Respiratory and Airway Management Practice Questions

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

Tip of curved blade is inserted into aryepiglottic fold. ***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**.

Q: Which is correct about the laryngoscope blades shown below? (Recent NEET Pattern 2016-17)

A= Macintosh blade, B= Miller's blade. ***A= Macintosh blade, B= Miller's blade*** - Image A shows a **curved blade**, which is characteristic of the **Macintosh blade**. This blade is designed to displace the epiglottis indirectly. - Image B displays a **straight blade**, which is consistent with the **Miller blade**. This blade directly lifts the epiglottis. *A= Miller's blade, B= Macintosh blade* - This is incorrect because the blade in image A is curved, not straight, and the blade in image B is straight, not curved. - The **Macintosh blade is curved** and engages the vallecula, while the **Miller blade is straight** and directly lifts the epiglottis. *A= Millard blade, B= Macintosh blade* - This is incorrect as **Millard blades** are typically designed for specific pediatric uses and have a distinct shape, not matching image A. - Image B clearly shows a straight blade, which identifies it as a Miller blade, not a Macintosh blade. *A= Macintosh blade, B= Millard blade* - While image A correctly depicts a Macintosh blade, image B does not show a **Millard blade**. - **Millard blades** are generally straight blades with a specific curvature near the tip, differing from the uniform straightness of the Miller blades shown in B.

Q: A construction worker met with an accident when a cement block fell on his face. He sustained severe maxillofacial and laryngeal injury. He was not able to open his mouth and is having jaw fracture with obstruction in nasopharynx and oropharynx. To stabilize his airway, the following procedure was done on him. Which option describes the procedure done on him?

Tracheostomy. ***Tracheostomy*** - A tracheostomy creates a surgical opening in the **trachea** to establish a direct airway, bypassing the upper airway. This is crucial when the **nasopharynx and oropharynx are obstructed** due to severe maxillofacial and laryngeal injuries, as described in the case. - The procedure allows for ventilation and prevents aspiration, making it the most suitable long-term solution for definitive airway management in patients with extensive facial and jaw trauma preventing oral or nasal intubation. *Cricothyroidotomy* - This procedure involves making an incision through the **cricothyroid membrane** into the trachea. It is typically a **rapid, emergency airway** procedure. - While it provides an immediate airway, it is generally considered a temporary measure due to potential complications like **subglottic stenosis** with prolonged use, and not ideal for the described severe, multifocal obstruction requiring a more stable, long-term solution. *Subcutaneous tracheostomy* - This term is **not a recognized medical procedure** for establishing an airway. - Tracheostomies are performed with direct access to the trachea, not subcutaneously. *Submental insertion of ET* - This technique involves passing an endotracheal tube through a submental incision into the oropharynx, bypassing the mouth in cases of **maxillofacial trauma** and securing the airway. - However, the question describes **obstruction in both the nasopharynx and oropharynx**, and also a laryngeal injury, which would likely preclude the passage of an endotracheal tube even via a submental approach, making a direct tracheal access (tracheostomy) a more appropriate and definitive solution.

Q: What is the mode of ventilation shown here?

SIMV. ***SIMV*** - The graph clearly shows a combination of **patient-triggered breaths** and **time-triggered breaths**, which is characteristic of Synchronized Intermittent Mandatory Ventilation (SIMV). - In SIMV, the ventilator delivers a set number of mandatory breaths, but also allows the patient to breathe spontaneously between these mandatory breaths, and the mandatory breaths are synchronized with the patient's inspiratory effort if within a specific window. *ACMV* - In **Assist-Control Mechanical Ventilation (ACMV)**, every patient inspiratory effort above a set threshold triggers a full mandatory breath from the ventilator. If the patient does not trigger a breath within a set time, the ventilator delivers a mandatory breath. There are no truly spontaneous breaths in ACMV. - The graph shows clearly differentiated patient-triggered and time-triggered breaths, but also implies periods where the patient might breathe spontaneously without full ventilator assistance which isn't the primary characteristic of ACMV. *CPAP* - **Continuous Positive Airway Pressure (CPAP)** provides a constant level of positive pressure throughout the respiratory cycle, supporting spontaneous breathing but not delivering mandatory breaths. - The graph shows distinct pressure cycles indicative of ventilator-delivered breaths, not just continuous positive pressure. *Volume controlled ventilation* - This term describes a **mode of breath delivery** (volume, as opposed to pressure control), not an overall ventilation strategy like SIMV or ACMV. SIMV can be delivered in either volume-controlled or pressure-controlled modes. - While the breaths shown might be volume-controlled, the question asks for the overall mode of ventilation, which is better described by how mandatory and spontaneous breaths are managed.

Q: The following ventilation modality is used in:

Assessment of extubation potential. ***Assessment of extubation potential*** - The image depicts **Continuous Positive Airway Pressure (CPAP)**, as indicated by the "Applied CPAP level" and the continuous positive pressure throughout the respiratory cycle, with slight variations but no distinct inspiratory aid. - CPAP is commonly used as a **weaning modality** to assess a patient's ability to breathe spontaneously and maintain adequate oxygenation and ventilation before extubation. *Meconium aspiration syndrome* - Meconium aspiration syndrome often causes severe respiratory distress, requiring **high-frequency oscillatory ventilation (HFOV)** or **conventional mechanical ventilation** with high PEEP and ventilation strategies to minimize barotrauma and air trapping. - While CPAP might be used in milder cases or during the weaning phase, it is not the primary or defining ventilation modality for initial management of severe MAS. *Bronchiolitis obliterans organizing pneumonia* - **Bronchiolitis obliterans organizing pneumonia (BOOP)**, now known as cryptogenic organizing pneumonia, is a restrictive lung disease that typically responds to **corticosteroids**. - Ventilatory support, if needed, would generally involve conventional mechanical ventilation, not specifically CPAP in its primary management. *Acute exacerbation of chronic bronchitis* - **Acute exacerbations of chronic bronchitis (AECB)**, particularly those leading to hypercapnic respiratory failure, are commonly treated with **non-invasive positive pressure ventilation (NIPPV)**, such as BiPAP, which provides both inspiratory (IPAP) and expiratory (EPAP) pressure support. - While CPAP can be used in some cases, BiPAP is generally preferred for its ability to reduce the work of breathing and improve ventilation in hypercapnic patients.

Q: (1) Name the forceps being used in the procedure being performed:

Magill forceps. ***Magill forceps*** - The image shows **Magill forceps** being used to guide an endotracheal tube or gastric tube through the pharynx into the trachea or esophagus under direct vision. - They are specifically designed for use in the airway, often for retrieving foreign bodies or guiding tubes during **intubation**, characterized by their angled shape. *Caldwell Luc forceps* - **Caldwell-Luc forceps** are typically used in rhinology for procedures within the **maxillary sinus**, such as removing polyps or diseased tissue. - Their shape and angulation are designed for accessing the maxillary antrum, not for manipulating objects in the oropharynx as depicted. *Adson forceps* - **Adson forceps** are small, delicate forceps, often with teeth, used primarily for handling **fine tissues** in surgical procedures. - They are not designed for airway management or for manipulating large tubes in the pharynx. *Bulldog forceps* - **Bulldog forceps** (or bulldog clamps) are small, spring-loaded clamps used to temporarily occlude blood vessels, primarily in vascular surgery. - They are designed to hold tissue or vessels gently but firmly and are not suitable for guiding or retrieving objects in the airway.

Q: Maximum oxygen concentration can be delivered by:

Non-rebreather mask. ***Non-rebreather mask*** - A **non-rebreather mask** provides the highest possible FiO₂ (up to **95–100%**) in spontaneously breathing patients. - It uses a **one-way valve** that prevents rebreathing of exhaled air and a **reservoir bag** that pre-fills with 100% oxygen between breaths. - This device is used for patients with **severe hypoxemia** requiring aggressive oxygen therapy. *Venturi mask* - A **Venturi mask** delivers precise, controlled oxygen concentrations (24%, 28%, 35%, 40%, 50%) through colour-coded Venturi adapters. - It is preferred for patients with **COPD** where precise FiO₂ delivery is critical to avoid suppressing the hypoxic respiratory drive. - Maximum FiO₂ achievable: ~50%. *Nasal cannula* - A **nasal cannula** delivers relatively low concentrations of oxygen (**24–44%** with flow rates of 1–6 L/min). - Suitable for patients requiring **low-flow oxygen therapy**; allows eating, drinking, and talking comfortably. *Simple face mask* - A **simple face mask** delivers moderate oxygen concentrations (**35–50%** with flow rates of 6–10 L/min). - Has no reservoir bag and no one-way valves, so there is some rebreathing of exhaled air, limiting the maximum FiO₂ achievable.

Question 1

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

Accepted Answer

Tip of curved blade is inserted into aryepiglottic fold

Answer

Macintosh laryngoscope is being used for intubation

Answer

Tongue swept to left using flange of blade

Answer

Handle raised up and away, perpendicular to patient's mandible to expose vocal cords

Question 2

Which is correct about the laryngoscope blades shown below? (Recent NEET Pattern 2016-17)

Accepted Answer

A= Macintosh blade, B= Miller's blade

Answer

A= Miller's blade, B= Macintosh blade

Answer

A= Millard blade, B= Macintosh blade

Answer

A= Macintosh blade, B= Millard blade

Question 3

Which is correct about the instrument shown?

Accepted Answer

Insert with rotation movement of 90 degrees with convex upwards

Answer

Insert in clonus stage to prevent tongue bite

Answer

Assist in oropharyngeal suctioning

Answer

Can prevent aspiration of GI contents

Question 4

A construction worker met with an accident when a cement block fell on his face. He sustained severe maxillofacial and laryngeal injury. He was not able to open his mouth and is having jaw fracture with obstruction in nasopharynx and oropharynx. To stabilize his airway, the following procedure was done on him. Which option describes the procedure done on him?

Accepted Answer

Tracheostomy

Answer

Cricothyroidotomy

Answer

Subcutaneous tracheostomy

Answer

Submental insertion of ET

Question 5

The equipment shown below is used for:

Accepted Answer

Create and maintain air passage between tongue and posterior pharyngeal wall

Answer

Create and maintain air passage between tongue and soft palate

Answer

Create and maintain air passage between tongue and hard palate

Answer

Create air and maintain air passage between tongue and anterior pharyngeal wall

Question 6

What is the mode of ventilation shown here?

Accepted Answer

SIMV

Answer

ACMV

Answer

CPAP

Answer

Volume controlled ventilation

Question 7

What is the mode of ventilation shown here?

Accepted Answer

SIMV

Answer

ACMV

Answer

CPAP

Answer

Noninvasive ventilation

Question 8

The following ventilation modality is used in:

Accepted Answer

Assessment of extubation potential

Answer

Meconium aspiration syndrome

Answer

Bronchiolitis obliterans organizing pneumonia

Answer

Acute exacerbation of chronic bronchitis

Question 9

(1) Name the forceps being used in the procedure being performed:

Accepted Answer

Magill forceps

Answer

Caldwell Luc forceps

Answer

Adson forceps

Answer

Bulldog forceps

Question 10

Maximum oxygen concentration can be delivered by:

Accepted Answer

Non-rebreather mask

Answer

Venturi mask

Answer

Nasal cannula

Answer

Simple face mask

Respiratory and Airway Management — MCQs

Respiratory and Airway Management — MCQs

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