Upper Airway Disorders Practice Questions

30 multiple-choice questions on Upper airway disorders for paramedic and EMT students, from Chapter 17 (Respiratory Emergencies). Read each question, pick your answer, then tap Show answer to check it and read the explanation.

30 practice questions

1. Two months after being intubated for 10 days with pneumonia, a 45-year-old has slowly worsening noisy breathing on inspiration and dyspnea on exertion. His inhalers do not help. What should you suspect?

   1. A. Tracheal narrowing from the tube
   2. B. Adult-onset asthma after the infection
   3. C. Anxiety left over from his ICU stay
   4. D. A return of the original pneumonia
   Show answer

   Answer: A. Tracheal narrowing from the tube

   Prolonged intubation can scar the trachea, causing tracheal narrowing (stenosis) weeks to months later, with inspiratory or biphasic stridor and exertional dyspnea that is often mistaken for asthma and does not respond to inhalers. Adult-onset asthma causes expiratory wheezing that improves with bronchodilators. Anxiety from his ICU stay does not cause stridor. A return of the pneumonia would cause fever and cough rather than slowly worsening stridor.

2. The parents of a toddler with croup ask whether he should sit in a steamy bathroom before going to the hospital. What is the best answer?

   1. A. Steam shrinks the swelling below the cords
   2. B. Humidified air has not been shown to help
   3. C. Cold mist is the preferred first treatment
   4. D. Ten minutes of steam can replace transport
   Show answer

   Answer: B. Humidified air has not been shown to help

   Controlled trials and a Cochrane review found no benefit from humidified air or mist in croup, and hot steam risks scalds. Steroids and, for stridor at rest, nebulized epinephrine are the effective treatments. Steam does not reduce subglottic swelling. Cold mist has no proven benefit either. Steam is no substitute for evaluation when a child has stridor.

3. You are off duty at a park when a child with a peanut allergy develops wheezing, hives, and lip swelling. His mother's only auto-injector expired last month, and EMS is 15 minutes away. What should be done?

   1. A. Discard it and wait for the ambulance
   2. B. Use the expired auto-injector now
   3. C. Give oral diphenhydramine instead
   4. D. Inject half of it to limit side effects
   Show answer

   Answer: B. Use the expired auto-injector now

   An expired epinephrine auto-injector still delivers most of its dose, and in anaphylaxis with no alternative it is far better than no epinephrine. Waiting 15 minutes without epinephrine risks airway loss and shock. Diphenhydramine does not reverse airway swelling or bronchospasm. Auto-injectors cannot deliver a partial dose, and a lower dose would undertreat him.

4. A toddler who choked on peanuts yesterday now wheezes on one side. The family says a chest X-ray was normal. Why does this not rule out an inhaled foreign body?

   1. A. Peanuts dissolve before an X-ray is taken
   2. B. Most food does not show up on X-ray
   3. C. X-rays cannot image a child's bronchi
   4. D. Wheezing proves the object was swallowed
   Show answer

   Answer: B. Most food does not show up on X-ray

   Nuts and other foods are radiolucent, so a plain X-ray often looks normal or shows only subtle air trapping; bronchoscopy may still be needed when the history fits. Peanuts do not dissolve in the airway; they swell and inflame it. X-rays do image a child's chest. One-sided wheezing points to the airway, not the esophagus.

5. 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.

6. Why has the incidence of pediatric epiglottitis dropped sharply in the United States?

   1. A. Earlier use of steroids
   2. B. Antiviral use for influenza
   3. C. Routine tonsillectomy
   4. D. Widespread Hib vaccination
   Show answer

   Answer: D. Widespread Hib vaccination

   The Haemophilus influenzae type b (Hib) vaccine has made pediatric epiglottitis rare, although it still occurs in adults and unvaccinated children.

7. A 3-year-old swallowed a coin 30 minutes ago. He drools and will not swallow, but he is crying loudly and breathing quietly with good color. What should you do?

   1. A. Give back blows and chest thrusts now
   2. B. Have him drink water to wash it down
   3. C. Sweep his mouth to try to reach the coin
   4. D. Keep him upright and calm, and transport
   Show answer

   Answer: D. Keep him upright and calm, and transport

   Drooling and refusal to swallow with a strong cry and quiet breathing suggest the coin is in the esophagus and the airway is open. Keep him calm and upright and transport for an X-ray. Back blows and thrusts are for a severe airway obstruction, which he does not have. Drinking can cause choking or aspiration. Blind finger sweeps can push an object deeper and are not recommended.

8. After falling face-first while drunk, a man is missing two front teeth that no one can find at the scene. He now coughs and has new wheezing over the right chest. What should you report to the hospital?

   1. A. He has a new asthma attack from the fall
   2. B. The missing teeth may be in his airway
   3. C. The teeth were most likely swallowed safely
   4. D. The wheezing is caused by rib bruising
   Show answer

   Answer: B. The missing teeth may be in his airway

   Teeth and dental work knocked loose in facial trauma can be inhaled, especially by an intoxicated patient, and often lodge in the right bronchus, causing cough and one-sided wheezing. Tell the receiving team so they can image the chest. New asthma is unlikely to cause one-sided wheezing after a fall. Assuming the teeth were swallowed ignores the new airway signs. Rib bruising causes pain, not wheezing.

9. Among nonfood objects, which is the leading cause of choking deaths in young children?

   1. A. Small rubber bouncy balls
   2. B. Glass marbles
   3. C. Small coins
   4. D. Pieces of latex balloons
   Show answer

   Answer: D. Pieces of latex balloons

   Uninflated balloons and balloon pieces are the leading cause of choking deaths from children's products, because the soft latex molds to the airway and seals it. Small balls and marbles are also choking hazards, but they cause fewer deaths. Coins are more often swallowed into the esophagus than inhaled.

10. A 52-year-old with a dental infection has swelling under the jaw, elevation of the tongue, drooling, and difficulty breathing. What is the greatest concern?

    1. A. Loss of the airway
    2. B. Severe dehydration
    3. C. Spread into the bloodstream
    4. D. Aspiration of drooled saliva
    Show answer

    Answer: A. Loss of the airway

    Ludwig angina can rapidly obstruct the airway. Early recognition and preparation for a difficult airway are critical. Sepsis, dehydration and aspiration are real concerns, but the elevated tongue and difficulty breathing make airway loss the immediate threat.

11. You arrive to find an adult who suddenly grabbed her throat at dinner and cannot speak, cough, or breathe. A bystander has given 5 back blows without success, and she is still conscious. What should you do next?

    1. A. Give 5 more back blows
    2. B. Give 5 abdominal thrusts
    3. C. Give 5 chest thrusts
    4. D. Lower her to the floor and begin CPR
    Show answer

    Answer: B. Give 5 abdominal thrusts

    This is a severe obstruction in a conscious adult. The 2025 AHA adult BLS guideline recommends repeated cycles of 5 back blows followed by 5 abdominal thrusts until the object comes out or she becomes unresponsive, so after the back blows comes a set of abdominal thrusts. Giving more back blows without the thrusts breaks the recommended cycle. Chest thrusts replace abdominal thrusts when you cannot reach around the abdomen or the patient is late in pregnancy, and neither applies. CPR begins once she becomes unresponsive, not while she is still conscious. (2025 AHA Guidelines, Part 7: Adult BLS, section 10.1.)

12. A man choking on steak was cleared after several abdominal thrusts by his wife. He now feels fine and wants to decline transport. What should you tell him?

    1. A. No follow-up is needed once he can talk
    2. B. He should lie flat for an hour and rest
    3. C. He should be checked for internal injury
    4. D. He can wait and see his doctor next week
    Show answer

    Answer: C. He should be checked for internal injury

    Abdominal thrusts can injure abdominal and chest organs, so current AHA guidance advises medical evaluation after they are used, even when the patient feels well. Being able to talk shows the airway is clear, not that there is no injury. Lying flat does not address injury and is not needed. Waiting a week delays care for injuries that may cause few early symptoms.

13. A 17-year-old runner suddenly develops throat tightness and noisy inspiration during a race. Her SpO2 is 98%, her lungs are clear, she has no hives, and albuterol does not help. What is the most likely cause?

    1. A. Exercise-induced asthma
    2. B. Vocal cord dysfunction
    3. C. Food-triggered anaphylaxis
    4. D. Spontaneous pneumothorax
    Show answer

    Answer: B. Vocal cord dysfunction

    Inspiratory noise and throat tightness during exercise with normal saturation, clear lungs, and no response to albuterol suggest vocal cord dysfunction (inducible laryngeal obstruction), in which the cords close on inspiration. Exercise-induced asthma causes expiratory wheezing that improves with albuterol. Anaphylaxis involves hives, swelling, or hypotension. A pneumothorax causes pleuritic pain and one-sided decreased breath sounds.

14. A 63-year-old taking lisinopril has a swollen tongue and floor of mouth, a muffled voice, and drooling. Her SpO2 is 95%. What is the best plan?

    1. A. Give oral diphenhydramine and observe on scene
    2. B. Keep her upright and transport early
    3. C. Lay her flat to examine the tongue
    4. D. Wait for hives before starting care
    Show answer

    Answer: B. Keep her upright and transport early

    ACE inhibitor angioedema is driven by bradykinin, so antihistamines help little and the swelling can progress quickly. Keep her upright, prepare for a difficult airway, give epinephrine if your protocol allows, and transport early to a facility that can secure the airway. An oral drug cannot be swallowed safely and will not stop the swelling. Lying flat worsens obstruction. Hives are usually absent in this type of angioedema.

15. A man who smoked crack cocaine from a hot glass pipe now has a severe sore throat, a muffled voice, drooling, and soft stridor. What should you suspect?

    1. A. Cocaine-induced bronchospasm
    2. B. A panic attack from the drug
    3. C. A heat injury swelling his upper airway
    4. D. A cocaine-related myocardial infarction
    Show answer

    Answer: C. A heat injury swelling his upper airway

    Inhaling superheated vapor or debris from a pipe can burn the epiglottis and supraglottic tissues, causing a picture like epiglottitis that can progress to obstruction; keep him upright and prepare for a difficult airway. Bronchospasm causes wheezing, not drooling and a muffled voice. Panic does not cause drooling or stridor. Cocaine can cause an MI, but that does not explain these airway findings.

16. A retropharyngeal abscess most commonly affects which age group?

    1. A. Adults over age 65
    2. B. Children aged 6 to 12
    3. C. Children under age 5
    4. D. Young adults aged 18 to 30
    Show answer

    Answer: C. Children under age 5

    Retropharyngeal abscesses occur mainly in young children because of lymph nodes in that space. Signs include fever, neck stiffness, drooling, and difficulty swallowing. These nodes shrink after early childhood, so school-age children are affected less often, and adolescents and young adults more often develop a peritonsillar abscess instead; older adults are uncommonly affected.

17. A 2-year-old with croup has stridor at rest and chest retractions, but her SpO2 is 97% on room air. How should you interpret the SpO2?

    1. A. It shows that the croup is mild
    2. B. It does not rule out severe obstruction
    3. C. It means the stridor is from her crying
    4. D. It means oxygen would be harmful
    Show answer

    Answer: B. It does not rule out severe obstruction

    In croup, hypoxemia appears late, so severity is judged by stridor at rest, retractions, air entry, and mental status. Stridor at rest with retractions is at least moderate croup even with a normal SpO2. Stridor at rest is not caused by crying. Oxygen is not harmful in croup and is given for hypoxemia or distress.

18. A 2-year-old drank from the spout of a teapot of just-boiled water. Her lips are blistered, she is drooling and hoarse, and soft stridor is starting. What is the main concern?

    1. A. Viral croup that began at the same time
    2. B. Burn swelling of the upper airway
    3. C. Epiglottitis from a bacterial infection
    4. D. An inhaled foreign body in the larynx
    Show answer

    Answer: B. Burn swelling of the upper airway

    Hot liquid swallowed or sipped can burn the lips, tongue, and supraglottic tissues, and drooling, hoarseness, and new stridor warn that swelling is closing the airway; transport urgently to a center that can manage a pediatric airway. Croup does not start with burned lips. Bacterial epiglottitis comes with fever and toxicity rather than a scald history. No object was inhaled.

19. Three days after a choking episode on peanuts that seemed to resolve, a 2-year-old has fever, a cough, and wheezing heard only over the right chest. What should you suspect?

    1. A. New-onset asthma triggered by a viral cold
    2. B. Viral croup spreading to the lungs
    3. C. A peanut allergy flaring up again
    4. D. A retained foreign body with infection
    Show answer

    Answer: D. A retained foreign body with infection

    Focal wheezing with fever days after a choking episode suggests a piece of food still lodged in a bronchus, with infection beyond it; it needs bronchoscopy. Asthma wheezing is usually on both sides. Croup causes stridor and a barking cough, not one-sided wheezing. An allergic reaction occurs within minutes to hours of exposure, not days later with fever.

20. A woman in anaphylaxis has stridor and a BP of 80/50 after IM epinephrine. She feels faint and wants to stand up and walk to the stretcher. What position is best?

    1. A. Standing and walking with your support
    2. B. Prone, to help drain the swollen airway
    3. C. Sitting on the edge of the bed, legs down
    4. D. Semi-reclined, legs raised if tolerated
    Show answer

    Answer: D. Semi-reclined, legs raised if tolerated

    Sudden standing or walking during anaphylactic shock has been linked to cardiac arrest from an empty ventricle, so move her without exertion. A semi-reclined position balances her breathing against her low blood pressure, and the legs can be raised if tolerated. Standing and walking is the dangerous choice. Prone positioning does not help airway swelling and hinders care. Sitting with the legs down pools blood and worsens hypotension.

21. A 9-year-old inhaled a plastic pen cap 20 minutes ago. He is coughing now and then but speaking and breathing comfortably. What should you do?

    1. A. Give back blows and thrusts right now
    2. B. Reassure the family; the cap has a hole
    3. C. Have him drink water to wash it down
    4. D. Keep him calm and transport for removal
    Show answer

    Answer: D. Keep him calm and transport for removal

    A child who can speak and breathe has a partial obstruction; let him cough and transport him for removal, ready to give back blows and abdominal thrusts if he can no longer speak or breathe. Giving back blows and thrusts right now is for severe obstruction, not a child moving air. Many pen caps have a vent hole to let some air through if inhaled, but the cap must still be removed. Drinking water can cause aspiration.

22. A 4-month-old has had noisy, high-pitched breathing on inspiration since soon after birth. It is louder when she cries or lies on her back, but she feeds well, is gaining weight, and has normal color. What is the most likely cause?

    1. A. Acute bacterial epiglottitis
    2. B. Laryngomalacia, a floppy larynx
    3. C. Viral croup
    4. D. An inhaled foreign body in the larynx
    Show answer

    Answer: B. Laryngomalacia, a floppy larynx

    Laryngomalacia is the most common cause of chronic stridor in infants: soft supraglottic tissue collapses on inspiration, making noise that worsens with crying, feeding, or lying supine. Most infants who are feeding and growing well outgrow it. Epiglottitis is acute, with fever and toxicity. Croup is uncommon this young and comes with a barking cough after a cold. A foreign body causes sudden symptoms, not stridor present since birth.

23. Which finding suggests that an upper airway obstruction is severe and nearing complete?

    1. A. Stridor only when the child cries
    2. B. Loud, barking cough at night
    3. C. Fading stridor, poor air movement
    4. D. Hoarse voice but full sentences
    Show answer

    Answer: C. Fading stridor, poor air movement

    Softening of stridor with poor air movement and fatigue may mean the airway is closing, not improving.

24. An adult with epiglottitis typically complains first of:

    1. A. Severe, painful sore throat
    2. B. Barking cough and runny nose
    3. C. Wheezing and chest tightness
    4. D. Sharp pain on deep inspiration
    Show answer

    Answer: A. Severe, painful sore throat

    Adults with epiglottitis present with severe sore throat and odynophagia that seems out of proportion to the throat's appearance.

25. Laryngeal spasm causing stridor may occur after extubation or with:

    1. A. Hypernatremia
    2. B. Hypocalcemia
    3. C. Hypoglycemia
    4. D. Hyperkalemia
    Show answer

    Answer: B. Hypocalcemia

    Low calcium increases neuromuscular excitability and can cause laryngospasm. Laryngospasm also occurs after airway manipulation or irritation.

26. What positioning is best for a conscious patient with an upper airway obstruction who is moving air?

    1. A. Prone with the head turned
    2. B. Supine with legs elevated
    3. C. Left lateral recumbent position
    4. D. Upright position of comfort
    Show answer

    Answer: D. Upright position of comfort

    Allowing the patient to stay in the position that maximizes airflow, usually sitting up, avoids worsening the obstruction.

27. A 19-year-old got a tongue piercing 2 days ago. Now his tongue is swollen and painful, he has a fever, his speech is muffled, and he is drooling. What is the main danger?

    1. A. Normal healing that needs no added care
    2. B. A skin allergy to the metal stud
    3. C. Nerve damage that numbs the tongue
    4. D. Swelling that can block his airway
    Show answer

    Answer: D. Swelling that can block his airway

    Infection after tongue piercing can cause rapid swelling of the tongue and floor of the mouth, and drooling with muffled speech warns of airway compromise; keep him upright and transport. This degree of swelling with fever is not normal healing. A metal allergy causes a local rash, not fever and drooling. Nerve damage causes numbness without swelling.

28. A woman at 36 weeks' gestation is choking and cannot speak. She is still conscious after you give 5 back blows, and the object has not come out. What should you do next?

    1. A. Give 5 chest thrusts from behind
    2. B. Give 5 abdominal thrusts from behind
    3. C. Give 5 more back blows
    4. D. Lower her and start CPR
    Show answer

    Answer: A. Give 5 chest thrusts from behind

    In late pregnancy abdominal thrusts are impossible to do effectively or inappropriate, so the 2025 AHA adult BLS guideline recommends repeated cycles of 5 back blows followed by 5 chest thrusts until the object comes out or she becomes unresponsive. Chest thrusts are given standing behind her, with your arms under her armpits and your fist on the center of the sternum. Abdominal thrusts follow the back blows in other adults, not with a gravid abdomen. Giving more back blows without the thrusts breaks the recommended cycle. CPR begins once she becomes unresponsive. (2025 AHA Guidelines, Part 7: Adult BLS, section 10.3.)

29. A 76-year-old taking warfarin has a purple swelling under her tongue that pushes the tongue up and back. She is drooling and her voice is muffled. What is the likely cause?

    1. A. Angioedema from an ACE inhibitor
    2. B. Bleeding into the floor of the mouth
    3. C. Ludwig angina from a tooth infection
    4. D. An allergic reaction to food
    Show answer

    Answer: B. Bleeding into the floor of the mouth

    Anticoagulated patients can bleed spontaneously into the sublingual space; the hematoma lifts the tongue and can obstruct the airway. Keep her upright, prepare for a difficult airway, and report the anticoagulant. She takes no ACE inhibitor, and angioedema causes pale, not purple, swelling. Ludwig angina follows a dental infection with fever. A food allergy would cause hives or lip swelling rather than a purple mass under the tongue.

30. You suspect epiglottitis in a 45-year-old with stridor and drooling who is still maintaining her airway. What is the best plan?

    1. A. Minimize agitation and transport
    2. B. Give a nebulized bronchodilator first
    3. C. Attempt immediate intubation on scene
    4. D. Inspect the throat with a tongue blade
    Show answer

    Answer: A. Minimize agitation and transport

    If the patient is maintaining her airway, avoid unnecessary manipulation, prepare for a difficult airway, and transport to a facility able to secure it.