Pedia Stridor

Question 1

differences of pediatric airway from adult

Answer 1

• 1/3 the size of adult’s larynx
• smaller subglottis (5-7 mm in diameter)
• consistency is softer and more flexible
• arytenoids is 50% of framework (adults = 25%)
• epiglottis rests on soft palate
• cricoid at c4

Question 2

narrowest portion in child’s and adults’ airway

Answer 2

child: subglottic region
adult: gottis

Question 3

what is hagen poiseuille’s law

Answer 3

flow rate is proportional to radius to the fourth power

= small increase in internal diameter leads to dramatic increase in flow rate

Question 4

t/f a decrease in mucosal swelling by a few mm can cause a significant decrease in luminal size and airway resistance

Answer 4

false, increase in mucosal swelling

pedia: small luminal size = small swelling can cause more airway resistance

Question 5

associated with turbulent, high pitched, monophonic sound when breathing

Answer 5

stridor, signifies upper airway obstruction

Question 6

conditions presenting early in childhood

Answer 6

laryngeal web
glottic atresia
congenital subglottic stenosis
congenital vocal cord paralysis

Question 7

presentation of laryngeal web

Answer 7

• weak voice with respiratory distress, stridor, and unusual cry
• due to incomplete resorption of epithelial layer that normally obliterates at 6th aog
• usually eliminated dby 10th week

Question 8

t/f glottic atresia is incompatible with life

Answer 8

true

Question 9

presentation of congenital subglottic stenosis

Answer 9

• partial or complete narrowing of the airway
• sob, stridor, hoarseness
• can be incompatible with life

Question 10

presentation of congenital vocal cord paralyss

Answer 10

• moebius syndrome: weak cry or hardly any sound

- can be iatrogenic or neuromuscular dysfunction (gbs or mg)

Question 11

most common cause of congenital stridor in children less than 1 yo

Answer 11

laryngomalacia

Question 12

etiology of layngomalacia

Answer 12

• redundant laryngeal soft tissue
• poor cartilaginous support
• inadequate neurologic support
• narrow omega shaped epiglottis

Question 13

diagnosis for laryngomalacia

Answer 13

awake flexible endoscopy

- stridor = supraglottic disorder

Question 14

what is congenital laryngeal cysts or saccule

Answer 14

• mucus producing gland

- appendage lying between false vocal fold and thyroid cartilage

Question 15

what is laryngocoele

Answer 15

• benign laryngeal lesions which may have an external component
• manifests as lateral neck bulge or laryngeal mass on direct or indirect laryngoscopy

Question 16

laryngocele vs saccular cyst

Answer 16

laryngocele: contains air

saccular cyst: fluid filled mass

Question 17

what are laryngeal hemangiomas

Answer 17

benign vascular tumors

Question 18

congenital vs adult laryngeal hemangioma

Answer 18

congenital: more common, <2 mos, resolves spontaneously in first 2 yrs
adult: irritation at the region, seen in endoscopy, tx is laser ablation

Question 19

asleep vs awake stridor

Answer 19

asleep: supralaryngeal or pharyngeal (tonsils or adenoids)
awake: laryngea, tracheal, or bronchial; manifests as dyspnea on exertion

Question 20

inspiratory vs expiratory stridor

Answer 20

inspiration: extrathoracic (laryngomalacia, bilateral cord paralysis)
expiration: intrathoracic (asthma, tracheo or bronchomalacia, vascular rings)

Question 21

gold standard for diagnostics

Answer 21

laryngotracheobronchoscopy

Question 22

t/f acute epiglotitis is life threatening for children only

Answer 22

false, life threatening for both children and adults

Question 23

causes for acute epiglotitis

Answer 23

h influenzae b
pneumococci
b hemolytic strep

Question 24

presentation of acute epiglotitis

Answer 24

• fever, drooling patient in respiratory distress
• tripod position: jaw and mouth open and neck extended
• thumb sign on lateral xray

Question 25

tx for acute epiglotitis

Answer 25

- intubation for airway intervention - supportive: humidification, iv antibiotics, close observation and iv steroids - double set-up intubation, 3rd gen cephalosporing, systemic steroids, sedation

Question 26

presentation of croup or laryngotracheobronchitis

Answer 26

- subglottic swelling - 6 mos to 3 yrs - biphasic stridor - >90% are mild, subsides in 2-5 days - potential acute airway obstruction, intubation might be necessary - steeple sign on ap xray

Question 27

most common viral organisms associated with croup

Answer 27

parainfluenza, rsv, meases, vzv, rubella

Question 28

tx for croup

Answer 28

humidification, epi inhalation, steroids, systemic antibiotics, intubation (for severe airway compromise)

Question 29

most common cause of stridor among infants

Answer 29

laryngomalacia

Question 30

presentation of laryngomalacia

Answer 30

- secondary to delayed maturation of supporting structures of the larynx or neuromuscular hypotonia - leads to collapse of supralaryngeal structures on inspiration - causes narrowing of airway and turbulent flow - dx: awake flexible endoscopy

Question 31

tx for laryngomalacia

Answer 31

``` mild = observe severe = secure airway with tracheostomy ```

Question 32

2nd most frequent cause for congenital stridor

Answer 32

congenital subglottic stenosis

Question 33

presentation and dx of subglottic stenosis

Answer 33

- can be acquired or congenital - variants include soft stenosis and hard stenosis, associated with malformation of cricoid cartilage - dx gold standard: laryngoscopy

Question 34

tx for subglottic stenosis

Answer 34

(depends on length of stenosis and how small luminal circumference is) - cricoid split - pearson thyrotracheopexy - tracheostomy - co2 ablation

Question 35

most common benign laryngeal tumors in children

Answer 35

papilloma and laryngeal papillomatosis (hpv 6 and 11) tx: co2 laser surgery

Question 36

presentation of vocal cord paralysis

Answer 36

- weak cry, stridor, episodes of respiratory distress, dysphonia, aspiration - 65-70% resolve spontaneously

Question 37

tx for vocal cord paralysis

Answer 37

(depends on paralyzes and position) | medialization, cordectomy, arytenoidectomy

Question 38

most common age group for foreign body aspiration

Answer 38

1-3 yo

Question 39

presentation of foreign body aspiration

Answer 39

- cough, wheezing, harsh or decreased breath sounds - right bronchus more common affected - most sensitive factor in hx: witness choking

Question 40

phases of foreign body aspiration

Answer 40

acute phase: life threatening, s/sx acute and severe coughing, choking, gagging, gasping, wheezing and/or stridor, perioral cyanosis asymptomatic phase: irritation subsides complication phase: reactive airway disease (hemoptysis, chronic cough, recurrent or persistent pneumonia, bronchitis)

Question 41

most common cause of death in foreign body aspiration requiring prompt management

Answer 41

laryngeal foreign body (at laryngeal inlet)

Question 42

manifestations of laryngeal foreign body

Answer 42

- inappropriate food for age - mimic croup - respiratory distress (hoarseness, stridor, dyspnea)

Question 43

the power of bronchial obstruction to cause bronchial and pulmonary disease is ___ fold

Answer 43

3x fold

Question 44

types of bronchial obstruction

Answer 44

ball valve: flapper valve; in the reverse position =causes atelectasis and collapse in a few minutes bypass valve: partial obstruction check valve: obstructive emphysema stop valve: complete obstruction, obstructive atelectasis, absorption of air by circulation takes 24 or more hours to cause atelectasis

Question 45

___ allows immediate removal of obstructions

Answer 45

diagnostic bronchoscopy bronchoscopic aspiration for own secretions

Question 46

diagnostic of choice for foreign body aspiration

Answer 46

neck soft tissue anteroposterior lateral view chest xray