Paramedics Exam Airway, Respiration & Ventilation 2 — Questions and Answers
Question 1: A patient in respiratory arrest has dentures. What is the correct action before attempting BVM ventilation?
- Remove dentures to prevent airway obstruction
- Leave well-fitting dentures in place to maintain facial seal (Correct answer)
- Remove upper denture only
- Pack gauze around loose dentures
Correct answer: Leave well-fitting dentures in place to maintain facial seal
Well-fitting dentures should remain in place as they help maintain a better mask seal during BVM ventilation.
Question 2: Which waveform on capnography indicates a patient is rebreathing CO2 due to an incompetent expiratory valve?
- Shark fin waveform
- Elevated baseline above zero (Correct answer)
- Prolonged plateau phase
- Absent waveform
Correct answer: Elevated baseline above zero
An elevated CO2 baseline above zero on capnography indicates rebreathing of CO2, often due to an incompetent expiratory valve or exhausted CO2 absorber.
Question 3: During rapid sequence intubation, succinylcholine is contraindicated in a patient with crush injuries from 10 days ago. Why?
- It causes bronchospasm in trauma patients
- Upregulation of acetylcholine receptors leads to life-threatening hyperkalemia (Correct answer)
- It prolongs the QT interval in traumatized muscle
- Myoglobin binds succinylcholine causing prolonged paralysis
Correct answer: Upregulation of acetylcholine receptors leads to life-threatening hyperkalemia
After 48–72 hours, denervated or damaged muscle upregulates acetylcholine receptors; succinylcholine causes massive potassium efflux, potentially causing cardiac arrest.
Question 4: A 4-year-old child is in respiratory distress. The appropriately-sized ETT is selected using the formula. Which formula is correct for uncuffed tubes?
- (Age + 16) / 4
- (Age / 4) + 4 (Correct answer)
- (Age / 2) + 4
- Age + 3
Correct answer: (Age / 4) + 4
The Broselow tape or the formula (Age/4) + 4 estimates uncuffed ETT internal diameter in millimeters for pediatric patients.
Question 5: A patient is intubated and has equal bilateral breath sounds, but SpO2 remains at 84%. Waveform capnography shows a normal square waveform at 38 mmHg. What is the most likely cause?
- Esophageal intubation
- Right mainstem intubation
- Ventilation-perfusion mismatch (Correct answer)
- Equipment malfunction of the pulse oximeter
Correct answer: Ventilation-perfusion mismatch
Confirmed tube placement with normal ETCO2 and equal breath sounds rules out malposition; persistent low SpO2 with good ventilation suggests V/Q mismatch (e.g., pulmonary embolism, ARDS).
Question 6: When performing cricothyrotomy, the cricothyroid membrane is located between which two structures?
- Hyoid bone and thyroid cartilage
- Thyroid cartilage and cricoid cartilage (Correct answer)
- Cricoid cartilage and first tracheal ring
- Thyroid cartilage and arytenoid cartilages
Correct answer: Thyroid cartilage and cricoid cartilage
The cricothyroid membrane spans between the inferior thyroid cartilage and the superior cricoid cartilage and is the target for emergency surgical airway access.
Question 7: A COPD patient receiving high-flow oxygen becomes increasingly drowsy and develops a respiratory rate of 8. What is occurring?
- Oxygen toxicity to pulmonary tissue
- Hypoxic drive suppression reducing respiratory stimulus (Correct answer)
- Carbon monoxide poisoning from cigarette use
- Nitrogen narcosis from high-pressure oxygen
Correct answer: Hypoxic drive suppression reducing respiratory stimulus
Some COPD patients rely on hypoxic drive; administering high-flow O2 can suppress this drive, reduce respiratory rate, and cause CO2 retention and altered mental status.
Paramedics Exam Airway, Respiration & Ventilation 2
A patient in respiratory arrest has dentures.
What is the correct action before attempting BVM ventilation?