NBCRNA Airway Management 1 — Questions and Answers
Question 1: According to the ASA Difficult Airway Algorithm, after a failed intubation attempt in a 'cannot intubate, cannot oxygenate' (CICO) scenario, what is the definitive rescue technique?
- Emergency front-of-neck airway (cricothyrotomy) (Correct answer)
- Repeated direct laryngoscopy attempts
- Blind nasal intubation
- Retrograde wire intubation
Correct answer: Emergency front-of-neck airway (cricothyrotomy)
In a CICO emergency, emergency front-of-neck airway access (surgical or needle cricothyrotomy) is the definitive rescue step to restore oxygenation and prevent death.
Question 2: The Mallampati classification is used preoperatively to predict what?
- Difficulty of laryngoscopy and intubation (Correct answer)
- Aspiration risk
- Depth of anesthesia required
- Likelihood of post-operative sore throat
Correct answer: Difficulty of laryngoscopy and intubation
The Mallampati score assesses oropharyngeal structures visible with mouth open and tongue protruded; higher scores (III–IV) correlate with restricted laryngoscopic view and difficult intubation.
Question 3: Rapid sequence induction (RSI) is indicated in patients at risk for pulmonary aspiration and includes preoxygenation followed by what drug sequence?
- Induction agent + succinylcholine (or rocuronium), no mask ventilation (Correct answer)
- Induction agent + non-depolarizing NMB + mask ventilation
- Induction agent only, awake intubation
- Inhalation induction with cricoid pressure
Correct answer: Induction agent + succinylcholine (or rocuronium), no mask ventilation
Classic RSI uses an induction agent with succinylcholine (or high-dose rocuronium for a modified RSI) without positive-pressure mask ventilation to minimize aspiration risk before cuff inflation.
Question 4: The epiglottis is lifted indirectly when the laryngoscope blade tip is placed in the vallecula during which technique?
- Curved (Macintosh) blade laryngoscopy (Correct answer)
- Straight (Miller) blade laryngoscopy
- Video laryngoscopy with hyperangulated blade
- Fiberoptic nasotracheal intubation
Correct answer: Curved (Macintosh) blade laryngoscopy
The Macintosh curved blade is placed in the vallecula (between the base of tongue and epiglottis); advancement stretches the hyoepiglottic ligament, indirectly elevating the epiglottis.
Question 5: Which finding on laryngoscopy corresponds to a Cormack-Lehane Grade III view?
- Only epiglottis visible, no glottic structures seen (Correct answer)
- Full glottis visible
- Posterior glottis visible
- No laryngeal structures visible
Correct answer: Only epiglottis visible, no glottic structures seen
A Grade III Cormack-Lehane view means only the epiglottis can be seen, with no part of the glottis visible, indicating a difficult intubation.
Question 6: Awake fiberoptic intubation is the preferred technique in which type of patient?
- Known or anticipated difficult airway with full stomach risk (Correct answer)
- Pediatric patient with small airways
- Patient with history of malignant hyperthermia
- Morbidly obese patient with normal airway exam
Correct answer: Known or anticipated difficult airway with full stomach risk
Awake fiberoptic intubation preserves spontaneous respiration and airway reflexes, making it ideal for patients with known difficult airways where loss of airway control under anesthesia would be dangerous.
NBCRNA Airway Management 1
According to the ASA Difficult Airway Algorithm, after a failed intubation attempt in a 'cannot intubate, cannot oxygenate' (CICO) scenario, what is the definitive rescue technique?