Airway management and pre-anaesthetic assessment

24 NEET-PG practice questions on Airway management and pre-anaesthetic assessment, part of Anaesthesia. The first 24 are below; the first 5 with answers and explanations (tap Show answer after you have chosen), the rest in Learn with a free account.

Question 1 · Medium
A 48-year-old woman is seen in the pre-anaesthetic clinic before elective laparoscopic cholecystectomy. She weighs 112 kg with a BMI of 42 kg/m^2. Her hypertension is well controlled on one drug, she does not smoke, and her exercise tolerance is fair. What is her ASA physical status?
1. AASA II
2. BASA I
3. CASA III
4. DASA IV
Show answerHide answer
Answer: C · ASA III
The ASA examples place morbid obesity (BMI 40 or more) in class III, severe systemic disease, even when other conditions are controlled. Well-controlled hypertension alone, or a BMI between 30 and 40, would be class II. ASA class predicts overall perioperative risk but not airway difficulty, so she also needs a specific airway assessment (Mallampati grade, neck circumference, mouth opening, STOP-Bang for sleep apnoea). Obese patients desaturate quickly, so pre-oxygenation in a head-up ramped position is planned.
- A: ASA II covers controlled hypertension or a BMI of 30 to under 40, not morbid obesity.
- B: ASA I is a healthy, non-smoking patient with minimal alcohol use.
- D: ASA IV is severe disease that is a constant threat to life, such as recent MI or sepsis.
Question 2 · Medium
A 74-year-old edentulous man with a thick beard and a BMI of 31 kg/m^2 is to have general anaesthesia for an elective hernia repair. He snores at night. His Mallampati class is II and his mouth opens well. Which part of airway management is most likely to be difficult?
1. ATracheal extubation
2. BNasogastric tube insertion
3. CFace-mask ventilation
4. DDirect laryngoscopy
Show answerHide answer
Answer: C · Face-mask ventilation
A beard, obesity, absent teeth, age over 55 and snoring are the recognised predictors of difficult mask ventilation. Without teeth the cheeks fall in and the mask cannot seal, and a beard adds leaks. Laryngoscopy, by contrast, is often easier in the edentulous patient. Leaving dentures in during mask ventilation, an oropharyngeal airway and a two-handed mask grip help.
- A: Nothing here predicts a difficult extubation more than a difficult mask seal.
- B: These features do not predict a difficult nasogastric tube.
- D: Absent teeth and good mouth opening usually make laryngoscopy easier, not harder.
Question 3 · Medium
A 35-year-old woman listed for elective laparoscopic cholecystectomy at 9 am drank a cup of tea with milk at 6 am because she felt dizzy. She has eaten nothing since dinner at 8 pm. Under the ASA fasting guidelines, from what time can her anaesthetic safely begin?
1. A8 am
2. B10 am
3. C12 noon
4. D2 pm
Show answerHide answer
Answer: C · 12 noon
Tea with milk counts as non-human milk, which needs 6 hours, not as a clear fluid; 6 am plus 6 hours is 12 noon. Black tea or coffee without milk would count as a clear fluid with a 2-hour limit. Her dinner at 8 pm already meets the 8-hour rule for a full meal. The sensible course is to move her later on the list rather than cancel, and to explain why.
- A: 8 am treats milky tea as a clear fluid, which needs only 2 hours.
- B: 10 am uses the 4-hour rule for breast milk, not cow's milk.
- D: 2 pm uses the 8-hour rule for a fried or fatty meal.
Question 4 · Medium
A 58-year-old man with end-stage renal disease on regular haemodialysis three times a week is listed for revision of his arteriovenous fistula. He has no other illness, walks a kilometre daily without difficulty, and his last dialysis was yesterday. What is his ASA physical status?
1. AASA III
2. BASA IV
3. CASA V
4. DASA II
Show answerHide answer
Answer: A · ASA III
The ASA's own examples place end-stage renal disease on regularly scheduled dialysis in class III, severe systemic disease. End-stage or acute renal disease not on regularly scheduled dialysis is class IV, a constant threat to life. Before surgery his potassium and fluid status are checked after dialysis, and the fistula arm is protected from BP cuffs and cannulas.
- B: ASA IV applies to kidney failure not on regular dialysis, a constant threat to life.
- C: ASA V is a moribund patient not expected to survive without the operation.
- D: ASA II is mild systemic disease, such as well-controlled hypertension, without functional limitation.
Question 5 · Medium
A 56-year-old man is seen before elective knee replacement. His wife says he snores loudly and he often feels sleepy during the day; she has never noticed him stop breathing at night. He has no hypertension. His BMI is 33 kg/m^2 and neck circumference 43 cm. What is his STOP-Bang score and risk category for obstructive sleep apnoea?
1. A4, intermediate risk
2. B5, high risk
3. C6, high risk
4. D3, intermediate risk
Show answerHide answer
Answer: B · 5, high risk
STOP-Bang gives one point each for Snoring, Tiredness, Observed apnoea, high blood Pressure, BMI above 35, Age above 50, Neck above 40 cm and male Gender. He scores snoring 1, tiredness 1, observed apnoea 0, pressure 0, BMI 0 (33 is below 35), age 1, neck 1 and gender 1, a total of 5. A score of 0-2 is low risk, 3-4 intermediate and 5-8 high risk. He should be planned for difficult mask ventilation, opioid-sparing analgesia and closer post-operative monitoring.
- A: 4 leaves out one positive item, such as male sex.
- C: 6 wrongly scores a BMI of 33, which is below the cut-off of 35.
- D: 3 leaves out two positive items, such as age and male sex.
Question 6 · Medium
A 28-year-old woman at term is taken for an emergency caesarean under general anaesthesia because of cord prolapse with severe fetal bradycardia; there is no time for a spinal. She ate a full meal 3 hours ago. Just before induction, which drug is given by mouth to raise her gastric pH at once?
1. AOral famotidine tablet
2. BMagnesium trisilicate suspension
3. COral metoclopramide tablet
4. D30 mL of 0.3 M sodium citrate
Answer and explanation in LearnFree account
Question 7 · Easy
A 30-year-old man with a head injury is intubated in casualty. The resident hears breath sounds on both sides of the chest and sees misting in the tube. Which finding most reliably confirms that the tube is in the trachea?
1. ANormal SpO2 on pulse oximetry
2. BChest rising with each breath
3. CSustained waveform on capnography
4. DBilateral breath sounds on auscultation
Answer and explanation in LearnFree account
Question 8 · Hard
A 30-year-old man with perforation peritonitis who ate 2 hours ago needs an emergency laparotomy. The anaesthesia resident outlines her plan for rapid sequence induction: 1. Pre-oxygenate with 100% oxygen through a tight-fitting mask. 2. Titrate the induction agent slowly until the eyelash reflex is lost. 3. Give a small priming dose of vecuronium a few minutes before induction. 4. Use rocuronium 1.2 mg/kg if succinylcholine is contraindicated. Which parts of the plan are correct?
1. A1 and 4 only
2. B1 and 3 only
3. C1, 2 and 4 only
4. D1, 2, 3 and 4
Answer and explanation in LearnFree account
Question 9 · Medium
A 6-year-old boy is extubated at the end of adenotonsillectomy while still lightly anaesthetised. He makes a high-pitched crowing noise that then stops; his chest and abdomen move but no air enters, and his SpO2 falls to 88%. What is the first step?
1. AEmergency needle cricothyroidotomy
2. BIV dexamethasone and adrenaline nebulisation
3. C100% oxygen with CPAP via a tight mask and jaw thrust
4. DImmediate reintubation without any drugs
Answer and explanation in LearnFree account
Question 10 · Medium
A 60-year-old man with hypertension and stable angina takes metoprolol 50 mg twice daily. He is listed for elective laparoscopic hernia repair at 10 am. What advice should he receive about the morning dose of metoprolol?
1. ATake the usual dose with a sip of water
2. BReplace it with clonidine the night before
3. COmit it from 24 hours before surgery
4. DStop it one week before surgery
Answer and explanation in LearnFree account
Question 11 · Medium
A 50-year-old man treated with radiotherapy for oral cancer has a hard, fibrosed neck and is listed for excision of a recurrent lesion. Mouth opening is 2 cm, thyromental distance 5 cm and neck extension is severely limited; the Mallampati view cannot be seen. He breathes comfortably at rest. What is the safest plan for securing his airway?
1. AInhalational induction and direct laryngoscopy
2. BAwake fibreoptic intubation
3. CRapid sequence induction with succinylcholine
4. DIntravenous induction and a supraglottic airway
Answer and explanation in LearnFree account
Question 12 · Medium
A 72-year-old man collapses at home with severe back pain and is brought to casualty with BP 70/40 mmHg and a pulsatile abdominal mass. CT shows a ruptured infrarenal abdominal aortic aneurysm, and he is taken straight to theatre. What ASA physical status should the anaesthetist record?
1. AASA VE
2. BASA VI
3. CASA IVE
4. DASA IIIE
Answer and explanation in LearnFree account
Question 13 · Easy
A 7-month-old exclusively breastfed infant is listed first on the morning list for repair of an inguinal hernia at a medical college. The mother asks how long before surgery she must stop breastfeeding. What is the minimum fasting time for breast milk under the ASA fasting guidelines?
1. A6 hours
2. B8 hours
3. C4 hours
4. D2 hours
Answer and explanation in LearnFree account
Question 14 · Medium
Before a 45-year-old woman's thyroidectomy, an intern lists four statements about predicting a difficult airway: 1. A thyromental distance below 6 cm suggests difficult laryngoscopy. 2. The Mallampati test is done sitting, with the mouth fully open and the tongue out, without phonation. 3. An ASA class of III or more predicts difficult intubation. 4. An inter-incisor gap of 2 cm suggests difficult laryngoscopy. Which statements are correct?
1. A2, 3 and 4 only
2. B1, 2, 3 and 4
3. C1, 2 and 4 only
4. D1 and 2 only
Answer and explanation in LearnFree account
Question 15 · Easy
During direct laryngoscopy for an elective hernia repair in a 52-year-old man, the anaesthetist can see the epiglottis but no part of the glottis, not even the arytenoids. What is the Cormack-Lehane grade of this view?
1. ACormack-Lehane grade 1
2. BCormack-Lehane grade 3
3. CCormack-Lehane grade 2
4. DCormack-Lehane grade 4
Answer and explanation in LearnFree account
Question 16 · Hard
A 17-year-old boy has a large anterior mediastinal mass compressing the lower trachea on CT. He becomes breathless lying flat and sleeps propped up on pillows. A tissue diagnosis is needed, and an enlarged supraclavicular lymph node is palpable. What is the safest way to obtain tissue?
1. ANode biopsy under local anaesthesia, sitting up
2. BMediastinoscopy under GA with a muscle relaxant
3. CNode biopsy under GA after IV induction
4. DSupine CT-guided biopsy of the mass under GA
Answer and explanation in LearnFree account
Question 17 · Medium
For awake fibreoptic intubation in a 40-year-old man with severe ankylosing spondylitis, the anaesthetist injects 4% lignocaine through the cricothyroid membrane. The patient coughs, spreading the drug over the trachea and the undersurface of the vocal cords. Which nerve supplies the mucosa anaesthetised by this injection?
1. AExternal laryngeal nerve
2. BGlossopharyngeal nerve
3. CInternal laryngeal nerve
4. DRecurrent laryngeal nerve
Answer and explanation in LearnFree account
Question 18 · Hard
A 34-year-old woman is given propofol and rocuronium for elective surgery. Three attempts at intubation, including one with a videolaryngoscope, fail; two different supraglottic airways do not ventilate; and two-person face-mask ventilation with an oropharyngeal airway also fails. Her SpO2 is 72% and falling, and sugammadex is not immediately available. What is the next step?
1. ABlind nasal intubation
2. BWait for spontaneous breathing to return
3. CA fourth attempt at intubation
4. DScalpel cricothyroidotomy
Answer and explanation in LearnFree account
Question 19 · Easy
In the pre-anaesthetic clinic of a district hospital, a 38-year-old woman listed for thyroidectomy sits upright, opens her mouth fully and protrudes her tongue without speaking. The anaesthetist sees the soft palate and only the base of the uvula; the faucial pillars and the rest of the uvula are hidden. What is her modified Mallampati class?
1. AMallampati class II
2. BMallampati class I
3. CMallampati class III
4. DMallampati class IV
Answer and explanation in LearnFree account
Question 20 · Medium
A 62-year-old woman with rheumatoid arthritis for 20 years is listed for elective total hip replacement. She reports neck pain and tingling in both hands when she bends her head forward. What is the most appropriate pre-operative investigation for her airway?
1. ASpirometry with a flow-volume loop
2. BArterial blood gas on room air
3. CIndirect laryngoscopy of the vocal cords
4. DFlexion and extension lateral cervical X-rays
Answer and explanation in LearnFree account
Question 21 · Hard
A 40-year-old man is anaesthetised for an elective septoplasty. After three attempts by an experienced anaesthetist, including one with a videolaryngoscope and bougie, his trachea cannot be intubated. A second-generation supraglottic airway is then inserted and he is ventilated easily, with SpO2 99%. What is the most appropriate course now?
1. AElective surgical tracheostomy to proceed
2. BProceed with septoplasty on the supraglottic airway
3. CFurther attempts at direct laryngoscopy
4. DWake him up and postpone the surgery
Answer and explanation in LearnFree account
Question 22 · Hard
A 25-year-old motorcyclist is brought to casualty after a crash with a GCS of 7 and a rigid cervical collar in place. Cervical spine injury has not yet been excluded. He needs tracheal intubation now. How should his cervical spine be protected during laryngoscopy?
1. AManual in-line stabilisation, collar front opened
2. BSniffing position with a pillow under the head
3. CDefer intubation until CT clears the spine
4. DKeep the collar fully closed for laryngoscopy
Answer and explanation in LearnFree account
Question 23 · Medium
A 64-year-old man with type 2 diabetes controlled on metformin is seen before an elective open inguinal hernia repair. He has no chest pain or breathlessness and climbs two flights of stairs to his office every day without stopping. His resting ECG is normal. What is the next step before surgery?
1. ADobutamine stress echocardiography
2. BCoronary angiography
3. CTreadmill exercise stress test
4. DProceed without further cardiac tests
Answer and explanation in LearnFree account
Question 24 · Easy
A 45-year-old man with acute intestinal obstruction and repeated vomiting is taken for emergency laparotomy. During rapid sequence induction, the assistant presses backwards on a cartilage in the front of the neck to squeeze the oesophagus against the cervical vertebra. Why is this particular cartilage chosen?
1. AIt is the largest cartilage of the larynx
2. BIt is attached directly to the hyoid bone
3. CIt is the only complete ring in the airway
4. DIt lies at the level of the vocal cords
Answer and explanation in LearnFree account

Airway management and pre-anaesthetic assessment

A 48-year-old woman is seen in the pre-anaesthetic clinic before elective laparoscopic cholecystectomy. She weighs 112 kg with a BMI of 42 kg/m^2. Her hypertension is well controlled on one drug, she does not smoke, and her exercise tolerance is fair. What is her ASA physical status?

A 74-year-old edentulous man with a thick beard and a BMI of 31 kg/m^2 is to have general anaesthesia for an elective hernia repair. He snores at night. His Mallampati class is II and his mouth opens well. Which part of airway management is most likely to be difficult?

A 35-year-old woman listed for elective laparoscopic cholecystectomy at 9 am drank a cup of tea with milk at 6 am because she felt dizzy. She has eaten nothing since dinner at 8 pm. Under the ASA fasting guidelines, from what time can her anaesthetic safely begin?

A 58-year-old man with end-stage renal disease on regular haemodialysis three times a week is listed for revision of his arteriovenous fistula. He has no other illness, walks a kilometre daily without difficulty, and his last dialysis was yesterday. What is his ASA physical status?

A 28-year-old woman at term is taken for an emergency caesarean under general anaesthesia because of cord prolapse with severe fetal bradycardia; there is no time for a spinal. She ate a full meal 3 hours ago. Just before induction, which drug is given by mouth to raise her gastric pH at once?

A 30-year-old man with a head injury is intubated in casualty. The resident hears breath sounds on both sides of the chest and sees misting in the tube. Which finding most reliably confirms that the tube is in the trachea?

A 6-year-old boy is extubated at the end of adenotonsillectomy while still lightly anaesthetised. He makes a high-pitched crowing noise that then stops; his chest and abdomen move but no air enters, and his SpO2 falls to 88%. What is the first step?

A 60-year-old man with hypertension and stable angina takes metoprolol 50 mg twice daily. He is listed for elective laparoscopic hernia repair at 10 am. What advice should he receive about the morning dose of metoprolol?

A 72-year-old man collapses at home with severe back pain and is brought to casualty with BP 70/40 mmHg and a pulsatile abdominal mass. CT shows a ruptured infrarenal abdominal aortic aneurysm, and he is taken straight to theatre. What ASA physical status should the anaesthetist record?

A 7-month-old exclusively breastfed infant is listed first on the morning list for repair of an inguinal hernia at a medical college. The mother asks how long before surgery she must stop breastfeeding. What is the minimum fasting time for breast milk under the ASA fasting guidelines?

During direct laryngoscopy for an elective hernia repair in a 52-year-old man, the anaesthetist can see the epiglottis but no part of the glottis, not even the arytenoids. What is the Cormack-Lehane grade of this view?

A 17-year-old boy has a large anterior mediastinal mass compressing the lower trachea on CT. He becomes breathless lying flat and sleeps propped up on pillows. A tissue diagnosis is needed, and an enlarged supraclavicular lymph node is palpable. What is the safest way to obtain tissue?

A 62-year-old woman with rheumatoid arthritis for 20 years is listed for elective total hip replacement. She reports neck pain and tingling in both hands when she bends her head forward. What is the most appropriate pre-operative investigation for her airway?

A 25-year-old motorcyclist is brought to casualty after a crash with a GCS of 7 and a rigid cervical collar in place. Cervical spine injury has not yet been excluded. He needs tracheal intubation now. How should his cervical spine be protected during laryngoscopy?

A 64-year-old man with type 2 diabetes controlled on metformin is seen before an elective open inguinal hernia repair. He has no chest pain or breathlessness and climbs two flights of stairs to his office every day without stopping. His resting ECG is normal. What is the next step before surgery?