ADVANCED AIRWAY EXAM 1 COMPREHENSIVE QUESTIONS
WITH 100% VERIFIED SOLUTIONS-2024-2025
A difficult airway includes:
•Difficult _____
•Difficult ________
•Difficult ________
•Difficult ____ placement
•Difficult _______
BMV
laryngoscopy
intubation
EGD
criciothyrotomy
According to the ASA closed claims database, what is the most important factor leading to a failed
airway?
Failure to evaluate the airway and predict difficulty
Clinical situation in which a conventionally trained anesthesia provider experiences difficulty with face
mask ventilation of the upper airway, difficulty with tracheal intubation, or both
Difficult airway
Inability of a trained anesthetist to maintain a patient's spo2 above 90% by using face mask ventilation
Difficult mask airway
Inability to place an endotracheal tube within 10 minutes or three attempts at direct laryngoscopy
Or
Experienced laryngoscopist using direct laryngoscopy requires
•1)more than one attempt with the same blade
•2)change in blade or adjunct (bougie) or
•3)use of alternate device following failed intubation with direct laryngoscopy
Difficult intubation
6 adverse outcomes associated with difficult airway
Death
brain injury
cardiopulmonary arrest
unnecessary tracheostomy
airway trauma
damage to teeth
Failed airway:
,___ or more failed attempts at orotracheal intubation by ______ practitioner
Failure to maintain spo2% _____
3; skilled
>90
What are the typical presentations of a failed airway and which is an emergency?
Can ventilate/can't intubate (not an emergency)
Can't ventilate/can't intubate - emergency
Difficult BMV predictors (MOANS)
Mask seal
obese
age
no teeth
snores/stiff
What 3 things can make a mask seal difficult?
Bushy beards
crusted blood on face
disruption of lower facial continuity
What are the bonus Ms in MOANS?
Male gender
minimal jaw protrusion
MP 3/4
5 factors that fall under obese/obstructing lesion for diff BMV
Term pregnancy
BMI>30
angioedema
Ludwig's angina
upper airway abscesses
What is the bonus O in MOANS?
Obstructing lesion
At what age does BMV become diff?
Greater than 55
Why is being greater than age 55 a predictor for diff BMV?
Loss of muscle and tissue tone in the upper airway
,What is the bonus N in MOANS?
Neck radiation/fixed flexion deformity
3 factors that fall under snores/stiff for diff BMV
OSA
increased airway resistance (deadly asthma)
poor lung compliance (pulm edema)
Difficult mask ventilation:
Cannot provide sufficient gas exchange due to: poor _____ between mask & patient’s face, large ______
_____, or excessive ________ to ingress or egress of gas
Seak
volume leaks
resistance
BMV classification: ventilation by mask not attempted
Grade 0
BMV classification: ventilated by mask
Grade 1
BMV classification: ventilated by mask with oral airway or other adjuvant
Grade 2
BMV classification: difficult mask ventilation (inadequate, unstable, or requiring two practitioners)
Grade 3
BMV classification: unable to mask ventilate
Grade 4
Signs of diff mask ventilation:
•____ end-tidal CO2
•____ exhaled tidal volume
•___ chest movement
•____ breath sounds
•Auscultatory signs of severe ______
•____ or inadequate oxygen saturation
Decreased
decreased
decreased
decreased
, obstruction
decreased
The primary anesthesiologist stands at the head of the patient and uses left and right hands in classic
fashion. The secondary (helping) person stands facing the primary anesthesiologist at the level of the
patient's shoulder and uses the right hand to help achieve left-sided jaw thrust and mask seal while the
left hand achieves right-sided jaw thrust and mask seal
Two-person BMV
If you encounter a difficult BMV while you are alone, what do you do?
Turn flows up high with the APL closed and hold the mask on patient's face
Predicting diff laryngoscopy and intubation (LEMON)
Look externally
evaluate 3-3-2
mallampati score
obstruction
neck mobility
Look externally at what when predicting diff laryngoscopy and intubation?
Mandible
Protruding teeth
Trauma to oromaxillary structures
True or false: if an airway looks difficult, it probably is!
True
First 3 in evaluate 3-3-2
Mouth opening
Look externally- can cause a difficult laryngoscopy
Prognathism
Look externally- can cause a difficult laryngoscopy
Micrognathia
WITH 100% VERIFIED SOLUTIONS-2024-2025
A difficult airway includes:
•Difficult _____
•Difficult ________
•Difficult ________
•Difficult ____ placement
•Difficult _______
BMV
laryngoscopy
intubation
EGD
criciothyrotomy
According to the ASA closed claims database, what is the most important factor leading to a failed
airway?
Failure to evaluate the airway and predict difficulty
Clinical situation in which a conventionally trained anesthesia provider experiences difficulty with face
mask ventilation of the upper airway, difficulty with tracheal intubation, or both
Difficult airway
Inability of a trained anesthetist to maintain a patient's spo2 above 90% by using face mask ventilation
Difficult mask airway
Inability to place an endotracheal tube within 10 minutes or three attempts at direct laryngoscopy
Or
Experienced laryngoscopist using direct laryngoscopy requires
•1)more than one attempt with the same blade
•2)change in blade or adjunct (bougie) or
•3)use of alternate device following failed intubation with direct laryngoscopy
Difficult intubation
6 adverse outcomes associated with difficult airway
Death
brain injury
cardiopulmonary arrest
unnecessary tracheostomy
airway trauma
damage to teeth
Failed airway:
,___ or more failed attempts at orotracheal intubation by ______ practitioner
Failure to maintain spo2% _____
3; skilled
>90
What are the typical presentations of a failed airway and which is an emergency?
Can ventilate/can't intubate (not an emergency)
Can't ventilate/can't intubate - emergency
Difficult BMV predictors (MOANS)
Mask seal
obese
age
no teeth
snores/stiff
What 3 things can make a mask seal difficult?
Bushy beards
crusted blood on face
disruption of lower facial continuity
What are the bonus Ms in MOANS?
Male gender
minimal jaw protrusion
MP 3/4
5 factors that fall under obese/obstructing lesion for diff BMV
Term pregnancy
BMI>30
angioedema
Ludwig's angina
upper airway abscesses
What is the bonus O in MOANS?
Obstructing lesion
At what age does BMV become diff?
Greater than 55
Why is being greater than age 55 a predictor for diff BMV?
Loss of muscle and tissue tone in the upper airway
,What is the bonus N in MOANS?
Neck radiation/fixed flexion deformity
3 factors that fall under snores/stiff for diff BMV
OSA
increased airway resistance (deadly asthma)
poor lung compliance (pulm edema)
Difficult mask ventilation:
Cannot provide sufficient gas exchange due to: poor _____ between mask & patient’s face, large ______
_____, or excessive ________ to ingress or egress of gas
Seak
volume leaks
resistance
BMV classification: ventilation by mask not attempted
Grade 0
BMV classification: ventilated by mask
Grade 1
BMV classification: ventilated by mask with oral airway or other adjuvant
Grade 2
BMV classification: difficult mask ventilation (inadequate, unstable, or requiring two practitioners)
Grade 3
BMV classification: unable to mask ventilate
Grade 4
Signs of diff mask ventilation:
•____ end-tidal CO2
•____ exhaled tidal volume
•___ chest movement
•____ breath sounds
•Auscultatory signs of severe ______
•____ or inadequate oxygen saturation
Decreased
decreased
decreased
decreased
, obstruction
decreased
The primary anesthesiologist stands at the head of the patient and uses left and right hands in classic
fashion. The secondary (helping) person stands facing the primary anesthesiologist at the level of the
patient's shoulder and uses the right hand to help achieve left-sided jaw thrust and mask seal while the
left hand achieves right-sided jaw thrust and mask seal
Two-person BMV
If you encounter a difficult BMV while you are alone, what do you do?
Turn flows up high with the APL closed and hold the mask on patient's face
Predicting diff laryngoscopy and intubation (LEMON)
Look externally
evaluate 3-3-2
mallampati score
obstruction
neck mobility
Look externally at what when predicting diff laryngoscopy and intubation?
Mandible
Protruding teeth
Trauma to oromaxillary structures
True or false: if an airway looks difficult, it probably is!
True
First 3 in evaluate 3-3-2
Mouth opening
Look externally- can cause a difficult laryngoscopy
Prognathism
Look externally- can cause a difficult laryngoscopy
Micrognathia
