Airway management: ankylosing spondylitis: 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 management: ankylosing spondylitis

Sample item

A 45-year-old man with advanced ankylosing spondylitis has a fixed flexion deformity of the neck and a rigid spine and requires general anaesthesia. Which airway approach is best?

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

The answer and the reasoning

B. Awake fibreoptic intubation

A fused cervical spine makes the laryngeal view extremely difficult and mask ventilation may fail after induction. Awake fibreoptic intubation keeps the airway reflexes and spontaneous breathing until the tube is secured. Rough manipulation also risks fracture of the brittle spine.

Option by option

  • A. Routine induction with direct laryngoscopy

    Direct laryngoscopy would be very difficult and unsafe after paralysis.

  • B. Awake fibreoptic intubation (correct)

    Correct. Preserving spontaneous breathing makes this the safest technique in an anticipated difficult airway.

  • C. Blind nasal intubation after induction

    Blind nasal intubation after induction carries a high risk of failure and trauma.

  • D. Rapid sequence induction with suxamethonium and cricoid pressure

    A rapid sequence induction removes the safety of spontaneous ventilation in a predicted difficult airway.

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 B, Awake fibreoptic intubation. A fused cervical spine makes the laryngeal view extremely difficult and mask ventilation may fail after induction.

Why is "Routine induction with direct laryngoscopy" not the answer?

Direct laryngoscopy would be very difficult and unsafe after paralysis.

Why is "Blind nasal intubation after induction" not the answer?

Blind nasal intubation after induction carries a high risk of failure and trauma.

Why is "Rapid sequence induction with suxamethonium and cricoid pressure" not the answer?

A rapid sequence induction removes the safety of spontaneous ventilation in a predicted difficult airway.

What concept does this question test?

It tests Airway management: ankylosing spondylitis in Anaesthesia. Awake fibreoptic intubation keeps the airway reflexes and spontaneous breathing until the tube is secured. Rough manipulation also risks fracture of the brittle spine.

How hard is this question?

We tag it as a multi-step question: it asks you to combine more than one idea. 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 management: ankylosing spondylitis?

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.