which is a step for confirming tube placement, not initiating the intubation process. - Head positioning (A) is also placed last, which is contrary to the vital initial steps of airway management for intubation.

Question 8: In correct positioning the tip of the instrument shown in the image should lie at:

A. Thyroid cartilage
B. Above esophagus
C. Vocal cords
D. Epiglottis (Correct Answer)

Explanation: ***Epiglottis*** - The image shows a **Laryngeal Mask Airway (LMA)**, which is designed to sit in the hypopharynx, with its tip resting at the **epiglottis**. - This positioning allows the LMA to create a seal around the laryngeal inlet, facilitating effective ventilation without entering the trachea. *Vocal cords* - The LMA is designed to provide a seal *above* the vocal cords, ensuring ventilation of the trachea without direct intubation of the vocal cords themselves. - Positioning the tip *at* the vocal cords would hinder proper airway sealing and could cause trauma. *Thyroid cartilage* - The thyroid cartilage is an anterior neck structure and is not the anatomical landmark for the tip of a properly placed LMA. - The LMA sits deeper in the pharynx, above the glottic opening, making the epiglottis the relevant landmark. *Above esophagus* - While the LMA sits **above the esophageal inlet**, diverting air primarily into the trachea, its *tip* specifically rests at the epiglottis, covering the laryngeal opening. - Stating "above the esophagus" is too general; the precise anatomical placement for the tip is at the epiglottis.

Question 9: All are correct about the procedure being performed except: (Recent NEET Pattern 2016-17)

A. Macintosh laryngoscope is being used for intubation
B. Tongue swept to left using flange of blade
C. Tip of curved blade is inserted into aryepiglottic fold (Correct Answer)
D. Handle raised up and away, perpendicular to patient's mandible to expose vocal cords

Explanation: ***Tip of curved blade is inserted into aryepiglottic fold*** - This statement is incorrect because the tip of a **Macintosh blade** (curved blade) is designed to be placed in the **vallecula**, the space between the base of the tongue and the epiglottis, not the aryepiglottic fold. - Positioning in the vallecula allows the blade to indirectly lift the **epiglottis**, exposing the vocal cords. *Macintosh laryngoscope is being used for intubation* - The image clearly shows a **curved laryngoscope blade**, which is characteristic of the **Macintosh blade**. - The Macintosh laryngoscope is commonly used for **oral endotracheal intubation** to visualize the vocal cords. *Tongue swept to left using flange of blade* - During direct laryngoscopy, the laryngoscope blade is inserted on the **right side of the tongue** and then used to sweep the tongue to the left. - This maneuver helps to clear the line of sight and prevent obstruction from the tongue. *Handle raised up and away, perpendicular to patient's mandible to expose vocal cords* - To properly expose the vocal cords, the laryngoscope handle should be lifted **upward and outward** along the axis of the handle, away from the patient's face. - This action elevates the **epiglottis** and associated structures, providing a clear view of the **larynx**.

Question 10: Which of the following indicates anticipated difficult bag-mask ventilation?

A. Age > 30 years
B. BMI > 20 kg/m²
C. Beard (Correct Answer)
D. None of the above

Explanation: **Explanation:** The correct answer is **Beard**. Bag-mask ventilation (BMV) requires an airtight seal between the patient’s face and the mask to generate positive pressure. A **beard** acts as a physical barrier, preventing an adequate seal and allowing gas to leak, which directly leads to difficult BMV. **Analysis of Options:** * **Age > 30 years (Incorrect):** While age is a predictor, the threshold for difficult BMV is typically **age > 55 years**. This is due to loss of tissue elasticity and potential edentulousness (lack of teeth), which causes facial collapse. * **BMI > 20 kg/m² (Incorrect):** A BMI of 20 is within the normal range. The risk factor for difficult BMV is **Obesity**, specifically a **BMI > 26–30 kg/m²**. Excess soft tissue in the upper airway increases resistance and reduces compliance. * **Beard (Correct):** As discussed, facial hair interferes with the mask-to-skin interface. **High-Yield Clinical Pearl: The MOANS Mnemonic** For NEET-PG, remember the **MOANS** mnemonic to predict difficult bag-mask ventilation: 1. **M – Mask Seal:** Beard, facial trauma, or drainage. 2. **O – Obesity/Obstruction:** BMI > 26 kg/m², pregnancy, or upper airway masses (e.g., epiglottitis). 3. **A – Age:** > 55 years. 4. **N – No teeth (Edentulous):** Causes the cheeks to cave in (Note: Leaving dentures in during BMV can actually improve the seal). 5. **S – Stiff lungs/Snoring:** Increased airway resistance or decreased compliance (e.g., COPD, ARDS, or OSA). **Key Fact:** The most common cause of airway obstruction during BMV in an unconscious patient is the **tongue** falling back against the posterior pharynx. This is managed by the "Head tilt-Chin lift" or "Jaw thrust" maneuver.

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