Acute Inflammatory Airway Obstruction

Question 1

Defines the narrowest portion of the upper airways in children <10 yrs

Answer 1

Cricoid cartilage

Question 2

Bark-like or brassy cough

Answer 2

Croup

Question 3

Harsh, high-pitched respiratory sound which is usually inspiratory but can be biphasic

Answer 3

Stridor

Question 4

Most acute infections of the upper airway are caused by ___ with the exception of diphtheria, bacterial tracheitis, and epiglottitis

Answer 4

Viruses

Question 5

Account for ~75% of infectious upper airway obstruction

Answer 5

Parainfluenza

Question 6

Croup peaks at what age

Answer 6

2 y/o

Question 7

Croup is aka

Answer 7

Laryngotracheobronchitis

Question 8

MCC of pediatric epiglottitis in vaccinated children

Answer 8

S. pyogenes, S. pneumoniae, S. aureus; Hib has been reduced due to vaccination

Question 9

MCC of croup

Answer 9

Viruses

Question 10

MC form of upper airway osbtruction

Answer 10

Croup

Question 11

Barking cough, hoarseness, inspiratory stridor

Answer 11

Croup

Question 12

T/F Symptoms of croup are worse at night

Answer 12

T

Question 13

T/F Croup is a clinical diagnosis and does not require a radiograph of the neck

Answer 13

T

Question 14

Radiographs of the neck in croup can show the typical ___

Answer 14

Subglottic narrowing or steeple sign

Question 15

Accepted treatment for moderate to severe croup which causes constriction of the precapillary arterioles through β-adrenergic receptors, causing fluid resorption and decreased edema

Answer 15

Nebulized racemic epinephrine

Question 16

T/F Effectiveness of oral corticosteroids in viral croup is well-established

Answer 16

T

Question 17

Upper airway obstruction: Drooling with hyperextended neck in an attempt to maintain the airway

Answer 17

Acute epiglottitis

Question 18

Upper airway obstruction: Tripod position

Answer 18

Acute epiglottitis

Question 19

Upper airway obstruction: Stridor is a late finding

Answer 19

Acute epiglottitis

Question 20

T/F In acute epiglottitis, no other family members are ill with acute respiratory symptoms

Answer 20

T

Question 21

Upper airway obstruction: Cherry red epiglottis

Answer 21

Acute epiglottitis

Question 22

T/F Diagnosis of acute epiglottitis REQUIRES visualization of a large cherry red swollen epiglottis by laryngoscopy

Answer 22

T

Question 23

Classic radiographic picture of child who has epiglottitis

Answer 23

Thumb sign

Question 24

T/F Establishing an airway is indicated in patients with epiglottitis regardless of degree of apparent respiratory distress

Answer 24

T

Question 25

Reason why it is necessary to establish an airway in epiglottitis regardless of degree of respiratory distress

Answer 25

As many as 6% of children without an artificial airway die compared to <1% with artificial airway

Question 26

T/F Children with epiglottitis are intubated for 2-3 days because response to antibiotics is usually rapid

Answer 26

T

Question 27

Choices for empiric therapy of epiglottitis

Answer 27

IV Ceftri, Cefotax, Merop (BECAUSE 10-40% of Hib are resistant to Ampicillin)

Question 28

Indications for household members prophylaxis in cases of epiglottitis

Answer 28

1) <48 months of age incompletely immunized 2) <12 months with no primary vaccination series 3) Immunocompromised child

Question 29

Medication used for prophylaxis in cases of epiglottitis

Answer 29

Rifampin

Question 30

MCC of acute infectious laryngitis

Answer 30

Virus

Question 31

Upper airway obstruction: Hoarseness and loss of voice may be out of proportion to systemic signs and symptoms

Answer 31

Acute infectious laryngitis

Question 32

MC isolated pathogen in bacterial tracheitis

Answer 32

S. aureus

Question 33

T/F Bacterial tracheitis often follows a viral respiratory infection

Answer 33

T

Question 34

Upper airway obstruction: Brassy cough, high fever, and "toxicity" with respiratory distress immediately or after a few days of apparent improvement

Answer 34

Bacterial tracheitis

Question 35

Most important ddx for acute infectious laryngitis

Answer 35

Bacterial tracheitis

Question 36

MC complication of acute infectious laryngitis

Answer 36

Extension of infectious process to involve other regions of the respiratory tract including the middle ear, terminal bronchioles, or pulmonary parenchyma

Question 37

Major pathologic feature of bacterial tracheitis

Answer 37

Mucosal swelling at the level of the cricoid cartilage