Pediatric Upper Respiratory Disorders

Question 1

Croup (Laryngotracheobronchitis)

Answer 1

• Presents in fall and winter
• 3mo->3yrs
• Preceded by URI, barking cough, inspiratory stridor, hoarse voice
• Sx worse at night
• Neck x-ray: Steeple Sign

Question 2

Pertussis

Answer 2

*Bordetella Pertussis

3 stages:

1) Catarrhal stage= 1-2 wks of cough, rhinorrhea, wheezing
2) Paroxysmal stage=2-4 wks of paroxysmal cough w/ “whoops”
3) Convalescent stage=1-2 wks of persistent chronic cough

Tx: Macrolide (azithromycin=drug of choice) to shorten infectious period, does not affect duration of Sx, otherwise supportive

Question 3

Epiglottitis

Answer 3

MEDICAL EMERGENCY

H. influenzae type B

Fulminant inspiratory stridor, drooling, postures in ‘sniffing position’, dysphagia, “hot potato” voice

X-ray–> “Thumb print sign” (lateral neck film)

Examine pt in OR, intubate as needed

Ceftriaxone

Question 4

Foreign-body aspiration

Answer 4

Generally > 6 months
Inspiratory stridor
chronic wheeze, decrease breath sounds, dysphagia, unresolved pneumonia

CxR–>Hyperinflation on affected side