MRCP 2 Question 5

A mother is concerned about her overweight 6 year old son who appears to be constantly tired during the day. She has noticed that her son has loud snoring and mouth breathing which causes the child to awaken frequently, often coughing and gasping for breath.

Appropriate management should include:

a) No medical treatment required
b) refer to an ENT specialist
c) Cromoglycate inhalers
d) inhaled low dose corticosteroids
e) Single dose 1 ml 0.5% salbutamol




ANSWER
The correct answer is B

Explanation

It is essential to refer these children to an ENT specialist to assess for adenoid and tonsillar hypertrophy.

Obstructive sleep apnea occurs during deep levels of sleep, is associated with snoring and mouth breathing, and causes the child to awaken frequently, often coughing and gasping for breath. This cycle may recur continuously during the night, robbing the child of necessary REM sleep due to intermittent airway obstruction.

Children with OSA are often drowsy during the day and they and their families suffer emotionally as well as physically. The most important piece of information that will uncover an association between allergy and OSA is the child's weight, as up to 17% of obese children experience OSA.

Additional questions to pursue include the presence of snoring and mouth breathing during the night, as well as frequent nocturnal crying, awakening, coughing, and gasping for breath.

Once the association is made, it is essential to refer these children to an ENT specialist to assess for adenoid and tonsillar hypertrophy, which may further cloud the diagnostic picture.

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