Pediatric Sleep Apnea — MCQs
Child wakes up at night sweating and terrified, does not remember the episode - diagnosis?
Which of the following conditions is treated by laser-assisted uvulopalatoplasty?
A 3-4 month old baby with heart rate 250/min, QRS complex less than 0.07 sec and no P wave, Diagnosis will be :
Severe Obstructive sleep apnea is defined as AHI of greater than
Which of the following is not seen in scoline apnea?
A child presenting with recurrent respiratory tract infections, mouth breathing and decreased hearing. Treatment of choice is
A 1-year-old child has spastic cerebral palsy. Which of the following tests is being performed on the child?
All of the following are correct about the image shown except:
The facial features shown in the image are characteristic of:
What is the immediate management of a child with foreign body inhalation?
Pediatric Sleep Apnea Indian Medical PG Practice Questions and MCQs
Question 1: Child wakes up at night sweating and terrified, does not remember the episode - diagnosis?
- A. Narcolepsy
- B. Nightmares
- C. Night terrors (Correct Answer)
- D. Somnambulism
Explanation: ***Night terrors*** - **Night terrors** are characterized by partial arousals from **deep non-REM sleep** (typically N3 stage), often accompanied by loud screams, thrashing, and autonomic symptoms like sweating and tachycardia. - The child is very difficult to awaken or comfort during an episode and, crucially, has **no memory of the event** upon waking, which differentiates it from nightmares. *Narcolepsy* - **Narcolepsy** is a chronic neurological condition characterized by overwhelming daytime **sleepiness** and sudden attacks of sleep. - It often involves **cataplexy** (sudden loss of muscle tone triggered by strong emotions) and **hypnagogic/hypnopompic hallucinations**, which are not described. *Nightmares* - **Nightmares** are vivid, frightening dreams that occur during **REM sleep** and typically result in full awakening and the ability to **recall the dream content**. - While they cause fear and distress, episodes do not usually involve the terrified unresponsiveness or lack of recall seen in night terrors. *Somnambulism* - **Somnambulism** (sleepwalking) occurs during **deep non-REM sleep**, and affected individuals may perform complex actions while partially aroused. - While there is amnesia for the event, prominent features like **sweating and intense terror** are not typical components of sleepwalking.
Question 2: Which of the following conditions is treated by laser-assisted uvulopalatoplasty?
- A. Stammering
- B. Pharyngotonsillitis
- C. Snoring (Correct Answer)
- D. Cleft palate
Explanation: ***Snoring*** - **Laser-assisted uvulopalatoplasty (LAUP)** is a surgical procedure used to **reduce or eliminate snoring** by reshaping the uvula and soft palate. - This procedure helps to open the airway by removing excess tissue, thereby reducing vibrations that cause snoring. *Stammering* - Stammering, or stuttering, is a **speech disorder** characterized by repetitions or prolongations of sounds, syllables, or words. - Its treatment typically involves **speech therapy** and behavioral interventions, not surgical procedures like LAUP. *Pharyngotonsillitis* - Pharyngotonsillitis is an inflammation of the **pharynx and tonsils**, commonly caused by bacterial or viral infections. - Treatment usually involves **antibiotics** for bacterial infections or supportive care for viral infections, and in severe recurrent cases, a **tonsillectomy** may be performed, not LAUP. *Cleft palate* - A cleft palate is a birth defect where the roof of the mouth does not form completely, resulting in an **opening that can extend to the nasal cavity**. - Its treatment involves **reconstructive surgery** to close the opening, often performed in infancy, which is distinct from LAUP.
Question 3: A 3-4 month old baby with heart rate 250/min, QRS complex less than 0.07 sec and no P wave, Diagnosis will be :
- A. VT
- B. PSVT with block
- C. SVT (Correct Answer)
- D. Sinus tachycardia
Explanation: **SVT** - A heart rate of 250/min in a 3-4 month old infant, along with a **narrow QRS complex (<0.07 sec)**, is highly indicative of **supraventricular tachycardia (SVT)**. - The **absence of visible P waves** suggests that the atrial activity is either too rapid to be clearly distinguished or is retrograde and hidden within the QRS complex. *VT* - **Ventricular tachycardia (VT)** is characterized by **wide QRS complexes** (typically >0.09-0.10 sec in adults, proportionally less in infants) because the impulse originates in the ventricles. - The patient's QRS complex is **narrow (<0.07 sec)**, ruling out typical VT. *PSVT with block* - **Paroxysmal supraventricular tachycardia (PSVT) with block** would still present with a rapid atrial rate, and while there might be block to the ventricles, the dominant rhythm would stem from supraventricular activity causing narrow QRS, but the term "with block" usually implies some degree of AV nodal block which would lead to a ventricular rate slower than the atrial rate, unlike the observed 250/min. - The absence of P waves makes identification of a specific "block" pattern difficult, and the high ventricular rate favors a direct conduction rather than a blocked rhythm limiting ventricular response. *Sinus tachycardia* - **Sinus tachycardia** is usually characterized by discernible **P waves** preceding each QRS complex and a heart rate that typically doesn't exceed 220 bpm in infants unless under extreme physiological stress. - A heart rate of 250/min is generally above the physiological limit for sinus tachycardia in infants, and the **absence of P waves** further distinguishes it from sinus tachycardia.
Question 4: Severe Obstructive sleep apnea is defined as AHI of greater than
- A. 15 events/hour
- B. 30 events/hour (Correct Answer)
- C. 25 events/hour
- D. 20 events/hour
Explanation: ***30 events/hour*** - A **severe form of obstructive sleep apnea (OSA)** is diagnosed when the Apnea-Hypopnea Index (AHI) is greater than or equal to **30 events per hour** [1]. - The AHI represents the average number of **apnea and hypopnea events** per hour of sleep [1]. *15 events/hour* - An AHI of **15 to 30 events/hour** typically defines **moderate sleep apnea**, not severe. - This level indicates a significant number of sleep disturbances, but less than what is categorized as severe. *25 events/hour* - An AHI of **25 events/hour** falls within the **moderate range** of OSA severity (15-30 events/hour). - It does not meet the criteria for severe OSA, which requires a higher AHI. *20 events/hour* - An AHI of **20 events/hour** also falls into the **moderate category** of OSA. - This value is above the threshold for mild OSA (5-15 events/hour) but below the threshold for severe OSA.
Question 5: Which of the following is not seen in scoline apnea?
- A. It occurs due to deficiency of acetylcholinesterase (Correct Answer)
- B. It is due to succinylcholine
- C. Patients usually do not die of scoline apnea if they are properly managed
- D. It can be inherited
Explanation: ***It occurs due to deficiency of acetylcholinesterase*** - **Scoline apnea** is caused by a deficiency of **pseudocholinesterase (butyrylcholinesterase)**, not acetylcholinesterase. - **Pseudocholinesterase** is responsible for metabolizing **succinylcholine**, while acetylcholinesterase breaks down acetylcholine at the neuromuscular junction. *It is due to succinylcholine* - **Scoline apnea** is indeed triggered by the administration of **succinylcholine** in individuals with a genetic defect in **pseudocholinesterase**. - Without proper metabolism by pseudocholinesterase, succinylcholine prolongs its action, leading to prolonged neuromuscular blockade. *Patients usually do not die of scoline apnea if they are properly managed* - With appropriate management, which involves **mechanical ventilation** until the succinylcholine is metabolized, patients typically recover fully from scoline apnea. - The primary risk is respiratory failure due to prolonged paralysis, which can be managed by supportive care. *It can be inherited* - The deficiency of **pseudocholinesterase** that causes scoline apnea is an **autosomal recessive inherited disorder**. - Genetic testing can identify individuals who are at risk for this condition.
Question 6: A child presenting with recurrent respiratory tract infections, mouth breathing and decreased hearing. Treatment of choice is
- A. Grommet insertion
- B. Tonsillectomy
- C. Myringotomy
- D. Adenoidectomy (Correct Answer)
Explanation: ***Adenoidectomy*** - The combination of **recurrent respiratory tract infections**, **mouth breathing**, and **decreased hearing** strongly suggests hypertrophied adenoids. - **Adenoidectomy** is the definitive treatment to remove the enlarged adenoids, alleviating airway obstruction and improving Eustachian tube function. *Grommet insertion* - **Grommet insertion** (tympanostomy tubes) is primarily done for **recurrent acute otitis media** or **otitis media with effusion** to ventilate the middle ear. - While it can help hearing loss secondary to middle ear fluid, it doesn't address the underlying cause of recurrent infections and mouth breathing from adenoid hypertrophy. *Tonsillectomy* - **Tonsillectomy** is indicated for **recurrent tonsillitis** or significant **obstructive sleep apnea** due to enlarged tonsils. - Although often performed with adenoidectomy, the primary symptoms described (mouth breathing, recurrent URTIs, hearing loss) point more specifically to adenoid issues than tonsillar hypertrophy alone. *Myringotomy* - **Myringotomy** is a surgical incision into the **eardrum** to drain fluid from the middle ear. - It is often a first step before grommet insertion but doesn't provide a long-term solution for recurrent fluid or address the underlying cause of Eustachian tube dysfunction, which is often adenoid hypertrophy.
Question 7: A 1-year-old child has spastic cerebral palsy. Which of the following tests is being performed on the child?
- A. Otoacoustic emission
- B. Brainstem evoked auditory response (Correct Answer)
- C. Pure tone audiometry
- D. Caloric electronystagmogram
Explanation: ***Brainstem evoked auditory response*** - The image shows a child with electrodes placed on the head and an earphone in the ear, along with a waveform graph labeled "Neonate" and showing peaks I, III, and V, which are characteristic of **Brainstem Evoked Auditory Response (BAER)**, also known as ABR. - BAER is an objective and reliable test for assessing **auditory nerve and brainstem pathways** in infants and uncooperative individuals, making it suitable for a 1-year-old with spastic cerebral palsy to screen for hearing loss. *Otoacoustic emission* - This test measures sounds produced by the **cochlea's outer hair cells** and is primarily used for **newborn hearing screening**. - While also objective, it does not assess the **auditory nerve or brainstem function**, which is often crucial in children with neurological conditions like cerebral palsy. *Pure tone audiometry* - This is a **subjective test** that requires the patient to respond to different tones, which is not feasible for a 1-year-old child, especially one with spastic cerebral palsy. - It measures the **thresholds of hearing across different frequencies** but cannot be performed reliably in uncooperative patients. *Caloric electronystagmogram* - This test assesses the function of the **vestibular system** by introducing warm or cold water into the ear canal to induce nystagmus. - It is used to evaluate **balance disorders** and vertigo, not for assessing primary hearing loss, and is generally performed in older children or adults.
Question 8: All of the following are correct about the image shown except:
- A. Omega shaped epiglottis
- B. High pitched expiratory stridor (Correct Answer)
- C. Cry is normal
- D. 10% cases need surgery due to development of OSA or Cor Pulmonale
Explanation: ***High pitched expiratory stridor*** - The image depicts an **omega-shaped epiglottis** and collapsed aryepiglottic folds, consistent with **laryngomalacia**. - Laryngomalacia typically presents with **inspiratory stridor**, not expiratory, resulting from airway collapse during inspiration. - **This is the EXCEPT answer** - high-pitched expiratory stridor is NOT a feature of laryngomalacia. *Omega shaped epiglottis* - The image clearly shows an **omega-shaped epiglottis**, a characteristic feature of **laryngomalacia**. - This anatomical variation contributes to the collapse of supraglottic structures during inspiration. *Cry is normal* - In laryngomalacia, the **vocal cords** themselves are not affected, so the **cry typically remains normal**. - The abnormal sounds (stridor) arise from the supraglottic structures, not the vocal cord function during crying. *10% cases need surgery due to development of OSA or Cor Pulmonale* - While most cases of laryngomalacia are self-limiting, approximately **10% of infants may require surgical intervention** (supraglottoplasty). - This is usually due to severe symptoms like **obstructive sleep apnea (OSA)**, failure to thrive, or the rare development of **cor pulmonale**.
Question 9: The facial features shown in the image are characteristic of:
- A. Frog face deformity
- B. Adenoid facies (Correct Answer)
- C. Ashen grey facies
- D. Thyrotoxicosis
Explanation: ***Adenoid facies*** - The image displays characteristic features of adenoid facies, including a **long, open-mouthed face**, a **pinched nose**, and possibly a **high-arched palate** due to chronic mouth breathing from enlarged adenoids. - This chronic condition often leads to a dull expression, sometimes with **strabismus** (crossed eyes) as seen in the image, and a forward head posture. *Frog face deformity* - This deformity is characterized by **ocular hypertelorism** (widely spaced eyes), a **flat nasal bridge**, and a **short nose**, often associated with conditions like Apert syndrome. - While there is some facial dysmorphology, the specific combination of features does not align with a typical frog face. *Ashen grey facies* - This refers to a **pale, grayish complexion**, often indicative of severe cardiovascular compromise like **circulatory collapse** or **shock**. - The child in the image has a normal skin tone for their ethnicity and does not show signs of acute circulatory distress. *Thyrotoxicosis* - **Thyrotoxicosis** (hyperthyroidism) in children can cause symptoms like **exophthalmos** (bulging eyes), **tachycardia**, weight loss, and an enlarged thyroid gland. - While the child's eyes appear wide-set and sometimes strabismic, these are more consistent with the long-term effects of chronic mouth breathing on facial development rather than acute thyroid dysfunction.
Question 10: What is the immediate management of a child with foreign body inhalation?
- A. Intermittent Positive Pressure Ventilation (IPPV)
- B. Bronchoscopy (Correct Answer)
- C. Tracheostomy
- D. Exploratory Thoracotomy
Explanation: **Explanation:** **Foreign body (FB) inhalation** is a life-threatening emergency in the pediatric population, most commonly occurring in children aged 1–3 years. 1. **Why Bronchoscopy is the Correct Answer:** Rigid bronchoscopy is the **gold standard** for both the diagnosis and management of inhaled foreign bodies. It allows for direct visualization of the airway, provides a secure channel for ventilation, and facilitates the use of specialized forceps to grasp and remove the object. In an emergency setting, removing the obstruction is the definitive step to restore airway patency. 2. **Why Other Options are Incorrect:** * **IPPV (A):** Positive pressure ventilation is contraindicated if a foreign body is partially obstructing the airway, as it can push the object deeper into the distal tracheobronchial tree, leading to a complete "ball-valve" obstruction or total lung collapse. * **Tracheostomy (C):** This is indicated for upper airway obstructions (at or above the larynx). Since most inhaled foreign bodies lodge in the main bronchi (right more commonly than left), a tracheostomy would not bypass the obstruction. * **Exploratory Thoracotomy (D):** This is a major surgical procedure reserved only for rare cases where endoscopic removal fails or if the foreign body has caused severe vascular injury or irreversible lung damage. **High-Yield Clinical Pearls for NEET-PG:** * **Most Common Site:** Right main bronchus (due to it being wider, shorter, and more vertical than the left). * **Classic Triad:** Sudden onset of coughing, wheezing, and diminished breath sounds. * **Radiology:** The most common finding is **obstructive emphysema** (air trapping) on expiratory films. Radio-opaque objects are seen in only ~10-15% of cases. * **Vegetable FB:** Peanuts are the most common; they cause a severe inflammatory reaction known as **vegetal bronchitis**.
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