CRNA CRNA Airway Management 2 — Questions and Answers
Question 1: What does the 3-3-2 rule assess in predicting difficult intubation?
- Mouth opening, thyromental distance, and hyomental distance (Correct answer)
- Cervical spine flexion, mouth opening, and BMI
- Mallampati class, neck circumference, and mouth opening
- Neck mobility, upper lip bite test, and thyromental distance
Correct answer: Mouth opening, thyromental distance, and hyomental distance
The 3-3-2 rule evaluates: ≥3 finger-breadths mouth opening, ≥3 finger-breadths thyromental distance, and ≥2 finger-breadths hyomental space to predict intubation difficulty.
Question 2: A laryngeal mask airway (LMA) is contraindicated in which of the following situations?
- Full stomach with risk of aspiration (Correct answer)
- Difficult mask ventilation
- Short surgical procedure under 30 minutes
- Patient refusal of endotracheal intubation
Correct answer: Full stomach with risk of aspiration
LMAs do not protect the airway from regurgitation and aspiration; a full stomach or high aspiration risk is a primary contraindication.
Question 3: During nasotracheal intubation, in which naris should the tube be advanced to minimize resistance and bleeding?
- The right naris (bevel faces the septum) (Correct answer)
- The left naris always
- The larger-appearing naris regardless of side
- Either naris with equal preference
Correct answer: The right naris (bevel faces the septum)
The right naris is preferred because advancing the tube with the bevel facing the nasal septum reduces turbinate trauma and epistaxis risk.
Question 4: What is the maximum safe duration of apnea in a healthy, well-preoxygenated adult patient before SpO2 begins to desaturate?
- 8–10 minutes (Correct answer)
- 30–60 seconds
- 2–3 minutes
- 15–20 minutes
Correct answer: 8–10 minutes
A healthy, well-preoxygenated adult can tolerate approximately 8–10 minutes of apnea before significant oxyhemoglobin desaturation occurs.
Question 5: Which technique can extend the safe apnea time during intubation attempts in an obese or pediatric patient?
- Apneic oxygenation via nasal cannula at high flow (Correct answer)
- Rapid bag-mask ventilation between attempts
- Administration of atropine to reduce oxygen consumption
- Preoxygenation with room air followed by 100% FiO2
Correct answer: Apneic oxygenation via nasal cannula at high flow
High-flow nasal cannula oxygen (15 L/min) during laryngoscopy maintains oxygenation through apneic diffusion, significantly extending safe apnea time.
Question 6: Which clinical sign is most specific for identifying right mainstem bronchus intubation?
- Decreased or absent breath sounds on the left (Correct answer)
- SpO2 below 90%
- High peak airway pressure
- Presence of end-tidal CO2
Correct answer: Decreased or absent breath sounds on the left
Absent or markedly diminished breath sounds on the left side upon auscultation is the most specific clinical indicator of right mainstem bronchus intubation.
CRNA CRNA Airway Management 2
What does the 3-3-2 rule assess in predicting difficult intubation?