Airway Assessment Practice Questions

31 multiple-choice questions on Airway assessment for paramedic and EMT students, from Chapter 16 (Airway Management). Read each question, pick your answer, then tap Show answer to check it and read the explanation.

31 practice questions

1. On a ventilated patient, the capnography baseline no longer returns to zero and rises with each breath. What is the most likely cause?

   1. A. The tube has entered the esophagus
   2. B. The patient is rebreathing exhaled CO2
   3. C. Cardiac output has suddenly risen
   4. D. The crew is ventilating the patient too fast
   Show answer

   Answer: B. The patient is rebreathing exhaled CO2

   An elevated baseline means CO2 is present during inspiration, so exhaled gas is being rebreathed, for example from a faulty exhalation valve or added dead space. Check the circuit and valve. An esophageal tube gives no sustained waveform. A rise in cardiac output raises the plateau, not the baseline. Fast ventilation lowers EtCO2 and does not lift the baseline.

2. An intubated patient's capnography plateau now shows a notch in each waveform, and his limbs are starting to move. What does this indicate?

   1. A. The tube has entered the esophagus
   2. B. Bronchospasm is slowing his exhalation
   3. C. His heart has stopped pumping
   4. D. He is starting to breathe on his own
   Show answer

   Answer: D. He is starting to breathe on his own

   A notch or 'cleft' in the plateau means he is starting to breathe on his own, typically as sedation or a paralytic wears off. Reassess sedation and analgesia. An esophageal tube gives no ongoing waveform. Bronchospasm causes a sloped 'shark-fin' upstroke. A heart that has stopped pumping drops EtCO2 sharply rather than adding a notch.

3. A child has stridor on both inspiration and expiration. Where is the narrowing most likely?

   1. A. Above the glottis, in the pharynx
   2. B. In the small bronchioles
   3. C. In the nasal passages
   4. D. At or just below the glottis
   Show answer

   Answer: D. At or just below the glottis

   Biphasic stridor points to a fixed narrowing at the glottis, subglottis, or upper trachea. Supraglottic narrowing (such as epiglottitis) mainly causes inspiratory stridor. Narrowing in the small bronchioles causes wheezing, not stridor. Nasal obstruction causes snoring-type noise (stertor), not stridor.

4. A patient with severe tongue swelling cannot lie flat and insists on sitting up. Why does this matter for airway management?

   1. A. Lying flat may obstruct his airway
   2. B. Sitting up raises the aspiration risk
   3. C. It means anxiety is driving his distress
   4. D. It shows the swelling is likely mild
   Show answer

   Answer: A. Lying flat may obstruct his airway

   A patient who must sit up to breathe is using gravity to keep the airway open. Laying him flat can collapse a marginal airway, so preoxygenate and manage him upright for as long as possible. Sitting up lowers, not raises, aspiration risk. Insisting on sitting up signals a threatened airway; it does not point to anxiety as the cause or to mild swelling.

5. Why is the Mallampati score often not usable in emergency airway assessment?

   1. A. It needs a seated, cooperative patient
   2. B. It requires a laryngoscope to measure it
   3. C. It applies to children and not adults
   4. D. It is scored after paralysis is given
   Show answer

   Answer: A. It needs a seated, cooperative patient

   Mallampati is scored with the patient sitting up, mouth open, and tongue out, which many emergency patients cannot do; use the rest of LEMON instead. It is a visual mouth check and needs no laryngoscope. It was developed for adults. It is done before any drugs, not after paralysis.

6. Only one fingerbreadth fits between a patient's chin tip and hyoid bone. What does this predict?

   1. A. An easy view with a curved blade
   2. B. Little room to displace the tongue
   3. C. A larynx that sits too low
   4. D. A mouth opening that is far too small
   Show answer

   Answer: B. Little room to displace the tongue

   The 3-3-2 rule expects about three fingers from chin to hyoid. A short distance means a small space under the jaw for the tongue to be pushed into, so the tongue blocks the view and laryngoscopy is harder. It predicts a harder, not easier, view. A short chin-hyoid distance is linked to an anterior, not low, larynx. Mouth opening is the first '3', measured between the incisors.

7. In the LEMON airway assessment, what does the "E" stand for?

   1. A. Evaluate 3-3-2
   2. B. Estimate body weight
   3. C. Extend the head
   4. D. Examine the neck
   Show answer

   Answer: A. Evaluate 3-3-2

   LEMON: Look externally, Evaluate 3-3-2, Mallampati, Obstruction/obesity, Neck mobility.

8. In the 3-3-2 rule, what does the "2" measure?

   1. A. Mouth opening at incisors
   2. B. Chin tip to hyoid bone
   3. C. Thyroid to sternal notch
   4. D. Mouth floor to thyroid notch
   Show answer

   Answer: D. Mouth floor to thyroid notch

   Three fingers between the incisors, three fingers from chin to hyoid, and two fingers from the hyoid (floor of mouth) to the thyroid notch suggest favorable anatomy.

9. Which finding defines a Mallampati class IV view?

   1. A. The entire uvula is visible
   2. B. Soft palate and fauces visible
   3. C. Only the hard palate seen
   4. D. Only the uvula base is seen
   Show answer

   Answer: C. Only the hard palate seen

   In class IV, the tongue hides everything except the hard palate, predicting a difficult laryngoscopy.

10. During laryngoscopy you can see the epiglottis but no part of the glottis. What Cormack-Lehane grade is this?

    1. A. Grade 4
    2. B. Grade 3
    3. C. Grade 2
    4. D. Grade 1
    Show answer

    Answer: B. Grade 3

    Grade 1 is the full glottis, grade 2 is partial glottis or arytenoids, grade 3 is epiglottis only, and grade 4 is no epiglottis visible.

11. Using the MOANS mnemonic, which patient feature predicts difficult bag-mask ventilation?

    1. A. No teeth
    2. B. Recent oral intake
    3. C. Age under 30
    4. D. Loose upper incisors
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    Answer: A. No teeth

    MOANS: Mask seal problems, Obesity/obstruction, Age over 55, No teeth, Stiff lungs. Edentulous patients are hard to seal. Recent oral intake raises the aspiration risk but does not make the mask harder to seal, loose incisors are a laryngoscopy concern, and age under 30 is the opposite of the age criterion.

12. In the RODS mnemonic for predicting difficult supraglottic airway use, the "R" stands for:

    1. A. Recurrent airway infection
    2. B. Recent oral intake
    3. C. Rapid respiratory rate
    4. D. Restricted mouth opening
    Show answer

    Answer: D. Restricted mouth opening

    RODS: Restricted mouth opening, Obstruction, Distorted airway, Stiff lungs or cervical spine.

13. Which finding from the SMART mnemonic predicts a difficult cricothyrotomy?

    1. A. Prior neck radiation
    2. B. Young adult age
    3. C. A short, thin neck
    4. D. Recent oral intake
    Show answer

    Answer: A. Prior neck radiation

    SMART: Surgery, Mass, Access/anatomy problems, Radiation, Tumor. Radiation scars and distorts neck tissue.

14. A patient on a nasal capnography cannula shows a flat EtCO2 line, but he is talking and his chest is rising. What is the most likely cause?

    1. A. He has stopped breathing and is apneic
    2. B. His cardiac output has stopped
    3. C. He is hyperventilating sharply
    4. D. He is breathing through his mouth
    Show answer

    Answer: D. He is breathing through his mouth

    A talking patient with chest rise is breathing, so a flat line most likely means the nasal prongs are not sampling exhaled gas, as in mouth breathing, or the line is kinked or blocked. Use an oral-nasal sampling cannula. He cannot be apneic while talking. Cardiac arrest is impossible in a talking patient. A patient hyperventilating sharply still shows a waveform, just with a lower EtCO2.

15. A rider struck across the neck by a cable has hoarseness, crackling under the skin of the neck, and pain on swallowing. What do these findings suggest?

    1. A. A laryngotracheal injury
    2. B. A strained neck muscle
    3. C. A simple neck bruise
    4. D. An esophageal foreign body
    Show answer

    Answer: A. A laryngotracheal injury

    Hoarseness, subcutaneous emphysema, and painful swallowing after a direct blow to the neck point to a laryngotracheal injury (fractured larynx or torn trachea), which can obstruct suddenly. Avoid blind devices that could create a false passage, and plan early for a definitive airway. A muscle strain or bruise does not cause hoarseness with air under the skin. Nothing suggests a swallowed esophageal foreign body.

16. Which finding is the best indicator of adequate tidal volume in a breathing patient?

    1. A. Absence of any cyanosis
    2. B. A rate between 12 and 20
    3. C. Good, equal chest rise
    4. D. An SpO2 reading above 94%
    Show answer

    Answer: C. Good, equal chest rise

    A normal rate or saturation can coexist with shallow, inadequate breaths. Look for adequate, symmetric chest rise and good air movement.

17. A sleeping 2-month-old has breathing pauses of 5 to 10 seconds followed by regular breaths. Her color, tone, and heart rate stay normal. How should you interpret this?

    1. A. Apnea that needs bag-mask breaths now
    2. B. Cheyne-Stokes breathing from brain injury
    3. C. Seizure activity that needs midazolam
    4. D. Normal periodic breathing of infancy
    Show answer

    Answer: D. Normal periodic breathing of infancy

    Young infants often have periodic breathing: pauses of under about 20 seconds without color change or bradycardia, followed by normal breaths. Pathologic apnea is a pause of 20 seconds or more, or a shorter pause with cyanosis, pallor, or bradycardia, and that would need bag-mask breaths. Cheyne-Stokes breathing waxes and wanes with brain injury or heart failure and does not fit a well infant. Nothing suggests seizure activity, so midazolam has no role.

18. An infant's head bobs forward with each breath. What does this indicate?

    1. A. Normal breathing for a sleepy infant
    2. B. Neck pain from a recent fall onto the head
    3. C. A seizure involving the neck muscles
    4. D. Accessory neck muscles are working hard
    Show answer

    Answer: D. Accessory neck muscles are working hard

    Head bobbing occurs when an infant uses neck muscles to help breathe; it signals significant distress and possible fatigue. It is not normal sleep breathing. Nothing suggests neck pain from a fall. A rhythmic bob timed with breathing is work of breathing, not seizure activity.

19. Irregular breaths of varying depth with unpredictable periods of apnea, seen with increased intracranial pressure, are called:

    1. A. Biot (ataxic) respirations
    2. B. Cheyne-Stokes respirations
    3. C. Kussmaul respirations
    4. D. Central neurogenic breathing
    Show answer

    Answer: A. Biot (ataxic) respirations

    Biot or ataxic respirations are chaotic and irregular and indicate serious brainstem compromise.

20. During bag-mask ventilation of an apneic patient, you attach capnography to the mask and see a steady square waveform. What does this confirm?

    1. A. The stomach is not filling up with air
    2. B. Gas is moving in and out of the lungs
    3. C. The SpO2 will stay above 94%
    4. D. Cardiac output is adequate
    Show answer

    Answer: B. Gas is moving in and out of the lungs

    A sustained waveform with BVM breaths shows gas is moving in and out of the lungs, which helps you judge mask seal and positioning. It does not rule out air filling up the stomach. It says nothing certain about the future SpO2. EtCO2 reflects perfusion too, but a waveform alone does not prove adequate cardiac output.

21. Hours after thyroid surgery, a patient has rapidly expanding swelling of the neck and new stridor. What is the most likely cause?

    1. A. A recurrent laryngeal nerve palsy
    2. B. A hematoma compressing the airway
    3. C. An allergic reaction to sutures
    4. D. Low calcium causing tetany
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    Answer: B. A hematoma compressing the airway

    An enlarging neck mass with stridor after thyroid surgery is a bleeding hematoma pressing on the airway, which can obstruct quickly; it needs immediate airway support and surgical evacuation. Nerve palsy can cause hoarseness or stridor but not swelling. A suture reaction would not cause rapid swelling with stridor. Low calcium causes tingling and spasm but not neck swelling.

22. Your patient with severe asthma can only speak two or three words between breaths. This indicates:

    1. A. Mild respiratory distress
    2. B. Anxiety rather than hypoxia
    3. C. Upper airway obstruction
    4. D. Severe respiratory distress
    Show answer

    Answer: D. Severe respiratory distress

    Being unable to speak in full sentences is a reliable sign of severe distress and limited air movement.

23. Why is cyanosis considered an unreliable early indicator of hypoxia?

    1. A. It shows before the SpO2 drops
    2. B. Polycythemia hides it
    3. C. It is a late sign
    4. D. It occurs only with anemia
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    Answer: C. It is a late sign

    Cyanosis often appears only after significant desaturation, and may be absent in anemic patients. Do not wait for it before treating. It does not appear before the SpO2 falls, and polycythemia makes cyanosis easier, not harder, to see; it is anemia that can mask it.

24. A patient with advanced rheumatoid arthritis needs intubation. Which LEMON concern applies most?

    1. A. A Mallampati class I view on exam
    2. B. Limited and unstable neck motion
    3. C. A large mouth opening
    4. D. A long thyromental distance
    Show answer

    Answer: B. Limited and unstable neck motion

    Rheumatoid arthritis stiffens the cervical spine and can loosen the C1-C2 joint, so neck movement is limited and can be dangerous; this is the 'N' in LEMON. Plan for in-line positioning and video laryngoscopy. A Mallampati I view, a large mouth opening, and a long thyromental distance all predict easier laryngoscopy.

25. A 24-year-old has a muffled voice, trouble opening her mouth, and a uvula pushed toward the left. What is the most likely cause?

    1. A. Left peritonsillar abscess
    2. B. Acute bacterial epiglottitis
    3. C. Ludwig angina
    4. D. Right peritonsillar abscess
    Show answer

    Answer: D. Right peritonsillar abscess

    An abscess pushes the uvula away from its side, so a uvula deviated left means a right-sided peritonsillar abscess. Trismus and a muffled 'hot potato' voice fit. Epiglottitis causes drooling and distress without uvula deviation. Ludwig angina causes a firm, swollen floor of the mouth with an elevated tongue.

26. A trauma patient is in a cervical collar. Which component of the LEMON assessment is directly affected?

    1. A. Mallampati score
    2. B. Look externally
    3. C. Obstruction
    4. D. Neck mobility
    Show answer

    Answer: D. Neck mobility

    Spinal motion restriction prevents optimal head positioning, making laryngoscopy more difficult.

27. Seesaw (paradoxical abdominal) breathing in an infant indicates:

    1. A. Normal breathing for an infant
    2. B. Early, mild respiratory distress
    3. C. Severe respiratory distress
    4. D. Compensated distress that is easing
    Show answer

    Answer: C. Severe respiratory distress

    Infants normally breathe with their abdomen, but chest retraction while the abdomen rises (seesaw breathing) indicates severe distress and possible impending failure. Seesaw breathing is a late finding, so it does not mean mild or early distress, and it is not a sign that compensation is improving.

28. The plateau (phase III) of a normal capnography waveform represents:

    1. A. Anatomic dead space gas
    2. B. The start of exhalation
    3. C. The inspiratory phase
    4. D. Exhaled alveolar gas
    Show answer

    Answer: D. Exhaled alveolar gas

    Phase III is the alveolar plateau; its end value is the EtCO2. Phase I is dead space and the downstroke is inspiration.

29. A drowsy patient breathing 30 times per minute with very shallow breaths has an EtCO2 of 14 mmHg and a small waveform. How should you read this?

    1. A. He is hyperventilating and is stable now
    2. B. His PaCO2 must also be about 14
    3. C. The breaths are mostly dead-space gas
    4. D. The reading means good ventilation
    Show answer

    Answer: C. The breaths are mostly dead-space gas

    Tiny breaths may never empty alveolar gas past the sensor, so the sample is mostly dead-space air and the EtCO2 reads falsely low even as the arterial CO2 climbs. Treat the patient, not the number: he needs assisted ventilation. A low reading here does not mean he is hyperventilating and stable, does not equal the PaCO2, and does not show adequate ventilation.

30. When you pull gently on the upper teeth of a crash victim, the whole upper jaw and palate move together. What airway concern is greatest?

    1. A. A dislocated jaw that blocks the mouth
    2. B. Mask seal and bleeding from a midface fracture
    3. C. A lower jaw fracture that lets the tongue fall back
    4. D. A broken nose that blocks nasal breathing
    Show answer

    Answer: B. Mask seal and bleeding from a midface fracture

    A mobile maxilla means a midface (Le Fort) fracture. These bleed heavily into the airway and make a mask seal hard, and nasal devices are avoided. A dislocated mandible locks the mouth but does not move the palate. A mandible fracture can let the tongue fall back, but the moving palate points to the upper jaw. A broken nose alone does not move the palate.

31. You arrive to find a 45-year-old with facial fractures from a fall and blood pooling in the mouth. What is your first airway priority?

    1. A. Insert a nasal airway
    2. B. Suction the oropharynx
    3. C. Begin bag-mask ventilation
    4. D. Apply a nonrebreather mask
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    Answer: B. Suction the oropharynx

    Clear blood from the airway first. Ventilating over blood pushes it into the lungs, and a nasal airway is a poor choice with midface injury.