Facial and Airway-threatening Conditions Practice Questions

30 multiple-choice questions on Facial and airway-threatening conditions for paramedic and EMT students, from Chapter 20 (Diseases of the Eyes, Ears, Nose, and Throat). Read each question, pick your answer, then tap Show answer to check it and read the explanation.

30 practice questions

1. A 50-year-old wakes with one side of his face drooping, inability to close one eye, and a flattened forehead crease on the same side. His arm and leg strength are normal. What is most likely?

   1. A. TMJ dislocation
   2. B. Bell's palsy
   3. C. Acute ischemic stroke
   4. D. Trigeminal neuralgia
   Show answer

   Answer: B. Bell's palsy

   Bell's palsy is a peripheral CN VII palsy that affects the entire half of the face, including the forehead. A stroke typically spares the forehead and may involve the limbs or speech.

2. A 35-year-old woke with weakness of the entire right side of his face, including his forehead. His stroke exam is otherwise normal. He wants to wait a week to see his doctor. Why is earlier care advised?

   1. A. Steroids work best within 3 days
   2. B. Bell palsy is usually permanent
   3. C. Antibiotics should start the same day
   4. D. Surgery is needed within 24 hours
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   Answer: A. Steroids work best within 3 days

   For Bell palsy, oral steroids started within 72 hours of onset improve the chance of full facial nerve recovery, so the patient should be seen promptly rather than in a week, and eye protection should begin now. Most cases recover even without treatment, antibiotics are not used for Bell palsy, and surgery is not a routine early treatment.

3. Why should Bell's palsy be a diagnosis of exclusion in the field?

   1. A. It has no treatment
   2. B. It is usually permanent
   3. C. It is contagious to others
   4. D. Stroke can look similar
   Show answer

   Answer: D. Stroke can look similar

   Facial weakness from stroke is time critical. Perform a full stroke assessment and treat as a stroke when in doubt, per protocol. Bell palsy has a treatment (steroids within 72 hours), most patients recover, and it is not contagious.

4. A 60-year-old has a painful, red, swollen lump at the inner corner of her lower eyelid, beside the nose. Her eye has been tearing for weeks, and today she has a fever. Pressing on the lump brings pus out of the inner corner. What is the most likely cause?

   1. A. An infected tear drainage sac
   2. B. A stye of the upper lid margin
   3. C. Allergic swelling of the eyelids
   4. D. A blocked oil gland under the lid
   Show answer

   Answer: A. An infected tear drainage sac

   Tears drain from the inner corner of the eye into the lacrimal sac beside the nose. When the duct below it is blocked, the sac can become infected (dacryocystitis), causing a red, tender swelling at the inner corner, tearing and pus from the tear opening. It needs antibiotics and can spread to the orbit, so watch for pain with eye movement or vision changes. A stye of the upper lid margin is a small lump at the lashes, allergic swelling of the eyelids is itchy and not tender with pus, and a blocked oil gland under the lid (chalazion) is a painless lump in the lid.

5. A week after a cold, a 40-year-old has aching pain in several upper back teeth on the left, pressure under the left eye that worsens when she bends forward, and thick nasal discharge. What is the most likely cause?

   1. A. A left maxillary sinus infection
   2. B. Decay in several upper back teeth
   3. C. Trigeminal neuralgia
   4. D. A left orbital fracture
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   Answer: A. A left maxillary sinus infection

   The roots of the upper back teeth sit just below the maxillary sinus, so maxillary sinusitis can cause aching in several upper teeth along with pressure under the eye that worsens when bending forward and thick nasal discharge after a cold. Decay usually affects one tooth without nasal symptoms, trigeminal neuralgia causes brief electric-shock pain, and an orbital fracture needs trauma.

6. During a dental filling with a high-speed air drill, a 30-year-old's cheek and neck suddenly swell. You feel crackling under the skin, and there is no rash or itching. What is the most likely cause?

   1. A. An allergy to the local anesthetic
   2. B. A bleed into the cheek
   3. C. A sudden dental abscess
   4. D. Air forced into the tissues
   Show answer

   Answer: D. Air forced into the tissues

   Air-driven dental drills can force air into the soft tissues, causing sudden swelling with crackling (subcutaneous emphysema) that can track into the neck and chest and occasionally threaten the airway. Monitor the airway and transport. An allergy to the local anesthetic causes hives or itching rather than crackling, a bleed into the cheek causes a firm bruise, and an abscess develops over days with fever.

7. A 5-year-old had a dental filling with a numbing injection yesterday. Today his lower lip is swollen with a raw, whitish sore, and he is otherwise well. What is the most likely cause?

   1. A. Physical abuse by a caregiver
   2. B. An allergic reaction to the filling
   3. C. A spreading dental abscess
   4. D. He bit the lip while it was numb
   Show answer

   Answer: D. He bit the lip while it was numb

   Children often bite or chew a numb lip after a dental nerve block, producing a swollen lip with a whitish ulcer the next day that can be mistaken for infection or abuse. It heals with comfort care. With this clear history and an otherwise well child, physical abuse by a caregiver is unlikely, though injuries should always fit the story. An allergic reaction to the filling causes rash or swelling without a bite ulcer, and an abscess causes fever and gum swelling near the tooth.

8. A patient with facial and neck swelling has a hoarse voice and stridor. Which airway intervention is most likely to be difficult or contraindicated?

   1. A. Positioning upright
   2. B. A blind airway device
   3. C. High-flow oxygen
   4. D. Gentle suctioning of the mouth
   Show answer

   Answer: B. A blind airway device

   Swelling distorts anatomy and narrows the glottis, so supraglottic and other blind airway devices may fail or worsen the obstruction; prepare for a difficult airway, including surgical options per protocol. Upright positioning, high-flow oxygen, and gentle suctioning of the mouth remain appropriate supportive steps.

9. A 2-month-old has a large red birthmark over her chin, jaw and lower lip in a 'beard' pattern. Over the past week she has developed noisy breathing on both inhaling and exhaling. What should you suspect?

   1. A. Normal infant nasal congestion
   2. B. A similar growth inside her airway
   3. C. Simple viral croup
   4. D. Laryngomalacia that will soon resolve
   Show answer

   Answer: B. A similar growth inside her airway

   Infantile hemangiomas in a beard pattern are linked to hemangiomas in the airway below the vocal cords, which grow during the first months of life and can cause stridor and obstruction. She needs prompt airway evaluation. Nasal congestion causes snuffling rather than stridor on both phases, croup would come with a barking cough and fever, and laryngomalacia causes noise only on inhaling that usually starts in the first weeks of life.

10. A Le Fort I fracture involves:

    1. A. The maxilla at the level of the teeth
    2. B. The mandibular condyles only
    3. C. The entire face separating from the skull
    4. D. A pyramid-shaped nasal-maxillary block
    Show answer

    Answer: A. The maxilla at the level of the teeth

    Le Fort I is a horizontal maxillary fracture above the teeth. Le Fort II is pyramidal through the nose and maxilla, and Le Fort III separates the entire face from the skull (craniofacial dissociation).

11. Which Le Fort fracture is described as craniofacial dissociation?

    1. A. Le Fort III
    2. B. Le Fort I
    3. C. Le Fort IV
    4. D. Le Fort II
    Show answer

    Answer: A. Le Fort III

    Le Fort III separates the facial bones from the cranial base. It is associated with significant airway risk and possible CSF leak.

12. A 14-year-old with a week of sinusitis now has a soft, tender swelling of the middle of his forehead, fever and a severe headache. What does the forehead swelling suggest?

    1. A. A bruise from a forgotten bump
    2. B. Bone infection from the sinus
    3. C. An allergic reaction to his medicine
    4. D. A harmless fatty lump
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    Answer: B. Bone infection from the sinus

    Frontal sinusitis in adolescents can spread into the frontal bone, causing a soft, tender forehead swelling (Pott puffy tumor) from a bone infection with an abscess under the scalp. It is often linked to infection inside the skull, so severe headache and fever make this an emergency. A bruise needs trauma, an allergic reaction to medicine causes hives or general swelling, and a harmless fatty lump is not tender or linked to fever.

13. A patient with severe midface trauma requires an advanced airway. Which route is generally avoided?

    1. A. Nasotracheal intubation
    2. B. Surgical cricothyrotomy
    3. C. Video laryngoscopy
    4. D. Orotracheal intubation
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    Answer: A. Nasotracheal intubation

    Nasotracheal intubation risks passing the tube through a basilar skull or cribriform plate fracture. Orotracheal intubation or a surgical airway is preferred.

14. A 35-year-old has bulging eyes with a wide-eyed stare, a fine hand tremor, weight loss and a heart rate of 118. What is the most likely cause?

    1. A. Cavernous sinus thrombosis
    2. B. Orbital cellulitis in both eyes
    3. C. An overactive thyroid gland
    4. D. Anxiety with panic attacks
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    Answer: C. An overactive thyroid gland

    Graves disease, an autoimmune cause of an overactive thyroid, can push both eyes forward and retract the lids, giving a staring look, along with tremor, weight loss and tachycardia. Watch for thyroid storm if she has fever or confusion. Cavernous sinus thrombosis and orbital cellulitis cause painful, red bulging eyes with fever, and anxiety does not cause bulging eyes and weight loss.

15. Ten days after starting lamotrigine, a 25-year-old has a fever, painful mouth sores, red eyes and dusky spots on her skin that are starting to blister. What should you suspect?

    1. A. A severe drug skin reaction
    2. B. Hand, foot and mouth disease
    3. C. Viral conjunctivitis
    4. D. A mild rash from the drug
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    Answer: A. A severe drug skin reaction

    Stevens-Johnson syndrome is a severe reaction, often to anticonvulsants such as lamotrigine, sulfa drugs or allopurinol, that affects the mouth, eyes and skin with blistering and peeling. It can threaten the airway, eyes and fluid balance, so stop the drug and transport. Hand, foot and mouth disease does not cause red eyes and dusky blisters, viral conjunctivitis does not cause skin blisters, and calling it a mild rash ignores the mucosal involvement.

16. Which dressing is appropriate for an open wound to a major neck vein?

    1. A. No dressing, to monitor bleeding
    2. B. A circumferential pressure wrap
    3. C. An occlusive dressing
    4. D. A loose gauze dressing
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    Answer: C. An occlusive dressing

    An occlusive dressing prevents air from entering the vein and causing an air embolism. Apply pressure that controls bleeding without compressing the airway or both carotids.

17. Why should you never apply a circumferential pressure dressing around the neck?

    1. A. It increases infection risk
    2. B. It slows wound clotting
    3. C. It can compress the airway
    4. D. It can cause an air embolism
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    Answer: C. It can compress the airway

    Circumferential neck dressings can compress the airway and impair cerebral blood flow. Use direct pressure over the wound instead. A wrap does not slow clotting or let air into a vein; air embolism is prevented by sealing the wound with an occlusive dressing, and infection risk is not the reason to avoid it.

18. Police sprayed a 22-year-old with pepper spray 10 minutes ago. His eyes burn and tear. He has asthma, and he is now wheezing with an SpO2 of 90%. What is your first priority?

    1. A. Flush his eyes before anything else
    2. B. Treat his breathing problem
    3. C. Wash his face with milk
    4. D. Release him since it wears off soon
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    Answer: B. Treat his breathing problem

    Pepper spray (capsaicin) inflames the eyes and skin, but it also irritates the airways and can trigger bronchospasm, especially in people with asthma. Wheezing with an SpO2 of 90% is the priority, so treat his breathing problem first: give oxygen and a bronchodilator per protocol, then flush the eyes with water or saline. Flushing his eyes before anything else delays airway care, washing his face with milk is no better than water, and releasing him because it wears off soon ignores the bronchospasm.

19. A diabetic patient with severe ear pain, drainage, and facial weakness that has not responded to drops may have:

    1. A. Malignant otitis externa
    2. B. Ménière's disease
    3. C. Cerumen impaction
    4. D. Simple swimmer's ear
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    Answer: A. Malignant otitis externa

    Malignant (necrotizing) otitis externa spreads to the skull base in diabetic or immunocompromised patients and can involve cranial nerves such as CN VII. It is a serious infection.

20. A patient has a rapidly enlarging, pulsatile neck hematoma after a stab wound. Which finding requires immediate airway preparation?

    1. A. A bruit heard over the wound
    2. B. A weak radial pulse
    3. C. Mild neck tenderness
    4. D. Stridor or voice change
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    Answer: D. Stridor or voice change

    An expanding hematoma can compress the airway. Stridor, voice change, or difficulty breathing signals impending obstruction requiring advanced airway or surgical access. A bruit or a weak arm pulse points to an arterial injury that needs surgery, but those signs do not show that the airway is closing, and mild tenderness is expected.

21. A child has fever, swelling around one eye, and red, warm skin over the eyelid but normal eye movement and vision. What is most likely?

    1. A. Orbital cellulitis
    2. B. Preseptal cellulitis
    3. C. Acute angle glaucoma
    4. D. Retinal detachment
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    Answer: B. Preseptal cellulitis

    Preseptal cellulitis is limited to the eyelid and surrounding tissue. Pain with eye movement, proptosis, or vision changes suggests orbital cellulitis, which is more dangerous.

22. Which facial infection carries risk of spreading to the cavernous sinus because of venous drainage?

    1. A. Infection of the scalp
    2. B. Infection of the earlobe
    3. C. Infection of the back of the neck
    4. D. Infection of the mid-face
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    Answer: D. Infection of the mid-face

    The 'danger triangle' of the face (nose and upper lip) drains through veins that connect to the cavernous sinus, so mid-face infections can lead to cavernous sinus thrombosis. Infections of the scalp, earlobe and back of the neck drain away from this route and carry much less of this risk.

23. A patient with a sinus infection has fever, bulging eyes, painful eye movements, and cranial nerve palsies. What should you suspect?

    1. A. Cavernous sinus thrombosis
    2. B. Allergic conjunctivitis
    3. C. Simple stye
    4. D. Bell's palsy
    Show answer

    Answer: A. Cavernous sinus thrombosis

    Cavernous sinus thrombosis causes proptosis, chemosis, ophthalmoplegia, headache, and fever. It is rare but life threatening.

24. A 16-year-old with a tongue ring is postictal and needs bag-mask ventilation. The ring is loose, and its ball has come off. What should you do with the jewelry?

    1. A. Remove it before ventilating
    2. B. Push it into the tongue to hold it
    3. C. Leave it in place during ventilation
    4. D. Tape the ring to the lower lip
    Show answer

    Answer: A. Remove it before ventilating

    Loose oral jewelry and its parts can be aspirated or block the airway during ventilation or suctioning, so remove it when it is loose or in the way. Keep the parts and give them to the patient or hospital. Pushing it into the tongue can injure the tongue, leaving it ignores the aspiration risk, and taping the ring to the lower lip still leaves loose parts in the mouth.

25. A patient has a sudden severe sore throat after a fishbone was swallowed and points to a specific spot. He is breathing normally. What is appropriate?

    1. A. Induce vomiting to expel it
    2. B. Transport for ED removal
    3. C. Perform abdominal thrusts
    4. D. Perform a blind finger sweep
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    Answer: B. Transport for ED removal

    A lodged fishbone with a patent airway requires visualization and removal in the ED. Abdominal thrusts are for complete or severe obstruction, and blind sweeps can push objects deeper.

26. A 1-month-old with an unrepaired cleft palate coughs and chokes during feeds, and milk comes out of her nose. She is breathing normally between feeds. What is the main concern?

    1. A. Aspiration of milk into the lungs
    2. B. Normal feeding for this age
    3. C. A foreign body lodged in her nose
    4. D. An allergy to her formula
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    Answer: A. Aspiration of milk into the lungs

    A cleft palate leaves an opening between the mouth and the nose, so milk can come out the nose and be aspirated, especially if the infant is fed lying flat. Feed upright with a special bottle, suction as needed and watch for breathing problems or pneumonia. Choking and nasal milk are not normal feeding, a foreign body lodged in her nose does not cause this pattern, and a formula allergy causes rash, vomiting or diarrhea.

27. A 30-year-old has a laceration through the inner part of his lower eyelid, close to the nose. The globe looks intact. What structure is at special risk with this injury?

    1. A. The tear drainage duct
    2. B. The lacrimal gland
    3. C. The optic nerve
    4. D. The facial nerve branch to the lips
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    Answer: A. The tear drainage duct

    Tears drain through small openings and canals in the inner part of the lids into the nasolacrimal duct. A laceration of the inner lower lid near the nose can cut this drainage canal, which needs specialist repair to prevent lifelong tearing, so cover it with a moist dressing and transport. The lacrimal gland that makes tears is in the upper outer orbit, the optic nerve lies deep behind the globe, and the facial nerve branch to the lips is far from the inner eyelid.

28. Which statement about facial trauma and cervical spine injury is most accurate?

    1. A. Facial injuries rule out spinal injury
    2. B. The two are unrelated
    3. C. Spinal injury may coexist
    4. D. Spinal injury occurs only with falls
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    Answer: C. Spinal injury may coexist

    Forces strong enough to cause major facial injury can also injure the cervical spine. Assess for spinal injury and apply motion restriction per protocol.

29. A 66-year-old who had a total laryngectomy speaks with a voice prosthesis in the wall between his trachea and esophagus. The prosthesis fell out while cleaning, cannot be found, and he is now coughing. What is the main concern?

    1. A. The prosthesis may be in his airway
    2. B. He will lose his voice permanently
    3. C. The stoma will close within minutes
    4. D. He swallowed it, so it is harmless
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    Answer: A. The prosthesis may be in his airway

    A voice prosthesis sits in a puncture between the trachea and esophagus. If it falls out and cannot be found, it may have been aspirated through the stoma, and coughing raises that concern, so he needs evaluation and transport. Fluids can also leak from the esophagus into the airway through the open puncture. Losing it does not mean he will lose his voice permanently, the stoma itself does not close within minutes, and assuming he swallowed it could miss an aspirated foreign body.

30. Facial bones are highly vascular. What does this mean for facial injuries?

    1. A. Swelling is usually minimal
    2. B. Healing is very slow
    3. C. Bleeding may be heavy
    4. D. Bleeding stops without pressure
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    Answer: C. Bleeding may be heavy

    The rich blood supply of the face causes heavy bleeding and swelling that can threaten the airway, but it also aids healing, so healing is usually faster rather than slower. Facial wounds often need firm direct pressure to stop bleeding.