EXAM #2: UPPER AIRWAY OBSTRUCTION IN KIDS

Question 1

What are the symptoms of the common cold?

Answer 1

• Rhinorrhea
• Sore throat
• Sneezing
• Coughing
• Mild fever

*Resolving in 10 days

Question 2

What are the symptoms of persistent sinusitis?

Answer 2

1) Rhinorrhea that becomes cloudy or colored
2) Daytime cough (worse night)

*Lasting for 10 days and does NOT improve

Question 3

What are the distinguishing symptoms of a severe sinusitis?

Answer 3

1) Fever over 102.2 F for 3x days

2) Mucus that is thick, cloudy, or colored

Question 4

In the first year of life, how many colds will a child get?

Answer 4

6-8

Question 5

When are abx indicated for sinusitis?

Answer 5

10 days of sx with no improvement

Question 6

What are the signs of laryngotracheobronchitis?

Answer 6

Prodrome followed by:

1) Stridor
2) Retractions of chest wall
3) Flaring of nostrils
4) Barking cough

Question 7

What is the alternate name for laryngotracheobronchitis?

Answer 7

Viral croup

Question 8

What age range is most common for viral croup?

Answer 8

6 months to 6 years

Question 9

How is stridor defined?

Answer 9

Harsh, high-pitched INSPIRATORY sound

Question 10

Why are kids susceptible to viral croup?

Answer 10

Anatomically smaller airway that gets inflamed

Question 11

What virus most commonly causes croup?

Answer 11

Parainfluenza Type 1*

Question 12

What is the differential diagnosis for croup?

Answer 12

1) Epiglottitis
2) Bacterial tracheitits
3) FB
4) Laryngomalacia
5) Retropharyngeal abscess

Question 13

What is the classic x-ray finding associated with croup?

Answer 13

Steeple sign

Question 14

What is the treatment for croup?

Answer 14

1) Humidification at HOME
2) Nebulized racemic epinephrine
3) Dexamethasone (IM or PO)

Question 15

What patients with croup require hospitalization?

Answer 15

Stridor refractory to racemic epinephrine

Question 16

What are the signs/sx. of epiglottitis?

Answer 16

1) Abrupt onset respiratory distress

2) High anxiety

Question 17

Why is epiglottitis on the decline?

Answer 17

Haemophilus influenza type B vaccine

Question 18

What is the initial management for epiglottitis?

Answer 18

Calm environment with Mom

Question 19

If epiglottitis, what should you do?

Answer 19

Go to the OR to intubate, with preparation to do a tracheostomy

Question 20

What should you NOT do in a case of suspected epiglottitis?

Answer 20

1) NO tongue depressor
2) NO labs
3) NO x-ray

Question 21

What is bacterial tracheitis?

Answer 21

Essentially, bacterial infection of the trachea

Question 22

How old are kids that get bacterial tracheitis?

Answer 22

Under 3 y/o

Question 23

What is the presentation of bacterial tracheitis?

Answer 23

1) Brassy cough
2) High fever
3) Toxicity

*Possibly causing life threatening obstruction

Question 24

What most commonly causes bacterial tracheitis?

Answer 24

Staphylococcus aureus

Question 25

When is FB aspiration most common?

Answer 25

1-3 y/o

Question 26

What are the signs/symptoms of FB airway obstruction?

Answer 26

1) Cough 2) Stridor 3) Wheezing 4) Drooling 5) Respiratory distress

Question 27

How is the diagnosis of FB aspiration made?

Answer 27

1) Clinical suspicion 2) 2x view neck AND insp/expiratory films *95% are radiolucent; thus, the insp/exp films are to see mediastinal shift/ impaired filling

Question 28

How do you tell the difference between a coin in the trachea vs. esophagus?

Answer 28

asdf

Question 29

What is a retorpharyngeal abscess?

Answer 29

Infection between the buccopharyngeal fascia and prevertebral fascia *Lymph nodes in this region suppurate from extension

Question 30

What bacteria most commonly cause a retorpharyngeal abscess?

Answer 30

1) Strep pyogenes 2) Oral anaerobes 3) S. aureus

Question 31

What age group is a retropharyngeal abscess most common?

Answer 31

Less than 3 y/o b/c the prevertebral space is still open (closes around 3-4)

Question 32

What is the ddx for a retropharyngeal abscess in a child or adolescent?

Answer 32

Peritonsillar abscess

Question 33

What is the presentation for a retropharyngeal abscess?

Answer 33

1) Fever 2) Sore throat 3) Neck pain 4) Progressive dysphagia and respiratory distress

Question 34

What are the signs of a retropharyngeal abscess?

Answer 34

1) Torticollis 2) Trismus *Plus drooling and stridor

Question 35

If you have a high suspicion for a retropharyngeal abscess, what should you do?

Answer 35

CT of the neck

Question 36

What is the treatment for a retropharyngeal abscess?

Answer 36

1) Drainage | 2) Abx

Question 37

What is the most common cause of stridor in infancy?

Answer 37

Laryngomalacia

Question 38

What causes laryngomalacia?

Answer 38

1) Immaturity of the supporting structures around the larynx 2) Abnormal NM development

Question 39

What is the classic presentation for Laryngomalacia?

Answer 39

Stridor in an infant (under 6 months) that: - Worsens with agitation/ being supine - Improves with being prone

Question 40

What typically happens with laryngomalacia?

Answer 40

Resolution around 12-18 months

Question 41

How does the presentation of Tracheomalacia differ from Laryngomalacia?

Answer 41

Wheezing is more common

Question 42

What congenital abnormality is associated with Tracheomalacia?

Answer 42

TE fistula