Airway

Question 1

Croup: acute laryngotracheobronchitis

Answer 1

MCC upper aiwway obstruction
1 year old average
Parainfluenza or RSV
Steeple sign
Barky cough
Epi and cortico nebs

Question 2

Epiglotitis

Answer 2

3-6 year
H. influenza type b, however Strep A beta hemolytic is taking over
Other: Sarcoid and TB
Omega epiglots: fake out due to obliquiti

Question 3

Exudative tracheitis (bacterial tracheitis)

Answer 3

6-10 years
Linear soft tissue filling defect within the airway. Irregular tracheal walls
S. aureus.

Question 4

Retropharyngeal cellulitis/abscess

Answer 4

Repeat with extended neck

75% of cases occurring before the age of 5 years, and often in the first year of life

Lemierre and Griselle syndromes (Grisel syndrome is a rare cause of torticollis that involves subluxation of atlanto-axial joint from inflammatory ligamentous laxity following an infectious process in the head and neck)

Question 5

Subglottic hemangiomas

Answer 5

Favors left side
50% associated with cutaneous hemangiomas
7% PHACES (posterior fossa, hemangiomas, arterial anomalies, coarctation of aorta, eyes abnormal, subglottic hemangiomas/sternal cleft/supraumbilical rafe)

Question 6

Laryngeal cleft

Answer 6

Associated with GI abnormalities

Question 7

Laryngeal cleft

Answer 7

Associated with GI abnormalities

Question 8

Congenital tracheoesophageal fistula

Answer 8

Clinical presentation is similar for all types except for type E (H-type).

Antenatally polyhydramnios

Associations: Cardiac anomalies, VATER/VACTERL, aneuploid chromosomal abnormalities, non aneuploid chromosomal abnormalities (CHARGE, Feingold, Pallister Hall)

proximal atresia with distal fistula (Type C): 85%
isolated esophageal atresia: (Type A) 8%
isolated fistula (H-type) (Type E): 4%
double fistula with intervening atresia (Type D): 1%
proximal fistula with distal atresia (Type B): 1%

Question 9

Recurrent respiratory papillomatosis

Answer 9

• laryngeal
• tracheobronchial

Juvenile:<20 years of age,aggressive/recurrent, HPV infection occurs via vertical transmission, either through the placenta (prior to birth) or by direct inoculation through the birth canal (during birth)

Adult: > 20 years of age,solitary papilloma. HPV infection occurs via intimate contact.

HPV-6 and 11 are most commonly implicated (90% total cases), although HPV-16, 18, 31, and 33 also implicated
HPV-11 is associated with more aggressive papillomatosis
HPV-16 and 18 are more associated with malignant transformation, although “low risk” sub-types (e.g. 6, 11) have also resulted in malignant degeneration