Pediatric Obstructive Sleep Apnea — MCQs
2 months old child having birth weight 2kg, with poor feeding, very sleepy and wheezing. The diagnosis is?
Which of the following conditions is treated by laser-assisted uvulopalatoplasty?
Which of the following statements about obstructive sleep apnea is false?
A child presenting with recurrent respiratory tract infections, mouth breathing and decreased hearing. Treatment of choice is
All the following are Causes of spasticity in a 2 year old child except
According to the DSM-5 criteria for Autism Spectrum Disorder, which of the following is required for diagnosis in children?
What is the minimum number of apnea episodes required for the diagnosis of obstructive sleep apnea?
All of the following are correct about the image shown except:
Mainstay of treatment of glue ear -
Patient with obstructive sleep apnea-hypopnea syndrome is unlikely to have which of the following?
Pediatric Obstructive Sleep Apnea Indian Medical PG Practice Questions and MCQs
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
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
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: Which of the following statements about obstructive sleep apnea is false?
- A. Apnea is associated with high respiratory effort
- B. Apnea is associated with fall in SpO2
- C. Apnea is associated with sudden awakening
- D. Contraction of pharyngeal muscles can worsen obstruction (Correct Answer)
Explanation: ***Contraction of pharyngeal muscles can worsen obstruction*** - In **obstructive sleep apnea (OSA)**, the pharyngeal muscles are normally responsible for maintaining airway patency [1]. - A *contraction* of these muscles would *open* the airway, whereas *relaxation* or *loss of tone* leads to collapse and obstruction. *Apnea is associated with high respiratory effort* - During an **apneic episode** in OSA, the airway is *obstructed*, leading to continued but **unsuccessful inspiratory efforts** against a closed airway. - This results in a significant increase in **respiratory effort** as the diaphragm and accessory muscles try to overcome the obstruction. *Apnea is associated with fall in SpO2* - The cessation of airflow during **apnea** prevents **gas exchange**, leading to a progressive decrease in **oxygen saturation (SpO2)**. - This **hypoxia** is a hallmark physiological consequence of apneic events and often triggers arousal from sleep [2]. *Apnea is associated with sudden awakening* - The combination of **hypoxia** and **hypercapnia** (increased CO2), along with the increased respiratory effort, stimulates the central nervous system [2]. - This stimulation causes a **brief arousal or awakening** from sleep, often accompanied by gasping or snorting, to re-establish airway patency.
Question 4: 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 5: All the following are Causes of spasticity in a 2 year old child except
- A. Congenital muscular dystrophy (Correct Answer)
- B. Cerebral Palsy
- C. Kernicterus
- D. Birth asphyxia
Explanation: ***Congenital muscular dystrophy*** - This condition is characterized by **muscle weakness and hypotonia**, not spasticity, due to primary muscle pathology. - Spasticity is a sign of **upper motor neuron involvement**, whereas muscular dystrophies are disorders of peripheral muscle fibers resulting in **flaccid weakness**. *Cerebral Palsy* - This is the **most common cause of spasticity in children**, resulting from **non-progressive brain injury during development**. - **Spastic cerebral palsy** accounts for 70-80% of CP cases, characterized by increased muscle tone, hyperreflexia, and extensor plantar responses. *Kernicterus* - **Bilirubin encephalopathy** from severe neonatal hyperbilirubinemia causes **basal ganglia damage**. - Results in **extrapyramidal cerebral palsy** with spasticity, choreoathetosis, and developmental delays. *Birth asphyxia* - **Hypoxic-ischemic encephalopathy** from perinatal asphyxia causes **upper motor neuron damage**. - Leads to spastic quadriplegia or diplegia with increased tone, hyperreflexia, and developmental impairment.
Question 6: According to the DSM-5 criteria for Autism Spectrum Disorder, which of the following is required for diagnosis in children?
- A. Language delay before age 2
- B. Persistent deficits in social communication and interaction (Correct Answer)
- C. Presence of seizure disorder
- D. Intellectual disability
Explanation: ***Persistent deficits in social communication and interaction*** - This is a **core diagnostic criterion** for Autism Spectrum Disorder (ASD) according to DSM-5, encompassing difficulties in social-emotional reciprocity, nonverbal communicative behaviors, and developing/maintaining relationships. - These deficits must be present across **multiple contexts** and not better explained by other conditions. *Language delay before age 2* - While language delay is common in ASD, it is **not a mandatory diagnostic criterion** in the DSM-5; some individuals with ASD may have typical or even advanced language skills. - The focus has shifted from specific language milestones to broader **social communication deficits**. *Presence of seizure disorder* - **Seizures** are a co-occurring medical condition that can affect individuals with ASD, but they are absolutely **not a diagnostic criterion** for the disorder itself. - The presence of a seizure disorder suggests comorbidity, not a defining feature of autism. *Intellectual disability* - **Intellectual disability** frequently co-occurs with ASD (approximately 30-50% of cases), but it is **not a required criterion** for diagnosis. - Many individuals with ASD have average or above-average intellectual abilities.
Question 7: 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 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: Mainstay of treatment of glue ear -
- A. Temporal bone resection
- B. Tonsillectomy & adenoidectomy
- C. Radical Mastoidectomy
- D. Myringotomy + aeration to middle ear (Correct Answer)
Explanation: ***Myringotomy + aeration to middle ear*** - **Myringotomy** involves creating a small incision in the eardrum to drain fluid, and inserting a **grommet (ventilation tube)** to aerate the middle ear, which is the primary treatment for persistent glue ear (otitis media with effusion). - This procedure aims to restore ventilation to the middle ear, allowing trapped fluid to drain and preventing recurrent fluid accumulation, which improves hearing. *Temporal bone resection* - This is a major surgical procedure involving the removal of part of the temporal bone, typically reserved for extensive **malignant tumors** or severe infections, and is not indicated for glue ear. - It carries significant risks and is disproportionate to the treatment of a benign condition like glue ear. *Tonsillectomy & adenoidectomy* - While **adenoidectomy** can sometimes be performed in conjunction with grommet insertion if enlarged adenoids contribute to eustachian tube dysfunction, it is not the **primary treatment** for glue ear itself. - **Tonsillectomy** is generally performed for recurrent tonsillitis and has no direct role in treating glue ear. *Radical Mastoidectomy* - This is a highly invasive surgical procedure involving the removal of the mastoid air cells and part of the external auditory canal, typically performed for severe **cholesteatoma** or chronic mastoiditis. - It is an extensive and risky operation that is not appropriate for the management of glue ear, which is a much milder condition.
Question 10: 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.
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