Continuous Positive Airway Pressure — MCQs
Modafinil is approved by FDA for treatment of all except:
A 42-year-old obese male presented with disturbed sleep and daytime somnolence. All of the following are correct except?
Patient with obstructive sleep apnea-hypopnea syndrome is unlikely to have which of the following?
What is not true about the use of intranasal steroids in nasal polyposis?
What is the minimum number of apnea episodes required for the diagnosis of obstructive sleep apnea?
A man is brought to casualty who met with an accident. He sustained multiple rib fractures with paradoxical movement of chest. Management is:
A neonate with micrognathia has episodes of cyanosis while feeding. Best management is:
A patient arrived in ER following an RTA with hypotension, respiratory distress and subcutaneous emphysema with no entry of air on one side. What will be the best management?
What is to be addressed first in case of polytrauma -
In case of Labour complicated with cord prolapse, which of the following statements are correct? 1. Reposition the patient in exaggerated Sims position 2. To replace the cord in the vagina 3. To replace the cord inside the uterus 4. Early amniotomy can prevent cord prolapse Select the correct answer using the code given below:
Continuous Positive Airway Pressure Indian Medical PG Practice Questions and MCQs
Question 1: Modafinil is approved by FDA for treatment of all except:
- A. Narcolepsy
- B. Shift work sleep disorder (SWSD)
- C. Obstructive sleep apnea syndrome (OSAS)
- D. Lethargy in depression (Correct Answer)
Explanation: ***Lethargy in depression*** - Modafinil is **not FDA-approved** for treating lethargy or fatigue specifically in the context of depression. Its primary indications are for disorders of excessive daytime sleepiness. - While it may be used off-label in some cases for depression-related fatigue, it lacks formal FDA approval and specific efficacy data for this indication. *Narcolepsy* - Modafinil is **FDA-approved** as a wakefulness-promoting agent for the treatment of excessive daytime sleepiness associated with **narcolepsy**. - It helps reduce the frequency and severity of sleep attacks by promoting wakefulness through effects on **dopamine**, **norepinephrine**, and **histamine** systems in the brain. *Shift work sleep disorder (SWSD)* - Modafinil is **FDA-approved** to improve wakefulness in patients with excessive sleepiness associated with **shift work sleep disorder**. - It helps individuals working non-traditional hours (night shifts, rotating shifts) maintain alertness during their work periods. *Obstructive sleep apnea syndrome (OSAS)* - Modafinil is **FDA-approved** as an **adjunctive treatment** for residual excessive daytime sleepiness in patients with **obstructive sleep apnea/hypopnea syndrome (OSAHS)** who are receiving adequate treatment with CPAP. - It addresses persistent sleepiness that remains even after appropriate primary airway management.
Question 2: A 42-year-old obese male presented with disturbed sleep and daytime somnolence. All of the following are correct except?
- A. Apnea with hypoxia
- B. Pharyngeal muscle contraction increases OSA (Correct Answer)
- C. Apnea with awakening
- D. Apnea with fall in saturation
Explanation: ***Pharyngeal muscle contraction increases OSA*** - Obstructive sleep apnea (OSA) is caused by the collapse of the upper airway due to the **relaxation** and consequent loss of tone in the **pharyngeal muscles** during sleep, not by their contraction [1]. - While muscle contraction normally helps maintain airway patency, **reduced muscle activity** allows the airway to narrow or collapse. *Apnea with hypoxia* - **Apnea**, defined as a cessation of breathing for at least 10 seconds, often leads to periods of **hypoxia** (decreased blood oxygen levels) due to insufficient gas exchange [1]. - This **recurrent hypoxia** is a hallmark of OSA and contributes to its cardiovascular and neurological consequences. *Apnea with awakening* - Following an apneic episode, the body's protective reflex often causes a brief **arousal or awakening** from sleep to restore airway patency and ventilation [2]. - These frequent **micro-awakenings** are a primary reason for the disturbed sleep and subsequent daytime somnolence experienced by patients with OSA [2]. *Apnea with fall in saturation* - During an apneic event, the lack of airflow into the lungs results in a **decrease in oxygen saturation (SpO2)**, which is a key diagnostic criterion for OSA severity [2]. - This **desaturation** is directly linked to the duration and frequency of apneic episodes.
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
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.
Question 4: What is not true about the use of intranasal steroids in nasal polyposis?
- A. Effective in all types of nasal polyps (Correct Answer)
- B. May cause nasal irritation
- C. Reduce recurrence
- D. Most effective in eosinophilically predominant polyps
Explanation: ***Effective in all types of nasal polyps*** - Intranasal steroids are primarily effective in nasal polyps with an **eosinophilic inflammatory component**, which is the most common type. - They are **not effective in all types** - efficacy is significantly reduced in polyps with **neutrophilic inflammation** or those related to conditions like **cystic fibrosis**, reflecting different underlying pathologies. - This statement is **FALSE**, making it the correct answer to this negation question. *May cause nasal irritation* - **Nasal irritation**, including **burning, stinging**, or **dryness**, is a common local side effect associated with the use of intranasal steroids. - Other local side effects can include **epistaxis** (nosebleeds) and mucosal atrophy, though less common. - This statement is **TRUE**. *Reduce recurrence* - **Intranasal steroids** are crucial in **reducing the recurrence** of nasal polyps after surgical removal. - Their anti-inflammatory action helps to **control the underlying inflammation** that contributes to polyp formation. - This statement is **TRUE**. *Most effective in eosinophilically predominant polyps* - Intranasal steroids primarily target the **eosinophilic inflammatory pathway**, which is characteristic of the majority of **chronic rhinosinusitis with nasal polyps (CRSwNP)**. - While they have **maximal efficacy** in eosinophilic polyps, they may have limited benefit in mixed inflammatory patterns. - Their efficacy is significantly reduced in polyps that are predominantly **neutrophilic** or associated with systemic conditions like **cystic fibrosis**, as these involve different inflammatory mechanisms. - This statement is **TRUE**.
Question 5: What is the minimum number of apnea episodes required for the diagnosis of obstructive sleep apnea?
- A. AHI ≥ 10 events/hour
- B. AHI ≥ 2 events/hour
- C. AHI ≥ 5 events/hour (Correct Answer)
- D. AHI ≥ 4 events/hour
Explanation: ***AHI ≥ 5 events/hour*** - An **apnea-hypopnea index (AHI)** of 5 or more events per hour of sleep, accompanied by symptoms such as **daytime sleepiness**, snoring, or witnessed apneas, is the diagnostic criterion for obstructive sleep apnea (OSA) [1]. - This threshold signifies a clinically significant frequency of **breathing disturbances** during sleep [1]. *AHI ≥ 2 events/hour* - An AHI of 2 events/hour is generally considered within the **normal range** or indicates very mild, non-pathological sleep disordered breathing. - It is **insufficient** to diagnose OSA in adults, even with associated symptoms. *AHI ≥ 10 events/hour* - An AHI of 10 events/hour would indicate at least **mild to moderate OSA**, well above the minimum diagnostic threshold. - While diagnostic, it is not the *minimum* number required for initial diagnosis. *AHI ≥ 4 events/hour* - An AHI of 4 events/hour is close to the diagnostic threshold but still **below the minimum** required for a formal diagnosis of OSA. - It would typically be considered **mild sleep-disordered breathing** that may not meet diagnostic criteria without other significant factors.
Question 6: A man is brought to casualty who met with an accident. He sustained multiple rib fractures with paradoxical movement of chest. Management is:
- A. Strapping
- B. Intermittent positive pressure ventilation (Correct Answer)
- C. Tracheostomy
- D. Consult cardiothoracic surgeon
Explanation: ***Intermittent positive pressure ventilation*** - **Flail chest** with paradoxical movement indicates severe respiratory compromise requiring immediate support. - **Positive pressure ventilation** stabilizes the chest wall internally and improves oxygenation. *Strapping* - **Strapping** the chest for rib fractures is now discouraged as it can restrict breathing and increase the risk of atelectasis and pneumonia. - It does not effectively stabilize a flail segment; instead, it can worsen respiratory distress. *Tracheostomy* - While a **tracheostomy** might be considered for long-term airway management in severe trauma, it is not the primary immediate management for flail chest with paradoxical movement. - The initial priority is to stabilize ventilation, which can often be achieved with endotracheal intubation and mechanical ventilation. *Consult cardiothoracic surgeon* - Consulting a **cardiothoracic surgeon** is important for definitive management and considering surgical stabilization, but it is not the immediate first-line management in the emergency setting for stabilizing paradoxical chest movement. - The immediate priority is to secure the airway and support ventilation.
Question 7: A neonate with micrognathia has episodes of cyanosis while feeding. Best management is:
- A. Tongue-lip adhesion
- B. Prone positioning (Correct Answer)
- C. CPAP
- D. Tracheostomy
Explanation: ***Prone positioning*** - This helps by allowing the **tongue to fall forward** due to gravity, preventing it from obstructing the airway. - It's a non-invasive, initial management strategy for neonates with **micrognathia** causing airway obstruction, especially during feeding. *Tongue-lip adhesion* - This is a surgical procedure considered for more severe cases where **prone positioning** and other conservative measures fail. - It involves suturing the **tongue to the lower lip** to keep the airway open. *CPAP* - **Continuous positive airway pressure** can help maintain airway patency by providing constant pressure. - While it can be useful in some cases of airway obstruction, it might not be the initial best approach for feeding-related cyanosis in micrognathia, and **prone positioning** is simpler and often effective first. *Tracheostomy* - This is an **invasive surgical procedure** to create an artificial airway, reserved for severe, life-threatening airway obstruction that cannot be managed by other means. - It is not the initial or best management for recurrent cyanosis during feeding due to **micrognathia**, unless other measures have proven insufficient.
Question 8: A patient arrived in ER following an RTA with hypotension, respiratory distress and subcutaneous emphysema with no entry of air on one side. What will be the best management?
- A. Needle decompression in 5th intercostal space in the midaxillary line (Correct Answer)
- B. Continue PPV
- C. Shift to ICU and intubate
- D. Secure IV line and start fluid resuscitation after insertion of the wide-bore IV line
Explanation: ***Needle decompression in 5th intercostal space in the midaxillary line*** - The combination of **hypotension**, **respiratory distress**, and **subcutaneous emphysema** without unilateral tracheal deviation strongly suggests **tension pneumothorax**. - **Needle decompression** in the 5th intercostal space at the midaxillary line is the immediate life-saving intervention to relieve the pressure while awaiting definitive chest tube insertion. *Continue PPV* - Continuing **positive pressure ventilation (PPV)** in a patient with a tension pneumothorax would worsen the condition by increasing intrathoracic pressure and exacerbating hemodynamic instability. - PPV can force more air into the pleural space, converting a simple pneumothorax into a **tension pneumothorax** or worsening an existing one, leading to quicker deterioration. *Shift to ICU and intubate* - While critical care management and intubation might eventually be necessary, these are not the **immediate life-saving interventions** required for a tension pneumothorax. - Delaying needle decompression to transfer the patient to the ICU or intubate could lead to **cardiac arrest** due to severe hemodynamic compromise. *Secure IV line and start fluid resuscitation after insertion of the wide-bore IV line* - **Fluid resuscitation** is important for managing hypovolemic shock, but it will not address the underlying **mechanical compression** of the heart and great vessels caused by a tension pneumothorax. - While securing an IV line is a crucial step in trauma management, addressing the tension pneumothorax takes immediate priority to prevent further **cardiovascular collapse**.
Question 9: What is to be addressed first in case of polytrauma -
- A. Circulation
- B. Neurology
- C. Blood Pressure
- D. Airway (Correct Answer)
Explanation: ***Airway*** - Maintaining a **patent airway** is the absolute first priority in polytrauma management according to the **ATLS (Advanced Trauma Life Support)** protocol. - Failure to secure an airway can lead to **hypoxia** and **brain damage** within minutes, regardless of other injuries. *Circulation* - While critical, addressing **circulation** (C in ABCDE) comes after establishing a secure airway and adequate breathing (A and B). - Uncontrolled hemorrhage would be the focus of circulation management, but only after guaranteeing proper oxygenation. *Neurology* - Neurological assessment (D in ABCDE for Disability) follows the primary survey of airway, breathing, and circulation. - Initial neurological evaluation focuses on **level of consciousness** using the **GCS (Glasgow Coma Scale)**. *Blood Pressure* - **Blood pressure** is an indicator of circulatory status but is not the first thing to be addressed. - It falls under the "C" for circulation in the ATLS protocol, which is secondary to airway and breathing.
Question 10: In case of Labour complicated with cord prolapse, which of the following statements are correct? 1. Reposition the patient in exaggerated Sims position 2. To replace the cord in the vagina 3. To replace the cord inside the uterus 4. Early amniotomy can prevent cord prolapse Select the correct answer using the code given below:
- A. 1 only (Correct Answer)
- B. 1 and 2 only
- C. 3 and 4 only
- D. 1, 2, 3 and 4
Explanation: ***Correct: 1 only*** **Statement 1 - Reposition the patient in exaggerated Sims position** ✓ - **Correct** - Immediate repositioning (knee-chest, Trendelenburg, or exaggerated Sims position) is crucial to reduce pressure on the prolapsed cord and relieve compression - This helps displace the presenting part away from the cord using gravity **Statement 2 - To replace the cord in the vagina** ✗ - **Incorrect** - Manipulation or replacement of the prolapsed cord is **contraindicated** as it can cause vasospasm and further compromise fetal circulation - The correct approach is to **elevate the presenting part manually** (pushing it up off the cord) while keeping the cord moist and warm, NOT to reposition the cord itself **Statement 3 - To replace the cord inside the uterus** ✗ - **Incorrect** - This is contraindicated as it carries high risk of uterine infection, cord trauma, and vasospasm - Does not reliably prevent recurrence of prolapse **Statement 4 - Early amniotomy can prevent cord prolapse** ✗ - **Incorrect** - Early amniotomy actually **increases** the risk of cord prolapse, especially when the presenting part is not well-engaged - It removes the cushioning effect of forewaters that help keep the cord in place **Correct management of cord prolapse includes:** - Immediate repositioning (Trendelenburg/knee-chest position) - Manual elevation of presenting part to relieve cord compression - Keeping the prolapsed cord moist and warm - Avoiding cord manipulation - Emergency cesarean delivery or instrumental delivery if feasible *Incorrect: 1 and 2 only* - While statement 1 is correct, statement 2 (replacing the cord in vagina) is medically incorrect and contraindicated *Incorrect: 3 and 4 only* - Both statements are incorrect as explained above *Incorrect: 1, 2, 3 and 4* - Only statement 1 is correct; statements 2, 3, and 4 are all incorrect
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