Endotracheal Intubation MCQ — NEET PG Practice Question | NEETPGAI
Endotracheal Intubation
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syringe Anesthesia
A 52-year-old male patient with a history of rheumatoid arthritis presents for elective abdominal surgery. On airway assessment, he has a Mallampati score of III, limited neck extension due to cervical spine involvement, and an inter-incisor distance of 3 cm. After induction with propofol and succinylcholine, the anesthesiologist attempts oral intubation but encounters difficulty visualizing the vocal cords (Cormack-Lehane Grade III). What is the most appropriate immediate next step in airway management?
A. Attempt blind nasal intubation after topicalization
B. Immediately perform emergency cricothyrotomy
C. Wake the patient and reschedule surgery for awake fiberoptic intubation
D. Attempt intubation with a bougie or gum elastic introducer under direct laryngoscopy
Explanation
Approach to Grade III Laryngoscopic View
Key Point
Grade III view (only epiglottis visible, no vocal cords) is a difficult but manageable intubation scenario that does NOT immediately mandate emergency surgical airway.
High-YieldNEET PG
The bougie (gum elastic introducer) is the single most useful adjunct for Grade III views. It allows blind passage through the glottis, followed by railroading the endotracheal tube over it.
Why Bougie Works
1.
Can be advanced blindly past the epiglottis into the trachea (tactile feedback from tracheal rings)
2.
Reduces intubation failure rate from 50% to 90% success with Grade III view
3.
Avoids delay and maintains oxygenation with ongoing bag-mask ventilation between attempts
4.
Preserves the patient's airway without emergency intervention
Clinical Pearl
The "bougie technique" is the standard rescue maneuver for Cormack-Lehane Grade III. Success is achieved by:
Advancing bougie at 45° angle under the epiglottis
Feeling the characteristic "hold-up" as it lodges in the bronchus
Railroading the tube over the bougie
Why Other Options Are Incorrect
Table
Option
Why Wrong
Cricothyrotomy
Reserved for Grade IV views (no epiglottis visible) or failed intubation with inability to oxygenate. Grade III is not an emergency surgical airway indication.
Wake and reschedule
Unnecessary delay and patient morbidity. Bougie allows safe intubation in the current anesthetic.
Blind nasal intubation
Contraindicated in apneic patient post-succinylcholine; risks aspiration and epistaxis.
Warning
Do NOT confuse Cormack-Lehane Grade III (epiglottis visible) with Grade IV (no epiglottis visible). Only Grade IV + failed oxygenation = emergency surgical airway.
Walls & Murphy Emergency Airway Management Ch 5
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