166. Peds upper airway obst.

Question 1

4 main groups of obstruction

Answer 1

o Acute infections
o Undiagnosed congenital abnormalities
o Congenital abnormality with an acute infection
o Foreign bodies

Question 2

location of exp stridor

Answer 2

below glottis

Question 3

location of insp/exp stridor

Answer 3

above or at glottis

Question 4

15 causes of supraglottic obst

Answer 4

Congenital
- Pierre Robin
- micrognatia
- Treacher collins
- macroglossia
- Down syndrome
- storage disease
- Choanal atresia
- lingual thyroid
- thyroglossal cyst
Acquired
- adenopathy
- tonissilar hypertrophy
- FB
- pharyngeal abscess
- epiglottitis
Positional
- micrgnathia

Question 5

6 causes of glottic obstrcution

Answer 5

Congenital
- laryngomalacia
- vocal cord paralysis
- laryngeal web
- laryngocele
Acquired
- papillomas
- FB

Question 6

9 causes of subglottic obstruction

Answer 6

Congenital
- subglottic stenosis
- tracheomalacia
- tracheal stenosis
- vascular ring
- hemangioma
Acquired
- croup
- bacterial tracheitis
- subglottic stenosis
- FB

Question 7

Presentation of choanal atreia

Answer 7

o Persistence of the membrane at posterior of nares
o Bilateral is emergency
o Unilateral may only present when have URI and obstruct other side

Question 8

Definine retropharyngeal abscess and bacteria

Answer 8

• Infection of soft tissue space between wall and prevertebral fascia
• May be due to direct trauma (toothbrush) or nodes, or hematogenous
• Usually polymicrobial
• Strep most common

Question 9

Sx of retropharyngeal abscess

Answer 9

o Fever, sore throat, neck stiffness, trismus, torticollis, stridor, muffled voice
o Won’t look side to side

Question 10

xray findings of retropharyngeal abscess

Answer 10

 Should not be more than vertebral body beside
 Never more than 6-7mm at C2 level
 May have air fluid levels

Question 11

indications to drain retropharyngeal abscess

Answer 11

 Scalloping of abscess wall
 Rim enhancement
 > 2cm

Question 12

sensitivity of mono test

Answer 12

• IgM antibody test >90% sensitive in < 4yo

o 50% in older

Question 13

major RO in mono

Answer 13

o Look for lymphadenopathy and splenomegaly

 Need to RO lymphoma or may miss it!

Question 14

mgmt mono

Answer 14

o Possible steroids and racemic epi

Question 15

3 spaces of ludwig angina

Answer 15

sublingual
submandibular
submaxillary

Question 16

MGMT ludwig angina

Answer 16

o Broad spectrum Abx with anerobic coverage

Question 17

bacteria in epiglottitis

Answer 17

• H flu was most common, but now vaccine

o Strep and staph possible

Question 18

Sx of epiglottitis

Answer 18

o	Acute onset
o	High fever
o	Sore throat and toxic
o	Sniffing position
o	Drooling
o	Dyspnea, stridor, retraction, fever

Question 19

3 signs on xray for epiglottitis

Answer 19

 Thumbprint sign
 Thickened folds
 Air in vallecula

Question 20

MGMT of epiglotitisi

Answer 20

o Secure airway
o If maintain airway, do not move to examine or xray
 Quietly move to area where can intubate
o Adol. And adults can usually be observed in ICU
o If can’t bag or ETT, then cric

Question 21

MGMT of laryngomalacia

Answer 21

 Worse supine and with neck flexion
 Rare to have significant resp distress
 Better by 2yo

Question 22

Sx of hemangioma

Answer 22

 Stridor (bi) develops in first few weeks

Question 23

Define laryngeal papillomas

Answer 23

 Most common benign neoplasm

 Vertical HPV from mother

Question 24

Age range for croup

Answer 24

6-36 months

Question 25

4 variables to assess when deciding on croup severity

Answer 25

1. stridor at rest
2. tachypnea
3. restractions
4. mental status

Question 26

MGMT of croup

Answer 26

o	Oral dex small dose is as effective as large dose
	0.15mg/kg
o	Nebulized epi for stridor at rest
	Fast onset
	1-2 hour duration
o	Possible evidence for heliox

Question 27

Sx of bacterial tracheitis

Answer 27

 Toxic child with high fever
 Rapidly worsening stridor
 Does not improve with epi
 Sx may overlap with croup and epiglottitis

Question 28

bacteria in bacterial tracheitis

Answer 28

Staph A + polymicrobial

Question 29

MGMT FB in < 1yo

Answer 29

• 5 back blows
• Then 5 chest thrusts
• Head below trunk
• No blind sweep

Question 30

MGMT FB in >1yo

Answer 30

• Heimlich if conscious
• Chest compressions if unconscious
 If fails need advanced airway techniques
• Laryngoscopy and try to remove with magills
• If can’t see, intubate and try to push into mainstem