Resp - ENT 2

Question 1

Differentials for upper airway obstruction

Answer 1

Croup (laryngotracheitis)
Epiglottitis (supraglottic laryngitis)
Foreign body inhalation
Diphtheria

Question 2

Features of acute stridor due to viral croup

Answer 2

Onset - slow (12-48 hours)
Does NOT appear toxic
Cough - barking
Voice - hoarse
NO difficulty swallowing

Responds to cool mist inhalation or adrenaline inhalation (if SEVERE)

Question 3

Features of inspiratory stridor due to epiglotittis?

Answer 3

Cause - Haemophilus influenza type B

Onset - sudden (4-12 hours)

Toxic appearance
(lethargy, poor perfusion, cyanosis, hypo/hyperventilation)
Drooling, extended neck

NO cough

Voice - muffled

Difficulty swallowing

No response to inhalers

Question 4

Features of laryngeal dyphtheria causing stridor

Answer 4

Slow, then sudden onset: 4-5 days

Toxic appearance
Swollen neck

Barking cough
Hoarse voice
Difficulty swallowing

NO improvement with inhalers

Question 5

Features of foreign body inhalation leading to stridor

Answer 5

SUDDEN onset
Complete airway obstruction: resp distress, cyanosis, altered mental state

If partial obstruction, does not appear toxic

Choking
Inability to speak

Do the Heimlich maneuver or remove FB via rigid bronchoscopy

Question 6

X ray features of croup, epiglotittis, and FB

Answer 6

Croup - steeple sign (subglottic narrowing)

Epiglottitis - thumb sign (thickening of epiglottis on lateral xray)

FB - usually radiolucent

Question 7

Aetiology of acute tonsillitis

Answer 7

Viral (50-80%) - adenovirus, EBV, CMV, rhinovirus, influenza

Bacterial - streptococcus pyogenes (GAS)
Rarely - staph aureus, strep pneumoniae, mycoplasma pneumoniae

Question 8

Natural history of acute tonsillitis

Answer 8

Sudden onset of symptoms
Red and swollen pharynx, tonsillar exudates

Fever, sore throat, dysphagia

Painful, swollen cervical LN

Foul breath

Normally SELF-limiting

Question 9

Features of viral tonsillitis

Answer 9

headache
earache
nasal congestion
cough