Laryngo-tracheo-bronchial foreign bodies

Laryngo-tracheo-bronchial foreign bodies

Q. 1

For foreign body causing sudden choking, most appropriate first line of management is?

 A Tracheostomy
 B

Heimlich maneuver

 C Airway insertion
 D

Laryngoscopy

Q. 1

For foreign body causing sudden choking, most appropriate first line of management is?

 A Tracheostomy
 B

Heimlich maneuver

 C Airway insertion
 D

Laryngoscopy

Ans. B

Explanation:

Heimlich maneuver REF: Dhingra’s 4th ed p. 257

Management of Laryngeal foreign body:

A large bolus of food/ foreign body obstructed above the cords may make the patient totally aphonic, unable to cry for help. He may die of asphyxia unless immediate first aid measures are taken.

  1. Heimlich’s maneuvers: Sudden thrust directed upwards and backwards, below the epigastrium, squeezes the air from the lungs, sufficient to dislodge a foreign body.
  2. Cricothyrotomy or emergency tracheostomy should be done if Heimlich’s maneuvers fails.
  3. Once acute respiratory emergency is over, foreign body can be removed by direct laryngoscopyor  by laryngofissure, if found impacted

Management of Tracheal and bronchial foreign bodies:

Bronchoscopy under general anesthesia. Emergency removal of these foreign bodies is not indicated unless there is airway obstruction or they are of the vegetable nature (e.g. seeds) and likely to swell up. Methods to remove tracheobronchial foreign body:

  1. Conventional rigid bronchoscopy.
  2. Rigid bronchoscopy with telescopic aid.
  3. Bronchoscopy with C-arm fluoroscopy.
  4. Use of Dormia basket or Fogarty’s balloon for rounded objects.
  5. Tracheostomy first and then bronchoscopy through the tracheostome.
  6. Thoracotomy and bronchotomy for peripheral foreign bodies.
  7. Flexible fiber optic bronchoscopy in selected adult patients.

Q. 2

For Foreign bodies are retained in the larynx causing choking, first line of management is

 A Airway insertion
 B

Hemilich manouvere

 C Hemilich valve
 D Tracheostomy
Q. 2

For Foreign bodies are retained in the larynx causing choking, first line of management is

 A Airway insertion
 B

Hemilich manouvere

 C Hemilich valve
 D Tracheostomy
Ans. B

Explanation:

Hemilich manouvere


Q. 3

A 2-year-old child is brought by his parents to emergency with acute onset of respiratory distress and stridor. Most probable diagnosis is:

 A

Foreign body in airway

 B

Laryngomalacia

 C

Laryngotracheobronchitis

 D

Laryngeal papillomatosis

Q. 3

A 2-year-old child is brought by his parents to emergency with acute onset of respiratory distress and stridor. Most probable diagnosis is:

 A

Foreign body in airway

 B

Laryngomalacia

 C

Laryngotracheobronchitis

 D

Laryngeal papillomatosis

Ans. A

Explanation:

Q. 4

Heimlich manoeuver is done to:

 A

Remove foreign body

 B

Cardiac function without pacemaker

 C

Pulmonary function without heart lung machine

 D

Peripheral circulation

Q. 4

Heimlich manoeuver is done to:

 A

Remove foreign body

 B

Cardiac function without pacemaker

 C

Pulmonary function without heart lung machine

 D

Peripheral circulation

Ans. A

Explanation:

Q. 5

A 2 yrs old boy, is brought with sudden onset of stridor and respiratory difficulty. The chest examination reveals decreased breath sounds and wheeze in the right side. The chest X-Ray showed an opaque right hemithorax. Which of the following is the most likely diagnosis:

 A

Pneumothorax

 B

Acute epiglottitis

 C

Massive pleural effusion

 D

Foreign body aspiration

Q. 5

A 2 yrs old boy, is brought with sudden onset of stridor and respiratory difficulty. The chest examination reveals decreased breath sounds and wheeze in the right side. The chest X-Ray showed an opaque right hemithorax. Which of the following is the most likely diagnosis:

 A

Pneumothorax

 B

Acute epiglottitis

 C

Massive pleural effusion

 D

Foreign body aspiration

Ans. D

Explanation:

Foreign body inhalation is most common cause of acute collapse with peak age incedence in 1-2 years.

Ref: Textbook of Pediatrics By K.N Agarwal, 2010, Page 235


Q. 6

A child with acute respiratory distress shows hyperinflation of unilateral lung in chest X-ray. Most likely cause for above presentation is:

 A

Staphylococcal bronchopneumonia

 B

Aspiration pneumonia

 C

Congenital lobar emphysema

 D

Foreign body aspiration

Q. 6

A child with acute respiratory distress shows hyperinflation of unilateral lung in chest X-ray. Most likely cause for above presentation is:

 A

Staphylococcal bronchopneumonia

 B

Aspiration pneumonia

 C

Congenital lobar emphysema

 D

Foreign body aspiration

Ans. D

Explanation:

Foreign body aspiration is the commonest cause of acute lung collapse in a child.

Ref: Chest Radiology: The Essentials By Jannette Collins, Eric J. Stern, 2007, Page 196


Q. 7

Advantage of fibreoptic bronchoscopy over rigid bronchoscopy is :

 A

Foreign body removal

 B

Good view

 C

Bener airway control

 D

In a sick child it can be passed through endotracheal tube

Q. 7

Advantage of fibreoptic bronchoscopy over rigid bronchoscopy is :

 A

Foreign body removal

 B

Good view

 C

Bener airway control

 D

In a sick child it can be passed through endotracheal tube

Ans. B

Explanation:

Fibreoptic bronchoscopy can be easily performed and is rarely associated with complications.It has surpassed rigid bronchoscopy as the instrument of choice for evaluvating the tracheocbronchial tree.Further ,as compared to rigid bronchoscopy,flexibile bronchoscope allows for more complete exploration of the airway.It has a good view.

 
Ref: Knowles J., Rains A. (2011). Chapter 10. Compromised Airway. In R.L. Humphries, C. Stone (Eds), CURRENT Diagnosis & Treatment Emergency Medicine, 7e.

Q. 8

A five year old boy develops sudden aphonia and respiratory distress while having dinner. Which of the following is the next recommended step in the management of this patient?

 A

Heimlich’s manoeuvre

 B

Chest thrust manoeuvre

 C

Finger Sweep manoeuvre

 D

Cricothyroidotomy or Tracheostomy

Q. 8

A five year old boy develops sudden aphonia and respiratory distress while having dinner. Which of the following is the next recommended step in the management of this patient?

 A

Heimlich’s manoeuvre

 B

Chest thrust manoeuvre

 C

Finger Sweep manoeuvre

 D

Cricothyroidotomy or Tracheostomy

Ans. A

Explanation:

A large bolus of food obstructed above the cords may make the patient totally aphonic, unable to cry for help. He may die of asphyxia unless immediate first aid measures are taken. The measures consist of pounding on the back, turning the patient upside down & following Heimlich’s manoeuvre. These measures should not be done if patient is only partially obstructed, for fear of causing total obstruction.


Q. 9

The incidence of a foreign body being aspirated into the right lung is higher than into the left lung. All of the following statements support this, EXCEPT?

 A

Right inferior lobar bronchus is in continuation with the right principal bronchus

 B

Right principal bronchus is more vertical than the left bronchus

 C

Tracheal bifurcation directs the foreign body to the right lung

 D

Right lung is shorter and wider than left lung

Q. 9

The incidence of a foreign body being aspirated into the right lung is higher than into the left lung. All of the following statements support this, EXCEPT?

 A

Right inferior lobar bronchus is in continuation with the right principal bronchus

 B

Right principal bronchus is more vertical than the left bronchus

 C

Tracheal bifurcation directs the foreign body to the right lung

 D

Right lung is shorter and wider than left lung

Ans. D

Explanation:

A foreign body is more likely to get aspirated into the right lung as the right bronchus is wider, shorter and more vertical than the left principal bronchus. The greater width and the more vertical angulation of the right principal bronchus explain why foreign bodies enter it more commonly that the left.


Q. 10

An inhaled foreign body is likely to lodge in the right lung due to all of the following features except:

 A

Right lung is shorter & wider than left lung

 B

Right principal bronchus is more vertical than the left bronchus

 C

Tracheal bifurcation directs the foreign body to the right lung

 D

Right inferior lobar bronchus is in continuation with the principal bronchus

Q. 10

An inhaled foreign body is likely to lodge in the right lung due to all of the following features except:

 A

Right lung is shorter & wider than left lung

 B

Right principal bronchus is more vertical than the left bronchus

 C

Tracheal bifurcation directs the foreign body to the right lung

 D

Right inferior lobar bronchus is in continuation with the principal bronchus

Ans. A

Explanation:

A. i.e. Right lung is shorter and wider than left lung


Q. 11

Wheeze in children caused by –

 A

Foreign body

 B

Gastro-esophageal reflux disease

 C

Bronchial asthma

 D

a and c

Q. 11

Wheeze in children caused by –

 A

Foreign body

 B

Gastro-esophageal reflux disease

 C

Bronchial asthma

 D

a and c

Ans. D

Explanation:

Ans. is ‘a’ i.e., Foreign body; ‘c’ i.e., Bronchial asthma

Wheezing

o Wheezing referes to high pitch whistling sounds audible without auscultation by the stethoscope.

o It is produced by lower airway (bronchi and bronchioles) partial obstruction —) Sufficient air must flow through the narrowed airway to produce the wheezing.

o Common causes of wheezing in children :

  • Lower respiratory tract infections         
  • Bronchiolitis & Bronchial asthma      
  • Tropical eosinophilia
  • Loeffler’s syndrome                               
  • Hypersensitivity pneumonitis                     
  • Inhaled foreign bodies
  • Cystic fibrosis.        
  • External compression from enlarged mediastinal lymph nodes, cysts or tumor.

Q. 12

Acute onset of cough, stridor and dysponea in a child is mostly due to –

 A

Foreign body

 B

Acute Asthma

 C

Aspiration pneumonitis

 D

Primary complex

Q. 12

Acute onset of cough, stridor and dysponea in a child is mostly due to –

 A

Foreign body

 B

Acute Asthma

 C

Aspiration pneumonitis

 D

Primary complex

Ans. A

Explanation:

Ans. is ‘a’ i.e., Foreign body

“Choking and coughing episodes accompnied by wheezing are highly suggestive of airway foreign body” – Nelson

“Foreign body aspiration should always be considered as a potential cause of stridor and airway obstruction in children”.                                                                                                                           — O.P. Ghai

Foreign body aspiration

o Infants and toddlers use their mouths to explore their surroundings.

  • So, they are very prone to aspirate a foreign body.

o The most common age group is 6 months to 4 years.

o Most common foreign body aspirated is nuts (peanuts).

o Most airway foreign bodies lodge in a bronchus (right more than left).

Clinical manifestions

Three stages of symptoms may results : –

1. Stage I – Initial event —> Violent paroxysm of coughing (most common symptom), choking, gagging and wheeze immediately after aspiration. If obstruction is complete, child may be unable to vocalize (aphonia) and there may be cyanosis. If obstruction is incomplete drooling and stridor may occur.

2.  Stage H Asmptomatic —> The foreign body becomes lodged, reflex fatigue and immediate irritating symptoms subside. This stage is most tracherous and account for a large percentage of delayed diagnosis and overlooked foreign bodies.

3. Stage III – Complications —> Obstruction, erosions or infection can cause fever, hemoptysis, pneumonia and atelectasis. The most serious complication offoreign body aspiration is complete airway obstruction.


Q. 13

Immediate management of a child with foreign body inhalation is –

 A

IPPV

 B

Bronchoscopy

 C

Tracheostomy

 D

Exploratory Thoracotomy

Q. 13

Immediate management of a child with foreign body inhalation is –

 A

IPPV

 B

Bronchoscopy

 C

Tracheostomy

 D

Exploratory Thoracotomy

Ans. B

Explanation:

Ans. is ‘b’ i.e., Bronchoscopy

Treatment of aspirated foreign body

A)   Treatment of foreign body in upper respiratory tract.

o If obstruction is complete —> Immediate intervention.

o If obstruction is partial —> Patients should allow to use their own cough reflex to extrude the foreign body –> If it fails than intervention should be done.

o Method of removal of foreign body : –

1)If child is younger than 1 year —> Child should be placed face down over the rescuir’s arm with head positioned below trunk. Five measured back blows are delivered rapidly between the scapula. If obstruction persists, the infant should be rolled over and five rapid chest compressions should be performed. This sequence is repeated until the obstruction is relieved.

2) If child is elder than 1 year —> Abdominal thursts (Heimlich maneuver) should be performed.

B)   Treatment of foreign body in lower respiratory tract.

o The treatment of choice is prompt endoscopic (bronchoscopic) removal of foreign body.


Q. 14

In child, foreign body in lung –

 A

Rigid bronchoscopy

 B

Chest x-ray

 C

Flexible endoscopy

 D

Direct laryngoscopy

Q. 14

In child, foreign body in lung –

 A

Rigid bronchoscopy

 B

Chest x-ray

 C

Flexible endoscopy

 D

Direct laryngoscopy

Ans. A

Explanation:

Ans. is ‘a’ i.e., Rigid bronchoscopy

o Treatment of choice is removal of foreign body by rigid bronchoscope with appropriate antibiotics.


Q. 15

Commonest sign of intrabronchial foreign body in children is –

 A

Cough

 B

Wheeze

 C

Dyspnoea

 D

Stridor

Q. 15

Commonest sign of intrabronchial foreign body in children is –

 A

Cough

 B

Wheeze

 C

Dyspnoea

 D

Stridor

Ans. A

Explanation:

Ans. is ‘a’ i.e., Cough


Q. 16

If a 5-year-old child suddenly develops stridor, which one of the following would be the most likely diagnosis‑

 A

Laryngomalacia

 B

Acute laryngo-tracheobronchitis

 C

Foreign body aspiration

 D

Acute epiglottitis

Q. 16

If a 5-year-old child suddenly develops stridor, which one of the following would be the most likely diagnosis‑

 A

Laryngomalacia

 B

Acute laryngo-tracheobronchitis

 C

Foreign body aspiration

 D

Acute epiglottitis

Ans. C

Explanation:

Ans. is ‘c’ i.e., Foreign body aspiration


Q. 17

A 4-year child presents with a history of hoarseness, croupy cough and aphonia, the child has dyspnoea with wheezing. The most probable diagnosis is ‑

 A

Asthmatic bronchitis

 B

Laryngeal foreign body

 C

Bronchopneumonia

 D

Retropharyngeal abscess

Q. 17

A 4-year child presents with a history of hoarseness, croupy cough and aphonia, the child has dyspnoea with wheezing. The most probable diagnosis is ‑

 A

Asthmatic bronchitis

 B

Laryngeal foreign body

 C

Bronchopneumonia

 D

Retropharyngeal abscess

Ans. B

Explanation:

Ans. is ‘b’ i.e., Laryngeal foreign body


Q. 18

Pappu 2 yrs old boy presents in the causality with 11/0 sudden onset of respiratory difficulty & strider on ausculation .i,ed breath sound & wheeze on the RT side. The X-Ray shows RT opaque hamithorex what will be diagnosis-

 A

Pnumothorax

 B

Acute epiglottitis

 C

Massive plural effusion

 D

Foreign body aspiration

Q. 18

Pappu 2 yrs old boy presents in the causality with 11/0 sudden onset of respiratory difficulty & strider on ausculation .i,ed breath sound & wheeze on the RT side. The X-Ray shows RT opaque hamithorex what will be diagnosis-

 A

Pnumothorax

 B

Acute epiglottitis

 C

Massive plural effusion

 D

Foreign body aspiration

Ans. D

Explanation:

D i.e. Foreign body aspiration


Q. 19

In erect posture commonest site of foreign body in bronchus –

 A

Right posterior basal

 B

Right anterior basal

 C

Lateral basal

 D

Medial basal

Q. 19

In erect posture commonest site of foreign body in bronchus –

 A

Right posterior basal

 B

Right anterior basal

 C

Lateral basal

 D

Medial basal

Ans. A

Explanation:

Ans is ‘a’ ie. Rt. posterior basal

  • Till now we have got only the below quoted text for aspiration and foreign body in lung.
  • From Schwart, 7/e        “The most common anatomic location for a foreign body is the right main stem bronchus or the rt. lower lobe.”
  • From Pretest (Pretest has quoted Harrison, I4/e, p 994)

” The right main stem bronchus is wider, shorter and vertically placed, and therefore the posterior segments of the right upper lobe (if the pt. aspirated while supine) are anatomically susceptible to aspiration puenmonia. The superior segments of the right lower lobe and left lower lobe (if the pt. supine) are also susceptible to aspiration pneumonia. These three segments are often referred to as the aspiration segments of the lung. The basilar segments of both lungs are susceptible to aspiration if the pts. aspirates while erect or sitting up.”

  • Inference : Segments involved
  • Aspiration in Supine Position :                                            
  • Aspiration in sitting or erection position
  • Rt. upper lobe – posterior segment*                          
  • Rt. basilar segments (of lower lobe)*.
  • Rt. lower lobe – superior segment*
  • Lt. lower lobe – superior segment*
  • This is the maximum we have got.

 


Q. 20

Foreign body aspiration in supine position causes which of the following parts of the lung commonly to be affected –

 A

Apical left lobe

 B

Apical lobe of right lung

 C

Apical part of the lower lobe

 D

Posterobasal segment of left lung

Q. 20

Foreign body aspiration in supine position causes which of the following parts of the lung commonly to be affected –

 A

Apical left lobe

 B

Apical lobe of right lung

 C

Apical part of the lower lobe

 D

Posterobasal segment of left lung

Ans. C

Explanation:

Ans. is ‘c’ i.e. Apical part of right lower lobe 


Q. 21

A foreign body completely obstructing the right main bronchus causes –

 A

Decreased ventilation perfusion ratio

 B

Increased ventilation in left lung

 C

Perfusion doubles in right lung

 D

Increased VF ratio in right lung

Q. 21

A foreign body completely obstructing the right main bronchus causes –

 A

Decreased ventilation perfusion ratio

 B

Increased ventilation in left lung

 C

Perfusion doubles in right lung

 D

Increased VF ratio in right lung

Ans. A

Explanation:

Answer is ‘a’ i.e. Decreased ventilation perfusion ratio


Q. 22

A 2-year-old boy presenting with sudden severe dyspnea, most common cause is:

 A

Foreign body

 B

Bronchiolitis

 C

Asthmatic attack

 D

None

Q. 22

A 2-year-old boy presenting with sudden severe dyspnea, most common cause is:

 A

Foreign body

 B

Bronchiolitis

 C

Asthmatic attack

 D

None

Ans. A

Explanation:

 

In case of stridor with acute airway obstruction (i.e. dyspnea) always history of any foreign body ingestion should be taken.


Q. 23

Palpatory thud audible slap is seen in:

 A

Tracheal foreign body

 B

Bronchial foregion body

 C

Laryngeal foreign body

 D

None

Q. 23

Palpatory thud audible slap is seen in:

 A

Tracheal foreign body

 B

Bronchial foregion body

 C

Laryngeal foreign body

 D

None

Ans. A

Explanation:

A foreign body in trachea may move up and down the trachea between the carnia and the undersurface of vocal cords causing “audible slap” and “palpatory thud.”


Q. 24

The commonest site of aspiration of a foreign body in the supine position is into the: 

 A

Right upper lobe apical 

 B

Right lower lobe apical

 C

Left basal

 D

Right medial

Q. 24

The commonest site of aspiration of a foreign body in the supine position is into the: 

 A

Right upper lobe apical 

 B

Right lower lobe apical

 C

Left basal

 D

Right medial

Ans. B

Explanation:

Q. 25

Best management for inhaled foreign body in an infant is: 

 A

Bronchoscopy

 B

IPPV and intubation

 C

Steroid

 D

Tracheostomy

Q. 25

Best management for inhaled foreign body in an infant is: 

 A

Bronchoscopy

 B

IPPV and intubation

 C

Steroid

 D

Tracheostomy

Ans. A

Explanation:

  • The peak incidence of inhaled foreign bodies is between the ages of one and three years with a male to female ratio of 2:1
  • Only 12% of the inhaled bodies impact in the larynx while most pass through the cords into the tracheobronchial tree.
  • In contrast to adults, where objects tend to lodge in the distal bronchi or right main bronchus, in children they tend to lie more centrally within the trachea (53%) or just distal to the carina (47%)
  • The treatment of choice for airway foreign bodies is prompt endoscopic removal with a Bronchoscope.

Q. 26

A 2 year old child with intercostal retraction and increas­ing cyanosis was brought with a history of foreign body aspiration. which might be lifesaving in this situation?

 A

Oxygen through face mask

 B

Heimlich’s manoeuvre

 C

Extra cardiac massage

 D

Intracaridiac adrenaline

Q. 26

A 2 year old child with intercostal retraction and increas­ing cyanosis was brought with a history of foreign body aspiration. which might be lifesaving in this situation?

 A

Oxygen through face mask

 B

Heimlich’s manoeuvre

 C

Extra cardiac massage

 D

Intracaridiac adrenaline

Ans. B

Explanation:

 

  • The child is presenting with cyanosis and intercostal retraction which indicates that the foreign body is lodged in the larynx.
  • Initial management for a foreign body lodged in trachea/larynx is Heimlich’s maneuver where a person stands behind the child and places his arms around his lower chest and gives four abdominal thrust.
  • In infants, lying the child on its back on the adults knee and pressing firmly on the upper abdomen is the preferred maneuver.
  • If Heimlich’s maneuvre fails, cricothyrotomy or emergency tracheostomy should be done.
  • Once acute respiratory emergency is over foreign body can be removed by direct laryngoscopy or by laryngofissure, if it is impacted.
  • Tracheal and bronchial foreign bodies are removed by bronchoscopy with full preparation and under GA.

 



Q. 27

A 2-year-old child develops acute respiratory distress. 0/E breath sounds are decreased with wheeze on right side. Chest X-ray shows diffuse opacity on right side—Most probable diagnosis:

 A

Pneumothorax

 B

Foreign body aspiration

 C

Pleural effusion

 D

U/L emphysema

Q. 27

A 2-year-old child develops acute respiratory distress. 0/E breath sounds are decreased with wheeze on right side. Chest X-ray shows diffuse opacity on right side—Most probable diagnosis:

 A

Pneumothorax

 B

Foreign body aspiration

 C

Pleural effusion

 D

U/L emphysema

Ans. B

Explanation:

 

Foreign body aspiration is a very common problem in pediatric age group (< 4 years). In the question, child is presenting with sudden onset respiratory distress and there is U/L decreased breath sounds + U/L wheezing and on chest X-ray a diffuse opacity is seen on right side i.e. there is clinical and radiological evidence of bronchospasm and collapse suggestive of a foreign body in bronchus


Q. 28

A 5-year-old boy having dinner suddenly becomes a phonic and is brought to casuality for the complaint of respiratory difficulty. What is the most appropriate management?

 A

Cricothyroidotomy

 B

Tracheostomy

 C

Humdifier

 D

Heimlich maneuver

Q. 28

A 5-year-old boy having dinner suddenly becomes a phonic and is brought to casuality for the complaint of respiratory difficulty. What is the most appropriate management?

 A

Cricothyroidotomy

 B

Tracheostomy

 C

Humdifier

 D

Heimlich maneuver

Ans. D

Explanation:

 

Emergency Physicians- 6th/ed pp 68,69

  • Aphonia (inability to speak) and sudden respiratory distress in a young boy while having food, suggests obstruction of the airway with a large bolus of food. Heimlich’s maneuver is the recommended, initial procedure of choice for relieving airway obstruction due to solid objects.
  • Cricothyroidotomy or tracheostomy should be performed if the Heimlich’s maneuver fails



Q. 29

A child develops acute respiratory distress, stridor, hyperinflation on one side of chest with decreased breath sound on that side. Most likely cause is :

 A

Asthma

 B

Aspiration pneumonia

 C

Foreign body aspiration

 D

Pleural effusion

Q. 29

A child develops acute respiratory distress, stridor, hyperinflation on one side of chest with decreased breath sound on that side. Most likely cause is :

 A

Asthma

 B

Aspiration pneumonia

 C

Foreign body aspiration

 D

Pleural effusion

Ans. C

Explanation:

Answer is C (Foreign Body Aspiration):

Foreign Body Aspiration is an important cause of stridor in. children. Obstruction leads to hyperinflation, chest wall hyperresonance and decreased breath sounds.

All the other choices mentioned in the question do not cause stridor.


Q. 30

During autopsy, foreign body is found in respiratory tract; manner of death is:

MP 07

 A

Homicide

 B

Suicide

 C

Accident

 D

Natural

Q. 30

During autopsy, foreign body is found in respiratory tract; manner of death is:

MP 07

 A

Homicide

 B

Suicide

 C

Accident

 D

Natural

Ans. C

Explanation:

Ans. Accident


Q. 31

A 5-year old boy while having dinner suddenly becomes aphonic and is brought to the casualty with the complaint of respiratory distress. Immediate management should be:   

AI 11

 A

Cricothyroidotomy

 B

Emergency tracheostomy

 C

Humidified oxygen

 D

Heimlich maneuver

Q. 31

A 5-year old boy while having dinner suddenly becomes aphonic and is brought to the casualty with the complaint of respiratory distress. Immediate management should be:   

AI 11

 A

Cricothyroidotomy

 B

Emergency tracheostomy

 C

Humidified oxygen

 D

Heimlich maneuver

Ans. D

Explanation:

Ans. Heimlich maneuver


Q. 32

Foreign body from trachea most common goes to right bronchus due to ‑

 A

Right bronchus shallow

 B

Wider & in continuous line with trachea

 C

Right bronchus is longer

 D

Right bronchus is horizontal

Q. 32

Foreign body from trachea most common goes to right bronchus due to ‑

 A

Right bronchus shallow

 B

Wider & in continuous line with trachea

 C

Right bronchus is longer

 D

Right bronchus is horizontal

Ans. B

Explanation:

Trachea bifurcates at Carina (at lower border of T4 vertebra at T4-T5 disc space) into right and left principal (primary) bronchi.

Right principal bronchus is wider, shorter (2.5 cm long), and more vertical in the line of trachea (25° with median plane).

Therefore a foreign body is most likely to lodge in the right bronchus.


Q. 33

Hemlichs maneuver is used for ‑

 A

Upper airway obstruction by foreign body

 B

BPPV

 C

Eustachian tube patency test

 D

Tympanic membrane integrity test

Q. 33

Hemlichs maneuver is used for ‑

 A

Upper airway obstruction by foreign body

 B

BPPV

 C

Eustachian tube patency test

 D

Tympanic membrane integrity test

Ans. A

Explanation:

Ans. is ‘a’ i.e., Upper airway obstruction by foreign body

Heimlich manoeuvre

Abdominal thrusts, also called the Heimlich manoeuvre or Heimlich maneuver, is a first aid procedure used to treat upper airway obstructions (or choking) by foreign objects. The term Heimlich maneuver is named after Dr. Henry Heimlich, who first described it in 1974.


Q. 34

A foreign body completely obstructing this structure (marked with arrow) causes?

 A

Decreased ventilation perfusion ratio

 B

Increased ventilation in left lung

 C

Perfusion doubles in right lung

 D

Increased VF ratio in right lung

Q. 34

A foreign body completely obstructing this structure (marked with arrow) causes?

 A

Decreased ventilation perfusion ratio

 B

Increased ventilation in left lung

 C

Perfusion doubles in right lung

 D

Increased VF ratio in right lung

Ans. A

Explanation:

Arrow representing Right bronchus

. Decreased ventilation perfusion ratio

Trachea bifurcates at Carina (at lower border of T4 vertebra at T4-T5 disc space) into right and left principal (primary) bronchi.



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