Paramedic FISDAP Airway Cognitive Exam
Practice Study Guide — 2026–2027 Edition
50 Multiple-Choice Questions with Answers and Rationales
Instructions
This study guide contains 50 multiple-choice questions covering all domains tested on the FISDAP Airway
cognitive exam. Each question includes the correct answer (highlighted in bold cyan) followed by a rationale
explaining the clinical reasoning. Use this guide to assess your knowledge and identify areas for further study.
Domain I: Respiratory Assessment and Airway Anatomy (Questions 1–9)
1. Which of the following structures is considered part of the LOWER airway?
A. Nasopharynx B. Oropharynx
C. Larynx D. Bronchioles
Rationale: The lower airway begins below the larynx and includes the trachea, bronchi, bronchioles, and alveoli. The
nasopharynx, oropharynx, and larynx are all upper airway structures. Understanding this distinction is essential for
recognizing the site of obstruction and selecting appropriate airway interventions.
2. Sellick’s maneuver (cricoid pressure) is performed to accomplish which of the following?
A. Displace the larynx posteriorly to improve glottic B. Compress the esophagus against the C6 vertebra
visualization to prevent aspiration
C. Open the vocal cords during direct laryngoscopy D. Stimulate a cough reflex to clear secretions from the
airway
Rationale: Sellick’s maneuver compresses the cricoid cartilage posteriorly against the C6 vertebral body, occluding the
esophagus to prevent passive regurgitation and aspiration of gastric contents during intubation. It should NOT be
applied until the endotracheal tube is at the vocal cords and must be released immediately if the patient gags or if
BURP is needed.
3. The BURP maneuver is used during intubation to improve the glottic view. What does BURP stand for?
A. Backward, Upward, Rightward Pressure on the B. Bilateral, Upward, Radial, Posterior displacement of
thyroid cartilage the cricoid
C. Backward, Upward, Lateral Pressure on the hyoid D. Brisk, Upward, Rightward Push on the epiglottis
bone
Rationale: BURP stands for Backward, Upward, Rightward Pressure applied to the thyroid cartilage. This maneuver
displaces the larynx to improve the view of the glottic opening during direct laryngoscopy. It is particularly useful when
the initial laryngoscopic view reveals only the epiglottis or a partial view of the cords.
1
, 4. A paramedic assesses a patient’s airway using the Mallampati classification and notes that only the hard palate
is visible. Which Mallampati class is this?
A. Class I B. Class II
C. Class III D. Class IV
Rationale: Mallampati Class IV is defined as visibility of only the hard palate when the patient opens the mouth and
protrudes the tongue. Class I shows full visualization of the tonsils, pillars, and uvula; Class II shows the uvula and
partial pillars; Class III shows the base of the uvula and soft palate. Class III and IV predict a difficult airway.
5. As part of the LEMON airway assessment, the “3-3-2 rule” evaluates which of the following?
A. Three fingers of mouth opening, three fingers B. Three facial features, three neck movements, two
from hyoid to mentum, two fingers from hyoid to breath sounds
thyroid notch
C. Three centimeters of mouth opening, three D. Three airway segments, three vital signs, two lung
centimeters mandibular space, two centimeters fields
subglottic diameter
Rationale: The 3-3-2 rule is a rapid bedside assessment of airway adequacy: 3 fingers of mouth opening (adequate
inter-incisor distance), 3 fingerbreadths from the hyoid bone to the mentum (anterior mandibular space), and 2
fingerbreadths from the hyoid bone to the thyroid notch (space for laryngoscope blade). Values less than these suggest
a potentially difficult intubation.
6. Which component of the LEMON assessment evaluates the patient for visible signs that may complicate
intubation?
A. Evaluate 3-3-2 rule B. Look externally
C. Mallampati score D. Neck mobility
Rationale: The “L” in LEMON stands for “Look externally.” This step involves visually inspecting the patient for facial
trauma, large incisors, beard or facial hair, micrognathia, obesity, or a short thick neck—all of which may predict a
difficult airway. LEMON as a whole stands for Look externally, Evaluate 3-3-2, Mallampati, Obstruction, Neck
mobility.
7. Compared to an adult, the pediatric airway has which distinguishing anatomical feature?
A. The narrowest point is at the vocal cords B. The epiglottis is long, U-shaped, and floppy
C. The tongue is relatively smaller D. The airway is positioned more posteriorly
Rationale: In pediatric patients, the epiglottis is proportionally longer, U-shaped, and more floppy compared to the
adult epiglottis. Additionally, the pediatric airway is more anterior and cephalad, the tongue is relatively larger, and
the narrowest point is at the cricoid ring (not the vocal cords as in adults). These differences make pediatric intubation
more challenging.
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Practice Study Guide — 2026–2027 Edition
50 Multiple-Choice Questions with Answers and Rationales
Instructions
This study guide contains 50 multiple-choice questions covering all domains tested on the FISDAP Airway
cognitive exam. Each question includes the correct answer (highlighted in bold cyan) followed by a rationale
explaining the clinical reasoning. Use this guide to assess your knowledge and identify areas for further study.
Domain I: Respiratory Assessment and Airway Anatomy (Questions 1–9)
1. Which of the following structures is considered part of the LOWER airway?
A. Nasopharynx B. Oropharynx
C. Larynx D. Bronchioles
Rationale: The lower airway begins below the larynx and includes the trachea, bronchi, bronchioles, and alveoli. The
nasopharynx, oropharynx, and larynx are all upper airway structures. Understanding this distinction is essential for
recognizing the site of obstruction and selecting appropriate airway interventions.
2. Sellick’s maneuver (cricoid pressure) is performed to accomplish which of the following?
A. Displace the larynx posteriorly to improve glottic B. Compress the esophagus against the C6 vertebra
visualization to prevent aspiration
C. Open the vocal cords during direct laryngoscopy D. Stimulate a cough reflex to clear secretions from the
airway
Rationale: Sellick’s maneuver compresses the cricoid cartilage posteriorly against the C6 vertebral body, occluding the
esophagus to prevent passive regurgitation and aspiration of gastric contents during intubation. It should NOT be
applied until the endotracheal tube is at the vocal cords and must be released immediately if the patient gags or if
BURP is needed.
3. The BURP maneuver is used during intubation to improve the glottic view. What does BURP stand for?
A. Backward, Upward, Rightward Pressure on the B. Bilateral, Upward, Radial, Posterior displacement of
thyroid cartilage the cricoid
C. Backward, Upward, Lateral Pressure on the hyoid D. Brisk, Upward, Rightward Push on the epiglottis
bone
Rationale: BURP stands for Backward, Upward, Rightward Pressure applied to the thyroid cartilage. This maneuver
displaces the larynx to improve the view of the glottic opening during direct laryngoscopy. It is particularly useful when
the initial laryngoscopic view reveals only the epiglottis or a partial view of the cords.
1
, 4. A paramedic assesses a patient’s airway using the Mallampati classification and notes that only the hard palate
is visible. Which Mallampati class is this?
A. Class I B. Class II
C. Class III D. Class IV
Rationale: Mallampati Class IV is defined as visibility of only the hard palate when the patient opens the mouth and
protrudes the tongue. Class I shows full visualization of the tonsils, pillars, and uvula; Class II shows the uvula and
partial pillars; Class III shows the base of the uvula and soft palate. Class III and IV predict a difficult airway.
5. As part of the LEMON airway assessment, the “3-3-2 rule” evaluates which of the following?
A. Three fingers of mouth opening, three fingers B. Three facial features, three neck movements, two
from hyoid to mentum, two fingers from hyoid to breath sounds
thyroid notch
C. Three centimeters of mouth opening, three D. Three airway segments, three vital signs, two lung
centimeters mandibular space, two centimeters fields
subglottic diameter
Rationale: The 3-3-2 rule is a rapid bedside assessment of airway adequacy: 3 fingers of mouth opening (adequate
inter-incisor distance), 3 fingerbreadths from the hyoid bone to the mentum (anterior mandibular space), and 2
fingerbreadths from the hyoid bone to the thyroid notch (space for laryngoscope blade). Values less than these suggest
a potentially difficult intubation.
6. Which component of the LEMON assessment evaluates the patient for visible signs that may complicate
intubation?
A. Evaluate 3-3-2 rule B. Look externally
C. Mallampati score D. Neck mobility
Rationale: The “L” in LEMON stands for “Look externally.” This step involves visually inspecting the patient for facial
trauma, large incisors, beard or facial hair, micrognathia, obesity, or a short thick neck—all of which may predict a
difficult airway. LEMON as a whole stands for Look externally, Evaluate 3-3-2, Mallampati, Obstruction, Neck
mobility.
7. Compared to an adult, the pediatric airway has which distinguishing anatomical feature?
A. The narrowest point is at the vocal cords B. The epiglottis is long, U-shaped, and floppy
C. The tongue is relatively smaller D. The airway is positioned more posteriorly
Rationale: In pediatric patients, the epiglottis is proportionally longer, U-shaped, and more floppy compared to the
adult epiglottis. Additionally, the pediatric airway is more anterior and cephalad, the tongue is relatively larger, and
the narrowest point is at the cricoid ring (not the vocal cords as in adults). These differences make pediatric intubation
more challenging.
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