Airway, Respiration, and Ventilation Practice Questions for Paramedics

850 free paramedic practice questions on airway management, oxygenation, ventilation, and respiratory emergencies: anatomy, assessment, adjuncts, supraglottic airways, intubation and RSI, surgical airways, asthma, COPD, pulmonary edema, PE, pneumothorax, CPAP, and capnography. Every question has the answer and a short explanation.

23 sample questions

1. The classic 'steeple sign' on a neck radiograph is associated with:

   1. A. Retropharyngeal abscess
   2. B. Croup
   3. C. Epiglottitis
   4. D. Peritonsillar abscess
   Show answer

   Answer: B. Croup

   The steeple sign reflects subglottic narrowing in croup. Epiglottitis classically shows a 'thumbprint' sign on lateral neck films.

2. A conscious patient with bilateral mandible fractures is drooling and obstructs when lying flat. His spine is cleared. Which position is best?

   1. A. Sitting up and leaning forward
   2. B. Flat on his back with a pillow
   3. C. Trendelenburg with head down
   4. D. Supine with the head turned
   Show answer

   Answer: A. Sitting up and leaning forward

   A bilateral mandible fracture lets the tongue lose its support, so it falls back when he lies flat. Sitting up and leaning forward lets the tongue fall forward and blood drain from the mouth. Flat or head-down positions worsen obstruction and aspiration. Turning the head while supine helps drainage less and is not enough here.

3. Why is it important to stay midline when performing a surgical cricothyrotomy?

   1. A. To avoid the esophagus
   2. B. Major vessels lie laterally
   3. C. The membrane lies off-center
   4. D. The thyroid gland is midline
   Show answer

   Answer: B. Major vessels lie laterally

   The carotid arteries and jugular veins lie laterally. Stabilizing the larynx and staying midline reduces the risk of major bleeding.

4. What is the purpose of the Murphy eye on an endotracheal tube?

   1. A. Alternate airflow path
   2. B. Inflates the cuff
   3. C. Marks the cord level
   4. D. Holds the stylet in place
   Show answer

   Answer: A. Alternate airflow path

   If the tube tip is occluded by the tracheal wall or secretions, air can still pass through the side hole (Murphy eye).

5. A patient with known hereditary angioedema has rapidly worsening lip and tongue swelling without hives. Epinephrine, diphenhydramine, and steroids help little. Which therapy targets the cause?

   1. A. Repeated nebulized albuterol
   2. B. A higher dose of diphenhydramine
   3. C. IV methylprednisolone 1 g
   4. D. Her C1-inhibitor or icatibant
   Show answer

   Answer: D. Her C1-inhibitor or icatibant

   Hereditary angioedema is caused by bradykinin excess from a C1-inhibitor deficiency, so the specific treatments are C1-inhibitor concentrate or a bradykinin-pathway drug such as icatibant (often carried by the patient), while the airway is closely watched. Antihistamines and steroids do not act on bradykinin. Albuterol treats lower-airway bronchospasm, not upper-airway swelling.

6. Which technique is commonly used to insert an OPA in an adult?

   1. A. Along the floor of the nose
   2. B. Sideways, then rotated 45°
   3. C. Upside down, rotated 180°
   4. D. Right side up, with no blade
   Show answer

   Answer: C. Upside down, rotated 180°

   In adults the OPA is inserted with the tip toward the hard palate and rotated 180° as it nears the posterior pharynx, so it does not push the tongue back.

7. A cuffed 4.5-mm tube passes a 3-year-old's vocal cords easily but meets firm resistance just below them. What is the best response?

   1. A. Twist and push it past the resistance
   2. B. Inflate the cuff to stretch the area
   3. C. Leave the tip above the cords and bag
   4. D. Change to a tube a half size smaller
   Show answer

   Answer: D. Change to a tube a half size smaller

   In young children the subglottic (cricoid) region is a functional narrow point, so a tube that clears the cords can still be too large below them. Swap to a tube a half size smaller. Twisting or pushing through tears the mucosa and leads to subglottic edema or stenosis. Inflating a cuff inside the narrowing adds pressure injury and does not dilate it. A tip left above the cords is not in the trachea and will dislodge or ventilate the stomach.

8. A patient with a vented chest seal over a gunshot wound becomes more short of breath, with falling SpO2 and rising heart rate. What should you do first?

   1. A. Add a second seal on top of the first
   2. B. Tape the seal down firmly on four sides
   3. C. Burp the seal by lifting one edge
   4. D. Remove the seal and leave the wound open
   Show answer

   Answer: C. Burp the seal by lifting one edge

   Blood can clog a vented seal and trap air, so worsening distress suggests a developing tension pneumothorax; lift an edge to let air escape and decompress if signs persist. A second seal or taping it down traps more air. Removing the seal leaves an open wound, while burping it releases the air and keeps the dressing in place.

9. Which statement about the time required to place a supraglottic airway during CPR is correct?

   1. A. It needs ROSC first
   2. B. It needs a 30-second pause
   3. C. It needs minimal CPR pause
   4. D. It needs a 1-minute pause
   Show answer

   Answer: C. It needs minimal CPR pause

   SGAs can be placed quickly with little or no interruption of compressions, which is one reason they are favored in cardiac arrest.

10. A 32-year-old woman has a dry cough, mild dyspnea, and tender red nodules on her shins. An earlier X-ray showed enlarged lymph nodes in both hila. Which condition best fits?

    1. A. Pulmonary embolism
    2. B. Spontaneous pneumothorax
    3. C. Acute asthma
    4. D. Sarcoidosis
    Show answer

    Answer: D. Sarcoidosis

    Sarcoidosis is an inflammatory disease that forms granulomas, often in the lungs and the hilar lymph nodes, and can cause tender red shin nodules (erythema nodosum). A PE causes sudden symptoms without skin nodules. A pneumothorax is sudden and one-sided. Asthma causes episodic wheezing.

11. Air embolism causing respiratory distress can occur during:

    1. A. Routine blood pressure checks
    2. B. Intramuscular injections
    3. C. Central line placement
    4. D. Nasogastric tube placement
    Show answer

    Answer: C. Central line placement

    Air can enter the venous system through central lines, especially with the patient upright or during inspiration. Positioning and occluding the site are key. IM injections, nasogastric tubes and blood pressure cuffs do not open a vein to the air.

12. You are listening to the lungs of a dyspneic patient wearing a thick sweater. How should you auscultate?

    1. A. Over the sweater to save time
    2. B. With quiet breathing through the nose
    3. C. On bare skin, with deep mouth breaths
    4. D. Over the front of the chest alone
    Show answer

    Answer: C. On bare skin, with deep mouth breaths

    Fabric rubbing on the stethoscope creates noise that can mimic crackles and muffles real sounds, so listen on bare skin while the patient breathes slowly and deeply through an open mouth, comparing side to side, front and back. Listening over the sweater is the error. Quiet breathing through the nose makes lung sounds faint. The front of the chest alone misses most of the lower lobes, which lie posteriorly.

13. COPD includes:

    1. A. Emphysema and chronic bronchitis
    2. B. Pulmonary fibrosis and sarcoidosis
    3. C. Pneumonia and pleural effusion
    4. D. Asthma and pulmonary fibrosis
    Show answer

    Answer: A. Emphysema and chronic bronchitis

    Often both coexist.

14. Why is a pulse oximetry reading important in a patient with suspected pneumonia?

    1. A. It rules out sepsis completely
    2. B. Hypoxemia guides oxygen therapy
    3. C. It shows how well he is ventilating
    4. D. A normal value rules out pneumonia
    Show answer

    Answer: B. Hypoxemia guides oxygen therapy

    Pneumonia impairs gas exchange. SpO2 helps identify hypoxemia and guides titration of oxygen. SpO2 reflects oxygenation, not ventilation or CO2, a normal reading does not exclude pneumonia, and it cannot rule out sepsis.

15. A patient on CPAP for pulmonary edema becomes confused and then unresponsive with shallow breathing. What should you do?

    1. A. Switch to a nasal cannula
    2. B. Increase CPAP to 15 cmH2O
    3. C. Continue CPAP and reassess
    4. D. Remove CPAP and assist with BVM
    Show answer

    Answer: D. Remove CPAP and assist with BVM

    CPAP requires a patient who is breathing spontaneously and can protect the airway. Declining mental status calls for assisted ventilation.

16. Where should your hands be placed for abdominal thrusts on an adult?

    1. A. On the xiphoid process
    2. B. On the lower sternum
    3. C. Just above the navel
    4. D. Below the navel
    Show answer

    Answer: C. Just above the navel

    Place the fist slightly above the navel and well below the xiphoid to reduce the risk of internal injury.

17. Which systemic steroid course does GOLD recommend for most COPD exacerbations?

    1. A. Prednisone 40 mg daily for 5 days
    2. B. Prednisone 60 mg daily for 4 weeks
    3. C. Methylprednisolone 1 g IV daily for 3 days
    4. D. One dose of dexamethasone 0.6 mg/kg
    Show answer

    Answer: A. Prednisone 40 mg daily for 5 days

    GOLD recommends prednisone 40 mg a day for 5 days, which works as well as longer courses with less steroid exposure. Four weeks of high-dose prednisone adds side effects without benefit. Gram doses of methylprednisolone are for other diseases. Dexamethasone 0.6 mg/kg is a pediatric croup dose.

18. Which position is best for a conscious patient in acute pulmonary edema with an adequate BP?

    1. A. Prone with the head turned
    2. B. Supine with legs elevated
    3. C. Trendelenburg position
    4. D. Upright, legs dangling
    Show answer

    Answer: D. Upright, legs dangling

    Sitting upright with legs down reduces venous return and pulmonary congestion and eases breathing.

19. A 19-year-old says she has used her albuterol inhaler "about every hour" for 2 days. What does this history suggest?

    1. A. Poorly controlled, high-risk asthma
    2. B. Well-controlled asthma using the rescue inhaler
    3. C. Albuterol tolerance that makes it useless now
    4. D. A viral cold that is unrelated to asthma
    Show answer

    Answer: A. Poorly controlled, high-risk asthma

    Needing a rescue inhaler every hour for days means the asthma is out of control, and heavy reliever use is a marker of risk for a severe or fatal attack. Treat her aggressively and transport. Controlled asthma needs a reliever rarely. Albuterol still works in an attack, although tolerance can blunt the response somewhat. A viral cold is a common trigger, not a separate problem.

20. A 20-kg child needs rocuronium 1 mg/kg for RSI. The vial contains 10 mg/mL. What volume should you draw up?

    1. A. 0.2 mL
    2. B. 2 mL
    3. C. 20 mL
    4. D. 1 mL
    Show answer

    Answer: B. 2 mL

    1 mg/kg x 20 kg = 20 mg. At 10 mg/mL, 20 mg is 2 mL. 0.2 mL (2 mg) and 1 mL (10 mg) underdose the child, and 20 mL (200 mg) is a tenfold overdose from confusing milligrams with milliliters.

21. Which patient is the best candidate for CPAP?

    1. A. An alert patient in pulmonary edema
    2. B. A patient with a tension pneumothorax
    3. C. A hypotensive patient in septic shock
    4. D. An apneic patient after an overdose
    Show answer

    Answer: A. An alert patient in pulmonary edema

    CPAP requires spontaneous breathing, an intact airway, and adequate blood pressure. It is ideal for alert patients with CHF or COPD exacerbations.

22. Normal exhalation at rest is:

    1. A. Active
    2. B. Controlled by the abdominal muscles
    3. C. Passive
    4. D. Triggered by high oxygen
    Show answer

    Answer: C. Passive

    The muscles relax and elastic recoil pushes air out. Forced exhalation, as in asthma, is active.

23. 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.