, Question 1
A patient with severe facial trauma and suspected basilar skull fracture requires
airway management. Which finding most strongly contraindicates
nasopharyngeal airway insertion?
A. Bilateral periorbital ecchymosis
B. Clear fluid drainage from the nares
C. Battle sign over the mastoid
D. Fractured mandible with trismus
Correct Answer: B - Clear fluid drainage from the nares
RATIONALE
CSF rhinorrhea indicates a cribriform plate disruption, creating a
direct pathway from the nasopharynx to the cranial vault; NPA
insertion risks intracranial placement and infection. Periorbital
ecchymosis and Battle sign are suggestive but not absolute
contraindications, and mandibular fracture with trismus actually
supports NPA use if the airway is otherwise patent.
Question 2
During bag-valve-mask ventilation, the provider notes increasing resistance
and absent chest rise. Which immediate action best addresses the most likely
correctable cause?
A. Increase the ventilation rate to 20/min
B. Reposition the airway and reassess for obstruction
C. Attach a PEEP valve and continue ventilation
D. Switch to a flow-restricted oxygen-powered device
Correct Answer: B - Reposition the airway and reassess for
obstruction
Page 2
, RATIONALE
The most common cause of increased BVM resistance with absent
chest rise is an improperly positioned airway or obstruction;
repositioning and reassessing is the first corrective step. Increasing
rate or adding PEEP does not resolve mechanical obstruction and may
worsen gastric insufflation, while switching devices does not address
the underlying problem.
Question 3
Which capnography waveform pattern most specifically indicates esophageal
intubation?
A. Gradual upsloping plateau (shark fin)
B. Absent or rapidly diminishing waveform to zero
C. Elevated baseline with a plateau
D. Curare cleft notch
Correct Answer: B - Absent or rapidly diminishing waveform to
zero
RATIONALE
Esophageal intubation produces no CO2 return to the lungs, so the
capnograph shows absent or rapidly diminishing waveform to zero
within a few breaths. A shark-fin pattern indicates bronchospasm, an
elevated baseline suggests rebreathing, and a curare cleft indicates
spontaneous respiratory effort against the ventilator.
Question 4
A patient with a tracheostomy is in respiratory distress with absent air
movement through the stoma. Which initial intervention is most appropriate
per current guidelines?
A. Suction the tracheostomy tube and assess patency
B. Deflate the cuff and attempt ventilation
C. Remove the tracheostomy tube and ventilate via stoma
Page 3
, D. Perform immediate orotracheal intubation
Correct Answer: A - Suction the tracheostomy tube and assess
patency
RATIONALE
The first step in a distressed tracheostomy patient is to suction and
assess for obstruction, as mucus plugging is the most common cause.
Deflating the cuff, removing the tube, or intubating without assessing
patency bypasses the most likely reversible cause and may cause
further harm.
Question 5
Which condition most specifically contraindicates the use of a supraglottic
airway device (SGA) in prehospital airway management?
A. Mallampati class III airway
B. Known or suspected esophageal varices
C. Gag reflex present
D. Obesity with short neck
Correct Answer: B - Known or suspected esophageal varices
RATIONALE
Esophageal varices create a high risk of fatal hemorrhage if the SGA
causes trauma or pressure necrosis; this is a strong contraindication.
Mallampati class III, gag reflex, and obesity are relative
considerations but not absolute contraindications to SGA use.
Question 6
During positive pressure ventilation, a patient develops sudden hypotension
and decreased breath sounds on the right. Which intervention is most
immediately indicated?
A. Increase ventilation rate and reassess
B. Needle decompression of the right chest
Page 4
A patient with severe facial trauma and suspected basilar skull fracture requires
airway management. Which finding most strongly contraindicates
nasopharyngeal airway insertion?
A. Bilateral periorbital ecchymosis
B. Clear fluid drainage from the nares
C. Battle sign over the mastoid
D. Fractured mandible with trismus
Correct Answer: B - Clear fluid drainage from the nares
RATIONALE
CSF rhinorrhea indicates a cribriform plate disruption, creating a
direct pathway from the nasopharynx to the cranial vault; NPA
insertion risks intracranial placement and infection. Periorbital
ecchymosis and Battle sign are suggestive but not absolute
contraindications, and mandibular fracture with trismus actually
supports NPA use if the airway is otherwise patent.
Question 2
During bag-valve-mask ventilation, the provider notes increasing resistance
and absent chest rise. Which immediate action best addresses the most likely
correctable cause?
A. Increase the ventilation rate to 20/min
B. Reposition the airway and reassess for obstruction
C. Attach a PEEP valve and continue ventilation
D. Switch to a flow-restricted oxygen-powered device
Correct Answer: B - Reposition the airway and reassess for
obstruction
Page 2
, RATIONALE
The most common cause of increased BVM resistance with absent
chest rise is an improperly positioned airway or obstruction;
repositioning and reassessing is the first corrective step. Increasing
rate or adding PEEP does not resolve mechanical obstruction and may
worsen gastric insufflation, while switching devices does not address
the underlying problem.
Question 3
Which capnography waveform pattern most specifically indicates esophageal
intubation?
A. Gradual upsloping plateau (shark fin)
B. Absent or rapidly diminishing waveform to zero
C. Elevated baseline with a plateau
D. Curare cleft notch
Correct Answer: B - Absent or rapidly diminishing waveform to
zero
RATIONALE
Esophageal intubation produces no CO2 return to the lungs, so the
capnograph shows absent or rapidly diminishing waveform to zero
within a few breaths. A shark-fin pattern indicates bronchospasm, an
elevated baseline suggests rebreathing, and a curare cleft indicates
spontaneous respiratory effort against the ventilator.
Question 4
A patient with a tracheostomy is in respiratory distress with absent air
movement through the stoma. Which initial intervention is most appropriate
per current guidelines?
A. Suction the tracheostomy tube and assess patency
B. Deflate the cuff and attempt ventilation
C. Remove the tracheostomy tube and ventilate via stoma
Page 3
, D. Perform immediate orotracheal intubation
Correct Answer: A - Suction the tracheostomy tube and assess
patency
RATIONALE
The first step in a distressed tracheostomy patient is to suction and
assess for obstruction, as mucus plugging is the most common cause.
Deflating the cuff, removing the tube, or intubating without assessing
patency bypasses the most likely reversible cause and may cause
further harm.
Question 5
Which condition most specifically contraindicates the use of a supraglottic
airway device (SGA) in prehospital airway management?
A. Mallampati class III airway
B. Known or suspected esophageal varices
C. Gag reflex present
D. Obesity with short neck
Correct Answer: B - Known or suspected esophageal varices
RATIONALE
Esophageal varices create a high risk of fatal hemorrhage if the SGA
causes trauma or pressure necrosis; this is a strong contraindication.
Mallampati class III, gag reflex, and obesity are relative
considerations but not absolute contraindications to SGA use.
Question 6
During positive pressure ventilation, a patient develops sudden hypotension
and decreased breath sounds on the right. Which intervention is most
immediately indicated?
A. Increase ventilation rate and reassess
B. Needle decompression of the right chest
Page 4
