DAANCE Exam Questions with Correct
Solutions 2026/2027 Dental Anesthesia
Assistant National Certification Examination.
DOMAIN 1: PATIENT ASSESSMENT, MONITORING & AIRWAY ANATOMY (14 Questions)
The Mallampati Classification — 3 Questions
Question 1 (Multiple-Choice)
During pre-operative assessment, the oral surgeon asks the anesthesia assistant to document
the Mallampati classification. The patient opens their mouth maximally and protrudes their
tongue. The assistant observes only the hard palate; the soft palate, uvula, and faucial pillars are
completely obscured by the base of the tongue. What is the correct Mallampati classification,
and what does it predict?
A. Class III; predicts moderate difficulty with bag-mask ventilation only
B. Class II; predicts easy intubation and no airway concerns
C. Class IV; predicts difficult endotracheal intubation and difficult bag-mask ventilation
D. Class I; predicts straightforward airway management with minimal risk
[CORRECT: C]
Rationale: According to the ASA Difficult Airway Algorithm and the Mallampati scoring system, a
Class IV view is defined by the visualization of only the hard palate with complete obscuration of
the soft palate, uvula, and faucial pillars. This classification is a strong predictor of both difficult
endotracheal intubation and difficult bag-mask ventilation, requiring the anesthesia team to
have advanced airway adjuncts immediately available. The dental anesthesia assistant must
ensure the emergency airway kit is prepared and the surgeon is alerted to the increased airway
risk.
Question 2 (Multiple-Choice)
A 42-year-old patient presents for third molar extraction under general anesthesia. The
anesthesia assistant performs the Mallampati assessment and notes the patient can visualize
,the soft palate and the base of the uvula, but the distal portion of the uvula is obscured by the
tongue. Which Mallampati class is this, and what equipment must the assistant confirm is
present in the emergency airway kit?
A. Class I; confirm presence of nasal cannula only
B. Class II; confirm presence of oropharyngeal airway, bag-valve-mask, and laryngoscope
C. Class III; confirm presence of endotracheal tubes in multiple sizes
D. Class IV; confirm presence of surgical airway equipment only
[CORRECT: B]
Rationale: Visualization of the soft palate and base of the uvula with obscuration of the distal
uvula defines a Mallampati Class II airway. While this represents a more favorable airway than
Class III or IV, the AAOMS Office Anesthesia Evaluation Manual requires the anesthesia assistant
to verify that the emergency airway kit contains the oropharyngeal airway (OPA), the bag-valve-
mask (BVM or Ambu bag), and the laryngoscope with the Macintosh blade for all patients
undergoing general anesthesia or deep sedation. These are the foundational components of
emergency airway management.
Question 3 (True/False)
Statement: A Mallampati Class IV airway view, in which only the hard palate is visible, indicates
that the patient will have an easy intubation and requires no special airway preparation.
A. True
B. False
[CORRECT: B]
Rationale: False. The Mallampati Class IV airway is the most severe classification and is a strong
predictor of difficult intubation and difficult mask ventilation. The AAOMS monitoring guidelines
and the ASA Difficult Airway Algorithm mandate that the anesthesia assistant must immediately
alert the provider, ensure advanced airway equipment is available (including the laryngoscope
with Macintosh blade, oropharyngeal and nasopharyngeal airways, and bag-valve-mask), and
consider awake intubation techniques or alternative airway strategies. Failure to recognize a
Class IV airway significantly increases the risk of a "cannot intubate, cannot ventilate" crisis.
Capnography Monitoring — 4 Questions
,Question 4 (Multiple-Choice)
During IV sedation for dental implant placement, the anesthesia assistant is monitoring the
capnography waveform. At 10:15 AM, a continuous, normal rectangular waveform is present
with an end-tidal CO2 (EtCO2) of 38 mmHg. At 10:22 AM, the waveform suddenly disappears
completely, and the EtCO2 reads zero. The pulse oximeter shows SpO2 at 97%. What is the most
likely cause, and what is the assistant's immediate action?
A. The patient has developed severe bronchospasm; administer albuterol immediately
B. The endotracheal tube or LMA has been dislodged into the esophagus, or there is a circuit
disconnection; alert the provider immediately
C. The patient is hyperventilating; reduce the oxygen flow rate
D. The capnograph is malfunctioning; replace the entire monitoring unit
[CORRECT: B]
Rationale: According to the AAOMS Parameters of Care and the ASA Standards for Basic
Anesthetic Monitoring, a sudden loss of the capnography waveform with an EtCO2 reading of
zero is an immediate critical event. In the presence of normal oxygen saturation (which may
remain transiently normal due to oxygen reserve), the most likely causes are esophageal
intubation/displacement of the airway device, or a complete disconnection of the breathing
circuit. The anesthesia assistant must alert the oral surgeon immediately, as this represents a
loss of ventilation that will rapidly lead to hypoxemia, hypercarbia, and cardiac arrest if not
corrected. The assistant should simultaneously check circuit connections and prepare for
emergency airway re-establishment.
Question 5 (Select-All-That-Apply)
The anesthesia assistant is responsible for monitoring capnography during a general anesthetic
for orthognathic surgery. Which of the following statements about capnography are correct?
(Select ALL that apply.)
A. A continuous capnography waveform must be present for the entire duration of general
anesthesia and deep sedation
B. A sudden loss of the capnography waveform indicates esophageal intubation or circuit
disconnection until proven otherwise
C. The normal end-tidal CO2 (EtCO2) range is approximately 35-45 mmHg
D. Capnography is optional during moderate sedation if pulse oximetry is functioning normally
E. An elevated EtCO2 with a gradually rising waveform may indicate malignant hyperthermia or
hypoventilation
, [CORRECT: A, B, C, E]
Rationale: The AAOMS Office Anesthesia Evaluation Manual and the ASA Standards for Basic
Anesthetic Monitoring mandate continuous capnography for all patients undergoing general
anesthesia and deep sedation. A sudden loss of waveform is a critical emergency indicating
esophageal intubation or disconnection (B). The normal EtCO2 is 35-45 mmHg (C). Capnography
is NOT optional during moderate sedation when administered in conjunction with other agents
that may depress respiration; it is a standard of care (making D incorrect). An elevated, gradually
rising EtCO2 is consistent with hypoventilation and may be an early sign of malignant
hyperthermia (E), requiring immediate intervention.
Question 6 (Multiple-Choice)
The anesthesia assistant notices that the capnography waveform has changed from its normal
rectangular shape to a sloped, prolonged upstroke with an elevated EtCO2 of 55 mmHg. The
patient is receiving general anesthesia for wisdom tooth extraction. The assistant should
recognize this pattern as indicating:
A. Normal ventilation with adequate gas exchange
B. Bronchospasm or airway obstruction causing delayed alveolar emptying
C. Hyperventilation requiring immediate reduction in anesthetic depth
D. Complete apnea requiring immediate chest compressions
[CORRECT: B]
Rationale: A capnography waveform with a sloped, prolonged upstroke (often described as a
"shark fin" or delayed upstroke pattern) indicates delayed emptying of alveolar gas, which is
characteristic of bronchospasm or partial airway obstruction. The elevated EtCO2 of 55 mmHg
confirms hypoventilation and CO2 retention. The anesthesia assistant must immediately alert
the provider, ensure 100% oxygen delivery, and prepare to assist with airway management and
possible bronchodilator administration. This waveform pattern is distinctly different from the
normal rectangular waveform, the flat line of apnea, or the low EtCO2 of hyperventilation.
Question 7 (True/False)
Statement: If the capnography waveform is lost during sedation but the pulse oximeter
continues to display an SpO2 of 98%, the anesthesia assistant can safely wait 2-3 minutes before
alerting the provider, as the oxygen saturation indicates adequate ventilation.
Solutions 2026/2027 Dental Anesthesia
Assistant National Certification Examination.
DOMAIN 1: PATIENT ASSESSMENT, MONITORING & AIRWAY ANATOMY (14 Questions)
The Mallampati Classification — 3 Questions
Question 1 (Multiple-Choice)
During pre-operative assessment, the oral surgeon asks the anesthesia assistant to document
the Mallampati classification. The patient opens their mouth maximally and protrudes their
tongue. The assistant observes only the hard palate; the soft palate, uvula, and faucial pillars are
completely obscured by the base of the tongue. What is the correct Mallampati classification,
and what does it predict?
A. Class III; predicts moderate difficulty with bag-mask ventilation only
B. Class II; predicts easy intubation and no airway concerns
C. Class IV; predicts difficult endotracheal intubation and difficult bag-mask ventilation
D. Class I; predicts straightforward airway management with minimal risk
[CORRECT: C]
Rationale: According to the ASA Difficult Airway Algorithm and the Mallampati scoring system, a
Class IV view is defined by the visualization of only the hard palate with complete obscuration of
the soft palate, uvula, and faucial pillars. This classification is a strong predictor of both difficult
endotracheal intubation and difficult bag-mask ventilation, requiring the anesthesia team to
have advanced airway adjuncts immediately available. The dental anesthesia assistant must
ensure the emergency airway kit is prepared and the surgeon is alerted to the increased airway
risk.
Question 2 (Multiple-Choice)
A 42-year-old patient presents for third molar extraction under general anesthesia. The
anesthesia assistant performs the Mallampati assessment and notes the patient can visualize
,the soft palate and the base of the uvula, but the distal portion of the uvula is obscured by the
tongue. Which Mallampati class is this, and what equipment must the assistant confirm is
present in the emergency airway kit?
A. Class I; confirm presence of nasal cannula only
B. Class II; confirm presence of oropharyngeal airway, bag-valve-mask, and laryngoscope
C. Class III; confirm presence of endotracheal tubes in multiple sizes
D. Class IV; confirm presence of surgical airway equipment only
[CORRECT: B]
Rationale: Visualization of the soft palate and base of the uvula with obscuration of the distal
uvula defines a Mallampati Class II airway. While this represents a more favorable airway than
Class III or IV, the AAOMS Office Anesthesia Evaluation Manual requires the anesthesia assistant
to verify that the emergency airway kit contains the oropharyngeal airway (OPA), the bag-valve-
mask (BVM or Ambu bag), and the laryngoscope with the Macintosh blade for all patients
undergoing general anesthesia or deep sedation. These are the foundational components of
emergency airway management.
Question 3 (True/False)
Statement: A Mallampati Class IV airway view, in which only the hard palate is visible, indicates
that the patient will have an easy intubation and requires no special airway preparation.
A. True
B. False
[CORRECT: B]
Rationale: False. The Mallampati Class IV airway is the most severe classification and is a strong
predictor of difficult intubation and difficult mask ventilation. The AAOMS monitoring guidelines
and the ASA Difficult Airway Algorithm mandate that the anesthesia assistant must immediately
alert the provider, ensure advanced airway equipment is available (including the laryngoscope
with Macintosh blade, oropharyngeal and nasopharyngeal airways, and bag-valve-mask), and
consider awake intubation techniques or alternative airway strategies. Failure to recognize a
Class IV airway significantly increases the risk of a "cannot intubate, cannot ventilate" crisis.
Capnography Monitoring — 4 Questions
,Question 4 (Multiple-Choice)
During IV sedation for dental implant placement, the anesthesia assistant is monitoring the
capnography waveform. At 10:15 AM, a continuous, normal rectangular waveform is present
with an end-tidal CO2 (EtCO2) of 38 mmHg. At 10:22 AM, the waveform suddenly disappears
completely, and the EtCO2 reads zero. The pulse oximeter shows SpO2 at 97%. What is the most
likely cause, and what is the assistant's immediate action?
A. The patient has developed severe bronchospasm; administer albuterol immediately
B. The endotracheal tube or LMA has been dislodged into the esophagus, or there is a circuit
disconnection; alert the provider immediately
C. The patient is hyperventilating; reduce the oxygen flow rate
D. The capnograph is malfunctioning; replace the entire monitoring unit
[CORRECT: B]
Rationale: According to the AAOMS Parameters of Care and the ASA Standards for Basic
Anesthetic Monitoring, a sudden loss of the capnography waveform with an EtCO2 reading of
zero is an immediate critical event. In the presence of normal oxygen saturation (which may
remain transiently normal due to oxygen reserve), the most likely causes are esophageal
intubation/displacement of the airway device, or a complete disconnection of the breathing
circuit. The anesthesia assistant must alert the oral surgeon immediately, as this represents a
loss of ventilation that will rapidly lead to hypoxemia, hypercarbia, and cardiac arrest if not
corrected. The assistant should simultaneously check circuit connections and prepare for
emergency airway re-establishment.
Question 5 (Select-All-That-Apply)
The anesthesia assistant is responsible for monitoring capnography during a general anesthetic
for orthognathic surgery. Which of the following statements about capnography are correct?
(Select ALL that apply.)
A. A continuous capnography waveform must be present for the entire duration of general
anesthesia and deep sedation
B. A sudden loss of the capnography waveform indicates esophageal intubation or circuit
disconnection until proven otherwise
C. The normal end-tidal CO2 (EtCO2) range is approximately 35-45 mmHg
D. Capnography is optional during moderate sedation if pulse oximetry is functioning normally
E. An elevated EtCO2 with a gradually rising waveform may indicate malignant hyperthermia or
hypoventilation
, [CORRECT: A, B, C, E]
Rationale: The AAOMS Office Anesthesia Evaluation Manual and the ASA Standards for Basic
Anesthetic Monitoring mandate continuous capnography for all patients undergoing general
anesthesia and deep sedation. A sudden loss of waveform is a critical emergency indicating
esophageal intubation or disconnection (B). The normal EtCO2 is 35-45 mmHg (C). Capnography
is NOT optional during moderate sedation when administered in conjunction with other agents
that may depress respiration; it is a standard of care (making D incorrect). An elevated, gradually
rising EtCO2 is consistent with hypoventilation and may be an early sign of malignant
hyperthermia (E), requiring immediate intervention.
Question 6 (Multiple-Choice)
The anesthesia assistant notices that the capnography waveform has changed from its normal
rectangular shape to a sloped, prolonged upstroke with an elevated EtCO2 of 55 mmHg. The
patient is receiving general anesthesia for wisdom tooth extraction. The assistant should
recognize this pattern as indicating:
A. Normal ventilation with adequate gas exchange
B. Bronchospasm or airway obstruction causing delayed alveolar emptying
C. Hyperventilation requiring immediate reduction in anesthetic depth
D. Complete apnea requiring immediate chest compressions
[CORRECT: B]
Rationale: A capnography waveform with a sloped, prolonged upstroke (often described as a
"shark fin" or delayed upstroke pattern) indicates delayed emptying of alveolar gas, which is
characteristic of bronchospasm or partial airway obstruction. The elevated EtCO2 of 55 mmHg
confirms hypoventilation and CO2 retention. The anesthesia assistant must immediately alert
the provider, ensure 100% oxygen delivery, and prepare to assist with airway management and
possible bronchodilator administration. This waveform pattern is distinctly different from the
normal rectangular waveform, the flat line of apnea, or the low EtCO2 of hyperventilation.
Question 7 (True/False)
Statement: If the capnography waveform is lost during sedation but the pulse oximeter
continues to display an SpO2 of 98%, the anesthesia assistant can safely wait 2-3 minutes before
alerting the provider, as the oxygen saturation indicates adequate ventilation.
