Pediatric ENT (OSA, Adenotonsillar Disease, Congenital Hearing Loss, Airway Foreign Bodies) MCQs

ENT · 49 free questions with answers & explanations.

1. A 6-year-old child is evaluated for pediatric obstructive sleep apnea (OSA). Overnight polysomnography shows an apnea-hypopnea index (AHI) of 5 events/hour. According to current guidelines, this AHI value in a pediatric patient is classified as:
2. A neonate is found to have bilateral choanal atresia at birth. Which of the following congenital syndromes most commonly includes choanal atresia as a component?
3. A 2-year-old is brought to the emergency with sudden onset choking, stridor, and decreased air entry on the right side after playing with peanuts. Which bronchoscope technique is preferred for retrieval of a right bronchus foreign body in a child?
4. Connexin 26 (GJB2 gene) mutations are the most common cause of autosomal recessive non-syndromic congenital sensorineural hearing loss (SNHL). Which pathophysiological mechanism best explains hearing loss in connexin-26 deficiency?
5. A 3-year-old child undergoes adenotonsillectomy for recurrent tonsillitis meeting Paradise criteria. In the immediate postoperative period, which is the most dangerous and immediately life-threatening complication?
6. A 5-year-old child is investigated for suspected obstructive sleep apnea. The gold standard diagnostic test and the apnea-hypopnea index (AHI) threshold for OSA diagnosis in children is:
7. A 3-year-old child presents with sudden onset coughing, choking, and unilateral wheeze. Chest X-ray in expiration shows air trapping (hyperinflation) of the right lung. The most likely site and nature of the foreign body is:
8. Congenital cytomegalovirus (CMV) infection is the most common non-genetic cause of sensorineural hearing loss in children. Which characteristic feature of CMV-associated hearing loss distinguishes it from other causes?
9. A 6-year-old child undergoes overnight polysomnography for suspected obstructive sleep apnoea. The apnoea-hypopnoea index (AHI) returns as 3 events/hour. According to paediatric OSA diagnostic thresholds, this result represents:
10. A neonate fails universal newborn hearing screening on both sides. Auditory brainstem response (ABR) at one month shows absent wave I at 95 dB nHL bilaterally but present cortical auditory evoked potentials (CAEPs). The most likely diagnosis is:
11. A 3-year-old child is brought to the emergency department with sudden onset choking followed by unilateral wheeze and decreased breath sounds on the right side. Chest X-ray shows mediastinal shift to the left on expiration. The most appropriate emergency management is:
12. Connexin 26 (GJB2) gene mutation is the most common cause of congenital non-syndromic autosomal recessive hearing loss worldwide. Which of the following statements regarding connexin 26-related hearing loss is MOST accurate?
13. Which of the following findings on polysomnography (PSG) specifically indicates the need for post-adenotonsillectomy monitoring in an inpatient setting in children with OSA, as per current paediatric guidelines?
14. A 5-year-old child presents with snoring, witnessed apneas, and behavioral issues including hyperactivity and poor school performance. Polysomnography shows an Apnea-Hypopnea Index (AHI) of 8/hour. What is the current recommended AHI threshold for diagnosing OSA in children, and what is the first-line surgical treatment?
15. A neonate is found to have bilateral severe-to-profound sensorineural hearing loss on newborn hearing screening (AABR-refer). Genetic testing reveals a homozygous mutation in the GJB2 gene encoding connexin 26. Which of the following best characterizes this condition?
16. A 2-year-old child presents with sudden onset stridor, cyanosis, and severe respiratory distress after playing with small toys. On CXR, there is mediastinal shift to the right and hyperlucency of the right lung. The most likely diagnosis and appropriate initial airway management are:
17. A 7-year-old child with recurrent tonsillitis has undergone tonsillectomy. On post-operative day 8, he presents with active bleeding from the tonsillar fossa. This is classified as which type of post-tonsillectomy hemorrhage, and what is its most common cause?
18. A 5-year-old with obstructive sleep apnea syndrome (OSAS) confirmed on polysomnography (AHI 15/hour) undergoes adenotonsillectomy. One year post-operatively, overnight oximetry shows persistent nocturnal hypoxemia. Which condition is most likely responsible for surgical failure?
19. A neonate fails newborn hearing screening bilaterally. Subsequent ABR shows absent waves bilaterally with click stimulus. Genetic testing reveals homozygous GJB2 (connexin 26) mutation. Which statement about cochlear implantation in this child is TRUE?
20. A 2-year-old is brought to the emergency department after witnessed aspiration of a peanut. Chest X-ray shows hyperinflation of the right lung. Which mechanism explains this radiographic finding?
21. Peritonsillar abscess in a 6-year-old child is being managed. Which feature MOST distinguishes peritonsillar abscess from peritonsillar cellulitis and indicates need for drainage?
22. A 5-year-old child has been snoring nightly for 1 year. Parents report observed apneas and the child has been restless during sleep with enuresis. Polysomnography shows an AHI of 8 events/hour. The best definitive management is:
23. A 2-year-old child is brought with sudden onset choking, coughing, and progressive wheeze. Chest X-ray shows hyperinflation of the right lung with mediastinal shift to the left. The most likely diagnosis and immediate intervention is:
24. Universal newborn hearing screening (UNHS) in India is recommended to detect congenital hearing loss. The appropriate two-stage screening protocol uses:
25. A 3-year-old child undergoes adenotonsillectomy for recurrent tonsillitis. In the immediate post-operative period (within 24 hours), she develops profuse bleeding from the mouth. The most appropriate first management step is:
26. A 5-year-old child with adenotonsillar hypertrophy is evaluated for OSA. Polysomnography shows an apnea-hypopnea index (AHI) of 12 events/hour. The most appropriate management is:
27. A 2-year-old child is brought with sudden onset choking, wheezing and decreased breath sounds on the right side after playing with peanuts. Chest X-ray shows air trapping on the right side (hyperinflation). The definitive management is:
28. Connexin 26 (GJB2) gene mutations account for what proportion of congenital non-syndromic autosomal recessive sensorineural hearing loss?
29. The Universal Newborn Hearing Screening (UNHS) protocol recommends that permanent hearing loss be identified and intervention initiated by what ages respectively?
30. A child with grade IV tonsillar hypertrophy (tonsils meeting in midline) and recurrent tonsillitis (7 episodes in the past year) is brought for assessment. His parents are concerned about anaesthetic risk because the child had a prolonged QT interval on a pre-operative ECG. The most appropriate next step is:
31. A 5-year-old child presents with snoring, witnessed apneas, and behavioral problems (hyperactivity, inattention). Overnight polysomnography shows an apnea-hypopnea index (AHI) of 8/hour. The treatment of choice is:
32. A 2-year-old child is brought with sudden onset choking and stridor while playing with small toys. A lateral neck X-ray shows a radiopaque foreign body at the level of C6. The most appropriate investigation to guide definitive management is:
33. Universal Newborn Hearing Screening (UNHS) targets detection of hearing loss before which age to optimize speech and language outcomes?
34. A 10-year-old child with persistent glue ear (otitis media with effusion) for 3 months, bilateral conductive hearing loss >25 dB, and speech delay is best managed by:
35. A 6-year-old child presents with habitual snoring, witnessed apneas, nocturnal enuresis, and behavioral problems at school. Polysomnography confirms obstructive sleep apnea. The Apnea-Hypopnea Index (AHI) threshold used to define OSA in children (as opposed to adults) is:
36. A 2-year-old child suddenly develops choking, coughing and unilateral wheeze after playing with small toys. Chest X-ray shows hyperinflation of the right lung. The most appropriate next step is:
37. Universal newborn hearing screening (UNHS) uses which two-tier approach to detect congenital hearing loss?
38. A 4-year-old has recurrent acute tonsillitis meeting the Paradise criteria for tonsillectomy. According to Paradise criteria, the minimum number of documented throat infections per year for 2 consecutive years that qualifies a child for tonsillectomy is:
39. A 5-year-old boy presents with chronic mouth breathing, snoring, and observed apneas. Polysomnography shows an Apnea-Hypopnea Index (AHI) of 8 events/hour. The recommended first-line surgical treatment is:
40. A 2-year-old child develops sudden onset choking, coughing and unilateral wheeze. Chest X-ray shows hyperinflation of the right lung. The most appropriate next step is:
41. Newborn hearing screening using automated ABR (AABR) detects sensorineural hearing loss ≥35 dB HL. A baby who fails the AABR twice should have confirmatory diagnostic evaluation completed by what age?
42. A 3-year-old girl with recurrent tonsillitis meets the Paradise criteria for tonsillectomy. According to the AAO-HNS guidelines, which set of criteria indicates a clear indication for surgery?
43. A 4-year-old presents with bilateral conductive hearing loss (35 dB HL), flat type B tympanograms, and absent stapedial reflexes for 3 months. He has no speech delay or learning difficulties. The most appropriate initial management is:
44. A 5-year-old child presents with recurrent snoring, witnessed apnea, and enuresis. Overnight polysomnography shows an apnoea-hypopnoea index (AHI) of 12 events/hour. The first-line treatment is:
45. A 2-year-old child is brought with sudden onset cough, wheeze, and decreased breath sounds on the right side after playing with peanuts. The next appropriate step after confirming a right-sided inhaled foreign body is:
46. Universal newborn hearing screening (UNHS) uses which test as the primary screening tool?
47. GJB2 (connexin 26) gene mutations are the most common cause of which type of hearing loss in children?
48. Peritonsillar abscess in a 12-year-old child is best managed by:
49. Which of the following findings on nasal endoscopy is MOST characteristic of adenoid hypertrophy in a child?