ENT

Question 1

A 7 year old girl attends your surgery because her mother is concerned about her snoring at night and the possibility of obstructive sleep apnea. What is the relationship of snoring to obstructive sleep apnoea in children?

Question 1Select one:

a.
Snoring is completely unrelated to sleep apnea

b.
Snoring is usually accompanied by sleep apnea

c.
Snoring causes the morbidity of sleep apnea

d.
Sleep apnea is usually accompanied by snoring

Answer 1

Sleep apnea is usually accompanied by snoring

Most snorers do not have apnea, but most apneas have snoring

Question 2

A 3-year old boy, otherwise well and developing normally, has had disrupted sleep with loud snoring heard from the next room with the door closed, snorting and pauses heard in breathing during sleep, and daytime overactivity. Sometimes he will fall into sleep very rapidly after being excessively active.

What is the best next management step for him?

Question 2Select one:

a.
Overnight home oximetry study

b.
Referral for adenotonsillectomy

c.
Full polysomnography in hospital

d.
Trial of CPAP via nasal mask

Answer 2

Referral for adenotonsillectomy

Question 3

What is the most common factor contributing to obstructive sleep apnea in children?

Question 3Select one:

a.
A large tongue (macroglossia)

b.
BMI above the 90th percentile

c.
Enlarged tonsils and adenoids

d.
Hypotonia of bulbar muscles

Answer 3

Enlarged tonsils and adenoids

Question 4

A 6-year-old child who presents with chronic nasal obstruction, and a number of other symptoms that his mother wonders may be due to obstructive sleep apnoea. WHICH ONE of the following symptoms is NOT associated with obstructive sleep apnoea?

Question 4Select one:

a.
School failure

b.
Daytime soiling

c.
Hyperactivity

d.
Growth failure

Answer 4

Daytime soiling

Question 5

You see an 8-year-old Maori boy with a sore throat and fever of 39.5°C. Examination reveals exudative tonsillitis. Throat swab yields group A haemolytic Streptococcus. In this situation, what is the recommended first-line treatment for first or second Group A Strep sore throat in the primary prevention of rheumatic fever?

Question 5Select one:

a.
Cotrimoxazole for 10 days

b.
Penicillin V for 5 days

c.
Penicillin V for 10 days

d.
Amoxycillin for 5 days

Answer 5

Penicillin V for 10 days

Other options: amox for 10 days, or 1x IM benzathine penicillin

Question 6

An 18-month-old boy, Devin, is brought to see you by his mother who is concerned that he is snoring every night. His snoring can be heard above the TV in the next room, and on occasions when they check on him, he has pauses in his breathing, followed by snorting, becoming unsettled and then going back to sleep in a new position. He is having 3 daytime sleeps of an hour or more each. What is the recommended management?

Question 6Select one:

a.
ENT assessment and overnight oximetry

b.
Reassurance—this is likely to be primary snoring

c.
ENT referral for adenotonsillectomy

d.
Overnight polysomnography in hospital

Answer 6

ENT assessment and overnight oximetry

too young for adenotonsillectomy