Breathing Difficulties II - include Epiglottitis VS Croup

Question 1

What are the causes of acute stridor?

Answer 1

Epiglottitis - Life-threatening!
Inhaled foreign object
Croup
Quinsy - Tonsillar abscess
Anaphylaxis - due to narrowing of upper airway

Question 2

What are the investigations done if suspected of foreign objects?

Answer 2

CXR - to look for unilateral hyperexpansion or radio-opaque objects
Rigid bronchoscopy to find and retrieve object

Question 3

What is coryza?

Answer 3

Coryza is a medical term for runny nose

Question 4

What is the coryza a feature of?

Answer 4

Coryza is a feature of bronchiolitis

Question 5

What is the cause of grunting?

Answer 5

Grunting occurs when infants close their glottis to generate end expiratory pressure to keep the alveoli open, especially when there are a lot of secretions.
It is seen in bronchiolitis.

Question 6

When is supplemental oxygen given?

Answer 6

When the oxygen saturation is below 95%

Question 7

What is the respiratory rate for each age group of children?

Answer 7

Ages 0 - 1 : 30 - 40
Ages 1 - 2 : 25 - 35
Ages 2 - 5 : 25 - 30
Ages 5 - 12 : 20 - 25
Ages >12 : 15 - 20

Question 8

In which condition is a CXR done even though there are no findings on auscultation?

Answer 8

CXR is done in infants < 3 years old if they present with fever, tachypnoea, or hypoxia.

Question 9

Why will patients present with a silent chest?

Answer 9

A silent chest occurs if airways are severely constricted, in the case of severe asthma, such that air can barely flow through

Question 10

The peak flow is charted according to the child’s age, height or weight?

Answer 10

The peak flow is charted according to the child’s height

Question 11

What are the commonest pathogens of coryza?

Answer 11

Rhinovirus, coronavirus and RSV

Question 12

Which medication is 1st line treatment of acute otitis media?

Answer 12

Amoxicillin

Question 13

Is there a cough in epiglottitis?

Answer 13

No

Question 14

Is there drooling of saliva in epiglottitis?

Answer 14

Yes

Question 15

What is the cause of acute epiglottitis?

Answer 15

Haemophilus influenza type B

Question 16

How acutely is the onset of croup and epiglottitis? Over days or over hours?

Answer 16

Croup occurs over days whereas epiglottitis is more acute and presents over hours.

Question 17

Is there preceding coryza before croup and before epiglottitis?

Answer 17

There is preceding coryza before croup, but none before epiglottitis

Question 18

Is the child able to drink in croup? How about in epiglottitis?

Answer 18

Child is able to drink and swallow in croup, but not in epiglotittis

Question 19

How high is the fever in croup? In epiglottitis?

Answer 19

<38.5 degree celsius in croup, but >38.5 in epiglottitis

Question 20

Describe the sound of stridor in croup and in epiglottitis

Answer 20

In croup, the sound of stridor is harsh and rasping.

In epiglottitis, the sound of stridor is soft and whispering

Question 21

What is the sound of the voice in croup and epiglottitis?

Answer 21

In croup, the voice is hoarse, but in epiglottitis, it is muffled. Child may be reluctant to speak.

Question 22

What is the management of airway obstruction in epiglottitis?

Answer 22

Airway can be maintained with a nasotracheal tube