, Question 1
A patient with severe facial trauma presents with gurgling respirations and
blood in the oropharynx. After manual suctioning, which airway adjunct is
most appropriate and why?
A. Oropharyngeal airway (OPA) because it prevents the tongue from
obstructing the airway.
B. Nasopharyngeal airway (NPA) because it bypasses oral secretions and
blood.
C. Supraglottic airway (SGA) because it seals the esophagus and provides
positive pressure ventilation.
D. Endotracheal intubation because it definitively isolates the airway
from aspiration.
Correct Answer: B - Nasopharyngeal airway (NPA) because it
bypasses oral secretions and blood.
RATIONALE
An NPA is preferred in facial trauma with intact gag reflex because it
is better tolerated and avoids oral obstruction from blood or swelling.
An OPA may induce gagging and vomiting, an SGA does not protect
against aspiration, and intubation may be difficult due to distorted
anatomy.
Question 2
During bag-valve-mask ventilation, a provider notes increasing resistance and
poor chest rise. Capnography shows a shark-fin waveform. What is the most
likely cause?
A. Esophageal intubation
B. Bronchospasm
C. Hyperventilation
D. Mucus plugging
Correct Answer: B - Bronchospasm
Page 2
, RATIONALE
A shark-fin waveform on capnography is characteristic of obstructive
airway diseases such as bronchospasm, where uneven alveolar
emptying causes a sloping upstroke. Esophageal intubation would
show absent or near-zero ETCO2, hyperventilation would show low
ETCO2 with normal shape, and mucus plugging may show a similar
but less specific pattern.
Question 3
Which of the following best describes the primary advantage of a video
laryngoscope over direct laryngoscopy in emergency airway management?
A. It eliminates the need for a stylet.
B. It provides a better glottic view in patients with difficult airways.
C. It reduces the risk of aspiration.
D. It allows for faster intubation in all patients.
Correct Answer: B - It provides a better glottic view in patients
with difficult airways.
RATIONALE
Video laryngoscopy improves glottic visualization by allowing
indirect viewing around the tongue and avoiding alignment of
oral-pharyngeal-laryngeal axes, which is particularly beneficial in
difficult airways. It does not eliminate the need for a stylet, reduce
aspiration risk, or universally speed intubation.
Question 4
A patient with a tracheostomy is in respiratory distress with absent breath
sounds and no air movement from the tracheostomy tube. After suctioning and
deflating the cuff, what is the next most appropriate step?
A. Remove the tracheostomy tube and ventilate via stoma with a
bag-valve-mask.
B. Insert a new tracheostomy tube immediately.
Page 3
, C. Perform oropharyngeal intubation.
D. Increase oxygen flow via the tracheostomy collar.
Correct Answer: A - Remove the tracheostomy tube and ventilate
via stoma with a bag-valve-mask.
RATIONALE
If a tracheostomy is obstructed and suctioning fails, the tube should be
removed and ventilation attempted via the stoma using a pediatric
mask or bag-valve-mask. Immediate reinsertion may be difficult and
dangerous without a secure airway; oral intubation may be impossible
due to altered anatomy.
Question 5
Which of the following is the most reliable indicator of correct endotracheal
tube placement immediately after intubation?
A. Chest rise with bag-valve-mask ventilation
B. Auscultation of equal breath sounds bilaterally
C. Continuous waveform capnography showing a square waveform
D. Pulse oximetry reading above 95%
Correct Answer: C - Continuous waveform capnography showing
a square waveform
RATIONALE
Continuous waveform capnography is the gold standard for
confirming endotracheal intubation, as it detects exhaled CO2 with
high sensitivity and specificity. Chest rise, auscultation, and pulse
oximetry can be misleading in cases of esophageal intubation or low
perfusion states.
Page 4
A patient with severe facial trauma presents with gurgling respirations and
blood in the oropharynx. After manual suctioning, which airway adjunct is
most appropriate and why?
A. Oropharyngeal airway (OPA) because it prevents the tongue from
obstructing the airway.
B. Nasopharyngeal airway (NPA) because it bypasses oral secretions and
blood.
C. Supraglottic airway (SGA) because it seals the esophagus and provides
positive pressure ventilation.
D. Endotracheal intubation because it definitively isolates the airway
from aspiration.
Correct Answer: B - Nasopharyngeal airway (NPA) because it
bypasses oral secretions and blood.
RATIONALE
An NPA is preferred in facial trauma with intact gag reflex because it
is better tolerated and avoids oral obstruction from blood or swelling.
An OPA may induce gagging and vomiting, an SGA does not protect
against aspiration, and intubation may be difficult due to distorted
anatomy.
Question 2
During bag-valve-mask ventilation, a provider notes increasing resistance and
poor chest rise. Capnography shows a shark-fin waveform. What is the most
likely cause?
A. Esophageal intubation
B. Bronchospasm
C. Hyperventilation
D. Mucus plugging
Correct Answer: B - Bronchospasm
Page 2
, RATIONALE
A shark-fin waveform on capnography is characteristic of obstructive
airway diseases such as bronchospasm, where uneven alveolar
emptying causes a sloping upstroke. Esophageal intubation would
show absent or near-zero ETCO2, hyperventilation would show low
ETCO2 with normal shape, and mucus plugging may show a similar
but less specific pattern.
Question 3
Which of the following best describes the primary advantage of a video
laryngoscope over direct laryngoscopy in emergency airway management?
A. It eliminates the need for a stylet.
B. It provides a better glottic view in patients with difficult airways.
C. It reduces the risk of aspiration.
D. It allows for faster intubation in all patients.
Correct Answer: B - It provides a better glottic view in patients
with difficult airways.
RATIONALE
Video laryngoscopy improves glottic visualization by allowing
indirect viewing around the tongue and avoiding alignment of
oral-pharyngeal-laryngeal axes, which is particularly beneficial in
difficult airways. It does not eliminate the need for a stylet, reduce
aspiration risk, or universally speed intubation.
Question 4
A patient with a tracheostomy is in respiratory distress with absent breath
sounds and no air movement from the tracheostomy tube. After suctioning and
deflating the cuff, what is the next most appropriate step?
A. Remove the tracheostomy tube and ventilate via stoma with a
bag-valve-mask.
B. Insert a new tracheostomy tube immediately.
Page 3
, C. Perform oropharyngeal intubation.
D. Increase oxygen flow via the tracheostomy collar.
Correct Answer: A - Remove the tracheostomy tube and ventilate
via stoma with a bag-valve-mask.
RATIONALE
If a tracheostomy is obstructed and suctioning fails, the tube should be
removed and ventilation attempted via the stoma using a pediatric
mask or bag-valve-mask. Immediate reinsertion may be difficult and
dangerous without a secure airway; oral intubation may be impossible
due to altered anatomy.
Question 5
Which of the following is the most reliable indicator of correct endotracheal
tube placement immediately after intubation?
A. Chest rise with bag-valve-mask ventilation
B. Auscultation of equal breath sounds bilaterally
C. Continuous waveform capnography showing a square waveform
D. Pulse oximetry reading above 95%
Correct Answer: C - Continuous waveform capnography showing
a square waveform
RATIONALE
Continuous waveform capnography is the gold standard for
confirming endotracheal intubation, as it detects exhaled CO2 with
high sensitivity and specificity. Chest rise, auscultation, and pulse
oximetry can be misleading in cases of esophageal intubation or low
perfusion states.
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