Platinum Final Exam EMTP 3.3 Review (2025 Version) – Practice Test (150
Questions – Latest Edition | Instructor Verified)
Domain I: Airway Management, Respiration, and Ventilation (Questions
1–24)
You are assessing a 68-year-old male with respiratory distress. He is sitting upright,
using accessory muscles, and you hear a "saw-tooth" sound on inspiration. His
mental status is altered. Which immediate intervention is most critical?
A. Administration of a nebulized bronchodilator
B. Immediate endotracheal intubation
C. CPAP with 100% oxygen
1. D. Nasopharyngeal airway placement
B. Immediate endotracheal intubation
The "saw-tooth" sound is stridor, indicating upper airway obstruction. The
altered mental status (AMS) signifies imminent failure of the airway and
respiratory compensation. While CPAP (C) can help in some obstruction
cases like pulmonary edema or mild croup, AMS dictates securing the airway
definitively before complete obstruction occurs. Bronchodilators (A) are
ineffective for anatomical obstructions. NPA (D) will not help if the obstruction
is above the nares or if the larynx is swollen shut.
Which of the following is an absolute contraindication for the insertion of a
nasopharyngeal airway (NPA)?
A. Unconscious patient with a gag reflex
B. Basilar skull fracture
C. Facial trauma involving the nose
2. D. A history of COPD
B. Basilar skull fracture
In a basilar skull fracture, the cribriform plate may be fractured. Inserting an
NPA could potentially enter the cranial vault, causing brain damage or
infection. Signs include raccoon eyes, Battle’s sign, or CSF
otorrhea/rhinorrhea. While facial trauma (C) is a relative contraindication (use
the other nostril), a skull fracture is absolute.
,You are ventilating a 45-year-old female with a BVM. You notice significant gastric
distention and minimal chest rise. What is the most likely cause?
A. Excessive tidal volume
B. Inadequate airway opening
C. High airway resistance (asthma)
3. D. Oxygen flow rate too high
B. Inadequate airway opening
Gastric distention usually occurs because air is entering the stomach rather
than the lungs. This is most commonly caused by failure to open the airway
properly (head-tilt/chin-lift or jaw-thrust), causing the epiglottis to remain
closed. While excessive volume (A) can cause it, the root cause is usually
poor technique. High resistance (C) makes ventilation difficult, but distention
specifically implies air is going the wrong way.
A 22-year-old male has sustained a severe facial injury in an assault. He is
conscious but gurgling. You are unable to open his mouth due to trismus. What is the
BEST airway management option?
A. Oropharyngeal airway (OPA)
B. Nasotracheal intubation
C. Surgical cricothyrotomy
4. D. Digital intubation
C. Surgical cricothyrotomy
This is a "cannot intubate, cannot ventilate" scenario (CICV). The patient has
massive facial trauma (likely unstable for nasal/oral intubation) and trismus
(cannot open mouth for OPA or oral intubation). Digital intubation (D) requires
mouth opening. A surgical airway is the definitive life-saving intervention here.
Which of the following capnography waveforms indicates hypoventilation?
A. Sudden drop to zero (apnea)
B. Gradual increase in baseline
C. Elevated EtCO2 (e.g., 50 mmHg) with a taller waveform
5. D. Slightly slanted upslope
C. Elevated EtCO2 (e.g., 50 mmHg) with a taller waveform
Hypoventilation leads to CO2 retention. This is reflected on capnography as
an increase in the numeric value (above normal 35-45) and a corresponding
increase in the height (amplitude) of the waveform. A drop to zero (A)
indicates esophageal intubation or circuit disconnect. A gradual increase in
baseline (B) indicates rebreathing.
According to the 2020 AHA Guidelines, what is the maximum duration of an
intubation attempt before you should stop and perform BVM ventilation?
,A. 60 seconds
B. 30 seconds
C. 45 seconds
6. D. 15 seconds
B. 30 seconds
To minimize hypoxia, each laryngoscopy attempt should last no longer than
30 seconds. After this, the procedure must be paused to ventilate the patient
with 100% oxygen before attempting again.
Proper placement of an endotracheal tube (ETT) in an adult female is confirmed at
the teeth/gums at which depth?
A. 19-21 cm
B. 21-23 cm
C. 23-25 cm
7. D. 25-27 cm
B. 21-23 cm
Average ETT depth is typically 21-23 cm for adult females and 23-25 cm for
adult males at the teeth or gums. This ensures the cuff is below the vocal
cords but not so deep as to result in a mainstem bronchus intubation (usually
right).
Which of the following patients requires rapid sequence intubation (RSI) most
urgently?
A. A trauma patient with a GCS of 14 and combativeness
B. A COPD patient with an SpO2 of 88% on room air
C. A stroke patient with a GCS of 8 and unprotected airway
8. D. An asthma patient with accessory muscle use
C. A stroke patient with a GCS of 8 and unprotected airway
A GCS of 8 generally indicates the loss of protective airway reflexes. This
patient is at high risk of aspiration and hypoxia. While the trauma patient (A) is
combative, RSI might be considered for airway protection, but the GCS of 8 in
the stroke patient is a clearer absolute indication for securing the airway.
During intubation, you view the epiglottis but cannot see the vocal cords. What is
your next step?
A. Pass the tube blindly
B. Apply external laryngeal manipulation (BURP)
C. Increase the blade size
9. D. Switch to a Mac blade from a Miller
B. Apply external laryngeal manipulation (BURP)
, If the epiglottis is visible but the cords are not, the larynx is likely anterior.
Backward, Upward, Rightward Pressure (BURP) by an assistant often brings
the glottic opening into view without changing the blade.
A patient with a severe asthma exacerbation is becoming fatigued. His SpO2 is 92%
on a non-rebreather. Which intervention is contraindicated?
A. CPAP
B. Heliox
C. Magnesium Sulfate
10.D. Excessive positive pressure ventilation with a BVM
D. Excessive positive pressure ventilation with a BVM
In severe asthma, air trapping (auto-PEEP) is a major risk. Aggressive BVM
ventilation can worsen this, leading to barotrauma and pneumothorax. CPAP
(A) helps stent airways open. Magnesium (C) is a bronchodilator. Aggressive
bagging is dangerous.
You are treating a 70-year-old male with COPD who is in respiratory distress. He is
lethargic. The SpO2 is 94%. What is the concern with administering high-flow
oxygen?
A. Hyperoxic seizure
B. Worsening respiratory acidosis due to hypoxic drive suppression
C. Oxygen toxicity
11.D. Absorption atelectasis
B. Worsening respiratory acidosis due to hypoxic drive suppression
While the "hypoxic drive" theory is sometimes debated, the reality is that high
concentrations of O2 in severe COPD retainers can lead to CO2 retention and
subsequent respiratory acidosis. Target saturation is usually 88-92%.
Seizures (A) and toxicity (C) are unlikely at this short duration.
You have just intubated a patient. You hear breath sounds bilaterally, but there is
gurgling over the epigastrium. What is the next step?
A. Secure the tube
B. Remove the tube and re-intubate
C. Check EtCO2
12.D. Suction the oropharynx
C. Check EtCO2
Epigastric sounds can occur even with proper placement if air is entering the
stomach, but they can also indicate esophageal intubation. The gold standard
for confirmation (along with auscultation) is waveform capnography. If there is
no waveform, the tube is in the esophagus.
Questions – Latest Edition | Instructor Verified)
Domain I: Airway Management, Respiration, and Ventilation (Questions
1–24)
You are assessing a 68-year-old male with respiratory distress. He is sitting upright,
using accessory muscles, and you hear a "saw-tooth" sound on inspiration. His
mental status is altered. Which immediate intervention is most critical?
A. Administration of a nebulized bronchodilator
B. Immediate endotracheal intubation
C. CPAP with 100% oxygen
1. D. Nasopharyngeal airway placement
B. Immediate endotracheal intubation
The "saw-tooth" sound is stridor, indicating upper airway obstruction. The
altered mental status (AMS) signifies imminent failure of the airway and
respiratory compensation. While CPAP (C) can help in some obstruction
cases like pulmonary edema or mild croup, AMS dictates securing the airway
definitively before complete obstruction occurs. Bronchodilators (A) are
ineffective for anatomical obstructions. NPA (D) will not help if the obstruction
is above the nares or if the larynx is swollen shut.
Which of the following is an absolute contraindication for the insertion of a
nasopharyngeal airway (NPA)?
A. Unconscious patient with a gag reflex
B. Basilar skull fracture
C. Facial trauma involving the nose
2. D. A history of COPD
B. Basilar skull fracture
In a basilar skull fracture, the cribriform plate may be fractured. Inserting an
NPA could potentially enter the cranial vault, causing brain damage or
infection. Signs include raccoon eyes, Battle’s sign, or CSF
otorrhea/rhinorrhea. While facial trauma (C) is a relative contraindication (use
the other nostril), a skull fracture is absolute.
,You are ventilating a 45-year-old female with a BVM. You notice significant gastric
distention and minimal chest rise. What is the most likely cause?
A. Excessive tidal volume
B. Inadequate airway opening
C. High airway resistance (asthma)
3. D. Oxygen flow rate too high
B. Inadequate airway opening
Gastric distention usually occurs because air is entering the stomach rather
than the lungs. This is most commonly caused by failure to open the airway
properly (head-tilt/chin-lift or jaw-thrust), causing the epiglottis to remain
closed. While excessive volume (A) can cause it, the root cause is usually
poor technique. High resistance (C) makes ventilation difficult, but distention
specifically implies air is going the wrong way.
A 22-year-old male has sustained a severe facial injury in an assault. He is
conscious but gurgling. You are unable to open his mouth due to trismus. What is the
BEST airway management option?
A. Oropharyngeal airway (OPA)
B. Nasotracheal intubation
C. Surgical cricothyrotomy
4. D. Digital intubation
C. Surgical cricothyrotomy
This is a "cannot intubate, cannot ventilate" scenario (CICV). The patient has
massive facial trauma (likely unstable for nasal/oral intubation) and trismus
(cannot open mouth for OPA or oral intubation). Digital intubation (D) requires
mouth opening. A surgical airway is the definitive life-saving intervention here.
Which of the following capnography waveforms indicates hypoventilation?
A. Sudden drop to zero (apnea)
B. Gradual increase in baseline
C. Elevated EtCO2 (e.g., 50 mmHg) with a taller waveform
5. D. Slightly slanted upslope
C. Elevated EtCO2 (e.g., 50 mmHg) with a taller waveform
Hypoventilation leads to CO2 retention. This is reflected on capnography as
an increase in the numeric value (above normal 35-45) and a corresponding
increase in the height (amplitude) of the waveform. A drop to zero (A)
indicates esophageal intubation or circuit disconnect. A gradual increase in
baseline (B) indicates rebreathing.
According to the 2020 AHA Guidelines, what is the maximum duration of an
intubation attempt before you should stop and perform BVM ventilation?
,A. 60 seconds
B. 30 seconds
C. 45 seconds
6. D. 15 seconds
B. 30 seconds
To minimize hypoxia, each laryngoscopy attempt should last no longer than
30 seconds. After this, the procedure must be paused to ventilate the patient
with 100% oxygen before attempting again.
Proper placement of an endotracheal tube (ETT) in an adult female is confirmed at
the teeth/gums at which depth?
A. 19-21 cm
B. 21-23 cm
C. 23-25 cm
7. D. 25-27 cm
B. 21-23 cm
Average ETT depth is typically 21-23 cm for adult females and 23-25 cm for
adult males at the teeth or gums. This ensures the cuff is below the vocal
cords but not so deep as to result in a mainstem bronchus intubation (usually
right).
Which of the following patients requires rapid sequence intubation (RSI) most
urgently?
A. A trauma patient with a GCS of 14 and combativeness
B. A COPD patient with an SpO2 of 88% on room air
C. A stroke patient with a GCS of 8 and unprotected airway
8. D. An asthma patient with accessory muscle use
C. A stroke patient with a GCS of 8 and unprotected airway
A GCS of 8 generally indicates the loss of protective airway reflexes. This
patient is at high risk of aspiration and hypoxia. While the trauma patient (A) is
combative, RSI might be considered for airway protection, but the GCS of 8 in
the stroke patient is a clearer absolute indication for securing the airway.
During intubation, you view the epiglottis but cannot see the vocal cords. What is
your next step?
A. Pass the tube blindly
B. Apply external laryngeal manipulation (BURP)
C. Increase the blade size
9. D. Switch to a Mac blade from a Miller
B. Apply external laryngeal manipulation (BURP)
, If the epiglottis is visible but the cords are not, the larynx is likely anterior.
Backward, Upward, Rightward Pressure (BURP) by an assistant often brings
the glottic opening into view without changing the blade.
A patient with a severe asthma exacerbation is becoming fatigued. His SpO2 is 92%
on a non-rebreather. Which intervention is contraindicated?
A. CPAP
B. Heliox
C. Magnesium Sulfate
10.D. Excessive positive pressure ventilation with a BVM
D. Excessive positive pressure ventilation with a BVM
In severe asthma, air trapping (auto-PEEP) is a major risk. Aggressive BVM
ventilation can worsen this, leading to barotrauma and pneumothorax. CPAP
(A) helps stent airways open. Magnesium (C) is a bronchodilator. Aggressive
bagging is dangerous.
You are treating a 70-year-old male with COPD who is in respiratory distress. He is
lethargic. The SpO2 is 94%. What is the concern with administering high-flow
oxygen?
A. Hyperoxic seizure
B. Worsening respiratory acidosis due to hypoxic drive suppression
C. Oxygen toxicity
11.D. Absorption atelectasis
B. Worsening respiratory acidosis due to hypoxic drive suppression
While the "hypoxic drive" theory is sometimes debated, the reality is that high
concentrations of O2 in severe COPD retainers can lead to CO2 retention and
subsequent respiratory acidosis. Target saturation is usually 88-92%.
Seizures (A) and toxicity (C) are unlikely at this short duration.
You have just intubated a patient. You hear breath sounds bilaterally, but there is
gurgling over the epigastrium. What is the next step?
A. Secure the tube
B. Remove the tube and re-intubate
C. Check EtCO2
12.D. Suction the oropharynx
C. Check EtCO2
Epigastric sounds can occur even with proper placement if air is entering the
stomach, but they can also indicate esophageal intubation. The gold standard
for confirmation (along with auscultation) is waveform capnography. If there is
no waveform, the tube is in the esophagus.
