Chapter 202 : Evaluation & Management of the Pediatric Airway

Question 1

noisy breathing from vibration of tissues above the level of the larynx

Answer 1

Stertor

Question 2

structures which cause stertor

Answer 2

“NNOSH”

Nose

Nasopharynx

Oropharynx

Hypopharynx

Supraglottis

Question 3

hallmark of any laryngeal obstruction and can be described as a high pitched, musical, or harsh sound often mistaken for “wheezing.”

Answer 3

stridor

Question 4

LEVEL OF OBSTRUCTION of inspiratory stridor

Answer 4

glottis

Question 5

LEVEL OF OBSTRUCTION of biphasic stridor

Answer 5

at or below the level of the glottis, in the subglottis and upper trachea

Question 6

LEVEL OF OBSTRUCTION of expiratory stridor

Answer 6

lesions in the distal trachea or mainstem bronchi

Question 7

most common cause of stridor

Answer 7

laryngomalacia

Question 8

profile of infants with laryngomalacia

Answer 8

term males with a normal birth weight

Question 9

population at higher risk for laryngomalacia

Answer 9

Premature Hispanic infants and black infants of all gestational ages

Question 10

type of noisy breathing in laryngomalacia

Answer 10

intermittent inspiratory stridor within the first 2 weeks of life, which resolves slowly over several months high-pitched, but compared with the stridor of vocal cord paralysis, it is rela- tively low in pitch and does not have a musical quality.

Question 11

what happens to the stridor of MILD laryngomalacia when the patient cries?

Answer 11

often improves with crying, as tone in the pharynx is increased

Question 12

what happens to the stridor of MOD TO SEVERE laryngomalacia when the patient cries?

Answer 12

stridor typically will worsen with crying because of the increased airflow through the severely collapsed larynx

Question 13

median time to spontaneous resolution

Answer 13

7-9 months ***majority will have no stridor by 18 months)

Question 14

neurologic disorder that may be associated with laryngomalacia

Answer 14

cerebral palsy

Question 15

cause of inspiratory stridor of LM (4 key points)

Answer 15

collapse of the supraglottic larynx, which creates a narrow airway and turbulent airflow related to neuromuscular hypotonia

Question 16

What is the laryngeal adductor reflex (LAR)?

Answer 16

vagal nerve-mediated reflex activated by sensory stimulation of the mechanoreceptors and chemoreceptors of the superior laryngeal nerve located in the region of the aryepiglottic fold

Question 17

endoscopic finding often associated with LM

Answer 17

omega- shaped epiglottis (NOTE: can also be found in otherwise normal infants with no airway obstruction)

Question 18

high prevalance of this laryngeal co-morbidity in LM

Answer 18

gastroesophageal reflux disease (GERD)

Question 19

FEES finding in severe LM

Answer 19

laryn- geal penetration in 88% of infants and aspiration beyond the vocal folds in 72% of infants.

Question 20

anatomic abnormalities that lead to supraglottic obstruction in laryngomalacia

Answer 20

(1) anterior prolapse of the mucosa overlying the arytenoid cartilages (57%) (2) short aryepiglottic folds that tether the epiglottis posteriorly (15%) (3) posterior collapse of the epiglottis (12%), (4) or some combination of these findings (15%)

Question 21

current standard treatment for LM

Answer 21

supraglottoplasty (aryepiglottoplasty)

Question 22

condition presenting with inspiratory or biphasic stridor with a high-pitched musical quality

Answer 22

Vocal fold paralysis (VFP)

Question 23

causes of VFP in a newborn

Answer 23

1) birth trauma or forceps delivery 2) thoracic diseases or procedures 3) central or peripheral 4) neurologic diseases 5) idiopathic causes.

Question 24

Iatrogenic left VFP is a known complication of this particular thoracic surgery. Associated sign?

Answer 24

patent ductus arteriosus ligation or repair of an interrupted aortic arch, which may be associated with difficulty weaning the infant off ventilator support

Question 25

Which recurrent laryngeal nerve is susceptible to injury and where?

Answer 25

The left recurrent laryngeal nerve is susceptible to injury at the point that it passes around the ductus arteriosus, unless a right aortic arch is present.

Question 26

Stertere is the Latin translation of:

Answer 26

Stertor

Question 27

True/False: Stertor can be heard below the supraglottic

Answer 27

FALSE

Question 28

Biphasic stridor is at the level of the:

Answer 28

Glottis, sublottic

Question 29

Expiratory stridor is at the level of the:

Answer 29

Distal trachea

Question 30

Inspiratory stridor is at the level of the:

Answer 30

Glottis

Question 31

Dynamic flexible laryngoscopy is best done in an ____ patient

Answer 31

Awake

Question 32

Most common cause of infantile stridor:

Answer 32

Laryngomalacia

Question 33

True/False: most cases of stridor secondary to laryngomalacia will self-resolve by 18 months

Answer 33

TRUE

Question 34

Classic description of laryngomalacia on endoscopy:

Answer 34

Omega-shaped

Question 35

Stridor associated with vocal fold paralysis in neonates

Answer 35

High-pitched, inspiratory/biphasic

Question 36

Laryngomalacia and vocal fold paralysis is best diagnosed by:

Answer 36

Fiberoptic flexible laryngoscopy

Question 37

Disorder presenting with high-pitched episodic stridor

Answer 37

Paradoxic vocal fold motion

Question 38

Chromosome anomaly associated with laryngeal webs

Answer 38

Chromosome 22q11.2

Question 39

Subglottic stenosis defintion in newborns

Answer 39

Cricoid diameter < 3.5 mm

Question 40

Most commonly used classification system for Laryngeal-Laryngotracheoesophageal clefts

Answer 40

Benjamin-Inglis