Deck 25: Pediatric Sleep-Disordered Breathing

Question 1

Which of the following statements best describes central sleep apnea?

A) Absence of respiratory effort and airflow.
B) Only abdominal movements occur with no airflow.
C) Only thoracic movements occur.
D) Paradoxical breathing movements occur.

Answer 1

A
In central sleep apnea (CSA), there is an absence of respiratory effort and airflow.

Question 2

What is the leading cause of death in infants?

A) Congenital malformations
B) CSA
C) SIDS
D) ALTE

Answer 2

C
Sudden infant death syndrome (SIDS) is a devastating event that accounted for 2226 infant deaths in 2009. It is the leading cause of death in infants in the first 12 months of life and is the third leading cause of death in infants overall in the United States. It is defined as "the sudden death of an infant less than one year of age, which remains unexplained after a thorough case investigation, including performance of a complete autopsy, examination of the death scene, and review of the clinical history".

Question 3

Which of the following body systems is the most important to evaluate when considering differential diagnoses for ALTE?

A) Gastrointestinal
B) Neurological
C) Respiratory
D) Cardiac

Answer 3

A
See Box 25-4. Evaluation must include a thorough history, including a family and social history. An accurate description of the event is crucial. A full review of systems and thorough physical examination should help to narrow the very extensive differential diagnosis. The physical examination should examine carefully for bruising and should include a full neurological examination including muscle tone and funduscopic examination. The physical examination should include a search for dysmorphic features, and abnormalities of the upper airway, chest, and cardiovascular system should be sought. Basic measurements of head circumference, body weight, length, and blood pressure should be made and compared with norms.

Question 4

Which of the following statements best describes the condition sudden infant death syndrome (SIDS)?

A) More than 70% of victims are found in the late evening hours after the afternoon naps.
B) Infants are most likely to experience SIDS in the first 12 to 24 months of life.
C) 90% of SIDS victims were affected after the first 6 months of life.
D) SIDS almost always takes place when the infant is presumed to have been asleep, either during the day or at night.

Question 5

According to the American Academy of Pediatrics, in addition to cessation of breathing, which of the following clinical signs is associated with central sleep apnea?

A) Tachycardia
B) Cyanosis
C) Hypertension
D) Hypertonia

Question 6

A newborn at 28 weeks of gestation is demonstrating periods of apnea. In addition to ventilatory support, what other treatment can the therapist suggest?

A) Placement of an oropharyngeal airway
B) Caffeine
C) Theophylline
D) Beta blockers

Question 7

Which of the following conditions is the major cause of OSA in children without any predisposing factor?

A) Choanal atresia
B) Macroglossia
C) Adenotonsillar hypertrophy
D) Pierre Robin Syndrome

Question 8

The childhood syndrome of OSA is distinct from adult OSA. Which of the following features are common in adult OSA but infrequent or less common in pediatric OSA?

A) Large neck circumference
B) Snoring
C) Excessive daytime sleepiness
D) REM abnormality

Question 9

A 7-year-old child was diagnosed with OSA due to tonsillar hypertrophy. Although adenotonsillectomy was performed, the child continues having daytime sleepiness and poor school performance. What should the therapist suggest at this time?

A) Consider uvulectomy.
B) Administer antireflux medications.
C) Perform allergy tests to confirm that airway obstruction is due to other clinical condition.
D) Provide continuous positive airway pressure.

Question 10

Definitive evaluation of breathing in sleep must include which of the following?

A) Pulmonary function testing.
B) An overnight polysomnogram.
C) Perform allergy tests to confirm that airway obstruction is due to other clinical condition.
D) Electrocardiogram.

Question 11

What is the age group with the highest prevalence of OSA?

A) First 6 months
B) 6 months to 1 year
C) 1 to 2 years
D) 2 years to 8 years

Question 12

Which of the following risk factors are associated with SIDS?
I) Maternal cigarette smoking
II) Supine sleeping position
III) Overheating
IV) Bed sharing

A) I and III only
B) I, II, and III only
C) I, II, and IV only
D) I, III, and IV only

Question 13

Which of the following are typical daytime symptoms associated with SDB in children?
I) Poor school performance
II) Hypoactivity
III) Inattention
IV) Passive behavior

A) I and III only
B) II and IV only
C) I, II, and IV only
D) I, III, and IV only

Question 14

The mother of an 11-month-old infant suspected of suffering from sleep-disordered breathing reports that her child sleeps 15 hours per day. What should the therapist tell her regarding the sleep duration of her infant?

A) The sleep duration is consistent with the infant's age.
B) The sleep duration is consistent with an infant in the first 24 hours of life.
C) The sleep duration is consistent with that of a 10-year-old child.
D) The sleep duration is consistent with a midadolescent child.

Question 15

Which of the following are typical features of the obstructive hypoventilation syndrome?
I) Disruption of sleep architecture
II) Degradation of sleep quality
III) Abnormal gas exchange
IV) Significant daytime symptoms

A) I and III only
B) II and IV only
C) I, II, and IV only
D) I, II, III, and IV

Question 16

Which age group is more often affected by periodic breathing?

A) Newborns
B) Infants
C) Children
D) Adults

Question 17

While working with a preterm neonate, the therapist notices the infant become apneic, cyanotic, and hypotonic. Consequently, the therapist nudges and stimulates the infant. On the basis of this scenario, what type of episode has occurred?

A) Sudden infant death syndrome
B) An apparent life-threatening event
C) A resuscitative event
D) An epileptiform activity