TEXAS CLASS A BARBER STATE
BOARD WRITTEN ACTUAL EXAM
2026/2027 | TDLR 6th Edition |
Comprehensive Practice Test | Verified
Q&A | Pass Guaranteed - A+ Graded
SECTION 1: AIRWAY ASSESSMENT & MANAGEMENT (20
Questions)
Q1: A 65-year-old male presents with stridor and respiratory distress. Which finding would
most suggest a difficult airway requiring preparation for surgical airway?
A. Mallampati Class II view
B. Thyromental distance of 5 cm [CORRECT]
C. Ability to protrude mandible beyond incisors
D. Neck circumference of 40 cm
Correct Answer: B
Rationale: A thyromental distance of less than 6 cm (approximately 3 fingerbreadths)
indicates an anterior larynx and predicts difficult intubation. This finding should prompt
preparation for alternative airway strategies including surgical airway. FCCS guidelines
emphasize that multiple airway predictors should be assessed together, but thyromental
distance <6 cm is a strong independent predictor of difficult laryngoscopy.
Q2: What is the most common cause of airway obstruction in an unconscious patient?
A. Laryngospasm
B. Foreign body aspiration
C. The tongue [CORRECT]
,D. Epiglottitis
Correct Answer: C
Rationale: The tongue is the most common cause of airway obstruction in unconscious
patients due to loss of muscle tone allowing the tongue to fall back against the posterior
pharynx. Simple airway maneuvers like head-tilt chin-lift or jaw thrust can often relieve this
obstruction. FCCS emphasizes that basic airway maneuvers should be attempted before
advanced interventions.
Q3: A 45-year-old trauma patient has a GCS of 7 and requires airway management. Before
intubation, which maneuver is MOST appropriate to open the airway while maintaining
cervical spine precautions?
A. Head-tilt chin-lift
B. Jaw thrust without head extension [CORRECT]
C. Placement of oropharyngeal airway only
D. Cricoid pressure application
Correct Answer: B
Rationale: The jaw thrust maneuver elevates the mandible and displaces the tongue anteriorly
without extending the neck, making it the preferred technique in trauma patients with
potential cervical spine injury. FCCS protocols emphasize maintaining inline stabilization
during all airway maneuvers in trauma patients.
Q4: Which patient is MOST likely to benefit from an oropharyngeal airway (OPA)?
A. A 28-year-old with intact gag reflex after seizure
B. A 55-year-old unconscious patient without gag reflex [CORRECT]
C. A 35-year-old with facial trauma and loose teeth
D. A 70-year-old with epiglottitis
Correct Answer: B
Rationale: OPAs are indicated in unconscious patients without an intact gag reflex to prevent
tongue-based airway obstruction. They are contraindicated in patients with intact gag reflexes
(risk of vomiting/aspiration), facial trauma (risk of displacing loose teeth), or epiglottitis (risk
,of precipitating complete obstruction). FCCS guidelines stress assessing gag reflex before
OPA insertion.
Q5: A nasopharyngeal airway (NPA) is CONTRAINDICATED in which situation?
A. Patient with basilar skull fracture [CORRECT]
B. Patient with clenched teeth
C. Patient requiring frequent suctioning
D. Patient with intact gag reflex
Correct Answer: A
Rationale: NPAs are contraindicated in suspected basilar skull fracture due to risk of entering
the cranial vault through a fractured cribriform plate. While NPAs are better tolerated than
OPAs in patients with intact gag reflexes, the risk of intracranial placement outweighs
benefits in basilar skull fractures. FCCS emphasizes checking for Battle's sign or raccoon
eyes before NPA placement.
Q6: During bag-mask ventilation, you notice poor chest rise and minimal air entry. The first
step in troubleshooting should be:
A. Immediately intubate the patient
B. Reposition the head and jaw [CORRECT]
C. Increase ventilation rate to 20 breaths/minute
D. Perform needle cricothyrotomy
Correct Answer: B
Rationale: Poor chest rise during bag-mask ventilation is most commonly due to inadequate
airway positioning or seal. The first step is to reposition using head-tilt chin-lift or jaw thrust
while ensuring proper mask seal with the E-C clamp technique. FCCS teaches that most BVM
difficulties are resolved with proper positioning and technique rather than immediate
escalation to invasive airway.
Q7: Which finding on capnography indicates CORRECT endotracheal tube placement?
A. Flat line waveform
, B. Square wave with consistent EtCO2 >10 mmHg [CORRECT]
C. Curved upward slope without plateau
D. Gradually decreasing EtCO2 over 3 minutes
Correct Answer: B
Rationale: A normal capnography waveform shows a square wave pattern with consistent
end-tidal CO2 >10 mmHg, indicating ventilation of perfused alveoli. Flat line suggests
esophageal intubation; gradually decreasing EtCO2 suggests decreased cardiac output or
hyperventilation. FCCS mandates continuous quantitative capnography for all intubated
patients as the gold standard for confirming and monitoring tube position.
Q8: A patient requires emergent intubation for respiratory failure. Which combination of drugs
is MOST appropriate for rapid sequence intubation (RSI) in a hemodynamically stable patient?
A. Midazolam and fentanyl only
B. Etomidate and succinylcholine [CORRECT]
C. Propofol and rocuronium
D. Ketamine and vecuronium
Correct Answer: B
Rationale: Etomidate provides rapid induction with minimal cardiovascular effects, making it
ideal for RSI in critically ill patients. Succinylcholine offers rapid onset (45-60 seconds) and
short duration for emergent intubation. FCCS recommends this combination for
hemodynamically stable patients requiring emergent airway control, with ketamine as an
alternative induction agent in hypotensive patients.
Q9: Following intubation, which finding confirms tracheal placement of the endotracheal tube
EXCEPT:
A. Bilateral breath sounds
B. Condensation in the tube
C. Chest rise with ventilation
D. Gastric distension with ventilation [CORRECT]
BOARD WRITTEN ACTUAL EXAM
2026/2027 | TDLR 6th Edition |
Comprehensive Practice Test | Verified
Q&A | Pass Guaranteed - A+ Graded
SECTION 1: AIRWAY ASSESSMENT & MANAGEMENT (20
Questions)
Q1: A 65-year-old male presents with stridor and respiratory distress. Which finding would
most suggest a difficult airway requiring preparation for surgical airway?
A. Mallampati Class II view
B. Thyromental distance of 5 cm [CORRECT]
C. Ability to protrude mandible beyond incisors
D. Neck circumference of 40 cm
Correct Answer: B
Rationale: A thyromental distance of less than 6 cm (approximately 3 fingerbreadths)
indicates an anterior larynx and predicts difficult intubation. This finding should prompt
preparation for alternative airway strategies including surgical airway. FCCS guidelines
emphasize that multiple airway predictors should be assessed together, but thyromental
distance <6 cm is a strong independent predictor of difficult laryngoscopy.
Q2: What is the most common cause of airway obstruction in an unconscious patient?
A. Laryngospasm
B. Foreign body aspiration
C. The tongue [CORRECT]
,D. Epiglottitis
Correct Answer: C
Rationale: The tongue is the most common cause of airway obstruction in unconscious
patients due to loss of muscle tone allowing the tongue to fall back against the posterior
pharynx. Simple airway maneuvers like head-tilt chin-lift or jaw thrust can often relieve this
obstruction. FCCS emphasizes that basic airway maneuvers should be attempted before
advanced interventions.
Q3: A 45-year-old trauma patient has a GCS of 7 and requires airway management. Before
intubation, which maneuver is MOST appropriate to open the airway while maintaining
cervical spine precautions?
A. Head-tilt chin-lift
B. Jaw thrust without head extension [CORRECT]
C. Placement of oropharyngeal airway only
D. Cricoid pressure application
Correct Answer: B
Rationale: The jaw thrust maneuver elevates the mandible and displaces the tongue anteriorly
without extending the neck, making it the preferred technique in trauma patients with
potential cervical spine injury. FCCS protocols emphasize maintaining inline stabilization
during all airway maneuvers in trauma patients.
Q4: Which patient is MOST likely to benefit from an oropharyngeal airway (OPA)?
A. A 28-year-old with intact gag reflex after seizure
B. A 55-year-old unconscious patient without gag reflex [CORRECT]
C. A 35-year-old with facial trauma and loose teeth
D. A 70-year-old with epiglottitis
Correct Answer: B
Rationale: OPAs are indicated in unconscious patients without an intact gag reflex to prevent
tongue-based airway obstruction. They are contraindicated in patients with intact gag reflexes
(risk of vomiting/aspiration), facial trauma (risk of displacing loose teeth), or epiglottitis (risk
,of precipitating complete obstruction). FCCS guidelines stress assessing gag reflex before
OPA insertion.
Q5: A nasopharyngeal airway (NPA) is CONTRAINDICATED in which situation?
A. Patient with basilar skull fracture [CORRECT]
B. Patient with clenched teeth
C. Patient requiring frequent suctioning
D. Patient with intact gag reflex
Correct Answer: A
Rationale: NPAs are contraindicated in suspected basilar skull fracture due to risk of entering
the cranial vault through a fractured cribriform plate. While NPAs are better tolerated than
OPAs in patients with intact gag reflexes, the risk of intracranial placement outweighs
benefits in basilar skull fractures. FCCS emphasizes checking for Battle's sign or raccoon
eyes before NPA placement.
Q6: During bag-mask ventilation, you notice poor chest rise and minimal air entry. The first
step in troubleshooting should be:
A. Immediately intubate the patient
B. Reposition the head and jaw [CORRECT]
C. Increase ventilation rate to 20 breaths/minute
D. Perform needle cricothyrotomy
Correct Answer: B
Rationale: Poor chest rise during bag-mask ventilation is most commonly due to inadequate
airway positioning or seal. The first step is to reposition using head-tilt chin-lift or jaw thrust
while ensuring proper mask seal with the E-C clamp technique. FCCS teaches that most BVM
difficulties are resolved with proper positioning and technique rather than immediate
escalation to invasive airway.
Q7: Which finding on capnography indicates CORRECT endotracheal tube placement?
A. Flat line waveform
, B. Square wave with consistent EtCO2 >10 mmHg [CORRECT]
C. Curved upward slope without plateau
D. Gradually decreasing EtCO2 over 3 minutes
Correct Answer: B
Rationale: A normal capnography waveform shows a square wave pattern with consistent
end-tidal CO2 >10 mmHg, indicating ventilation of perfused alveoli. Flat line suggests
esophageal intubation; gradually decreasing EtCO2 suggests decreased cardiac output or
hyperventilation. FCCS mandates continuous quantitative capnography for all intubated
patients as the gold standard for confirming and monitoring tube position.
Q8: A patient requires emergent intubation for respiratory failure. Which combination of drugs
is MOST appropriate for rapid sequence intubation (RSI) in a hemodynamically stable patient?
A. Midazolam and fentanyl only
B. Etomidate and succinylcholine [CORRECT]
C. Propofol and rocuronium
D. Ketamine and vecuronium
Correct Answer: B
Rationale: Etomidate provides rapid induction with minimal cardiovascular effects, making it
ideal for RSI in critically ill patients. Succinylcholine offers rapid onset (45-60 seconds) and
short duration for emergent intubation. FCCS recommends this combination for
hemodynamically stable patients requiring emergent airway control, with ketamine as an
alternative induction agent in hypotensive patients.
Q9: Following intubation, which finding confirms tracheal placement of the endotracheal tube
EXCEPT:
A. Bilateral breath sounds
B. Condensation in the tube
C. Chest rise with ventilation
D. Gastric distension with ventilation [CORRECT]
