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FISDAP-AIRWAY EXAM QUESTIONS

AND ANSWERS | UPDATED 2024

Upper Airway - Correct Answer-Consists of all structures above the level of the vocal cords. The nose, mouth, jaw, oral cavity and pharynx. Lower Airway - Correct Answer-Function is to exchange oxygen and carbon dioxide. Starts at the larynx. Spans from the glottis to the pulmonary capillary membrane. Turbinates - Correct Answer-Increase the surface area of the nasal mucosa, thereby improving the processes of warming, filtering and humidification of inhaled air. Hyoid Bone - Correct Answer-Small, horseshoe shaped bone that attaches to the tongue. Thyroid Cartilage - Correct Answer-Adams apple. Directly anterior to the glottic opening. Cricoid Cartilage - Correct Answer-AKA Cricoid Ring, forms the lowest portion of the larynx, and the first ring of the trachea. Cricothyroid Membrane - Correct Answer-Site for emergency surgical and nonsurgical access to the airway. Between the thyroid and cricoid cartilage. Vellecula - Correct Answer-Anatomic space or "pocket" located between the base of the tongue and the epiglottis. Where the MAC blade goes. Laryngospasm - Correct Answer-When the airway is stimulated (such as during aspiration of foreign material or submersion incident), defensive reflexes cause a spasmodic closure of the vocal cords, which seals off the airway. Trachea - Correct Answer-AKA Windpipe, is the conduit for air entry into the lungs. Approx 10-12 cm long, & consists of C-Shaped Cartilaginous rings. Begins immediately below the cricoid cartilage. Divides into the right and left mainstem bronchi at the level of the Carina. Mediastinum - Correct Answer-The space between the lungs that contains, in addition to the trachea, the heart, great vessels, and a portion of the esophagus. Main thing to know- the heart is housed there. Carina - Correct Answer-Where the right and left mainstem bronchi branch off. Goblet Cells - Correct Answer-Mucous producing cells, that are lined in the trachea and bronchi. They trap small particles and other potential contaminants.

Beta-2 Adrenergic Receptors - Correct Answer-Stimulate bronchodilation.

of Lobes in each Lung - Correct Answer-Right lung- 3, Left lung- 2.

Visceral pleura - Correct Answer-Thin, slippery, outer membrane covering the lungs. Parietal Pluera - Correct Answer-Lines the inside of the thoracic cavity. Bronchioles - Correct Answer-Made of smooth muscle & lined with beta-2 receptors, which can dilate and constrict based on stimuli. Alveoli - Correct Answer-Balloon-like clusters of single-layer air sacs, and serve as the functional site for the exchange of oxygen and CO2. This exchange occurs by simple diffusion over the pulmonary capillaries. Ventilation - Correct Answer-Process of moving air in and out of the lungs. Consist of two phases- inhalation and exhalation. Oxygenation - Correct Answer-Process of loading O2 molecules onto hemoglobin molecules in the bloodstream. Respiration - Correct Answer-Actual exchange of O2 and CO2 in the alveoli and the tissues of the body. Inhalation - Correct Answer-Air enters the body, the diaphragm and intercostal muscles contract. When the diaphragm contracts, it descends and enlarges the thoracic cage from top to bottom. When the intercostal muscles contract, they lift the ribs up and out. Diaphragm - Correct Answer-Stimulated by the Phrenic Nerve, it is a voluntary and involuntary muscle. Accessory Muscles - Correct Answer-Secondary muscles of breathing, and include the sternocleidomastoid and trapezius muscles of the neck. Negative Pressure Ventilation - Correct Answer-The air outside the body, is normally higher in pressure than the air within the thorax. During inhalation, the thoracic cage expands and the air within the thorax decreases, creating a slight vacuum. The vacuum pulls the air in through the trachea, causing the lungs to fill. Positive Pressure Ventilation - Correct Answer-With ineffective chest movement, or no chest movement, negative intrathoracic pressure cannot be created. When this occurs, the only way to move air into the lungs is by PPV, the forcing of air into the lungs. Tidal Vol/Dead Space/Residual Vol/Total Lung Capacity - Correct Answer-Tidal- 500ml Total Lung Capacity- 6,000ml/5-6L Dead Space- 150ml

Residual Vol- 1,200ml Hering- Breuer Reflex - Correct Answer-Terminates inhalation to prevent over- expansion of the lungs. Medulla - Correct Answer-Primary involuntary (autonomic) respiratory center. Connected to the respiratory muscles by the vagus nerve. The medullary respiratory center controls the rate, depth, and rhythm of breathing. Chemoreceptors - Correct Answer-Receptors that monitor the chemical composition (pH, CO2,) of body fluids that are located throughout the body. They measure the amount of CO2 in arterial blood and pH in CSF, and if sensed any changes will send signals to the respiratory center. Dorsal Respiratory Group - Correct Answer-Responsible for initiating inspiration based on the information received in the chemoreceptors. Ventral Respiratory Group - Correct Answer-Responsible for motor control of the inspiratory and expiratory muscles. Hypoxic Drive - Correct Answer-Pt's with COPD have a hard time eliminating CO2, therefore always have higher levels of it. The respiratory centers gradually accommodate elevated CO2 levels. The body uses a backup system, that stimulates breathing when the arterial O2 level falls, but then nerves and receptors are easily satisfied with minimal O2. Aerobic Metabolism - Correct Answer-In the presence of oxygen, the cells convert glucose into energy through this process. Anaerobic Metabolism - Correct Answer-Without adequate O2, the cells do not completely convert glucose into energy and lactic acid and other toxins accumulate into the cell. If this is not corrected (with adequate perfusion and ventilation) the cells will die. Hypoxia - Correct Answer-Dangerous condition in which the cells in the tissues do not receive enough O2. V/Q Mismatch - Correct Answer-Ventilation and perfusion must be matched. A failure to match ventilation and perfusion, lies behind most abnormalities in oxygen and carbon dioxide exchange. Hypoventilation - Correct Answer-Minute vol- decreases. CO2 elimination- decreases, leading to hypercarbia. The level of CO2 in the pt's blood will exceed normal limits.

Hyperventilation - Correct Answer-Minute vol- increases. CO2 elimiation- increases, leading to hypocarbia. The level of CO2 in pt's blood will fall below normal, leading to dizziness, and numbness in the face and extremities. Intrapulmonary Shunting - Correct Answer-Blood entering the lungs from the right side of the heart, in an unoxygenated state. Resp Acidosis - Correct Answer-Anytime a pt is in resp distress or is unable to breathe, acidosis quickly develops, because of a buildup in CO2. Resp Alkalosis - Correct Answer-Alkalosis can develop if respiration's are too high, and there is not enough CO2 in the body, the body will be high in base. Orthopnea - Correct Answer-Severe dyspnea experienced when recumbent and relieved by sitting or standing up. Apnuestic Breathing - Correct Answer-Prologned, gasping inhalation followed by extremely short, ineffective exhalation; associated with brainstem insult. Adventitious Respirations - Correct Answer-Abnormal airway sounds. Retractions - Correct Answer-Skin pulling between and around the ribs during inhalation. Paradoxical Motion - Correct Answer-The inward movement of a segment of the chest during inhalation and outward movement of the chest during exhalation, opposite normal chest movement and an indication of a flail chest. Pulsus Paradoxus - Correct Answer-A clinical finding in which the systolic blood pressure drops more than 10mmHg, during inhalation. A change in pulse quality, or a disappearance of a pulse during inhalation, may also be detected. COPD, pericaridal tamponade, tension pnuemothorax, & severe asthma attack. End- Tidal CO2 - Correct Answer-Detects the presence of CO2 in exhaled air and are important adjuncts for determining ventilation adequacy. Normally range between 35-

Capnographer - Correct Answer-Performs the same function and attaches in the same way as the capnometer, but it provides a graphic representation of exhaled carbon dioxide. Capnometer - Correct Answer-Capnometer provides a numeric reading of exhaled carbon dioxide. Phase A of Waveform - Correct Answer-First phase, is the respiratory baseline. The initial stage of exhalation; the gas sample is dead space gas, free of CO2.

Phase B of Waveform - Correct Answer-Second phase, abrupt rise in CO2 due to a mixture of alveolar gas with dead space gas, called the upslope. Also phase B-C. Phase C of Waveform - Correct Answer-Expiratory or alveolar plateau is represented by phase C-D, and the gas sampled is essentially alveolar. Phase D of Waveform - Correct Answer-Point D is maximal ETCO2 level, the best reflection of teh alveolar CO2 level. Phase E of Waveform - Correct Answer-Fresh gas is introduced during the inspiratory downstroke (phase D-E), and the waveform returns to the baseline level of CO2- approx

Bag Valve Mask - Correct Answer-Whenever possible, you and your partner should work together to provide ventilation's with the BVM, to ensure the artificial ventilations are adequate, you must look for CHEST RISE AND FALL, make sure the RATE IS NOT TOO FAST or SLOW, and make sure the PULSE RATE IMPROVES. CPAP - Correct Answer-CHF pt's, pulm edema, COPD, and acute bronchospasm (acute asthma), submersion accidents, pulse ox less than 90, and rapid breathing, are indications for CPAP. Do not use if pt has abnormal LOC, hypoventilation, pneumothorax, tracheostomy, and active GI bleed. PEEP - Correct Answer-Positive end expiratory pressure; during the epxiratory phase the pt exhales against this resistance. A PEEP of 5-10 is generally what is used. Suctioning a Trache - Correct Answer-Preoxygenate, insert 3ml of saline into stoma, instruct the pt to exhale while inserting the catheter, then begin suctioning on the way out. Ventilating a Trache Stoma - Correct Answer-Neither head tilt or chin lift is required for pt w/ a stoma. If using a BVM, use a pediatric mask over the stoma to get a good seal, then seal the pt's nose and mouth to prevent leakage. Tracheostomy Tube - Correct Answer-A plastic tube placed within the trachea site (stoma), and is compatible with BVM 15/22mm, so your BVM will connect right too it. May need to suction the trache tube before ventilating. Stenosis - Correct Answer-When the trache tube becomes dislodged, and is potentially life threatening because soft tissue damage may occur. You may have to insert an ET tube into the stoma before it becomes totally occluded. How to fix Stenosis - Correct Answer-Lubricate the same size trache tube or ET tube, instruct the pt to exhale and gently insert the tube approx 1 to 2 cm beyond the balloon

cuff. Inflate the balloon cuff. Confirm patency and proper placement of the tube, auscultate lung sounds. Predicting the Difficult Airway - Correct Answer-LEMON- Look externally, Evaluate 3-3- 2, Mallampati, Obstruction, Neck mobility. 3-3-2 RULE - Correct Answer-The first 3 refers to mouth opening, ideally a pt's mouth should open at least 3 fingerwidths (5cm). The second 3 refers to the length of the mandible, at least 3 fingerwidths is optimal. The 2 part refers to the distance from the hyoid bone to the thyroid notch; it should be at least 2 fingers wide. Complications of an ET tube - Correct Answer-Bleeding, hypoxia, laryngeal swelling, laryngospasm, vocal cord damage, mucosal necrosis and barotrauma. NEVER take your hand off the ET tube before it has been secured in place. Straight Blade (Miller) - Correct Answer-Designed to lift up the epiglottis, and goes beneath it. Beneficial for children who have large epiglottis, but requires great care and if used improperly it is more likely to damage teeth. Curved Blade (MAC) - Correct Answer-Goes into the vallecular space, between the tongue and the glottis, and indirectly lifts the epiglottis. Less likely to be levered against the teeth. Confirmation of ET tube placement - Correct Answer-Visualizing the passes of the tube through the vocal cords is your first confirmation and most reliable, listening to lung sounds and gastric sounds, resistance while BVM'ing, capnography readings, and the esophageal detector device. Steps for an ET tube - Correct Answer-Preparation (gathering all your supplies), preoxygenating (at least 2 minutes with an airway adjunct), positioning the patient (sniffing position, or ear to sternum), insert the blade, insert the tube you must see the tube pass through the vocal cords, if you don't see the vocal cords do not pass the tube, after you pass it through, remove your blade, hold the tube securely, and remove the stylet, inflate the cuff 5-10cc, and begin ventilations. BURP Maneuver - Correct Answer-Backward, upward, rightward position. Done by partner to help you visualize the vocal cords. Tracheobronchial Suctioning - Correct Answer-Sterile procedure, do not do if you do not have too, unless the secretions are so severe they are interfering with ventilation. Suctioning the trachea can cause dysrhythmias, so make sure you have the pt on a 12 lead. Preoxygenation is very important. Lubricate the suctioning tube. May be necessary to insert 3-5ml of saline to loosen the secretions. Gently insert until resistance is felt (when you hit the carina), and suction on the way out for no more than 10 seconds.

Extubation - Correct Answer-Process of removing the ET tube. Consider sedating the pt before remove the tube. Complications of removing the tube are vomiting, a laryngospasm, and airway swelling. Do not remove the tube if there is any risk of recurrent resp failure or uncertainty about a pt's ability to maintain their own airway. 20 Seconds or Less - Correct Answer-A single pediatric intubation should not exceed more than 20 seconds. If intubation cannot be performed at this time, abort the attempt and resume bag-mask ventilations. Pediatric Laryngoscope Blades - Correct Answer-Premature newborn- 0 straight Full-term newborn- size 1 straight 2 yrs to adolescent- size 2 straight Adolescent and older- size 3 straight or curved Differences in Pediatric Airway - Correct Answer-Infants and smaller children have a rounder, larger OCCIPUT. In children, the TONGUE is larger, and the EPIGLOTTIS is more floppy and omega-shaped. The TRACHEA in a child is smaller, shorter, and more narrow. Selecting Pediatric Tubes - Correct Answer-Children under 8-10 yrs old usually get an ET tube without a cuff, because inflating the cuff can cause damage to the trachea. ET tubes smaller than 5.0 generally do not have a cuff. Sedation - Correct Answer-Used in airway management to reduce a pt's anxiety, induce amnesia, and decrease the gag reflex. It is useful for pt's who are anxious, combative, or agitated. Complications with sedation include over sedating/under sedating. Butyrophenones - Correct Answer-Potent, effective sedatives. Two of these drugs are haloperidol (Haldol), and droperidol (Inapsine), are frequently used for relief of anxiety. They do not produce apnea and have little effect on the cardiovascular system. Benzodiazepines - Correct Answer-Sedative-hypnotic drugs. Diazepam (Valium), and midazolam (Versed), provide muscle relaxation and mild sedation and are used for anxiety and antiseizure medications. They also provide anterograde amnesia, which is beneficial for invasive and uncomfortable procedures; the pt will not likely recall the event. Resp depression and hypotension are potential side effects. Midazolam (Versed) - Correct Answer-Two-four times more potent as diazepam, is faster acting, and has a shorter duration of action. Because large doses of midazolam are necessary to achieve the desired effect, it should not be used as a induction agent. Barbiturates - Correct Answer-Sedative-hypnotic medications that have a long history of use. Barbiturates can cause significant respiratory depression and a drop in BP of approx 10% in normovolemic pt's. The drop in BP can be profound and potentially irreversible in hypovolemic pt's.

Opioids/Narcotics - Correct Answer-Potent analgesics with sedative properties. They can be used in emergency airway management as a premedication, during induction, and in maintenance of a sedation/amnesia. Most common are Fentanyl (sublimaze) and alfentanil (alfenta). Opioids can cause profound respiratory and CNS depression, and produce severe hypotension and bradycardia, esp in hemodynamically unstable pt's. These effects can be reversed with naloxone (narcan). Fentanyl - Correct Answer-It is 70-150 more potent than morphione. It has a rapid onset of action and relatively short duration of action. Non-narcotic/Non-barbiturate - Correct Answer-Etomidate (amidate) is a non-narcotic, non-barbiturate, hypnotic-sedative drug often used in the induction of general anesthesia. It is fast acting agent of short duration. This drug has little effect on pulse rate, BP and ICP, and does not cause histamine release and bronchoconstriction that may occur with other agents. Useful induction agent in pt's with coronary artery disease, increased ICP, or boderline hypotension/hypovolemia. Paralytics - Correct Answer-A safer, more effective approach is "chemical paralysis" with neuromuscular blocking agents. With the pt chemically sedated and paralyzed, his or her protective airway reflexes are lost; you can effectively perform oxygenation and ventilation, and the pt will not gag during insertion of an ET tube. Paralytics, unlike sedatives do not affect the LOC. Pt can still hear/think/and feel! Acetylcholine (ACh) - Correct Answer-Paralytic medications function at the neromuscular junction and relax the muscle by impeding the action of ACh. Depolarizing Neuromuscular Blocker - Correct Answer-Competitively binds with the ACh receptor sites but is not affected as quickly by acetylcholinesterase. Therefore, it causes depolarization of the muscle and prevents future signals for depolarization from have an effect because all of ACh receptor sites have been occupied. Very rapid onset (60- seconds) of total paralysis and short duration of action (5-10 minutes). Succinylcholine - Correct Answer-(Anectine): 1.15mg/kg via IV push (initial dose); repeated doses can be given based on the pt's clinical response. It is the only depolarizing neuromuscular blocking agent. Because it causes depolarization, fasciculations can be observed during its administration. Often used as a initial paralytic. Should be used in caution with pt's that have burns, crush injuries, and blunt trauma. Can cause bradycardia. *If you administer this without administering a long-acting paralytic (norcuron, pavulon), you will have to re-administer by IV bolus every 5 minutes. Fasciculations - Correct Answer-Brief, uncoordinated twitching of small muscle groups in the face, neck, trunk and extremities.

Nondepolarizing Neuromuscular Blocking Agents - Correct Answer-They also bind to ACh receptor sites: however, they do not cause depolarization of the muscle fiber. When given in sufficient quantity, the amount of nondepolarizing medication exceeds the amount of ACh in the synaptic cleft, and the critical threshold of depolarization cannot be achieved. Longer duration of paralysis. Multilumen Airway - Correct Answer-Inserted blindly and have been clinically proven to secure the airway and allow for better ventilation than a BVM or simple airway adjunct. Contraindications for Multilumen airway - Correct Answer-If the pt regains consciousness, the tube must be removed, none should be used on children less than 16 years old, and should only be used for Pt's between 5"-7". CHF - Correct Answer-Right or left sided heart failure. Causes pulm edema, nocturnal dyspnea, peripheral edema, a-Fibb, and crackles (Rales). Emphysema - Correct Answer-Destroys the walls of the alveoli, and causes air trapping. Asthma - Correct Answer-*Worst thing with asthma is when you hear absent breath sounds, that means no air is moving! Wheezing with asthma means that bronchoconstriction is happening, but at least air is moving. Pulmonary Embolism - Correct Answer-A PE can be blood, fat, or air. A blood clot can originate after long periods of inactivity. Inhalation of a Toxic Substance - Correct Answer-Soot, burn patients, should all be intubated prematurely because these things cause airway swelling. Inhalation of a Toxic Substance - Correct Answer-Soot, burn patients, should all be intubated prematurely because these things cause airway swelling.