Paramedic Airway, Respiration & Ventilation practice questions

Correct answer: A. the airway or the tube, since resistance has risen and compliance has not

Here's the split: peak pressure is resistance plus compliance, and plateau is compliance alone. When the gap between them widens, the problem is in the tube or the airways. That's how you tell a mucus plug from a stiffening lung in seconds.

• A. A rising peak with an unchanged plateau points to a resistance problem.
• B. A stiffer chest wall would raise the plateau pressure too.
• C. A volume error would change both pressures together.
• D. Falling compliance would raise the plateau pressure as well.

Correct answer: B. raising intra-alveolar pressure to drive fluid back into the circulation

CPAP reopens collapsed alveoli and raises the pressure inside them above the hydrostatic pressure pushing fluid out of the capillaries, so the fluid shifts back into the circulation. On top of that, it cuts the work of breathing and improves preload conditions.

• A. Nothing chemically breaks down the alveolar fluid.
• B. Higher pressure in the alveoli pushes back against the hydrostatic gradient causing the edema, and it reopens collapsed alveoli.
• C. Bronchodilation isn't the mechanism, though CPAP is also used in obstructive disease for different reasons.
• D. CPAP usually brings the rate down as the work of breathing falls.

Correct answer: B. leaves the trachea at a shallower angle than the left

The right bronchus comes off at a shallower angle, closer to straight in line with the trachea, so anything traveling down tends to keep going into it. That's why a tube pushed in too far ventilates only the right lung.

• A. Both bronchi are the same distance from the cords.
• B. Its shallower angle sends objects and tubes to the right more often.
• C. The right main bronchus is shorter, not longer.
• D. How ventilation is split between the lungs doesn't decide where things go.

Correct answer: B. the airway may close before arrival, so the plan is made now

A hoarse voice and a visibly swollen tongue mean the airway is narrowing, and soon you may not be able to reach it. Decide now what you'll do, who will do it and where, while there's still an airway to work with.

• A. A saturation of 92 percent hides an airway that is narrowing fast.
• B. Planning now for the airway closing is what keeps you from losing it later.
• C. Hoarseness with visible swelling means it's getting worse, not settling.
• D. Eight minutes with no improvement means the first dose hasn't worked.

Correct answer: B. holding collapsed alveoli open so they take part in gas exchange

Alveoli that collapse at the end of every breath add nothing to gas exchange, and it takes pressure to reopen them. Hold a small positive pressure at the end of expiration and they stay recruited. That's how it helps where turning up the oxygen alone doesn't.

• A. Delivered volume is set separately from end-expiratory pressure.
• B. Keeping alveoli recruited puts them back into gas exchange, which raising oxygen alone can't do.
• C. Oxygen concentration is a separate setting.
• D. It raises the pressures the ventilator has to generate. It doesn't lower them.

Correct answer: A. displacement most often occurs during transfers between surfaces

Every unrecognized displacement in transport happens when nobody has been assigned the airway. Name one person and an assumption everyone shares becomes a job someone owns.

• A. Transfers between surfaces are when displacement most often happens.
• B. Monitoring is a separate role from physically securing the tube.
• C. You assign it because of the clinical risk, not to satisfy a protocol.
• D. A secured tube doesn't need continuous manual support to stay patent.

Correct answer: D. oxygen continues to diffuse into the blood even without active ventilation

Oxygen moves down its gradient into the pulmonary circulation whether the chest is moving or not. Leave a nasal cannula running during laryngoscopy and you buy real time before the patient desaturates. It does nothing for carbon dioxide, though.

• A. Carbon dioxide keeps building during apnea.
• B. Induction dosing doesn't change.
• C. The flow doesn't do anything mechanical to the cords.
• D. Oxygen diffuses down its gradient into the blood without bulk gas movement.

Correct answer: B. swelling under the tongue displaces it backward and closes the airway

Infection in the floor of the mouth pushes the tongue up and back, and it has nowhere else to go. The airway closes a little at a time and gets very hard to secure. Make your airway decision early instead of waiting to see.

• A. Fever is part of the picture, but it isn't what makes this time-critical.
• B. Swelling in the floor of the mouth shoves the tongue backward and closes the airway.
• C. Bloodstream spread is a concern, but it isn't the immediate threat.
• D. Drooling means he can't swallow. It doesn't mean he has aspirated.