FISDAP Airway Management
Exam Practice 2025/2026
MODULE 1: Anatomy, Physiology & Assessment (Q1-12)
Q1 [Knowledge - AO1]: The superior laryngeal nerve, a branch of the vagus
nerve, provides sensory innervation to which anatomical structure?
● A. The true vocal cords (vocal folds) below the glottic opening
● B. The laryngeal surface of the epiglottis and the false vocal cords [CORRECT]
● C. The cricothyroid membrane and tracheal mucosa
● D. The carina and mainstem bronchi
Correct Answer: B
Rationale: The superior laryngeal nerve divides into internal and external branches. The
internal branch pierces the thyrohyoid membrane and provides sensory innervation to the
laryngeal surface of the epiglottis, the aryepiglottic folds, and the false vocal cords
(vestibular folds). The recurrent laryngeal nerve (inferior laryngeal nerve) provides sensory
innervation below the vocal cords (option A). Understanding this distinction is critical for
topical anesthesia during awake intubation and predicting cough reflex responses during
bronchoscopy.
Why distractors are incorrect:
● A describes the recurrent laryngeal nerve's sensory distribution
● C describes structures innervated by the recurrent laryngeal nerve (trachea) or not
specifically innervated by the superior laryngeal nerve alone
● D describes structures innervated by the vagus via the pulmonary plexus, not the superior
laryngeal nerve
Q2 [Application - AO2]: A 6-year-old child presents with partial airway
obstruction from a foreign body. Which anatomical characteristic of the
pediatric airway MOST increases the risk of complete obstruction?
● A. The narrowest portion being at the cricoid cartilage (subglottic region) [CORRECT]
● B. The presence of a floppy epiglottis that obstructs the glottic opening
● C. The anterior position of the larynx preventing jaw-thrust maneuver
, ● D. The large tongue base occupying 50% of the oral cavity
Correct Answer: A
Rationale: In children, the cricoid cartilage forms a complete, non-distensible ring and
represents the narrowest portion of the pediatric airway (vs. the glottic opening in adults).
This funnel-shaped anatomy means that even small amounts of edema (1 mm
circumferentially) reduce the cross-sectional area by approximately 75% (Poiseuille's Law:
resistance ∝ 1/radius⁴). A foreign body lodged at this level creates a "ball-valve" effect with
rapid progression to complete obstruction.
Why distractors are incorrect:
● B: The pediatric epiglottis is omega-shaped and floppy, but this primarily affects intubation
difficulty, not foreign body obstruction risk
● C: The anterior larynx (C3-C4 vs. C4-C6 in adults) actually facilitates jaw-thrust by bringing
the airway closer to the mandible
● D: While the tongue is relatively large, this affects mask ventilation, not lower airway
obstruction dynamics
Q3 [Knowledge - AO1]: The anatomical structure that separates the base of the
tongue from the epiglottis and is the correct location for placement of a
Macintosh blade tip during laryngoscopy is the:
● A. Vallecula [CORRECT]
● B. Glottic opening
● C. Vestibular fold
● D. Cricoid cartilage
Correct Answer: A
Rationale: The vallecula is the potential space or depression located between the base of the
tongue (posterior one-third) and the anterior surface of the epiglottis. When using a curved
(Macintosh) laryngoscope blade, the tip is placed in the vallecula. Applying anterior traction
(lifting toward the ceiling at a 45° angle, not levering) engages the hyoepiglottic ligament,
which indirectly elevates the epiglottis to expose the vocal cords. This technique minimizes
dental trauma and provides superior visualization compared to direct elevation of the
epiglottis with a straight blade in adults.
Why distractors are incorrect:
● B: The glottic opening is the target for tube passage, not blade placement
● C: The vestibular folds (false vocal cords) are superior to the true cords and would cause
laryngospasm if touched
, ● D: The cricoid cartilage is inferior to the cords and used for Sellick maneuver, not blade
placement
Q4 [Analysis - AO3] [Scenario]: You respond to a 34-year-old construction
worker who fell from scaffolding. He is conscious but anxious, speaking in short
phrases. Vital signs: HR 118, RR 32, BP 94/60, SpO₂ 89% on room air. Breath
sounds are diminished on the right with hyperresonance to percussion. Trachea
is deviated to the left. Which physiological derangement is PRIMARY?
● A. Hypoventilation causing respiratory acidosis
● B. Impaired oxygenation due to V/Q mismatch
● C. Decreased venous return and cardiovascular collapse from tension pneumothorax
[CORRECT]
● D. Upper airway obstruction from maxillofacial trauma
Correct Answer: C
Rationale: This presentation describes tension pneumothorax: tracheal deviation (away from
affected side), hypotension (94/60), tachycardia, and respiratory distress. The primary life
threat is cardiovascular, not respiratory. As intrapleural pressure exceeds atmospheric
pressure, it collapses the ipsilateral lung, but more critically, it shifts the mediastinum,
compressing the superior and inferior vena cava, obstructing venous return to the right heart.
This causes obstructive shock (cardiac output falls despite normal cardiac function). The
immediate intervention is needle decompression (14-gauge, 3.25 inch at 4th-5th ICS
mid-axillary or 2nd ICS mid-clavicular), not airway intervention.
Why distractors are incorrect:
● A: He is hyperventilating (RR 32), not hypoventilating
● B: While V/Q mismatch exists, it is not the immediate cause of hemodynamic collapse
● D: No signs of upper airway obstruction (stridor, voice changes, facial trauma described)
Q5 [Application - AO2] [Capnography]: A patient with COPD exacerbation has the
following capnography waveform: gradual upstroke, prolonged plateau with a
"shark fin" appearance, and elevated ETCO₂ of 58 mmHg. The most accurate
interpretation is:
● A. Normal waveform in a patient with metabolic alkalosis
● B. Bronchospasm with incomplete alveolar emptying [CORRECT]
● C. Esophageal intubation with CO₂ diffusion from gastric contents
● D. Hyperventilation with low ETCO₂
, Correct Answer: B
Rationale: The "shark fin" or "cobra head" capnogram is pathognomonic for bronchospasm
and obstructive lung disease. In COPD/asthma, narrowed airways and collapsed alveoli
create time-constant inequalities—some alveoli empty quickly, others slowly. The
capnograph samples gas from fast-emptying alveoli first (lower CO₂), then slow-emptying
alveoli (higher CO₂), creating the characteristic slanted upstroke and prolonged, sloping
plateau. The elevated ETCO₂ (58 mmHg, normal 35-45) indicates hypoventilation relative to
CO₂ production.
Why distractors are incorrect:
● A: Normal waveforms have sharp upstrokes and flat plateaus; metabolic alkalosis would
show normal shape, possibly elevated ETCO₂ compensation
● C: Esophageal intubation shows a flat or rapidly declining waveform after 6 breaths (gastric
CO₂ washout)
● D: Hyperventilation would show LOW ETCO₂ (<35 mmHg), not elevated
Q6 [Knowledge - AO1]: The primary determinant of oxygen content in arterial
blood (CaO₂) is:
● A. The partial pressure of oxygen (PaO₂)
● B. The oxygen saturation of hemoglobin (SaO₂) [CORRECT]
● C. The dissolved oxygen in plasma
● D. The respiratory rate and tidal volume
Correct Answer: B
Rationale: The oxygen content equation: CaO₂ = (1.34 × Hgb × SaO₂) + (0.003 × PaO₂).
Hemoglobin-bound oxygen constitutes ~98.5% of arterial oxygen content, while dissolved
oxygen contributes only 1.5% (0.003 mL O₂/dL blood/mmHg PaO₂). A patient with Hgb 15
g/dL and SaO₂ 90% carries 18.1 mL O₂/dL, while increasing PaO₂ from 60 to 100 mmHg adds
only 0.12 mL O₂/dL. This explains why patients with severe anemia (low Hgb) can have
normal SpO₂ yet profound tissue hypoxia.
Why distractors are incorrect:
● A: PaO₂ drives diffusion but contributes minimally to total content
● C: Dissolved oxygen is clinically negligible except in hyperbaric therapy
● D: Ventilation parameters affect PaCO₂ primarily and PaO₂ secondarily, not oxygen-carrying
capacity
Exam Practice 2025/2026
MODULE 1: Anatomy, Physiology & Assessment (Q1-12)
Q1 [Knowledge - AO1]: The superior laryngeal nerve, a branch of the vagus
nerve, provides sensory innervation to which anatomical structure?
● A. The true vocal cords (vocal folds) below the glottic opening
● B. The laryngeal surface of the epiglottis and the false vocal cords [CORRECT]
● C. The cricothyroid membrane and tracheal mucosa
● D. The carina and mainstem bronchi
Correct Answer: B
Rationale: The superior laryngeal nerve divides into internal and external branches. The
internal branch pierces the thyrohyoid membrane and provides sensory innervation to the
laryngeal surface of the epiglottis, the aryepiglottic folds, and the false vocal cords
(vestibular folds). The recurrent laryngeal nerve (inferior laryngeal nerve) provides sensory
innervation below the vocal cords (option A). Understanding this distinction is critical for
topical anesthesia during awake intubation and predicting cough reflex responses during
bronchoscopy.
Why distractors are incorrect:
● A describes the recurrent laryngeal nerve's sensory distribution
● C describes structures innervated by the recurrent laryngeal nerve (trachea) or not
specifically innervated by the superior laryngeal nerve alone
● D describes structures innervated by the vagus via the pulmonary plexus, not the superior
laryngeal nerve
Q2 [Application - AO2]: A 6-year-old child presents with partial airway
obstruction from a foreign body. Which anatomical characteristic of the
pediatric airway MOST increases the risk of complete obstruction?
● A. The narrowest portion being at the cricoid cartilage (subglottic region) [CORRECT]
● B. The presence of a floppy epiglottis that obstructs the glottic opening
● C. The anterior position of the larynx preventing jaw-thrust maneuver
, ● D. The large tongue base occupying 50% of the oral cavity
Correct Answer: A
Rationale: In children, the cricoid cartilage forms a complete, non-distensible ring and
represents the narrowest portion of the pediatric airway (vs. the glottic opening in adults).
This funnel-shaped anatomy means that even small amounts of edema (1 mm
circumferentially) reduce the cross-sectional area by approximately 75% (Poiseuille's Law:
resistance ∝ 1/radius⁴). A foreign body lodged at this level creates a "ball-valve" effect with
rapid progression to complete obstruction.
Why distractors are incorrect:
● B: The pediatric epiglottis is omega-shaped and floppy, but this primarily affects intubation
difficulty, not foreign body obstruction risk
● C: The anterior larynx (C3-C4 vs. C4-C6 in adults) actually facilitates jaw-thrust by bringing
the airway closer to the mandible
● D: While the tongue is relatively large, this affects mask ventilation, not lower airway
obstruction dynamics
Q3 [Knowledge - AO1]: The anatomical structure that separates the base of the
tongue from the epiglottis and is the correct location for placement of a
Macintosh blade tip during laryngoscopy is the:
● A. Vallecula [CORRECT]
● B. Glottic opening
● C. Vestibular fold
● D. Cricoid cartilage
Correct Answer: A
Rationale: The vallecula is the potential space or depression located between the base of the
tongue (posterior one-third) and the anterior surface of the epiglottis. When using a curved
(Macintosh) laryngoscope blade, the tip is placed in the vallecula. Applying anterior traction
(lifting toward the ceiling at a 45° angle, not levering) engages the hyoepiglottic ligament,
which indirectly elevates the epiglottis to expose the vocal cords. This technique minimizes
dental trauma and provides superior visualization compared to direct elevation of the
epiglottis with a straight blade in adults.
Why distractors are incorrect:
● B: The glottic opening is the target for tube passage, not blade placement
● C: The vestibular folds (false vocal cords) are superior to the true cords and would cause
laryngospasm if touched
, ● D: The cricoid cartilage is inferior to the cords and used for Sellick maneuver, not blade
placement
Q4 [Analysis - AO3] [Scenario]: You respond to a 34-year-old construction
worker who fell from scaffolding. He is conscious but anxious, speaking in short
phrases. Vital signs: HR 118, RR 32, BP 94/60, SpO₂ 89% on room air. Breath
sounds are diminished on the right with hyperresonance to percussion. Trachea
is deviated to the left. Which physiological derangement is PRIMARY?
● A. Hypoventilation causing respiratory acidosis
● B. Impaired oxygenation due to V/Q mismatch
● C. Decreased venous return and cardiovascular collapse from tension pneumothorax
[CORRECT]
● D. Upper airway obstruction from maxillofacial trauma
Correct Answer: C
Rationale: This presentation describes tension pneumothorax: tracheal deviation (away from
affected side), hypotension (94/60), tachycardia, and respiratory distress. The primary life
threat is cardiovascular, not respiratory. As intrapleural pressure exceeds atmospheric
pressure, it collapses the ipsilateral lung, but more critically, it shifts the mediastinum,
compressing the superior and inferior vena cava, obstructing venous return to the right heart.
This causes obstructive shock (cardiac output falls despite normal cardiac function). The
immediate intervention is needle decompression (14-gauge, 3.25 inch at 4th-5th ICS
mid-axillary or 2nd ICS mid-clavicular), not airway intervention.
Why distractors are incorrect:
● A: He is hyperventilating (RR 32), not hypoventilating
● B: While V/Q mismatch exists, it is not the immediate cause of hemodynamic collapse
● D: No signs of upper airway obstruction (stridor, voice changes, facial trauma described)
Q5 [Application - AO2] [Capnography]: A patient with COPD exacerbation has the
following capnography waveform: gradual upstroke, prolonged plateau with a
"shark fin" appearance, and elevated ETCO₂ of 58 mmHg. The most accurate
interpretation is:
● A. Normal waveform in a patient with metabolic alkalosis
● B. Bronchospasm with incomplete alveolar emptying [CORRECT]
● C. Esophageal intubation with CO₂ diffusion from gastric contents
● D. Hyperventilation with low ETCO₂
, Correct Answer: B
Rationale: The "shark fin" or "cobra head" capnogram is pathognomonic for bronchospasm
and obstructive lung disease. In COPD/asthma, narrowed airways and collapsed alveoli
create time-constant inequalities—some alveoli empty quickly, others slowly. The
capnograph samples gas from fast-emptying alveoli first (lower CO₂), then slow-emptying
alveoli (higher CO₂), creating the characteristic slanted upstroke and prolonged, sloping
plateau. The elevated ETCO₂ (58 mmHg, normal 35-45) indicates hypoventilation relative to
CO₂ production.
Why distractors are incorrect:
● A: Normal waveforms have sharp upstrokes and flat plateaus; metabolic alkalosis would
show normal shape, possibly elevated ETCO₂ compensation
● C: Esophageal intubation shows a flat or rapidly declining waveform after 6 breaths (gastric
CO₂ washout)
● D: Hyperventilation would show LOW ETCO₂ (<35 mmHg), not elevated
Q6 [Knowledge - AO1]: The primary determinant of oxygen content in arterial
blood (CaO₂) is:
● A. The partial pressure of oxygen (PaO₂)
● B. The oxygen saturation of hemoglobin (SaO₂) [CORRECT]
● C. The dissolved oxygen in plasma
● D. The respiratory rate and tidal volume
Correct Answer: B
Rationale: The oxygen content equation: CaO₂ = (1.34 × Hgb × SaO₂) + (0.003 × PaO₂).
Hemoglobin-bound oxygen constitutes ~98.5% of arterial oxygen content, while dissolved
oxygen contributes only 1.5% (0.003 mL O₂/dL blood/mmHg PaO₂). A patient with Hgb 15
g/dL and SaO₂ 90% carries 18.1 mL O₂/dL, while increasing PaO₂ from 60 to 100 mmHg adds
only 0.12 mL O₂/dL. This explains why patients with severe anemia (low Hgb) can have
normal SpO₂ yet profound tissue hypoxia.
Why distractors are incorrect:
● A: PaO₂ drives diffusion but contributes minimally to total content
● C: Dissolved oxygen is clinically negligible except in hyperbaric therapy
● D: Ventilation parameters affect PaCO₂ primarily and PaO₂ secondarily, not oxygen-carrying
capacity
