NUR 629 - AIRWAY EXAM QUESTIONS WITH COMPLETE
SOLUTIONS VERIFIED GRADED A+
What assessments are necessary in airway evaluation?
pt. history, physical assessment, physical examination, mallampati assessment,
Cormack and Lehane classification, Lemon assessment, MOUTHS
What are the congenital factors associated with difficult airway management?
Pierre-Robin, Treacher-Collins, Goldenhar's syndrome, Down Syndrome, Klippel-Fell
Describe the characteristics of Pierre-Robin.
Decreased thyromental distance,Small chin-micrognathia,retrognathia, downward
placement of tongue-glossalpytosis, cleft lip, cleft palate,
Causes not good face mask, cephalic displacement of larynx. Difficult to do direct
laryngoscopy. Want to nasally intubate but check pt/ptt.
Difficult to put in sniffing position
Describe the characteristics of treacher-collins
Ptosis of eye, retrognathia of chin, mandible very small. Zygomatic bone small-difficult
mask seal. Ocular defects.
These kids difficult mask seal/ventilation. Utilize oral airway-helps with mask fit. Pieces
of gauze around mouth can help.
What are the characteristics of Goldenhar's syndrome?
Ocular and auricular defects. Maxilla (malar) deformation. Mandible defects. Abnormally
gets worse with age. Status may be different from previous anesthesia record.
What are the characteristics of Down's Syndrome
More prevalent. Absence of bridge of nose or poorly developed. Big long tongues! Very
large in compared to their larynx. As adults, OSA problems because of central apnea
problem and low muscle tone in upper airway. Nasal passageways very narrow,
enlarged tongue. Large tonsillar tissue. Difficult to mask, difficult to tube-sweep out
tongue to get visualization is difficult. Increased saliva. Consider robinul.
What are the characteristics of Klippel-Feil Syndrome?
, No neck. Cervical vertabrae that are fused so sniffing position impossible. Short neck,
immobile. Mask ventilation difficult. Ribs can be fused, barrel chest
What are acquired factors associated with difficult airway management?
Benign tumors (lipoma, adenoma, goiter), Supraglottis (epiglottitis),
Laryngotracheobronchitis (Croup), Abcesses, Ludwig's angina, Ankylosing Spondylitis,
rheumatoid arthritis, OSA, morbid obesity, Acromegaly, Burns, Trauma
What do I need to think of when my patient has a goiter?
Can I do an awake fiberoptic? General with glidescope? Cricoidthyroidectomy not
option! Distorted airway, fixed, deviated.
How do I approach? Sedate, can I ventilate?, keep spontaneously ventilating until I get
tube in- use fiberoptic scope with sedated pt., going to cough but have propofol ready
when tube is going through the cords. What will happen when I relax muscles with
succs, propofol?
What are the characteristics of Laryngotracheobronchitis?
6 months - 6 years. Edema of the laryngopharynx, hoarse, barking cough. Humidified
o2, steroids, racemic epi. Medically manage first usually. May be recovering from croup
and could have some left over edema. 2-6 weeks ago.
On xray, steeple sign-narrowing of the trachea
Why is airway management difficult with a neck abcess?
Children or adults, infection from dental caries, parotid gland, abcess. Distort airway,
deviated. When it affects jaw and mandible, they have spasms in that area-difficult for
child to open mouth. Painful. Trismus (spasm of muscle)
What is Ludwig's Angina?
Cellulitis of the floor of the mouth. Can get necrotizing fascitis. More in adults. Can
invade into neck-death can occur. Swelling makes it difficult to visualize airway.
What is ankylosing spondylitis and why does it create diffiicult airway
management?
Inflammatory disease, vertebral bodies fuse together. The ability of patient to take deep
breath can be impeded. Difficult to get into sniffing position. Can't move their neck. Can
migrate to ribs also. If conventional methods to tube doesn't work, we may need to trach
if emergent case. Neck is usually shortened.
SOLUTIONS VERIFIED GRADED A+
What assessments are necessary in airway evaluation?
pt. history, physical assessment, physical examination, mallampati assessment,
Cormack and Lehane classification, Lemon assessment, MOUTHS
What are the congenital factors associated with difficult airway management?
Pierre-Robin, Treacher-Collins, Goldenhar's syndrome, Down Syndrome, Klippel-Fell
Describe the characteristics of Pierre-Robin.
Decreased thyromental distance,Small chin-micrognathia,retrognathia, downward
placement of tongue-glossalpytosis, cleft lip, cleft palate,
Causes not good face mask, cephalic displacement of larynx. Difficult to do direct
laryngoscopy. Want to nasally intubate but check pt/ptt.
Difficult to put in sniffing position
Describe the characteristics of treacher-collins
Ptosis of eye, retrognathia of chin, mandible very small. Zygomatic bone small-difficult
mask seal. Ocular defects.
These kids difficult mask seal/ventilation. Utilize oral airway-helps with mask fit. Pieces
of gauze around mouth can help.
What are the characteristics of Goldenhar's syndrome?
Ocular and auricular defects. Maxilla (malar) deformation. Mandible defects. Abnormally
gets worse with age. Status may be different from previous anesthesia record.
What are the characteristics of Down's Syndrome
More prevalent. Absence of bridge of nose or poorly developed. Big long tongues! Very
large in compared to their larynx. As adults, OSA problems because of central apnea
problem and low muscle tone in upper airway. Nasal passageways very narrow,
enlarged tongue. Large tonsillar tissue. Difficult to mask, difficult to tube-sweep out
tongue to get visualization is difficult. Increased saliva. Consider robinul.
What are the characteristics of Klippel-Feil Syndrome?
, No neck. Cervical vertabrae that are fused so sniffing position impossible. Short neck,
immobile. Mask ventilation difficult. Ribs can be fused, barrel chest
What are acquired factors associated with difficult airway management?
Benign tumors (lipoma, adenoma, goiter), Supraglottis (epiglottitis),
Laryngotracheobronchitis (Croup), Abcesses, Ludwig's angina, Ankylosing Spondylitis,
rheumatoid arthritis, OSA, morbid obesity, Acromegaly, Burns, Trauma
What do I need to think of when my patient has a goiter?
Can I do an awake fiberoptic? General with glidescope? Cricoidthyroidectomy not
option! Distorted airway, fixed, deviated.
How do I approach? Sedate, can I ventilate?, keep spontaneously ventilating until I get
tube in- use fiberoptic scope with sedated pt., going to cough but have propofol ready
when tube is going through the cords. What will happen when I relax muscles with
succs, propofol?
What are the characteristics of Laryngotracheobronchitis?
6 months - 6 years. Edema of the laryngopharynx, hoarse, barking cough. Humidified
o2, steroids, racemic epi. Medically manage first usually. May be recovering from croup
and could have some left over edema. 2-6 weeks ago.
On xray, steeple sign-narrowing of the trachea
Why is airway management difficult with a neck abcess?
Children or adults, infection from dental caries, parotid gland, abcess. Distort airway,
deviated. When it affects jaw and mandible, they have spasms in that area-difficult for
child to open mouth. Painful. Trismus (spasm of muscle)
What is Ludwig's Angina?
Cellulitis of the floor of the mouth. Can get necrotizing fascitis. More in adults. Can
invade into neck-death can occur. Swelling makes it difficult to visualize airway.
What is ankylosing spondylitis and why does it create diffiicult airway
management?
Inflammatory disease, vertebral bodies fuse together. The ability of patient to take deep
breath can be impeded. Difficult to get into sniffing position. Can't move their neck. Can
migrate to ribs also. If conventional methods to tube doesn't work, we may need to trach
if emergent case. Neck is usually shortened.
