EXAM #2: UPPER AIRWAY OBSTRUCTION IN KIDS Flashcards
What are the symptoms of the common cold?
- Rhinorrhea
- Sore throat
- Sneezing
- Coughing
- Mild fever
*Resolving in 10 days
What are the symptoms of persistent sinusitis?
1) Rhinorrhea that becomes cloudy or colored
2) Daytime cough (worse night)
*Lasting for 10 days and does NOT improve
What are the distinguishing symptoms of a severe sinusitis?
1) Fever over 102.2 F for 3x days
2) Mucus that is thick, cloudy, or colored
In the first year of life, how many colds will a child get?
6-8
When are abx indicated for sinusitis?
10 days of sx with no improvement
What are the signs of laryngotracheobronchitis?
Prodrome followed by:
1) Stridor
2) Retractions of chest wall
3) Flaring of nostrils
4) Barking cough
What is the alternate name for laryngotracheobronchitis?
Viral croup
What age range is most common for viral croup?
6 months to 6 years
How is stridor defined?
Harsh, high-pitched INSPIRATORY sound
Why are kids susceptible to viral croup?
Anatomically smaller airway that gets inflamed
What virus most commonly causes croup?
Parainfluenza Type 1*
What is the differential diagnosis for croup?
1) Epiglottitis
2) Bacterial tracheitits
3) FB
4) Laryngomalacia
5) Retropharyngeal abscess
What is the classic x-ray finding associated with croup?
Steeple sign
What is the treatment for croup?
1) Humidification at HOME
2) Nebulized racemic epinephrine
3) Dexamethasone (IM or PO)
What patients with croup require hospitalization?
Stridor refractory to racemic epinephrine
What are the signs/sx. of epiglottitis?
1) Abrupt onset respiratory distress
2) High anxiety
Why is epiglottitis on the decline?
Haemophilus influenza type B vaccine
What is the initial management for epiglottitis?
Calm environment with Mom
If epiglottitis, what should you do?
Go to the OR to intubate, with preparation to do a tracheostomy
What should you NOT do in a case of suspected epiglottitis?
1) NO tongue depressor
2) NO labs
3) NO x-ray
What is bacterial tracheitis?
Essentially, bacterial infection of the trachea
How old are kids that get bacterial tracheitis?
Under 3 y/o
What is the presentation of bacterial tracheitis?
1) Brassy cough
2) High fever
3) Toxicity
*Possibly causing life threatening obstruction
What most commonly causes bacterial tracheitis?
Staphylococcus aureus
When is FB aspiration most common?
1-3 y/o
What are the signs/symptoms of FB airway obstruction?
1) Cough
2) Stridor
3) Wheezing
4) Drooling
5) Respiratory distress
How is the diagnosis of FB aspiration made?
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
How do you tell the difference between a coin in the trachea vs. esophagus?
asdf
What is a retorpharyngeal abscess?
Infection between the buccopharyngeal fascia and prevertebral fascia
*Lymph nodes in this region suppurate from extension
What bacteria most commonly cause a retorpharyngeal abscess?
1) Strep pyogenes
2) Oral anaerobes
3) S. aureus
What age group is a retropharyngeal abscess most common?
Less than 3 y/o b/c the prevertebral space is still open (closes around 3-4)
What is the ddx for a retropharyngeal abscess in a child or adolescent?
Peritonsillar abscess
What is the presentation for a retropharyngeal abscess?
1) Fever
2) Sore throat
3) Neck pain
4) Progressive dysphagia and respiratory distress
What are the signs of a retropharyngeal abscess?
1) Torticollis
2) Trismus
*Plus drooling and stridor
If you have a high suspicion for a retropharyngeal abscess, what should you do?
CT of the neck
What is the treatment for a retropharyngeal abscess?
1) Drainage
2) Abx
What is the most common cause of stridor in infancy?
Laryngomalacia
What causes laryngomalacia?
1) Immaturity of the supporting structures around the larynx
2) Abnormal NM development
What is the classic presentation for Laryngomalacia?
Stridor in an infant (under 6 months) that:
- Worsens with agitation/ being supine
- Improves with being prone
What typically happens with laryngomalacia?
Resolution around 12-18 months
How does the presentation of Tracheomalacia differ from Laryngomalacia?
Wheezing is more common
What congenital abnormality is associated with Tracheomalacia?
TE fistula
