Apex Unit 2: Respiratory - Airway Management 128 Correct Solutions

Apex Unit 2: Respiratory - Airway
Management 128 Correct Solutions
Apex Unit 2: Respiratory - Airway
Management 128 Correct Solutions
Which airway exam helps us quantify the size of the tongue relative to the volume in the mouth? -
ANSWER Mallampati



(The more space the tongue occupies, the less space there is to work.)



What Mallampati scores are associated with a more difficult intubation? - ANSWER 3 and 4



True or false - By itself, Mallampati is a poor predictor of a difficult airway. - ANSWER True



(Its predictive power increases when we use it in conjunction with additional airway exams.)



Normal inter-incisor gap is _______ finger-breadths or _______ cm. - ANSWER 2-3 finger-breadths or 4
cm



(Long incisors reduce the gap. Buck teeth increase the risk of dental damage. Restriction of mouth
opening can be caused by arthritis, scar tissue, TMJ disease, and prior surgery.)



Which airway exam helps us estimate the size of the submandibular space? - ANSWER Thyromental
distance



(With the neck extended and mouth closed, you can measure the distance from the tip of the thyroid
cartilage to the tip of the mentum.)



Laryngoscopy may be more difficult if the thyromental disease is less than _____ cm or greater than
_____ cm. - ANSWER < 6 cm or > 9 cm

,Apex Unit 2: Respiratory - Airway
Management 128 Correct Solutions
(If the TMD is more than 9 cm, the larynx assumes a more caudal position. Because the tongue is fixed at
the hyoid bone, the tongue moves caudally as well. These changes shift the glottic opening beyond the
line of sight, increasing the difficulty of laryngoscopy.)



Which airway exam assess the function of the temporomandibular joint? - ANSWER Mandibular
protrusion test



(The patient is asked to sublux the jaw, and the position of the lower incisors is compared to the position
of the upper incisors.)



Mandibular protrusion test -



Class _______ - A patient can move the lower incisors past the upper incisors and bite the vermillion of
the lip.



Class ________ - A patient cannot move the lower incisors past the upper incisors.



Class ________ - A patient can move the lower incisors in line with the upper incisors. - ANSWER Class 1



Class 3



Class 2



(Class 3 is associated with an increased risk of difficult intubation.)



The ability to place the patient into the sniffing position is highly dependent on the mobility of the
______________ joint. - ANSWER Atlanto-occipital



Normal atlanto-occipital flexion and extension = 90-165 degrees

,Apex Unit 2: Respiratory - Airway
Management 128 Correct Solutions

Normal atlanto-occipital extension = 35 degrees



Laryngoscopy will be difficult with atlanto-occipital extension < ________ degrees - ANSWER < 23
degrees



(Conditions that impair atlanto-occipital mobility include degenerative joint disease, rheumatic arthritis,
ankylosing spondylitis, trauma, surgical fixation, Klippel-Feil, Down syndrome, and diabetes mellitus.)



Describe the 3-3-2 rule. - ANSWER Inter-incisor gap > 3 finger-breadths

Thyromental disease > 3 finger-breadths

Thyrohyoid > 2 finger-breadths



Only the epiglottis can be visualized during direct vision laryngoscopy. What is this patient's Cormack
and Lehane score? - ANSWER 3



Cormack and Lehane grade ______ - You have a complete or nearly complete view of the glottic
opening. - ANSWER Grade I



Cormack and Lehane grade ______ - You can see the posterior region of the glottic opening, but you
cannot see the anterior commissure. - ANSWER Grade II



Cormack and Lehane grade ______ - You can only see the epiglottis. You cannot see any part of the
glottic opening. - ANSWER Grade III



Cormack and Lehane grade ______ - You can only see the soft palate. You cannot see any part of the
larynx. - ANSWER Grade IV



Modification of the Cormack and Lehane score -

, Apex Unit 2: Respiratory - Airway
Management 128 Correct Solutions
Grade ______ = You can see the posterior region of the glottic opening.



Grade _______ = You can only see the corniculate cartilages and posterior vocal cords. You cannot see
any part of the glottic opening. - ANSWER Grade IIA



Grade IIB



How does the Cormack and Lehane score correlate with intubation?



Grade I and IIA = ________ intubation



Grade IIB and III = _________ intubation



Grade IV = Requires alternative approach to intubation - ANSWER Grade I and IIA = Easier intubation



Grade IIB - III = Difficult intubation (bougie is a great option)



Grade IV = Alternative approach to intubation



Identify the BEST predictors of difficult mask ventilation. (Select 3)

-Mallampati class III

-Old age

-Edentulousness

-Small mouth opening

-High, arched palate

-Presence of a beard - ANSWER Old age

Edentulousness

Presence of a beard