Sleep-Disordered Breathing Indian Medical PG Practice Questions and MCQs
Practice Indian Medical PG questions for Sleep-Disordered Breathing. These multiple choice questions (MCQs) cover important concepts and help you prepare for your exams.
Sleep-Disordered Breathing Indian Medical PG Question 1: 2 months old child having birth weight 2kg, with poor feeding, very sleepy and wheezing. The diagnosis is?
- A. Very severe disease (Correct Answer)
- B. No evidence of pneumonia
- C. Severe respiratory infection
- D. No diagnosis
Sleep-Disordered Breathing Explanation: ***Very severe disease***
- According to **WHO/IMNCI (Integrated Management of Neonatal and Childhood Illness) classification** for young infants (0-2 months), the presence of **danger signs** automatically classifies the condition as "Very severe disease"
- This infant presents with two critical danger signs: **poor feeding** and **lethargy (very sleepy)**, along with respiratory symptoms (wheezing)
- In young infants, any danger sign (poor feeding, lethargic/unconscious, convulsions, severe chest indrawing, central cyanosis) requires immediate classification as "Very severe disease" and **urgent referral** to higher center
- This is a specific diagnostic classification used in pediatric emergency protocols, not a general term
*Severe respiratory infection*
- While the child has respiratory symptoms (wheezing), this classification would only be appropriate if respiratory distress was present **without danger signs**
- The presence of danger signs (poor feeding, lethargy) escalates the classification to "Very severe disease" in the WHO/IMNCI protocol
- In young infants (0-2 months), the classification system prioritizes danger signs over organ-specific diagnoses
*No evidence of pneumonia*
- This is incorrect as the infant clearly presents with respiratory symptoms (wheezing) and systemic signs of illness
- The presence of wheezing, poor feeding, and lethargy indicates serious illness requiring urgent evaluation and treatment
- This option contradicts the clinical presentation
*No diagnosis*
- This is incorrect as the WHO/IMNCI classification provides a clear diagnostic framework
- The presence of danger signs in a young infant mandates classification as "Very severe disease"
- A working diagnosis is essential for guiding appropriate management and urgent referral
Sleep-Disordered Breathing Indian Medical PG Question 2: Laser uvulopalatoplasty is indicated for which of the following conditions?
- A. Obstructive sleep apnea (Correct Answer)
- B. Pharyngotonsillitis
- C. Cleft palate
- D. Stammering
Sleep-Disordered Breathing Explanation: ***Obstructive sleep apnea***
- **Laser uvulopalatoplasty (LUP)** is a surgical procedure that reshapes the **uvula** and **soft palate** to enlarge the airway in patients with **obstructive sleep apnea (OSA)**.
- OSA is characterized by repetitive episodes of upper airway obstruction during sleep, leading to snoring, daytime sleepiness, and other health issues.
*Pharyngotonsillitis*
- This condition involves inflammation of the **pharynx** and **tonsils**, usually caused by bacterial or viral infections.
- Treatment typically involves antibiotics for bacterial infections or symptomatic relief for viral infections, not surgical reshaping of the palate.
*Cleft palate*
- **Cleft palate** is a congenital birth defect where the roof of the mouth does not fully close during fetal development.
- The primary treatment involves **surgical repair** to close the opening, which is a different procedure from LUP and focuses on reconstructing normal anatomy.
*Stammering*
- **Stammering** is a **speech disorder** characterized by disruptions in fluency, such as repetitions, prolongations, or blocks in speech.
- It is managed through **speech therapy** and behavioral interventions, and is unrelated to airway obstruction or surgical procedures on the palate.
Sleep-Disordered Breathing Indian Medical PG Question 3: Patient with obstructive sleep apnea-hypopnea syndrome is unlikely to have which of the following?
- A. Absence of snoring
- B. Bradycardia during sleep episodes (Correct Answer)
- C. Normal oxygen saturation throughout sleep
- D. Decreased neck circumference
Sleep-Disordered Breathing Explanation: ***Bradycardia during sleep episodes***
- While patients with **obstructive sleep apnea (OSA)** commonly experience various cardiovascular complications, **bradycardia** during apneic episodes is *less typical* than **tachycardia**.
- The body's initial response to apnea and **hypoxia** usually involves a sympathetic surge leading to tachycardia upon arousal, followed by bradycardia if the apnea is prolonged. However, the dominant pattern is often elevated heart rate variability.
*Normal oxygen saturation throughout sleep*
- Patients with OSA frequently experience intermittent **hypoxemia** due to repeated apneas and hypopneas, leading to significant drops in **oxygen saturation** [1].
- A *normal oxygen saturation throughout sleep* would effectively rule out significant OSA, as desaturation is a hallmark of the condition [1].
*Absence of snoring*
- **Snoring** is a classic and highly prevalent symptom of OSA, caused by the vibration of upper airway tissues as air struggles to pass through an obstructed pharynx.
- While not all snorers have OSA, the *absence of snoring* makes OSA less likely, although it can occur in some subsets of patients, particularly those with central sleep apnea or certain anatomical variations.
*Decreased neck circumference*
- A **large neck circumference** is a well-established anatomical risk factor for OSA, indicating increased soft tissue in the neck that can contribute to upper airway collapse.
- A *decreased neck circumference* would generally be protective against OSA, making it less likely for an individual to have the condition.
Sleep-Disordered Breathing Indian Medical PG Question 4: A 3-month-old infant with no chest indrawing and a respiratory rate of 52/minute. The diagnosis is:
- A. Severe pneumonia
- B. Pneumonia (Correct Answer)
- C. No pneumonia
- D. Very severe disease
Sleep-Disordered Breathing Explanation: ***Pneumonia***
- A respiratory rate of 52/minute in a 3-month-old infant **meets the age-specific threshold for tachypnea** (respiratory rate ≥ 50 breaths/minute for infants 2-12 months according to IMCI guidelines).
- In the **absence of chest indrawing**, the presence of fast breathing (tachypnea) alone classifies this as **pneumonia** per IMCI classification.
- This requires **outpatient management with oral antibiotics** and close follow-up.
*No pneumonia*
- This diagnosis would apply if the respiratory rate was **< 50 breaths/minute** for this age group with no chest indrawing.
- Since the respiratory rate is 52/minute (≥ 50/minute), this rules out "no pneumonia."
*Severe pneumonia*
- This diagnosis requires the presence of **chest indrawing** in addition to fast breathing.
- The question explicitly states **"no chest indrawing,"** which excludes severe pneumonia.
- Severe pneumonia would require **hospitalization and parenteral antibiotics**.
*Very severe disease*
- This diagnosis involves **danger signs** such as inability to drink or breastfeed, persistent vomiting, convulsions, lethargy, unconsciousness, or severe malnutrition.
- None of these critical signs are mentioned in the clinical scenario.
- Very severe disease requires **urgent hospitalization and injectable antibiotics**.
Sleep-Disordered Breathing Indian Medical PG Question 5: Which of the following is not associated with primary ciliary dyskinesia?
- A. Sinusitis
- B. Respiratory infection
- C. Sterility in males
- D. Hypothyroidism (Correct Answer)
Sleep-Disordered Breathing Explanation: ***Hypothyroidism***
- **Hypothyroidism** is a condition related to the thyroid gland's function and is **not directly associated** with defects in ciliary structure or function.
- While other systemic conditions can coexist, there is no known mechanistic link between primary ciliary dyskinesia and thyroid dysfunction.
*Sterility in males*
- **Sterility in males** is a common manifestation of primary ciliary dyskinesia, as the abnormal cilia impair **sperm motility**, preventing effective fertilization.
- The **flagellum of sperm** shares structural similarities with cilia, and its dysfunction leads to **immotile spermatozoa**.
*Sinusitis*
- **Sinusitis** is a hallmark symptom of primary ciliary dyskinesia due to impaired ciliary clearance in the **paranasal sinuses**.
- The inability to effectively clear mucus leads to chronic and recurrent **sinus infections** and inflammation.
*Respiratory infection*
- **Recurrent respiratory infections**, including bronchitis, pneumonia, and bronchiectasis, are characteristic features of primary ciliary dyskinesia.
- Defective ciliary action in the **respiratory tract** prevents proper clearance of mucus and pathogens, leading to chronic infections.
Sleep-Disordered Breathing Indian Medical PG Question 6: Fast breathing in a 6-month-old infant is taken as:
- A. >30 breaths/min
- B. >50 breaths/min (Correct Answer)
- C. >60 breaths/min
- D. >40 breaths/min
Sleep-Disordered Breathing Explanation: ***>50 breaths/min***
- For infants aged 2 to 12 months, a respiratory rate of **greater than 50 breaths per minute** is considered consistent with **tachypnea** or fast breathing.
- This is an important indicator of respiratory distress, often used in clinical assessment frameworks like the **Integrated Management of Childhood Illness (IMCI)**.
*>30 breaths/min*
- A respiratory rate of **>30 breaths/min** would be considered fast breathing for an older child or adult, but it is within the normal range for an infant.
- Normal respiratory rates are **higher in infants** and gradually decrease with age.
*>60 breaths/min*
- While a respiratory rate of **>60 breaths/min** is indeed fast and indicates severe respiratory distress, it is not the initial threshold for defining fast breathing in a 6-month-old infant.
- This rate would suggest a more **severe clinical presentation** than simply "fast breathing."
*>40 breaths/min*
- A respiratory rate **>40 breaths/min** is typically considered fast breathing for children aged 1 to 5 years, but not for infants under 12 months.
- For a 6-month-old, this rate is still within the **normal or upper-normal range**, depending on activity and state.
Sleep-Disordered Breathing Indian Medical PG Question 7: According to IMNCI guidelines, what is the definition of fast breathing in a 5-month-old child?
- A. ≥40 breaths per minute
- B. More than 30 breaths per minute
- C. ≥50 breaths per minute (Correct Answer)
- D. ≥60 breaths per minute
Sleep-Disordered Breathing Explanation: ***≥50 breaths per minute***
- For infants aged **2-12 months**, fast breathing is defined as a respiratory rate of **≥50 breaths per minute** according to **WHO IMNCI guidelines**.
- A 5-month-old falls in this age category, making this the correct threshold for identifying **pneumonia** and severe acute respiratory infections.
- This cutoff is critical for **early detection** and appropriate management in primary care settings.
*≥40 breaths per minute*
- This is the cutoff for fast breathing in children aged **12 months to 5 years**, not for infants.
- Using this lower threshold for a 5-month-old would result in **missing cases** of pneumonia that require treatment.
*More than 30 breaths per minute*
- This respiratory rate is normal for older children and adults and is **far below** the threshold for tachypnea in infants.
- Infants have a naturally **higher baseline respiratory rate** due to smaller lung volumes and higher metabolic demands.
*≥60 breaths per minute*
- While this rate indicates significant respiratory distress, it **exceeds** the IMNCI definition of fast breathing for this age group.
- Using this higher threshold would delay recognition and treatment of pneumonia, leading to **worse outcomes**.
Sleep-Disordered Breathing Indian Medical PG Question 8: According to IMNCI, a baby of 6 months of age, the criteria for fast breathing is _____ or more breaths per minute.
- A. 60 breaths per minute
- B. 40 breaths per minute
- C. 30 breaths per minute
- D. 50 breaths per minute (Correct Answer)
Sleep-Disordered Breathing Explanation: ***50 breaths per minute***
- According to **IMNCI (Integrated Management of Neonatal and Childhood Illness)** guidelines, for an infant aged 2 months to 12 months, **fast breathing** is defined as a respiratory rate of 50 breaths per minute or more.
- This threshold helps in the rapid assessment and classification of **respiratory distress** in young children.
*60 breaths per minute*
- A respiratory rate of 60 breaths per minute or more is considered **fast breathing** for infants who are **less than 2 months old**, according to IMNCI guidelines.
- Incorrect for a 6-month-old, as the threshold for fast breathing decreases with age.
*40 breaths per minute*
- A respiratory rate of 40 breaths per minute is generally considered within the normal range for children aged **1 to 5 years**.
- This rate does not indicate **fast breathing** for a 6-month-old infant as per IMNCI criteria.
*30 breaths per minute*
- A respiratory rate of 30 breaths per minute is typically considered normal for **older children** (e.g., 5 years or older) and adults.
- This rate would be **abnormally low** for a 6-month-old infant, not indicative of fast breathing.
Sleep-Disordered Breathing Indian Medical PG Question 9: What is the recommended position of a child during an asthmatic attack?
- A. Supine
- B. Semi erect (Correct Answer)
- C. Erect
- D. Trendelenburg
Sleep-Disordered Breathing Explanation: ***Semi erect***
- A **semi-erect or sitting position** (also called the orthopneic position) is the recommended position for children during an asthmatic attack.
- This position optimizes **lung expansion**, facilitates use of accessory muscles of respiration, and reduces the work of breathing.
- The forward-leaning posture helps to **relieve dyspnea** and is the position most children naturally adopt during respiratory distress.
*Supine*
- Lying flat on the back **worsens breathing difficulty** by allowing abdominal contents to push against the diaphragm, restricting lung expansion.
- This position increases respiratory effort and may worsen **hypoxemia**.
- It also increases the risk of **aspiration** if the child coughs or vomits.
*Erect*
- While a fully upright sitting position is also helpful for breathing, the term **"semi-erect"** or **"sitting"** is more commonly used in clinical guidelines and textbooks when describing the optimal position for acute asthma.
- Both positions are acceptable in practice, but "semi-erect" is the preferred terminology as it encompasses the natural forward-leaning posture children adopt during respiratory distress.
*Trendelenburg*
- In the **Trendelenburg position**, the head is lower than the feet, which **significantly worsens respiratory distress** by increasing pressure on the diaphragm.
- This position is contraindicated in asthma and is used for specific conditions such as **hypotensive shock** or during certain surgical procedures, not for respiratory compromise.
Sleep-Disordered Breathing Indian Medical PG Question 10: All of the following criteria are required for diagnosis of obesity hypoventilation syndrome except -
- A. PaCO2 > 45 mmHg
- B. BMI 30 kg/m2
- C. Hypertension (Correct Answer)
- D. Sleep disorder breathing
Sleep-Disordered Breathing Explanation: ***Hypertension***
- While **hypertension** is a common comorbidity in patients with **obesity hypoventilation syndrome (OHS)**, it is _not_ a diagnostic criterion.
- OHS is defined by specific respiratory and obesity-related parameters, not the presence of associated cardiovascular conditions.
*BMI $\geq$ 30 kg/m$^2$*
- A **body mass index (BMI)** of **30 kg/m$^2$** or greater is a fundamental criterion for diagnosing OHS, as the syndrome is directly linked to obesity.
- Severe obesity leads to mechanical compression of the lungs and chest wall, contributing to hypoventilation.
*PaCO$_{2}$ > 45 mmHg*
- A **daytime arterial partial pressure of carbon dioxide (PaCO$_{2}$)** greater than **45 mmHg** is a key diagnostic criterion, indicating chronic alveolar hypoventilation.
- This persistent hypercapnia is present even when other causes like obstructive lung disease have been excluded.
*Sleep-disordered breathing*
- **Sleep-disordered breathing**, most commonly **obstructive sleep apnea (OSA)**, is almost universally present in OHS patients and is a required diagnostic criterion [1].
- The combination of severe obesity and OSA often leads to the development of chronic hypoventilation [1].
More Sleep-Disordered Breathing Indian Medical PG questions available in the OnCourse app. Practice MCQs, flashcards, and get detailed explanations.
