Airway management: Ludwig angina: 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: Ludwig angina

Sample item

A 45-year-old with a molar infection has fever, bilateral woody submandibular swelling, trismus and a raised tongue, and is listed for drainage. Which airway plan is safest?

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

The answer and the reasoning

A. Awake fibreoptic intubation or tracheostomy under local anaesthesia, with a surgical airway ready

Ludwig angina causes floor-of-mouth oedema, tongue elevation and trismus, so mask ventilation and laryngoscopy after induction may be impossible. The airway is secured awake while the patient maintains spontaneous breathing, with front-of-neck access prepared.

Option by option

  • A. Awake fibreoptic intubation or tracheostomy under local anaesthesia, with a surgical airway ready (correct)

    Correct. Securing the airway while awake avoids loss of the airway after induction.

  • B. Inhalational induction with sevoflurane and mask ventilation

    Loss of muscle tone with a raised tongue makes mask ventilation unsafe.

  • C. Rapid sequence induction with suxamethonium and direct laryngoscopy

    Paralysis and direct laryngoscopy risk a cannot-intubate, cannot-ventilate situation.

  • D. Intravenous induction followed by a supraglottic airway device

    A supraglottic device will not seat or seal in this 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.

More Anaesthesia questions

Questions about this Anaesthesia question

What is the answer to this Anaesthesia question?

The best answer is A, Awake fibreoptic intubation or tracheostomy under local anaesthesia, with a surgical airway ready. Ludwig angina causes floor-of-mouth oedema, tongue elevation and trismus, so mask ventilation and laryngoscopy after induction may be impossible.

Why is "Inhalational induction with sevoflurane and mask ventilation" not the answer?

Loss of muscle tone with a raised tongue makes mask ventilation unsafe.

Why is "Rapid sequence induction with suxamethonium and direct laryngoscopy" not the answer?

Paralysis and direct laryngoscopy risk a cannot-intubate, cannot-ventilate situation.

Why is "Intravenous induction followed by a supraglottic airway device" not the answer?

A supraglottic device will not seat or seal in this airway.

What concept does this question test?

It tests Airway management: Ludwig angina in Anaesthesia. The airway is secured awake while the patient maintains spontaneous breathing, with front-of-neck access prepared.

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: Ludwig angina?

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.