Peds-Upper Airway

Question 1

What are symptoms of more than a common cold?

Answer 1

High Fever, stridor

Question 2

What are the three types of sinusitis?

Describe them.

Answer 2

Persistent: Daytime cough, runny nose - 10 days and no improval
Severe: High Fever lasts at lease three days in a row. thick mucus
Worsening: Cold starts to improve, fever returns, cough, nose gets worse
Basically, things get worse consistently

Question 3

Describe Viral Croup (Laryngotrachealbronchitis)

Answer 3

6 mo - 6 yrs.
classically presents in middle of night
hoarse voice, barky cough, inspiratory sound
Sore throat, fever, coryza

Question 4

What are the two types of viral croup?

Answer 4

Classic - inspiratory wheeze, barky cough, 6 mo-6yr

Spasmodic croup - no prodrome, older kids, repeated attacks

Question 5

What is the treatment for viral croup?

Answer 5

Resolves on its own
Humidification may help
Emergencies:
Racemic Epinephrine decreases edema by vasoconstriction of the vasc.
Steroids also reduce edema (Dexamethasone)
Wait 3 hours - no improvement - admit

Question 6

What is the most common virus to cause viral croup?

Answer 6

Parainfluenza virus type 1

type 2 to a lesser extent

Question 7

How do you diagnose viral croup?

Answer 7

clinical findings,

AP CXR may show ‘steeple sign’ - mostly excludes other possibilities

Question 8

What is the cause of Epiglottitis?

Answer 8

Haemophilus Influenza type B bacteria

Question 9

Common presentation of Epiglottitis?

Answer 9

Child 1-5 years old, anxious, prefers sitting, neck hyperextension and drooling
thumb sign on xray

Question 10

Where should the exam be done for epiglottitis?

Answer 10

in a controlled environment with ability to intubate and do a tracheotomy

Question 11

4 things to remember when treating Epiglottitis

Answer 11

Keep them calm
DONT use tongue depressor to visualize
DONT attempt xray or lab work
Gather a team and do exam in OR

Question 12

How do you treat Epiglottitis?

Answer 12

Intubation
IV access
Blood count
BLood culture
Antibiotics

Question 13

Describe Bacterial Tracheitis

Answer 13

Under 3 years
Thick secretions about the cricoid cartilage
Brassy cough, high fever, toxicity
may follow croup

Question 14

What causes bacterial tracheitis?

Answer 14

Staph Aureus

Question 15

How do you diagnose Bacterial Tracheitis?

Answer 15

Presentation of respiratory distress

high fever, copious secretions, leukocytosis, left shift

Question 16

How do you treat Bacterial Tracheitis?

Answer 16

intubation and antistaphylococcal antibiotics

Question 17

How do you diagnose foreign body aspiration?

Answer 17

clinical suspicion due to history
poor response to treatment
2 views (ap and lateral) neck xray
Inspiratory and expiratory CXR

Question 18

What view of Xray is best to see foreign body in
Trachea?
Esophogus?

Answer 18

trachea-lateral

esophagus-ap

Question 19

what is treatment for foreign body aspiration?

Answer 19

removal by endoscopy by special dude

Question 20

Describe Retropharyngeal abscess

Answer 20

Less than 3 yrs (prevertebral space closes at 3)

Infection between buccopharyngeal fascia and prevertebral fascia.

Question 21

What causes retropharyngeal abscess?

Answer 21

Strep Pyogenes, oral anaerobes, Staph Aureus

Question 22

What is the presentation of Retropharyngeal abscess?

Answer 22

Baby with fever, sore throat, neck pain, resp. distress, torticollis and trismus

Question 23

How do you diagnose Retropharyngeal abscess?

Answer 23

clinical history, and CT of neck

Question 24

How do you treat Retropharyngeal abscess?

Answer 24

Drainage and antibiotics (gram positive

Question 25

What is the cause of Laryngomalacia?

Answer 25

1 cause of stridor in infants

1. Immaturity of supporting structures around the larynx
2. abnormal neuromuscular development

Question 26

Describe Laryngomalacia

Answer 26

Worsens with agitation/supine, improves in prone

Resolves usually in 12-18 mo

Question 27

How do yo diagnose laryngomalacia?

Answer 27

clinical grounds, if severe endoscopy

Question 28

How do you treat Laryngomalacia?

Answer 28

Reassurance if no respiratory distress/FTT

If severe - surgery

Question 29

Describe tracheomalacia

Answer 29

less common than laryngomalacia
wheezing more than stridor
Most infants improve w/o intervention (look for TE fistula)