Special Populations and the Difficult Airway Practice Questions

30 multiple-choice questions on Special populations and the difficult airway 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.

30 practice questions

1. In the HEAVEN criteria for predicting a difficult airway, what does the "V" stand for?

   1. A. Vomit, blood, or fluid
   2. B. Ventilation pressures
   3. C. Vocal cord paralysis
   4. D. Venous access problems
   Show answer

   Answer: A. Vomit, blood, or fluid

   HEAVEN: Hypoxemia, Extremes of size, Anatomic challenges, Vomit/blood/fluid, Exsanguination/anemia, Neck mobility.

2. Which term describes a patient whose airway is risky mainly because of hypotension, hypoxemia, or severe acidosis rather than anatomy?

   1. A. Physiologically difficult
   2. B. Failed airway
   3. C. Crash airway
   4. D. Anatomically difficult
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   Answer: A. Physiologically difficult

   Physiologic derangements raise the risk of peri-intubation cardiac arrest even when laryngoscopy is easy. Correct them before intubating when possible.

3. A child with suspected epiglottitis suddenly becomes apneic during transport. What should you do first?

   1. A. Blind finger sweep of the throat
   2. B. Bag-mask ventilation with a tight seal
   3. C. Immediate needle cricothyrotomy
   4. D. Abdominal thrusts to clear the upper airway
   Show answer

   Answer: B. Bag-mask ventilation with a tight seal

   Most children with epiglottitis can be ventilated with a BVM and a good seal, because positive pressure pushes air past the swollen epiglottis. Escalate only if BVM fails. Blind finger sweeps can worsen swelling and bleeding. A needle cric is reserved for when BVM cannot oxygenate. Abdominal thrusts are for foreign bodies, not swelling.

4. A 3-year-old with a croup-like cough looks toxic, has a high fever, and does not improve after nebulized epinephrine. What should you suspect?

   1. A. Simple viral croup
   2. B. Bacterial tracheitis
   3. C. Acute asthma exacerbation
   4. D. Spasmodic croup
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   Answer: B. Bacterial tracheitis

   A child with croup-like symptoms who looks toxic, has a high fever, and does not respond to epinephrine may have bacterial tracheitis, with thick secretions that can block the airway; prepare for airway support. Viral and spasmodic croup usually improve with epinephrine and are not toxic. Asthma causes wheezing rather than a barking cough and stridor.

5. A 4-year-old has just been intubated. Using the oral depth formula (age / 2) + 12, how deep should the tube be at the lips?

   1. A. About 18 cm
   2. B. About 10 cm
   3. C. About 14 cm
   4. D. About 22 cm
   Show answer

   Answer: C. About 14 cm

   (4 / 2) + 12 = 14 cm at the lips; confirm with breath sounds and waveform capnography. 18 cm and 22 cm would likely place the tip in a bronchus. 10 cm would leave the tip near the vocal cords, where it can dislodge.

6. Why do obese patients desaturate faster during apnea?

   1. A. Lower metabolic oxygen demand
   2. B. Larger oxygen reserve in fat
   3. C. Better alveolar recruitment
   4. D. Reduced residual capacity
   Show answer

   Answer: D. Reduced residual capacity

   Abdominal mass pushes on the diaphragm and lowers FRC, so the oxygen reservoir is small. Preoxygenate in a head-up position.

7. Why does a pregnant patient at term desaturate quickly during apnea?

   1. A. Slower heart rate
   2. B. Lower blood volume
   3. C. Low FRC, high O2 demand
   4. D. High FRC, low O2 demand
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   Answer: C. Low FRC, high O2 demand

   The gravid uterus reduces FRC while maternal oxygen consumption rises, shortening safe apnea time.

8. When intubating a woman in late pregnancy, why might a smaller endotracheal tube be needed?

   1. A. A narrower trachea
   2. B. Airway mucosal swelling
   3. C. A much higher larynx
   4. D. Thicker vocal cords
   Show answer

   Answer: B. Airway mucosal swelling

   Pregnancy causes edema and engorgement of the airway mucosa, so a slightly smaller tube may be needed and bleeding is more likely.

9. A trauma patient in a cervical collar needs intubation. How should the spine be protected during laryngoscopy?

   1. A. Hyperextend the head
   2. B. Use the sniffing position
   3. C. Manual in-line stabilization
   4. D. Keep the collar fully closed
   Show answer

   Answer: C. Manual in-line stabilization

   Open or remove the front of the collar so the mouth can open, while an assistant holds manual in-line stabilization.

10. An elderly patient with well-fitting dentures needs BVM ventilation. What should you do with the dentures?

    1. A. Push them back
    2. B. Tape them shut
    3. C. Remove them first
    4. D. Leave them in
    Show answer

    Answer: D. Leave them in

    Well-fitting dentures help maintain facial structure for a good mask seal. Remove them for intubation or if they are loose.

11. A 22-year-old with severe asthma was just intubated. How should ventilations be adjusted?

    1. A. Large volume, fast rate
    2. B. High PEEP, fast rate
    3. C. Slow rate, long exhalation
    4. D. Fast rate, short exhalation
    Show answer

    Answer: C. Slow rate, long exhalation

    Asthmatics need prolonged exhalation to avoid air trapping (auto-PEEP). Rapid ventilation can cause breath stacking, hypotension, and barotrauma.

12. Shortly after intubation, a patient in status asthmaticus becomes profoundly hypotensive. What is the best immediate action?

    1. A. Increase the breathing rate
    2. B. Give larger breath volumes
    3. C. Add a second paralytic
    4. D. Briefly disconnect the BVM
    Show answer

    Answer: D. Briefly disconnect the BVM

    Disconnecting lets trapped air escape and venous return recover. If hypotension persists, consider tension pneumothorax.

13. Which airway feature is common in patients with Down syndrome?

    1. A. A wide mouth
    2. B. A small tongue
    3. C. A long neck
    4. D. A large tongue
    Show answer

    Answer: D. A large tongue

    Patients with Down syndrome often have macroglossia and may have atlantoaxial instability, making careful head positioning important.

14. A trauma patient is in a cervical collar with manual in-line stabilization. Which device most improves the glottic view for intubation?

    1. A. A longer curved blade
    2. B. A tighter cervical collar
    3. C. Firm cricoid pressure
    4. D. A video laryngoscope
    Show answer

    Answer: D. A video laryngoscope

    Manual in-line stabilization limits neck movement and worsens the direct view. Video laryngoscopy lets you see around the curve without moving the neck and improves the view. A longer blade does not overcome the limited neck movement. A closed collar limits mouth opening; the front is opened for laryngoscopy. Cricoid pressure often worsens the view.

15. A child with a home tracheostomy is in respiratory distress, and her parent is present. What is the most helpful first step?

    1. A. Ask the parent to wait outside the room
    2. B. Intubate the child orally right away
    3. C. Use the family's emergency trach kit and help
    4. D. Wait for an ENT surgeon to meet you at the hospital
    Show answer

    Answer: C. Use the family's emergency trach kit and help

    Families of children with tracheostomies usually carry a go-bag with a spare tube (and a smaller size), suction catheters, and supplies, and they know the child's normal. Use both. Sending the parent away wastes that knowledge. Oral intubation is not the first step when the problem is usually a blocked or dislodged trach. Waiting for a surgeon delays care.

16. In an intubated adult with severe traumatic brain injury and no signs of herniation, what EtCO2 range should you target?

    1. A. 25 to 30 mmHg
    2. B. 35 to 45 mmHg
    3. C. 20 to 25 mmHg
    4. D. 50 to 60 mmHg
    Show answer

    Answer: B. 35 to 45 mmHg

    Routine hyperventilation lowers cerebral blood flow and worsens outcomes. Aim for normal ventilation with EtCO2 of about 35 to 45 mmHg.

17. A patient with severe DKA and Kussmaul respirations is intubated. Why is a low ventilator rate dangerous?

    1. A. Potassium falls
    2. B. Blood sugar rises
    3. C. CO2 falls too far
    4. D. Acidosis worsens
    Show answer

    Answer: D. Acidosis worsens

    These patients compensate with very high minute ventilation. Failing to match it after intubation lets CO2 rise and pH crash.

18. Why do children desaturate faster than adults during apnea?

    1. A. Higher oxygen use per kg
    2. B. Slower resting heart rates
    3. C. Larger lung reserves
    4. D. Lower metabolic rates
    Show answer

    Answer: A. Higher oxygen use per kg

    Children consume about twice as much oxygen per kilogram and have small FRC reserves, so preoxygenation and fast action matter.

19. During intubation of a 2-year-old, the heart rate falls from 130 to 60. What should you do?

    1. A. Start a cric
    2. B. Stop and oxygenate
    3. C. Continue the attempt
    4. D. Give a paralytic
    Show answer

    Answer: B. Stop and oxygenate

    Bradycardia in children is usually from hypoxia or vagal stimulation. Stop, ventilate with oxygen, and treat bradycardia if it persists.

20. An infant with a very small lower jaw has noisy, obstructed breathing while lying on her back. What should you try first?

    1. A. Hyperextend her neck as far as possible
    2. B. Place her prone or on her side
    3. C. Suction deeply past the larynx
    4. D. Lay her supine with a shoulder roll
    Show answer

    Answer: B. Place her prone or on her side

    In micrognathia (such as Robin sequence), the tongue falls back into the small pharynx when the infant is supine. Prone or side-lying lets the tongue fall forward. An NPA may help if positioning fails. Hyperextending her neck can compress the soft infant airway. Supine is the position that lets the tongue fall back, even with a shoulder roll, and deep suction does not relieve a tongue-based obstruction and can trigger laryngospasm or bradycardia.

21. Per current AHA PALS guidance, which statement about endotracheal tubes in children is correct?

    1. A. Cuffed tubes are reasonable
    2. B. Tubes must be 2 sizes larger
    3. C. Uncuffed tubes are required
    4. D. Cuffs should be fully inflated
    Show answer

    Answer: A. Cuffed tubes are reasonable

    Cuffed tubes are reasonable for infants and children; monitor cuff pressure to avoid mucosal injury.

22. For a child in out-of-hospital cardiac arrest, which airway approach does the AHA consider reasonable?

    1. A. Mandatory intubation
    2. B. Needle cric first
    3. C. BVM ventilation
    4. D. Nasal intubation
    Show answer

    Answer: C. BVM ventilation

    AHA notes BVM ventilation is reasonable compared with advanced airways for pediatric out-of-hospital cardiac arrest.

23. A 35-year-old with burns to the face from an enclosed-space fire has stridor and a hoarse voice. Why is early intubation considered?

    1. A. Oxygen is contraindicated
    2. B. Swelling can worsen fast
    3. C. Burns block oxygen uptake
    4. D. It prevents CO poisoning
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    Answer: B. Swelling can worsen fast

    Airway edema progresses over hours. Waiting can turn a manageable intubation into an impossible one.

24. 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.

25. A 45-year-old has a firm, swollen floor of mouth, an elevated tongue, and drooling after a dental infection. What condition should you suspect?

    1. A. Bell palsy
    2. B. Ludwig angina
    3. C. Peritonsillar abscess
    4. D. Epiglottitis
    Show answer

    Answer: B. Ludwig angina

    Ludwig angina is a rapidly spreading infection of the floor of the mouth that pushes the tongue up and back and can obstruct the airway.

26. A 6-year-old who had a tonsillectomy 7 days ago is spitting bright red blood. What is the best initial management?

    1. A. Sit her up, lean forward, suction, transport
    2. B. Lay her supine and pack the throat with gauze
    3. C. Give oral fluids and observe at home
    4. D. Insert a nasal airway to protect it
    Show answer

    Answer: A. Sit her up, lean forward, suction, transport

    Post-tonsillectomy bleeding often occurs 5 to 10 days after surgery, when the scab separates, and can be heavy. Keep her upright and leaning forward so blood drains, suction as needed, and transport quickly to surgery. Lying supine lets blood run into the airway, and packing the throat blindly can obstruct it. Home observation is unsafe. A nasal airway can worsen bleeding.

27. Why can an older adult be more difficult to ventilate and intubate?

    1. A. Stiff joints, no teeth
    2. B. Stronger airway reflexes
    3. C. Higher lung compliance
    4. D. A larger glottic opening
    Show answer

    Answer: A. Stiff joints, no teeth

    Arthritis limits neck and jaw mobility, missing teeth worsen mask seal, and reduced reflexes increase aspiration risk.

28. Bag-mask ventilation on a 160-kg patient is poor even after ramping. Which change most improves it?

    1. A. One-hand E-C hold with more force
    2. B. A faster rate with smaller tidal breaths
    3. C. Two-hand mask hold with OPA and NPAs
    4. D. Removing the ramp to lie him flat
    Show answer

    Answer: C. Two-hand mask hold with OPA and NPAs

    Obese patients need maximal airway opening: a two-person, two-handed mask hold with a jaw thrust, plus an OPA and one or two NPAs. A one-hand hold with more force rarely seals or lifts well enough. A faster rate with small breaths ventilates dead space. Lying flat worsens FRC and the airway.

29. When bagging a woman in late pregnancy who is in cardiac arrest, which additional measure helps circulation?

    1. A. Left uterine displacement
    2. B. A faster ventilation rate
    3. C. Right lateral tilt of 90°
    4. D. Trendelenburg positioning
    Show answer

    Answer: A. Left uterine displacement

    Displacing the uterus to the left relieves compression of the inferior vena cava and improves venous return during CPR.

30. A newborn needs positive-pressure ventilation. At what rate should breaths be given?

    1. A. 30 to 60 breaths per minute
    2. B. 10 to 12 breaths per minute
    3. C. 12 to 20 breaths per minute
    4. D. 80 to 100 breaths per minute
    Show answer

    Answer: A. 30 to 60 breaths per minute

    Current neonatal resuscitation guidance (2025 AHA/AAP, NRP 9th edition) is PPV at 30 to 60 breaths per minute, adjusted to heart rate rise and chest movement; older NRP editions taught 40 to 60. 10 to 12 is an adult rate, and 12 to 20 is too slow for a newborn. 80 to 100 per minute is too fast and risks air trapping and pneumothorax.