Stridor

Question 1

Causes of Stridor in children <6 mo of age

Answer 1

LAVaVoS

Laryngotracheomalacia

Airway hemangioma

Vascular ring/sling

Vocal cord paralysis

Subglottic stenosis

Question 2

Causes of Stridor in children >6 mo of age

Answer 2

CEB ForeignR

Croup

Epiglottitis

Bacterial tracheitis

Foreign body aspiration

Retropharyngeal abscess

Question 3

Partial obstruction of the upper airway at the nasopharynx and/or oropharyngeal level produces sonorous sounds

Answer 3

Stertor

Question 4

Define stridor

Answer 4

high-pitched, harsh, monophonic sound produced by turbulent airflow through a partially obstructed airway

Question 5

accounts for 60% of all neonatal laryngeal problems and results from a developmentally weak larynx.

Collapse occurs with each inspiration at the epiglottis, aryepiglottic folds, and arytenoids.

stridor worsens with crying and agitation but often improves with neck extension and when the child is prone

Answer 5

Laryngomalacia

Question 6

True or false

Laryngomalacia usually manifests shortly after birth, which is a key diagnostic feature, and generally resolves by 18 months of age.

Answer 6

True

Question 7

Vocal cord paralysis Diagnosis is by _____________.

Answer 7

flexible nasolaryngoscopy

Question 8

diagnosed when there is a narrowing of the laryngeal lumen

usually diagnosed in the first few months of life when the child is noted to have “persistent inspiratory stridor”

Answer 8

Subglottic stenosis

Question 9

Consider in new-onset stridor beginning after the first month of life without another explanation; definitive diagnosis requires airway visualization through endoscopy

Answer 9

airway hemangioma

Question 10

are rare congenital anomalies of the aortic arch and pulmonary artery in which anomalous vessels can compress the trachea or esophagus. Examples include a double- or right-sided aortic arch

Answer 10

Vascular rings and slings

Question 11

Other name for Croup

Answer 11

viral laryngotracheobronchitis

Question 12

most common cause of stridor outside the neonatal period, commonly affecting children 6 months to 3 years old

Answer 12

Croup (viral laryngotracheobronchitis)

Question 13

symptoms typically begin after 1 to 3 days of nasal congestion, rhinorrhea, cough, and low-grade fever.

“harsh barking cough”, hoarse voice, and stridor

worse at night

self-limited and short in duration, resolving spontaneously within 3 days

Answer 13

Croup (viral laryngotracheobronchitis)

Question 14

Steeple sign

Answer 14

Croup

Question 15

Management of croup

Answer 15

Give nebulized epinephrine for moderate to severe croup, primarily those with stridor at rest; mild croup generally does not require epinephrine

All patients with croup, whether mild, moderate, or severe, benefit from the administration of oral steroids as a one-time dose

Question 16

Disposition for croup

Answer 16

Children who have received nebulized epinephrine should be observed in the ED for 3 to 4 hours after administration.

Children with persistent stridor at rest, tachypnea, retractions, and hypoxia or those who require more than two treatments of epinephrine should be admitted to the hospital.

Question 17

Widespread administration of Haemophilus influenzae type B vaccine has significantly reduced the number of cases

Answer 17

EPIGLOTTITIS

Question 18

Most children appear toxic and anxious and may assume a tripod or sniffing position with the neck hyperextended and the chin forward to maintain the airway

Answer 18

EPIGLOTTITIS

Question 19

Answer 19

Thumb sign EPIGLOTTITIS

Question 20

True or false

 diagnosis of retropharyngeal abscess/ cellulitis is suggested when the retropharyngeal space at C2 is twice the diameter of the vertebral body or greater than one half the width of the C4 vertebral body

Answer 20

True

Question 21

True or false

Peritonsillar abscess, also known as a quinsy, is a posterior oropharyngeal infection.

occurs in adolescents and young adults

polymicrobial infections

Answer 21

True

Question 22

potentially life-threatening, rapidly expanding infection of the submandibular space

The submandibular space is composed of two spaces subdivided by the mylohyoid muscle into the sublingual and submylohyoid space (submaxillary space) and extends from the floor of the mouth to muscular attachments at the hyoid bone.

Infectious expansion into this space spreads superiorly and posteriorly and often involves the entire submandibular space

Most cases arise from an odontogenic source, often from the spread of periapical abscesses of mandibular molars.

polymicrobial involving oral flora.

Answer 22

LUDWIG’S ANGINA