ADVANCED AIRWAY MANAGEMENT: CHALLENGES
AND TECHNIQUES INSIDER ACCESS OF 2025/2026
EXAM QUESTIONS WITH 100% SUCCESS RATE
What are the two categories of airway difficulties? - Anatomically difficult airway and
physiologically difficult airway.
What defines an anatomically difficult airway? - It is characterized by physical attributes that
make airway management more challenging than in an ordinary patient.
What defines a physiologically difficult airway? - It requires the operator to optimize the
patient's overall physiology to manage airway complications caused by critically low oxygen
saturation, hemodynamic instability, or severe metabolic acidosis.
What are the four dimensions of an anatomically difficult airway? - 1. Difficult laryngoscopy and
intubation 2. Difficult bag-mask ventilation (BMV) 3. Difficult esophagogastroduodenoscopy
(EGD) 4. Difficult cricothyrotomy.
What percentage of adult emergency intubations involve difficult direct laryngoscopy? - About
10%.
How can the incidence of difficult intubation be reduced? - Using a video laryngoscope.
What is the preferred method for airway management in emergencies? - Rapid sequence
intubation (RSI), provided significant difficulty is not anticipated.
What is the Cormack and Lehane Classification used for? - It grades the difficulty of intubation
based on laryngoscopic visualization of the glottis and laryngeal structures.
What does Grade I of the Cormack and Lehane Classification indicate? - The entire glottis is
visible.
,What does Grade IV of the Cormack and Lehane Classification indicate? - Neither the glottis nor
the epiglottis are visible; only the soft palate is visible.
What does the LEMON mnemonic help identify? - Anatomic risks of difficulty in emergency
airway situations.
What does the 'E' in the LEMON mnemonic stand for? - Evaluate: Use the 3-3-2 rule to assess
mouth opening and larynx position.
What is the 3-3-2 rule used for? - To assess mouth opening and larynx position prior to
intubation.
What are the three measurements in the 3-3-2 rule? - 1. 3 fingerbreadths of mouth opening 2. 3
fingerbreadths of hyomental distance 3. 2 fingerbreadths of thyrohyoid distance.
What does the Mallampati classification assess? - Oral accessibility prior to intubation.
What is the risk associated with higher grades in the Mallampati classification? - The risk of
difficult intubation increases.
What does Mallampati I indicate? - The soft palate, uvula, and pillars are completely visible.
What does Mallampati IV indicate? - The soft palate is not visible; only the hard palate can be
seen.
What does the ROMAN mnemonic help assess? - Difficult bag-mask ventilation.
What does the 'R' in the ROMAN mnemonic stand for? - Radiation to the neck, which can lead
to difficult mask ventilation.
,What is the significance of the 3-3-2 rule in emergency settings? - It may not be practical in an
emergency setting.
What are some conditions to check for in the 'O' of the LEMON mnemonic? - Obstructive
conditions such as infection, angioedema, burns, or tumors.
What is the importance of identifying difficult airways in advance? - To prevent airway
management failure and to follow the difficult airway algorithm.
What is the role of the difficult airway algorithm? - To guide the management of patients with
identified difficult airways.
What factors make bag-mask ventilation (BMV) difficult? - Obesity, obstructive sleep apnea
(OSA), pregnancy, soft tissue lesions, facial hair, facial trauma, male sex, and a Mallampati class
3 or 4.
How does being edentulous affect mask seal during ventilation? - An edentulous patient may
have difficulty achieving an adequate mask seal due to poor facial support.
What age-related factor increases the risk of difficult BMV? - Age over 55 increases the risk due
to loss of muscle tone in the face.
What does the RODS mnemonic stand for in assessing difficult EGD placement? - Restriction,
Obesity/Obstruction, Disrupted or Distorted airway, Short thyromental distance.
What are some causes of airway resistance that can complicate EGD ventilation? - Airway
resistance, pulmonary compliance issues, restricted mouth opening, or cervical spine mobility
limitations.
, How does obesity affect EGD placement? - Obesity may increase ventilation resistance and can
complicate EGD if there is upper airway obstruction.
What conditions can hinder EGD positioning and sealing in the pharynx? - Spinal deformity,
neck injury, epiglottitis, or abscess.
What does the SMART mnemonic help identify in emergency cricothyrotomy? - Surgery (recent
or remote), Mass, Access/Anatomy, Radiation (and other deformity or scarring), Tumor.
What complications can arise from recent surgery during a cricothyrotomy? - Airway distortion,
scarring, edema, and bleeding.
What challenges does a mass or abscess present in cricothyrotomy? - It may obstruct the
procedure and make it difficult to locate anatomical landmarks.
What anatomical issues can complicate surgical access in cricothyrotomy? - Obesity,
subcutaneous emphysema, soft tissue infection, edema, short neck, and external immobilization
devices.
How can radiation therapy affect cricothyrotomy? - It can distort and scar tissues, causing
bonding between tissues.
What does the CRASH mnemonic assist with in airway management? - It helps assess and
manage the physiologically difficult airway.
What does each letter in the CRASH mnemonic represent? - C: Consumption Increase, R: Right
Ventricular Failure, A: Acidosis (Metabolic), S: Saturation, H: Hypotension/Volume.
What is the Shock Index (SI) and how is it calculated? - The Shock Index is calculated as heart
rate divided by systolic blood pressure.
AND TECHNIQUES INSIDER ACCESS OF 2025/2026
EXAM QUESTIONS WITH 100% SUCCESS RATE
What are the two categories of airway difficulties? - Anatomically difficult airway and
physiologically difficult airway.
What defines an anatomically difficult airway? - It is characterized by physical attributes that
make airway management more challenging than in an ordinary patient.
What defines a physiologically difficult airway? - It requires the operator to optimize the
patient's overall physiology to manage airway complications caused by critically low oxygen
saturation, hemodynamic instability, or severe metabolic acidosis.
What are the four dimensions of an anatomically difficult airway? - 1. Difficult laryngoscopy and
intubation 2. Difficult bag-mask ventilation (BMV) 3. Difficult esophagogastroduodenoscopy
(EGD) 4. Difficult cricothyrotomy.
What percentage of adult emergency intubations involve difficult direct laryngoscopy? - About
10%.
How can the incidence of difficult intubation be reduced? - Using a video laryngoscope.
What is the preferred method for airway management in emergencies? - Rapid sequence
intubation (RSI), provided significant difficulty is not anticipated.
What is the Cormack and Lehane Classification used for? - It grades the difficulty of intubation
based on laryngoscopic visualization of the glottis and laryngeal structures.
What does Grade I of the Cormack and Lehane Classification indicate? - The entire glottis is
visible.
,What does Grade IV of the Cormack and Lehane Classification indicate? - Neither the glottis nor
the epiglottis are visible; only the soft palate is visible.
What does the LEMON mnemonic help identify? - Anatomic risks of difficulty in emergency
airway situations.
What does the 'E' in the LEMON mnemonic stand for? - Evaluate: Use the 3-3-2 rule to assess
mouth opening and larynx position.
What is the 3-3-2 rule used for? - To assess mouth opening and larynx position prior to
intubation.
What are the three measurements in the 3-3-2 rule? - 1. 3 fingerbreadths of mouth opening 2. 3
fingerbreadths of hyomental distance 3. 2 fingerbreadths of thyrohyoid distance.
What does the Mallampati classification assess? - Oral accessibility prior to intubation.
What is the risk associated with higher grades in the Mallampati classification? - The risk of
difficult intubation increases.
What does Mallampati I indicate? - The soft palate, uvula, and pillars are completely visible.
What does Mallampati IV indicate? - The soft palate is not visible; only the hard palate can be
seen.
What does the ROMAN mnemonic help assess? - Difficult bag-mask ventilation.
What does the 'R' in the ROMAN mnemonic stand for? - Radiation to the neck, which can lead
to difficult mask ventilation.
,What is the significance of the 3-3-2 rule in emergency settings? - It may not be practical in an
emergency setting.
What are some conditions to check for in the 'O' of the LEMON mnemonic? - Obstructive
conditions such as infection, angioedema, burns, or tumors.
What is the importance of identifying difficult airways in advance? - To prevent airway
management failure and to follow the difficult airway algorithm.
What is the role of the difficult airway algorithm? - To guide the management of patients with
identified difficult airways.
What factors make bag-mask ventilation (BMV) difficult? - Obesity, obstructive sleep apnea
(OSA), pregnancy, soft tissue lesions, facial hair, facial trauma, male sex, and a Mallampati class
3 or 4.
How does being edentulous affect mask seal during ventilation? - An edentulous patient may
have difficulty achieving an adequate mask seal due to poor facial support.
What age-related factor increases the risk of difficult BMV? - Age over 55 increases the risk due
to loss of muscle tone in the face.
What does the RODS mnemonic stand for in assessing difficult EGD placement? - Restriction,
Obesity/Obstruction, Disrupted or Distorted airway, Short thyromental distance.
What are some causes of airway resistance that can complicate EGD ventilation? - Airway
resistance, pulmonary compliance issues, restricted mouth opening, or cervical spine mobility
limitations.
, How does obesity affect EGD placement? - Obesity may increase ventilation resistance and can
complicate EGD if there is upper airway obstruction.
What conditions can hinder EGD positioning and sealing in the pharynx? - Spinal deformity,
neck injury, epiglottitis, or abscess.
What does the SMART mnemonic help identify in emergency cricothyrotomy? - Surgery (recent
or remote), Mass, Access/Anatomy, Radiation (and other deformity or scarring), Tumor.
What complications can arise from recent surgery during a cricothyrotomy? - Airway distortion,
scarring, edema, and bleeding.
What challenges does a mass or abscess present in cricothyrotomy? - It may obstruct the
procedure and make it difficult to locate anatomical landmarks.
What anatomical issues can complicate surgical access in cricothyrotomy? - Obesity,
subcutaneous emphysema, soft tissue infection, edema, short neck, and external immobilization
devices.
How can radiation therapy affect cricothyrotomy? - It can distort and scar tissues, causing
bonding between tissues.
What does the CRASH mnemonic assist with in airway management? - It helps assess and
manage the physiologically difficult airway.
What does each letter in the CRASH mnemonic represent? - C: Consumption Increase, R: Right
Ventricular Failure, A: Acidosis (Metabolic), S: Saturation, H: Hypotension/Volume.
What is the Shock Index (SI) and how is it calculated? - The Shock Index is calculated as heart
rate divided by systolic blood pressure.
