To be precise, occipito-atlanto (C0-C1) joint mobility really determines head as opposed to c-spine mobility, but for the purpose of airway assessment we usually assess neck and head mobility together at the same time. Similarly to the measurement of thyromental distance (TMD) (see below), measurement of IIG is usually done by finger breadths in clinical practice rather than a tape measure. Click here for an excellent editorial on predicting the risk of difficult intubation, and the problems all tests suffer with regards to sensitivity, specificity, and predictive value. Like an increased aspiration risk, cardio-respiratory disease does not affect the mechanical aspects of airway management per se. For example, the Mallampati score together with the thyromental distance achieved around 80% sensitivity, 98% specificity and a PPV of almost 65% in one study (the PPV was so much higher because of the high specificity of this test combo).
Since measurements and classifications are lacking, quantifying these features and assigning predicitve value to them is difficult. Noticing them in a patient and expecting challenges in airway management based in their presence comes down to clinical experience. Both the angle measurement of the flexion/ extension range and the sternomental distance measurement are rarely performed in actual clinical practice. Most practitioners usually ask the patient to flex their neck and head (“Can you bring your chin down to your chest?”) and then extend their neck as much as possible. Rther than measuring angles or distances we generally rely on an ‘eyeball’ assessment of neck mobility. There are some easily overlooked aspects of preoperative airway assessment because they go beyond the more familiar medical history and examination discussed above and have more to do with logistics.
Observe if the lower incisors can be advanced in front of the upper ones. For the upper lip bite test the patient is asked to bite their upper lip (duh!). A functional impariment of mouth opening (e.g. due to TMJ pain/ discomfort) may improve with general anesthesia and muscle relaxation.
There is no prerequisites, but it is preferred -not mandatory- to have previous knowledge or work experience in this filed. The British Journal of Anesthesia has a nice review article ‘Dental knowledge for anesthetists’. Consider whether a patient had any of these interventions or treatments since the last documented ‘uneventful intubation’. Calculations must be re-checked and should not be used alone to guide patient care, nor should they substitute for clinical judgment. The STOP-BANG questionnaire is not well-validated in the obstetrical population, a subgroup with increased risk of OSA.
Being edentulous has been indentified as an independent risk factor for difficult mask ventilation. Obesity has several adverse effects on bag-mask ventilation and laryngoscopy, which are discussed in the page ‘Special patient circumstances’ – ‘The obese patient’. You are likely to come across patients who have not definitiely been diagnosed with OSA but in whom you strongly suspect it.
Use TrueLearn’s graphs to track your performance and see how you improve from spaced repetition. Take a deep dive into your specific individual testing habits and behaviors, seeing your average time per question and more with the SmartTips tool. Create customized quizzes around topics where you score low in a computer-simulated environment with ABA-style practice questions written in the same style you will encounter on test day. Brainscape is a digital flashcards platform where you can find, create, share, and study any subject on the planet. Talk with your doctor if you have questions or concerns about any of the tests he or she orders for you. To assess jaw protrusion (prognathism) ask your patient to open their mouth fully and then push their lower jaw forward.
It is a (surprinsingly) well-tolerated minimally-invasive procedure which can be performed in the OR or the preop area. Sedation is not required but topical local anesthesia is, and can easily be achieved with a nasal atomizer and 4% topical lidocaine. A flexible fiberoptic bronchocope is passed through a nostril and once the tip of the scope has reached the nasopharynx the scope is flexed caudad, allowing a look ‘down’ onto the larynx. The patients should protrude the tongue as much as possible to improve the view.
TrueLearn’s platform is enhanced with all of the features to help you reach your goals in medicine. With detailed score and percentile insights and real-time national average comparisons, you will know exactly where you stand amongst your peers. Learners took over 66 million questions within all our exam banks in 2022. The creator of this class did not yet add a description for what is included in this class. With our competitive price, you can attend the program live several times with the same fees.
However, you won’t see many providers getting a tape measure out and applying this to a patients neck. In practice any anesthesiologists measure with finger breadths, which will obviously vary between folks with slender digits or sausage fingers! Make a one time effort and measure the width of your index, index plus middle, index/ middle/ ring, and index/ middle/ ring/ pinkie fingers and remember those values. Like any kind of patient evaluation preoprative airway assessment can be divided into history and examination, supported by clinical tests. The assessment of the patient’s airway is an integral part of the pre-operative workup. Its purpose is to predict potential problems, allowing a management plan to be developed ahead of time and avoid an unanticipated difficult airway.
TrueLearn is indeed the holy grail of all the resource materials I used for my ABA In-Training exam prep. Doing the questions are great, but the real sauce is in the detailed explanation that follow each questions. I was able to fully invest in this material, and I got a perfect ITE score this year. To respond to the sample questions, first enter your first and last names in the boxes below (this information will not be recorded; it is strictly for purposes of identifying your results). Then click the button corresponding to the best answer for each question. When you are finished, click the “Evaluate” button at the bottom of the page.
Dr. Chung’s research interests include obstructive sleep apnea as well as ambulatory and geriatric anesthesia. To download instructions detailing how to access and interpret the AKT score reports, click here. Reduce the forgetting curve when you incorporate spaced repetition into your learning! Make difficult concepts easier to remember by studying a topic in systematic intervals.
On the other hand, the edentulous patient is often easier to intubate (with dentures removed), simply because there are no teeth in the way and an atrophic mandible does to need as much forward displacement with the laryngoscopy to get a good view. To retrieve score reports and normative data tables, log on to the PSI AMP Portal here. The approximate percentage of questions in each content areas is listed in parentheses.

Predicting difficulties with ventilation and oxygenation is more important than predicting difficulties with laryngoscopy. Failed laryngoscopy or intubation is not inherently dangerous if you can oxygenate your patient. With text reminders of key topics sent directly to your phone, you can continue to re-expose yourself to key learning points on missed questions even on clinically busy days. These key insights are sent at specific intervals to enhance learning and long-term retention.
Like the Mallampati score described above, thyromental distance (TMD) is supposed to be a measure of the ease of tongue displacement with a ‘standard’ laryngoscope (not videolaryngoscope) blade during intubation. The bigger the TMD the larger the mandibular or submandibular space into which the tongue is pushed with the laryngoscope. There is no objectively quantifiable measurement for a ‘short neck’ which has been evaluated in the context of airway assessment. TEFL has been evaluated as a tool for preoperative airway assessment (Gemma et al. 2020). A significant added benefit of doing a Mallampati score assessment is that it focusses the examiner’s attention on the anatomy of the oral cavity including dental status and patients’ ability to open their mouth. The Australian and New Zealand College of Anaesthetists (ANZCA) has put together an excellent document on preoperative airway assessment.

Retrieving and Interpreting the AKT Exams

Even with this combination of tests, while the sensitivity and specificity of the Wilson risk score are up to 55% and 90% respectively, the PPV is still only about 10%. Anterior mandibular subluxation can be limited due to issues not related to the temporomandibular joint. Soft tissue fibrosis/ skin scarring over the anterior neck due to radiation therapy for example can significantly reduce TMJ mobility without there being a joint abnormality as such. Thyromental distance is the distance from mental prominence (most anterior part of the bony chin) to the tip of the thyroid cartilage (thyroid notch or ‘Adam’s apple’) during maximum head extension with the mouth closed.
A significantly reduced IIG of less than 2.5cm will make insertion of a LMA Unique impossible. Below 1.5cm (one finger breadth in a majority of people) insertion of a (video)laryngoscope blade will be impossible. The Mallampati test gives and idea of the relationship between tongue size and mobility and size of the oral cavity.

Demonstrate an understanding of compliance with each JCI standards and measurable elements included in each chapter.2. Identify policies, procedures and programs component to fulfill standard requirements.4. Identify guidelines, protocols and clinical pathways required to fulfill standard requirement.5. Identify templates and forms either medical & non-medical required to fulfill standard requirement.6. Using certain tools and methods to achieve the requirements “Survey, Checklist, huddles, Flowcharts, etc….”7. Using Quality improvement tools to achieve standard requirements “PDCA, FMEA, cause & effect diagram, 5 whys, etc…”8.
Select well defined, evidence based key performance indicators that are applicable to patient population and services to comply with JCI standard.9. Perform a risk assessment through risk identification, risk mapping and risk mitigation plan.10. Following completion of the examination, score reports will be made available to the program director.
A screening score such as the STOP-BANG assessment, developed by the University Health Network in Toronto, CA, is helpful in identifying likely OSA cases and guide overall risk stratification. Studies have shown that simulating the testing experience helped to increase learning and decrease testing anxieties. TrueLearn’s board style questions, testing interface, and timed environment will get you one step closer to feeling comfortable on test day. JCI standards define the performance expectation, structures, or functions that must be in place for a hospital to be accredited by JCI.

It’s our mission to help you pass the ABA BASIC Exam the first time.

Individual score reports will include percent correct, a standard score, a percentile score based on national normative data, and keywords for questions answered incorrectly. Program directors will also have access to roster reports listing the results for all candidates from their programs. There are a number of anatomical features of the patients face and neck that can be visually assessed if not easily measured and predict difficult mask ventilation and/ or laryngoscopy.

Clearly TEFL is not a routine preoperative airway assessment tool but in can be useful in certain situations, particularly if there is a known (progressive) pathology in the oropharynx, hypopharynx or larynx. Contributing to this is the fact that loss of teeth often leads to significant mandibular atrophy. Certain patients are at an increased risk of regurgitation and aspiration of stomach contents such as food particles or gastric acid because of conditions such as GERD, hiatal hernia, obesity, autonomic neuropathy, non-npo status, etc. The Anesthesia Knowledge Test-24 (AKT-24) examination assesses knowledge after twenty-four months of clinical anesthesiology residency training (end of CA-2 year). The Anesthesia Knowledge Test-1 (AKT-1) examination assesses knowledge of basic anesthesiology concepts at the beginning of clinical anesthesiology residency training (CA-1 year) and the growth of that knowledge during the first 4-6 weeks of training. The AKT-1 consists of a pair of examinations given as a pre- and post-test.
Ask your patient if they had a formal diagnosis of OSA, which requires a sleep study, and if they use home CPAP. Although it is unlikely that a patient will be able to provide details about why airway management was difficult in the past, statements such as ‘ they we’re struggling to get the tube down’ or similar should obviously ring alarm bells. Airway management problems continue to be the single most common cause of morbidity and mortality attributable to anesthesia! In addition, these are problems that you own exclusively as an anesthesia provider. There is very little blame sharing in avoidable airway management mishaps.