34. Pediatric Airway

Question 1

Overgrowth of bony opening, noisy breathing worse with feeding and improving when crying, associated with central mega incisiors

Answer 1

Pyriform aperture stenosis

Question 2

Obliteration or blockage of the posterior nasal aperture, unilateral or bilateral, stertor with unilateral discharge, noisy breathing, cyanosis with feeds, relief with cries

Answer 2

Chiamalo atresia

Question 3

most common cause of ***

Answer 3

adenoid hypertrophy

Question 4

14 year old M presents to your pediatric clinic with a cheif complain of sinus pressure runny nose, cough, congestion, fever. Mom reports he has had recurrent issues with sinuses since playinh hockey, prefers sleeping on his side - can be deviated septum or septal perforation, deviated septum involves trauma from delivery, sports, MVA, symptoms are preferring to sleep on one side, recurrent sinus infections, difficulty sleeping, worsened by age, allergies, and illness, treatment is with sinus repair, septal perforation can be due to trauma, wegerner’s granulomatosis, ***, treatment with surgical repair

Answer 4

nasopharynx case

Question 5

18 month presents to pediatrician with runny nose and breathing problems, noisy breathing that has been getting worse since 4 days, breath is terrible - intranasal foreign body, associated wtih history of foreign body, unilateral mucopurulent nasal discharge, foul odor or halitosis, epistaxis, nasal obstruction, and mouth breathing, may remove with allgiator forceps or balloon catheter, most common item is paper, most dangerous item is button batteries

Answer 5

case II

Question 6

extends from soft palate to hyoid, macroglossia, **, abscess, foreign body

Answer 6

oropharynx

Question 7

can be due to tumors, hemagniomas, Beckwith-Wiedemann, hypothyroidism, Trisomy 21, present swith drooling, speech impairment, difficulty eating, stridor, and airway obstruction

Answer 7

macroglossia

Question 8

acute, potentially life threatening syndome, caused by the sudden release of mast cell mediators into the systemic circulation, history of exposure to allergen, symptoms of nasal discharge, nasal congestion, sneezing, itching of the throat and ear canals, change in voice quality, sensation of throat closure or choking, stridor,

Answer 8

anaphylaxis

Question 9

22 month old female presents to the ER with 2 days of fever, cough, shore throat, drooling, refusal to eat, stridor, she is febrile, tachycardic, tachypneic, and toxic appearing ***

Answer 9

oropharynx case

Question 10

bacterial infection of the posterior oropharynx, occurs at age 206 years, ill apperance, fever, sore throat, stertor/stridor, muffled voice, trismus, bulging of the posterior wall of the oropharynx, diagnosed with contrast CT of the neck, admit for empiric IV antibiotics, stablize the patient/phlegmon/abscess <2.5 cm, ENT surgery consult due to unstable patient before imaging ***

Answer 10

retropharyngeal abscess

Question 11

one of the suppurative complications of GAS pharyngitis but often polymicrobial, bacterial infection spreads beyond tonsil to neck and upper chest, AKA quinsy, more common in teens than younger kids, causes with fever, ill appearance, very sore throat, trismus, dysphagia, hot potato muffled voice, usually no stridor, unilateral erythema and bulging superior to the tonsil, uvula deviates away from the affected side, most managed as outpatients, drainage/aspiration in the emergency department, antibiotics, fluids/pain management, tonsillectomy at a later date may be recommended, complications are aspiration, airway obstruction, further dissemination of infection

Answer 11

peritonsillar abscess

Question 12

typically food or household items, may get lodged in upper palate, tonsil, base of tongue or piriform fossaie, inability to swallow or handle secretions, treatment with forceps or endoscopic removal

Answer 12

oropharynx foreign body

Question 13

extends from epiglottis to cricoid, continuation of the oropharynx and including the larynx and upper esophageal sphincter, glottis is the vocal cords, subglottis is below the vocal cords, ***

Answer 13

laryngopharynx

Question 14

inflammation of the epiglottitis, most commonly caused by haemphilus influenza type B, presents with drooling, tripoding, difficulty breathing, ill appearance, stridor without cough, management is cautious, minimal intervention while making plans to secure airway in the OR, IV acess and imaging are deferred, antibiotics are indicated

Answer 14

epiglottitis

Question 15

2 month old at your clinic for well child visit, noisy breathing with inspiration, present since birth and worse on feeds, soft inspiratory stridor

Answer 15

laryngopharynx case

Question 16

congenital stridor, stridor caused by collapse of the supraglottic airway, felt to be due to neuromuscular airway dysfunction, often worse when eating or sleeping, worse when supine, improves when prone, can range from mild to severe, typically clinical diagnosis, most mild cases self-resolve in the first few years of life, children with moderate/severe or progressive stridor, apnea, or cyanotic episodes, or poor growth requires endoscopic examination ***

Answer 16

laryngomalacia

Question 17

2 year old male presents to the ER at 3 AM, has had 2 days of runny nose and low grade fever with cough, cough is dry and harsh sounding, child has had a hoarse voice, child had worsening symptoms nad trouble breathing so dad rushed him in, on exam the child is non-toxic, tired, and has normal vital signs, clear runny nose ***

Answer 17

case III

Question 18

typically parainfluenza, primarily affects ages 3 months-3 years, older kids have larger airways, harsh barky cough, sometimes inspiratory stridor, may have URI symptoms and fever, raspy or hoarse voice, classically worse at night, child goes to bed fine and wakes with frightening cough and wheeze, positive steeple sign, if no stridor at rest give single dose dexamethasone/decadron, if stridor at rest give dexmethasone and nebulized epinephrine, consider other diagnosis if using racemic epinephrine and isn’t working

Answer 18

viral croup

Question 19

6 month old 27 week preemie male presents in clinic for well child, has had a hoarse cry since he was in the NICO, on exam is growing well, has normal vital signs, mild stridor at rest, and a weak, hoarse cry

Answer 19

case IV

Question 20

accounts for 10% of congenital stridor, most often iatrogenic by intubation or idiopathy, may be neurologic so will need to evaluate foramen magnum for chiari malformation, presents as hoarseness, dysphonia, stridor, absent or weak cry, diagnosed with flexible nasolaryngoscopy, treatment with speech therapy, surgery, or injections ***

Answer 20

vocal cord paralysis

Question 21

stenosis, cysts, webs, hemangiomas, papillomas

Answer 21

other subglottic pathology

Question 22

narrowing of the airway below the vocal cords and above the trachea at the cricoid (narrowest part), 3rd most common cause of congenital ***

Answer 22

subglottic stenosis

Question 23

presents with nosiy feeding and stridor, diagnosis with endoscopy, treatment with marsupialization

Answer 23

subglotting vallecular cysts

Question 24

incomplete separation of the vocal cords, presents with respiratory distress, weak or high pitched cry, diagnosis with endoscopy

Answer 24

subglottic webs

Question 25

most common neoplasm of infant airway, asymptomatic at birth, grow rapidly for 12-18 months, then involute, croup like cough, difficulty breathing, biphasic stridor by 6 momths, cutaneous hemagniomas are seen in 50% of affected individuals, diagnosis with ray or laryngoscopy, treatment is with propanolol and surgery

Answer 25

subglottic hemangiomas

Question 26

caused by HPV, more chronic/recurrent course, persistent stridor, treat with surgical removal and adjuvant chemotherapy as needed, prevention with HPV vaccine

Answer 26

subglottic papillomas

Answer 27

extra-thoracic trachea

Question 28

rare complication of viral UTI, colonizers of the respiratory tract invading damaged mucosa staph aureus, presents with sick child, stridor, fever, and cough, consider diagnosis if your croup patient is toxic appearing or not improved with usual treatment, treatment is respiratory support with intubation and antibiotics

Answer 28

bacterial tracheitis

Question 29

9 month old presents, immigrant from Mexico, was born with VACTERL syndrome, and had a tracheal-esophagela fistula repair as a neonate, on exam he is well appearing and afebrile, has persistent stridor at rest with mild subcostal retractions

Answer 29

case V

Question 30

dynamic collapse of the trachea/bronchi during inspiration, resulting in airway obstruction, can be congenital or acquired (trauma), can be due to prolonged positive pressure ventilation, external compression, or surgical repair of the TE fistula, ***

Answer 30

tracheobronchomalacia