Supraglottic Airways Practice Questions

30 multiple-choice questions on Supraglottic airways 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. Where does a supraglottic airway device sit when properly placed?

   1. A. Above the glottic opening
   2. B. Below the vocal cords
   3. C. Within the nasopharynx
   4. D. In the right mainstem
   Show answer

   Answer: A. Above the glottic opening

   Supraglottic airways sit above the glottis and direct ventilation into the larynx without passing through the vocal cords.

2. What is a major advantage of a supraglottic airway compared with endotracheal intubation?

   1. A. Higher pressure tolerance
   2. B. Full aspiration protection
   3. C. Direct view of the cords
   4. D. Blind, rapid insertion
   Show answer

   Answer: D. Blind, rapid insertion

   SGAs are placed blindly and quickly with a short learning curve, minimizing interruptions in CPR. They do not fully protect against aspiration.

3. Which statement about aspiration risk with supraglottic airways is correct?

   1. A. They reduce but do not remove it
   2. B. They raise it versus a BVM
   3. C. They remove it entirely
   4. D. They match a cuffed ET tube
   Show answer

   Answer: A. They reduce but do not remove it

   SGAs reduce gastric insufflation compared with BVM ventilation, but they do not seal the trachea the way a cuffed ET tube does.

4. Which i-gel size fits a 20-kg child?

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

   Answer: D. Size 2

   The i-gel is sized by weight: size 1.5 for 5 to 12 kg, size 2 for 10 to 25 kg, size 2.5 for 25 to 35 kg, and size 3 for 30 to 60 kg. A 20-kg child needs a size 2. Size 1 is for neonates (2 to 5 kg). Sizes 3 and 4 are for small and average adults.

5. Which size i-gel is generally appropriate for a 75-kg adult?

   1. A. Size 3
   2. B. Size 4
   3. C. Size 5
   4. D. Size 2.5
   Show answer

   Answer: B. Size 4

   Size 4 covers roughly 50 to 90 kg. Size 3 is for about 30 to 60 kg and size 5 for over 90 kg.

6. Why is a supraglottic airway useful for a trauma patient in spinal motion restriction?

   1. A. It can be placed with the head neutral
   2. B. It holds the cervical spine in alignment
   3. C. It removes the need for manual stabilization
   4. D. It needs the neck extended to seat
   Show answer

   Answer: A. It can be placed with the head neutral

   SGAs can be inserted with the head in neutral, so manual in-line stabilization can continue. The device does not align or stabilize the spine. Manual stabilization is still needed during and after placement. SGAs do not require neck extension.

7. Which King LT size is appropriate for a patient who is 5 feet 9 inches tall?

   1. A. Size 4
   2. B. Size 2
   3. C. Size 3
   4. D. Size 5
   Show answer

   Answer: A. Size 4

   Size 4 (red) is used for patients 5 to 6 feet tall.

8. What feature distinguishes the i-gel from the King LT and the LMA?

   1. A. Non-inflatable gel cuff
   2. B. Two separate cuffs
   3. C. A built-in laryngoscope
   4. D. A blind tracheal lumen
   Show answer

   Answer: A. Non-inflatable gel cuff

   The i-gel has a soft, non-inflatable cuff that molds to the laryngeal structures. The King LT has two inflatable cuffs that inflate together.

9. A King LT has two cuffs. Where are they designed to sit?

   1. A. Trachea and esophagus
   2. B. Oropharynx and esophagus
   3. C. Nasopharynx and larynx
   4. D. Larynx and right bronchus
   Show answer

   Answer: B. Oropharynx and esophagus

   The proximal cuff seals the oropharynx and the distal cuff seals the esophagus. Ventilation exits through openings between the cuffs toward the glottis.

10. You hear gurgling at the mouth with each forceful breath given through an i-gel. What should you do first?

    1. A. Add air to the i-gel's cuff
    2. B. Push the i-gel in deeper
    3. C. Bag faster to overcome the leak
    4. D. Give slower, gentler breaths
    Show answer

    Answer: D. Give slower, gentler breaths

    SGAs seal at low airway pressures, so forceful breaths leak around the device and can inflate the stomach. Slow, gentle breaths often stop the leak; then check size and position. The i-gel has no inflatable cuff. Pushing it past its seated position does not improve the seal. Faster bagging worsens the leak and gastric inflation.

11. A 46-year-old intentionally drank drain cleaner and is now unresponsive with poor respirations. Why is a King LT a poor choice?

    1. A. It cannot be sized for him
    2. B. Esophageal injury is likely
    3. C. It requires a gag reflex
    4. D. It requires direct laryngoscopy
    Show answer

    Answer: B. Esophageal injury is likely

    Caustic ingestion and known esophageal disease are contraindications for devices with an esophageal cuff because of the risk of perforation.

12. In a patient with a large foreign body lodged at the glottis, why will a supraglottic airway likely fail?

    1. A. It requires a gag reflex
    2. B. It cannot pass the teeth
    3. C. It sits above the blockage
    4. D. It enters the trachea
    Show answer

    Answer: C. It sits above the blockage

    An SGA delivers air to the glottic opening. If the obstruction is at or below the glottis, ventilation will remain blocked.

13. A King LT ventilates well after ROSC, and transport will take 20 minutes. Your partner wants to swap it for an ET tube in the moving ambulance. What is best?

    1. A. Remove the SGA and intubate en route
    2. B. Keep the working SGA and monitor it
    3. C. Deflate the cuffs to test his breathing
    4. D. Switch to a BVM with an OPA for transport
    Show answer

    Answer: B. Keep the working SGA and monitor it

    Keep the working SGA and monitor it: one that ventilates well, confirmed by waveform capnography, should stay in place. Swapping devices in a moving vehicle risks losing the airway, hypoxia, and re-arrest. Deflating the cuffs loses the seal. Switching to a BVM with an OPA removes a working airway without a reason.

14. During CPR, vomitus wells up around a properly seated i-gel. What is the best response?

    1. A. Remove the i-gel and ventilate with a face mask
    2. B. Suction and pass a tube through its gastric port
    3. C. Stop compressions until the vomit has cleared away
    4. D. Push the i-gel deeper to seal off the esophagus
    Show answer

    Answer: B. Suction and pass a tube through its gastric port

    If the i-gel still ventilates, leave it in, suction the mouth and around the device, and decompress the stomach by passing a tube through its gastric port. Removing a working device and switching to a face mask leaves the airway unprotected during ongoing regurgitation. Compressions should not stop. Pushing the device deeper misplaces it.

15. After placing a King LT, you see no capnography waveform, no chest rise, and no breath sounds. What should you do?

    1. A. Add 20 mL more to the cuff
    2. B. Leave it and recheck in 5 min
    3. C. Bag faster and harder
    4. D. Remove it and use the BVM
    Show answer

    Answer: D. Remove it and use the BVM

    No waveform and no chest rise mean the device is not ventilating. Remove it, resume BVM ventilation, and reconsider your airway plan.

16. When inserting a King LT, the tip is advanced along the hard palate until:

    1. A. Resistance is felt at the cords
    2. B. The cuff is visible in the mouth
    3. C. The connector base nears the teeth
    4. D. The patient begins to gag
    Show answer

    Answer: C. The connector base nears the teeth

    Advance until the base of the connector is aligned with the teeth or gums, inflate the cuffs, then gently withdraw until ventilation is easy.

17. After inflating the cuffs on a King LT, you find ventilation difficult. What is the recommended adjustment?

    1. A. Inflate the cuffs with more air
    2. B. Rotate the tube 180 degrees
    3. C. Push it in 2 cm further
    4. D. Withdraw slowly while bagging
    Show answer

    Answer: D. Withdraw slowly while bagging

    Slowly withdrawing while ventilating lets the ventilation outlets align with the glottis, at which point ventilation becomes easy.

18. How should an i-gel be inserted?

    1. A. Inflate it before inserting
    2. B. Glide along the hard palate
    3. C. Insert with cuff facing the palate
    4. D. Rotate it 180° on insertion
    Show answer

    Answer: B. Glide along the hard palate

    With the cuff outlet facing the patient's chin, glide the i-gel along the hard palate until definite resistance is felt. Facing the cuff toward the palate puts it in backward. There is nothing to inflate, and it is not rotated 180 degrees on insertion the way an adult OPA is.

19. Which supraglottic device features allow passage of an orogastric tube?

    1. A. A Murphy eye
    2. B. A gastric access channel
    3. C. A tracheal lumen
    4. D. An inflatable pilot cuff
    Show answer

    Answer: B. A gastric access channel

    Devices such as the i-gel and King LTS-D have a gastric channel that allows decompression of the stomach.

20. A 300-lb patient with severe bronchospasm is being ventilated through an LMA. You note a large air leak and poor chest rise. Why?

    1. A. The LMA is in the trachea
    2. B. The epiglottis has folded down over the bowl
    3. C. High airway pressures overcome the seal
    4. D. Bronchospasm has deflated the cuff
    Show answer

    Answer: C. High airway pressures overcome the seal

    SGAs leak at higher airway pressures, so stiff lungs, obesity, and bronchospasm make adequate ventilation harder. A downfolded epiglottis blocks airflow rather than causing a large leak, bronchospasm narrows the lower airways but does not let air out of the cuff, and a tip in the trachea would not ventilate at all.

21. You note an air leak around an LMA. Which action is most likely to cause new problems?

    1. A. Checking insertion depth
    2. B. Checking the device size
    3. C. Repositioning the head
    4. D. Overinflating the cuff
    Show answer

    Answer: D. Overinflating the cuff

    Overinflation can push the device out of position, worsen the leak, and injure pharyngeal tissue. Check size, depth, and position first.

22. A patient with a King LT in place starts to gag and move after ROSC. What should you do?

    1. A. Tape it more securely
    2. B. Deflate and remove it
    3. C. Inflate the cuffs more
    4. D. Advance it deeper
    Show answer

    Answer: B. Deflate and remove it

    A returning gag reflex means the patient may no longer tolerate the device and may vomit or develop laryngospasm. Have suction ready, deflate the cuffs, and remove it. Taping it more securely, inflating the cuffs more, or advancing it deeper all add stimulation and risk vomiting and aspiration.

23. According to AHA guidelines, which airway strategy is acceptable for adult out-of-hospital cardiac arrest?

    1. A. Only BVM is acceptable
    2. B. BVM, SGA, or ETI
    3. C. Only ETI is acceptable
    4. D. Only cricothyrotomy
    Show answer

    Answer: B. BVM, SGA, or ETI

    AHA considers BVM, supraglottic airways, and intubation all reasonable, with SGAs reasonable where intubation success rates are low.

24. What is a potential problem with an LMA that can obstruct ventilation even when the device is in the correct location?

    1. A. Overinflation of the lungs
    2. B. Downfolding of the epiglottis
    3. C. Tracheal placement of the tip
    4. D. Inflation of the stomach cuff
    Show answer

    Answer: B. Downfolding of the epiglottis

    The epiglottis can fold down over the glottis during insertion, blocking airflow. Repositioning may correct it.

25. Why is the Combitube contraindicated in patients with latex allergy?

    1. A. It requires latex gloves
    2. B. It must be lubricated with latex
    3. C. Its balloons contain latex
    4. D. Its tube is coated with latex
    Show answer

    Answer: C. Its balloons contain latex

    The Combitube's balloons contain latex. Most services now use newer single-lumen SGAs.

26. 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.

27. What should be done after a supraglottic airway is confirmed in a patient being transported?

    1. A. Recheck placement if the SpO2 drops
    2. B. Switch capnography to spot checks
    3. C. Secure it and reconfirm after moves
    4. D. Deflate both cuffs for transport
    Show answer

    Answer: C. Secure it and reconfirm after moves

    Secure the device and reconfirm position with continuous capnography after every patient move, since displacement can occur. Waiting for the SpO2 to fall detects a displaced airway late, spot checks can miss a dislodgment between readings, and deflating the cuffs loses the seal.

28. Which patient is the best candidate for a supraglottic airway?

    1. A. A drowsy patient who gags
    2. B. An alert asthma patient
    3. C. An apneic, unresponsive adult
    4. D. A patient with epiglottitis
    Show answer

    Answer: C. An apneic, unresponsive adult

    SGAs are for unresponsive patients without a gag reflex who need ventilation, such as those in cardiac arrest.

29. When an i-gel is properly seated, where should the integral bite block sit?

    1. A. Against the cords
    2. B. Between the teeth
    3. C. Past the uvula
    4. D. Behind the tongue
    Show answer

    Answer: B. Between the teeth

    The horizontal line on the bite block should lie at the level of the teeth when the device is fully inserted.

30. After a long transport with a King LT, the patient's tongue looks swollen and dusky. What is the most likely cause?

    1. A. An allergic reaction to the device's silicone
    2. B. Normal swelling that needs no action
    3. C. Excess cuff pressure on the tongue's veins
    4. D. A tongue laceration during insertion
    Show answer

    Answer: C. Excess cuff pressure on the tongue's veins

    An overinflated proximal cuff can compress venous outflow from the tongue and cause engorgement. Inflate to the maker's pressure (about 60 cmH2O) with a manometer rather than by volume alone. An allergic reaction to the silicone device is unlikely. Tongue swelling is not normal and needs attention. A laceration would bleed rather than turn the tongue dusky and swollen.