Airway: ramped position in obesity: practice question

A Anaesthesia question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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Anaesthesia · Airway: ramped position in obesity

Sample item

A patient with a BMI of 48 kg/m2 is being prepared for intubation. Which positioning technique improves both preoxygenation and the laryngoscopic view?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

A. Ramped position, with the ear level with the sternal notch

In the ramped position, padding under the shoulders and head aligns the external auditory meatus horizontally with the sternal notch. This offloads the chest and abdomen, increases functional residual capacity and improves mask ventilation and the laryngeal view. Reverse Trendelenburg also helps preoxygenation.

Option by option

  • A. Ramped position, with the ear level with the sternal notch (correct)

    Correct. Ramping aligns the airway axes and improves lung volume in obese patients.

  • B. Flat supine position with a single pillow

    A flat position increases airway obstruction and reduces functional residual capacity in obesity.

  • C. Head-down Trendelenburg tilt

    Head-down tilt worsens diaphragmatic splinting and the risk of regurgitation.

  • D. Lateral position with the head flexed

    The lateral position does not allow standard laryngoscopy or effective preoxygenation.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this Anaesthesia question

What is the answer to this Anaesthesia question?

The best answer is A, Ramped position, with the ear level with the sternal notch. In the ramped position, padding under the shoulders and head aligns the external auditory meatus horizontally with the sternal notch.

Why is "Flat supine position with a single pillow" not the answer?

A flat position increases airway obstruction and reduces functional residual capacity in obesity.

Why is "Head-down Trendelenburg tilt" not the answer?

Head-down tilt worsens diaphragmatic splinting and the risk of regurgitation.

Why is "Lateral position with the head flexed" not the answer?

The lateral position does not allow standard laryngoscopy or effective preoxygenation.

What concept does this question test?

It tests Airway: ramped position in obesity in Anaesthesia. This offloads the chest and abdomen, increases functional residual capacity and improves mask ventilation and the laryngeal view. Reverse Trendelenburg also helps preoxygenation.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Airway: ramped position in obesity?

Make a table of each agent, its key advantage and its main side effect. Then use the flashcards and the other Anaesthesia questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.