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Chapter 25: Evaluation of the Patient and Preoperative Preparation

Airway evaluation is recommended in all patients to detect characteristics suggestive of difficult intubation. For a male patient, which of the following findings on airway evaluation may suggest difficult intubation?

(A) presence of a beard

(B) neck thickness of 16 inches

(C) narrow palate

(D) uvula visible when tongue protruded

(E) thyromental distance greater than 3 finger breadths

The answer is C. Narrow palate is considered a nonreassuring airway exam finding suggestive of difficult intubation. Other nonreassuring airway exam findings include:

  • relatively long incisors

  • prominent “overbite”

  • inability to bring mandibular incisors in front of maxillary incisors

  • interincisor distance <3 cm

  • Mallampati class >2 (uvula not visible when tongue is protruded)

  • highly arched palate

  • thyromental distance <3 finger breadths

  • short, thick neck (>17 inches in men, >16 inches in women)

  • inability to touch tip of chin to chest

Refs: Miller RD. Miller's Anesthesia, 8th ed. Philadelphia, PA: Elsevier; 2015.

American Society of Anesthesiologists, Practice guidelines for management of the difficult airway: an updated report. Anesthesiology 2013;118:1269–1277.

According to the Mallampati classification of the airway, direct visualization of a Class III airway would reveal:

(A) hard palate only

(B) soft palate, fauces, uvula

(C) soft palate, tip of epiglottis

(D) soft palate, fauces, uvula, pillars

(E) soft palate, base of uvula

The answer is E. For the Mallampati classification of the airway, the following anatomic landmarks are visible during direct visualization with the patient seated:

  • I—soft palate, fauces, uvula, pillars

  • II—soft palate, fauces, uvula

  • III—soft palate, base of uvula

  • IV—hard palate only

The epiglottis is typically viewed with direct laryngoscopy. Cormack and Lehane's classification is used to describe laryngoscopic views.

Ref: Miller RD. Miller's Anesthesia, 8th ed. Philadelphia, PA: Elsevier; 2015.

A 44-year-old ASA I patient scheduled for a mandibular osteotomy requires which of the following routine preoperative tests?

(A) PTT/PT

(B) electrolytes

(C) ECG

(D) CXR

(E) no tests

The answer is E. Determining appropriate preoperative laboratory studies is a controversial topic.

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