ABA Airway Management 1 — Questions and Answers
Question 1: Which anatomical landmark is most commonly used as the primary reference point during direct laryngoscopy to expose the vocal cords?
- Arytenoid cartilages
- Thyroid cartilage
- Epiglottis (Correct answer)
- Cricoid cartilage
Correct answer: Epiglottis
The epiglottis is the primary landmark during direct laryngoscopy; the blade is placed in the vallecula (curved blade) or beneath it (straight blade) to lift and expose the vocal cords.
Question 2: The Mallampati classification is used primarily to predict which of the following?
- The likelihood of pulmonary aspiration
- The ease of mask ventilation
- Potential difficulty of laryngoscopy based on oropharyngeal visualization (Correct answer)
- The degree of subglottic stenosis
Correct answer: Potential difficulty of laryngoscopy based on oropharyngeal visualization
The Mallampati score assesses oropharyngeal space by visualizing structures (uvula, pillars, soft palate) and correlates with difficult laryngoscopy risk.
Question 3: A Cormack-Lehane Grade III laryngoscopic view reveals which of the following?
- Full glottis is visible
- Posterior portion of the glottis only
- Only the epiglottis is visible (Correct answer)
- No laryngeal structures are visible
Correct answer: Only the epiglottis is visible
Grade III reveals only the epiglottis with no part of the glottis visible, indicating a difficult intubation that typically requires adjuncts such as a bougie or video laryngoscopy.
Question 4: What is the recommended depth of insertion for an orotracheal tube in an average adult male, measured at the lips?
- 17–19 cm
- 21–23 cm (Correct answer)
- 25–27 cm
- 14–16 cm
Correct answer: 21–23 cm
An average adult male orotracheal tube is secured at 21–23 cm at the lips, placing the cuff approximately 2–4 cm below the vocal cords to avoid endobronchial or subglottic placement.
Question 5: The LEMON mnemonic for difficult airway assessment includes all of the following EXCEPT:
- Look externally for facial abnormalities
- Evaluate the 3-3-2 rule
- Mallampati score
- Neck circumference (Correct answer)
Correct answer: Neck circumference
LEMON stands for Look, Evaluate (3-3-2 rule), Mallampati, Obstruction, and Neck mobility — neck circumference is not one of the five components.
Question 6: What is the recommended endotracheal tube cuff pressure range to minimize tracheal mucosal ischemia while maintaining an adequate seal?
- 5–10 cmH2O
- 20–30 cmH2O (Correct answer)
- 35–45 cmH2O
- 50–60 cmH2O
Correct answer: 20–30 cmH2O
Cuff pressures of 20–30 cmH2O provide adequate sealing while avoiding tracheal mucosal ischemia, which begins when pressure exceeds capillary perfusion pressure (~30 cmH2O).
Question 7: Which of the following is an absolute contraindication to nasotracheal intubation?
- Class III obesity
- Anticipated difficult oral intubation
- Basilar skull fracture (Correct answer)
- Anticipated need for prolonged mechanical ventilation
Correct answer: Basilar skull fracture
Basilar skull fracture is an absolute contraindication because the nasal tube may traverse through the fracture site and enter the cranial vault.
ABA Airway Management 1
Which anatomical landmark is most commonly used as the primary reference point during direct laryngoscopy to expose the vocal cords?