Paediatrics: Respiratory

Question 1

What is stertor?

Answer 1

A low-pitched sonorous sound indicating pharyngeal obstruction, e.g: from the tonsils

Question 2

What is stridor?

Answer 2

A harsh monophonic noise from the trachea or larynx that occurs as a result of narrowing:
• Extrathoracic - usually an inspiratory noise but can be biphasic
• Intrathoracic - biphasic with a loud expiratory noise

Question 3

Causes of tracheal deviation?

Answer 3

Pushed away by a tension pneumothorax or large effusion

Pulled towards a significant collapse

Question 4

Differential diagnosis for paediatric stridor?

Answer 4

Viral croup

Epiglottitis

Inhaled foreign body

Acute allergic reaction

Airway burns and scalds, e.g: smoke and steam

Other infections, e.g: retropharyngeal abscess

Question 5

Mx of acute severe stridor?

Answer 5

Hold the O2 mask near to the child

Call for help (anaesthetist)

May require gaseous induction of anaesthesia and intubation before IV access can be established

Question 6

Assessment of persistent / recurrent stridor?

Answer 6

Plot on growth chart (consider failure to thrive)

Episodic vs continuous?

Hx of birth trauma / CN anomalies?

Hx of cardiac/thoracic society?

Any cutaneous haemangiomas?

Any swallowing issues? (consider bulbar dysfunction)

Question 7

Ix for stridor?

Answer 7

Blood tests (rarely, may reveal hypocalcaemia or hypomagnesaemia)

CXR

Flexible laryngobronchoscopy

Question 8

Causes of persistent inspiratory stridor in infancy?

Answer 8

LARYNGOMALACIA

Vocal cord palsy

Supraglottic OR laryngeal cyst

Laryngeal cleft

Hypocalcaemia or hypomagnesaemia

Lingual thyroid

Question 9

Causes of persistent biphasic stridor in infancy?

Answer 9

Vocal cord palsy

Subglottic stenosis

Subglottic cyst

Subglottic haemangioma

Branchial cleft cyst

Cystic hygroma

Vascular ring

Question 10

Causes of persistent stridor in an older child?

Answer 10

If recurrent, consider viral or allergic causes

Vocal cord dysfunction

Rare causes:
• Pharyngeal tumour
• Neck mass/tumour
• Juvenile papillomatosis
• Foreign body inhalation
• External tracheal compression, e.g: mediastinal lymphoma

Question 11

Ix for persistent stridor in an older child?

Answer 11

Spirometry

CXR

Flexible laryngoscopy

CT of chest and neck

Question 12

What is a wheeze?

Answer 12

A whistling, musical noise caused by turbulent airflow passing through narrowed medium-sized airways

Generally this noise is heard on expiration, unless severe

Question 13

Differential diagnosis of paediatric wheeze?

Answer 13

Asthma

Infection, e.g: bronchiolitis

Chronic lung disease

Cystic fibrosis

Aspiration lung injury / GORD

Moderate allergic reaction

Foreign body inhalation

Vocal cord dysfunction

Heart failure secondary to lymphatic engorgement

Question 14

Purpose of a cough?

Answer 14

To clear bulk materials from the airway; it can be produced or suppressed through volition

Question 15

Causes of a dry cough?

Answer 15

Asthma / reactive airway disease

GORD

Post-viral / post-pertussis

Habit cough

Postnasal drip

Tracheobronchomalacia

Drugs causes, e.g: ACEIs

Question 16

Causes of a productive cough?

Answer 16

Cystic fibrosis

Primary ciliary dyskinesia

Immune deficiency

Chronic endothelial dysfunction

Aspiration lung disease

Inhaled foreign body

Other causes of bronchiectasis