Sleep-Disordered Breathing — MCQs
2 months old child having birth weight 2kg, with poor feeding, very sleepy and wheezing. The diagnosis is?
Treatment of a 6-year-old child with recurrent URI, mouth breathing, failure to grow with high arched palate and impaired hearing is
Laser uvulopalatoplasty is indicated for which of the following conditions?
Patient with obstructive sleep apnea-hypopnea syndrome is unlikely to have which of the following?
A 3-month-old infant with no chest indrawing and a respiratory rate of 52/minute. The diagnosis is:
Which of the following is not associated with primary ciliary dyskinesia?
Fast breathing in a 6-month-old infant is taken as:
According to IMNCI guidelines, what is the definition of fast breathing in a 5-month-old child?
According to IMNCI, a baby of 6 months of age, the criteria for fast breathing is _____ or more breaths per minute.
What is the recommended position of a child during an asthmatic attack?
Sleep-Disordered Breathing 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: Treatment of a 6-year-old child with recurrent URI, mouth breathing, failure to grow with high arched palate and impaired hearing is
- A. Grommet insertion
- B. Tonsillectomy
- C. Myringotomy with grommet insertion
- D. Adenoidectomy with grommet insertion (Correct Answer)
Explanation: ***Adenoidectomy with grommet insertion*** - **Adenoid hypertrophy** frequently leads to mouth breathing, a high-arched palate, and can contribute to recurrent **otitis media with effusion (OME)**, causing impaired hearing and recurrent upper respiratory infections (URI). An adenoidectomy addresses the primary cause of these symptoms related to the nasopharynx. - **Grommet insertion** (tympanostomy tubes) is often performed concurrently or subsequently to manage the eustachian tube dysfunction and OME directly, restoring hearing and preventing further middle ear complications. The combination targets both the causative factor and the resulting hearing impairment. *Grommet insertion* - While grommet insertion treats the **impaired hearing** caused by otitis media with effusion (OME), it does not address the underlying **adenoid hypertrophy** responsible for mouth breathing, high-arched palate, and recurrent URIs. - Failure to treat the underlying cause means the patient is likely to continue experiencing **nasal obstruction** and potentially recurrent OME once the grommets extrude. *Tonsillectomy* - **Tonsillectomy** primarily addresses issues related to enlarged tonsils, such as recurrent tonsillitis or significant airway obstruction. It does not directly account for the combination of symptoms like a high-arched palate, mouth breathing, or impaired hearing. - While tonsil hypertrophy can contribute to airway issues, **adenoid hypertrophy** is more commonly associated with the specific constellation of symptoms presented, especially the chronic nasal obstruction and middle ear problems. *Myringotomy with grommet insertion* - **Myringotomy with grommet insertion** is synonymous with grommet insertion and specifically addresses **middle ear effusion**, thereby improving hearing. - This procedure treats a symptom (hearing impairment due to OME) but does not resolve the root cause of the patient's comprehensive set of symptoms, such as **mouth breathing**, **high-arched palate**, and **recurrent URI**, which are strongly suggestive of adenoid hypertrophy.
Question 3: Laser uvulopalatoplasty is indicated for which of the following conditions?
- A. Obstructive sleep apnea (Correct Answer)
- B. Pharyngotonsillitis
- C. Cleft palate
- D. Stammering
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.
Question 4: 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 5: 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
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**.
Question 6: Which of the following is not associated with primary ciliary dyskinesia?
- A. Sinusitis
- B. Respiratory infection
- C. Sterility in males
- D. Hypothyroidism (Correct Answer)
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.
Question 7: 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
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.
Question 8: 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
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**.
Question 9: 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)
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.
Question 10: What is the recommended position of a child during an asthmatic attack?
- A. Supine
- B. Semi erect (Correct Answer)
- C. Erect
- D. Trendelenburg
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.
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