15 free questions from the CinnaEMS airway, respiration and ventilation bank (271 in the app). Tap an answer to check it. The rationale opens right away.
After intubation, capnography shows small waveforms on the first few breaths that shrink with each breath and disappear by the sixth. What is the most likely explanation?
Answer: A. The tube is in the esophagus, washing out swallowed gas
Gas in the stomach from bagging or carbonated drinks can contain some CO2, giving a few small waveforms from an esophageal tube that fade as it washes out. That is why confirmation relies on a sustained waveform over several breaths. A mainstem tube keeps a sustained waveform, bronchospasm changes the shape, and recovery raises values.
A septic adult with a blood pressure of 76/40 and a saturation of 86% needs intubation. Before induction, the most important step to reduce the risk of arrest is to:
Answer: A. Improve perfusion and oxygenation before the attempt begins
Induction agents blunt sympathetic tone and positive-pressure ventilation lowers venous return, so a hypotensive, hypoxic patient can arrest within minutes of the tube passing. Resuscitate before you intubate: restore perfusion and preoxygenate first. Rushing the tube ignores that physiology, and rapid pre-ventilation causes gastric insufflation and further lowers venous return.
While ventilating a patient in severe asthma, the bag grows stiff and hard to squeeze and the chest stays over-inflated between breaths. The best adjustment is to:
Answer: A. Slow the rate and allow a longer time for exhalation
Narrowed airways make exhalation slow. If the next breath arrives before the last one is out, air is trapped, the chest stays inflated, pressure in the chest rises and venous return falls. Slowing the rate gives each breath time to empty. Squeezing harder and faster is the reflex response and it makes trapping worse; abandoning ventilation in a failing asthmatic is not an option.
Nasal cannula oxygen is running during an intubation attempt, yet the saturation falls quickly once the patient becomes apneic. Which factor most likely defeated apneic oxygenation?
Answer: A. The upper airway was obstructed because positioning was not maintained
Apneic oxygenation moves oxygen from the pharynx to the alveoli by mass flow as oxygen is absorbed, so the pathway from nose to lungs must stay open; a slack tongue or lost head-up, ear-to-sternal positioning blocks it. High flow is what makes the technique work, and chest movement is not needed because the driving force is oxygen uptake, not breathing.
After you place a supraglottic airway in an unresponsive adult, ventilation produces a loud air leak from the mouth and only minimal chest rise. The capnography waveform is small. What should you do?
Answer: A. Check cuff inflation and depth, and if the seal cannot be fixed, remove it and use a bag-mask
A loud leak with poor chest rise means the device is not sealing — wrong depth, wrong size or an under-inflated cuff. Correct those quickly; if adequate ventilation still is not achieved, remove it and return to bag-mask ventilation with adjuncts. Forcing bigger, faster breaths only pushes more air into the stomach, and a leak with a poor waveform is not acceptable ventilation.
A partner inflates a supraglottic airway cuff with far more air than the manufacturer recommends, 'to be sure it seals.' This is a problem because an over-inflated cuff can:
Answer: A. Injure the pharyngeal tissue and actually worsen the seal and position
Cuffs are filled to the recommended volume because extra pressure compresses the pharyngeal mucosa and can lift or displace the device, increasing the leak rather than stopping it. Cuff volume does not change gastric venting, the rate of air entering the lungs is set by how you bag, and capnography measures exhaled CO2, which cuff pressure does not inflate.
A patient with advanced chronic obstructive pulmonary disease is visibly hypoxic and cyanotic. Withholding oxygen out of concern for a 'hypoxic drive' is wrong because:
Answer: A. Untreated hypoxia kills long before any drive effect appears
Hypoxia is measured in minutes of organ damage; any blunting of respiratory drive develops far more slowly and is managed by watching the patient and being ready to ventilate. Give the oxygen the patient needs and titrate it. Claiming these patients never have an altered drive overstates the case in the other direction — the point is that the hypoxia outranks it.
After intubation the chest rises on the right with clear sounds there, sounds are absent on the left, and the waveform is good. The likely problem is:
Answer: A. The tube has passed into the right mainstem bronchus
The right mainstem leaves the trachea at a shallower angle, so a tube advanced too far goes there and ventilates one lung; withdrawing slowly until sounds equalize, then reconfirming and resecuring, fixes it. A good waveform rules out the esophagus, and a right tension pneumothorax would abolish the sounds on the right rather than the left.
Which drug class used for drug-assisted airway management tends to preserve spontaneous breathing and airway reflexes while producing a trance-like state?
Answer: A. Dissociative agent
Dissociative agents separate perception from awareness, generally preserving respiratory drive, airway reflexes and blood pressure. Benzodiazepines and opioids both depress breathing and can drop blood pressure, and a neuromuscular blocker abolishes breathing entirely while providing no sedation at all.
A responsive adult was struck in the jaw with a bat. The mandible is unstable on both sides, blood is pooling in his mouth and he keeps trying to sit up. He is alert, with no neck pain, midline tenderness or neurologic deficit. The best airway position is:
Answer: A. Seated upright and leaning forward so blood drains out
A mandible broken on both sides loses its hold on the tongue, which falls back when the patient lies flat, and blood runs into the pharynx. A responsive patient who is fighting to sit up is protecting his own airway; letting him lean forward drains blood and keeps the tongue forward. Forcing him supine when he has no spinal findings creates the obstruction you are trying to prevent, and an oral airway in a responsive patient triggers gagging.
A factory worker exposed to cyanide is confused and breathing fast. The pulse oximeter reads 99% and the skin is not cyanotic. Which type of hypoxia best explains the presentation?
Answer: A. Histotoxic hypoxia
Cyanide blocks the enzyme the mitochondria use to consume oxygen, so blood arrives fully loaded and the cells cannot use it — histotoxic hypoxia. That is why the saturation is normal and the skin is not blue. Hypoxemic hypoxia would lower the saturation, and stagnant hypoxia requires a failure of blood flow, which this patient does not yet have.
During CPR on an intubated adult, end-tidal CO2 has stayed at 7 mmHg for several minutes with a clear waveform. What is the most appropriate response?
Answer: A. Improve compression depth and rate and change compressors
During CPR, end-tidal CO2 reflects the blood flow compressions generate; a value persistently under about 10 mmHg with a clear waveform points to poor compression quality, so depth, rate, recoil and compressor fatigue are addressed. A present waveform argues against esophageal placement, faster ventilation lowers CO2 rather than raising it, and a low value alone is not a termination criterion.
A patient on home oxygen by nasal cannula is found with burns to the nose and upper lip. The family says she was lighting a candle. Beyond treating the burns, which airway concern is most important?
Answer: A. Possible airway injury from flame drawn along the oxygen tubing
In an oxygen-enriched stream a small flame burns intensely and can travel along the cannula to the face and into the nostrils, so a facial burn in an oxygen user raises the question of injury to the nasal passages and upper airway — watch for hoarseness, stridor and soot. The other choices are theoretical effects of the oxygen itself and do not explain the burn or threaten the airway now.
When applying the 3-3-2 rule, you place three fingers between the tip of the chin and the hyoid bone. What does this measurement estimate?
Answer: A. Room in the mandibular space to displace the tongue during laryngoscopy
The chin-to-hyoid distance estimates the mandibular space the tongue is pushed into by the blade; a short distance (receding chin) leaves nowhere for the tongue to go and hides the glottis. Mouth opening is the first '3' (between the incisors), and larynx height is the '2' (floor of mouth to thyroid notch), so those tempting answers belong to the other two measurements.
A patient struck in the front of the neck has a swelling that is visibly enlarging, a muffled voice and pain on swallowing. The greatest immediate concern is:
Answer: A. Progressive airway compression from the expanding swelling
Blood collecting in the neck has nowhere to go but inward, and a voice change tells you the larynx is already involved. This airway gets harder every minute, so it is recognized and managed early rather than watched. The other answers describe real injuries, but none of them closes the airway during your transport.
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