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Cadiopulmonary Medicine > Test 5 Ch.43 Croup and Croup- Like Syndromes > Flashcards

Test 5 Ch.43 Croup and Croup- Like Syndromes Flashcards

1
Q

This a general term that is used to describe the inspiratory barking or brassy sound associated w/ a partial upper airway obstruction

A

croup

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2
Q

What is the inspiratory barking sound that is heard in pt’s w/ a partial upper airway obstruction

A

inspiratory stridor

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3
Q

Another term for croup is

A

laryngotracheobronchitis (LTB)

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4
Q

Primarily affects the lower laryngeal area, trachea and ocasionally the bronchi the term

A

laryngotracheobronchitis (LTB) is used as a synonym for “classic” subglottic obstruction

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5
Q

LTB is an inflammatory process that causes

A

edema and swelling of the mucous membranes

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6
Q

What is the most common cause of croup or croup-like symptoms?

A

LTB

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7
Q

This is a life-threatening upper airway obstruction caused by an invasive bacterial infection of the soft tissues of the trachea

A

Bacterial tracheitis

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8
Q

Bacterial tracheitis is still considered to be

A

subglottic

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9
Q

This is life-threatening emergency, inflammation of the supraglottic region. Includes the epiglottis, aryepiglottic folds and false vocal cords

A

Acute epiglottis

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10
Q

Airway and obstruction caused by tissue swelling and mucopurulent membranous secretions below the vocal cords (SUBGLOTTIC)

A

Bacterial tracheitis

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11
Q

Airway obstruction caused by swelling just above the vocal cords (SUPRAGLOTTIC)

A

Epiglottitis

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12
Q

Airway obstruction caused by tissue swelling just below the vocal cords (SUBGLOTTIC)

A

LTB

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13
Q

What virus causes LTB in most cases?

A

Parainfluenza virus

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14
Q

Type 1 LTB is the most

A

common

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15
Q

Type 3 is

A

less common

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16
Q

Type 2 is

A

infrequent

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17
Q

What are other viruses that LTB may be caused by (6)

A
  • influenza A and B
  • RSV
  • Herpes simplex virus
  • Mycoplasma pneumoniae
  • rhinovirus
  • adenovirus
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18
Q

Influenza A affects more

A

kids

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19
Q

Influenza B affects more

A

adults

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20
Q

LTB is primarily seen in children

A

6 months to 5 years w/ peaking at 2nd year of life

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21
Q

Which gender is affected more?

A

Boys

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22
Q

LTB is slow and is most common during the

A

fall and winter

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23
Q

What is helpful w/ diagnosis of LTB? (2)

A
  • pt’s clinical history
  • radiologic examination
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24
Q

What commonly causes Bacterial tracheitis?

A

Staphylococcus aureus

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25
Q

Other bacteria that may case BT (3)

A
  • H. influenzae
  • Beta- hemolytic streptococcus
  • Streptococcus pyogens
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26
Q

_____________ _____________ has been implicated w/ increased frequency and is associated w/ severe BT

A

Moraxella catarrhalis

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27
Q

Rare gram-negative organism linked to BT include (2)

A
  • Pseudomonas
  • Klebsiella spp
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28
Q

BT is more commonly seen in the

A

winter months

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29
Q

What gender is affected in BT?

A

Boys

30
Q

The __________ _____ radiograph will rule out epiglottis

A

Lateral neck

31
Q

What is the most definitive method to diagnose BT

A

Direct visualization via laryngobronchoscopy of the airway

32
Q

What is Acute epiglottitis is almost always caused by

A

Haemophilus influenzae type B

33
Q

How is epiglottitis transmitted?

A

via aerosol droplets

34
Q

H. influenzae type B is still responsible for about…

A

25% of epiglottitis cases

35
Q

Other bacterial now associated w/ AE include (3)

A
  • H. parainfluenzae
  • Streptococus pneumoniae
  • group A S. pyrogens
36
Q

What has also been associated w/ AE in immunocompromised pts? (2)

A
  • Candida
  • Aspegillus
37
Q

AE has no clear out geographic or

A

seasonal incidence

38
Q

AE may develop in all age groups, most often occurs in

A

children 2 to 6 y/o

39
Q

AE is usually ________

A

abrupt

40
Q

In AE Inspiratory stridor is usually

A

softer and lower in pitch

41
Q

AE in adults is typically seen in pts w/

A

neck trauma

42
Q

Clinical manifestations of LTB,BT and AE

A

upper airway obstruction

43
Q

Vitals signs (3)

A
  • Increased RR
  • Increased HR
  • Increased BP
44
Q

Chest assessment findings (3)

A
  • prolonged inspiratory phase
  • diminished breath sounds
  • Inspiratory stridor
45
Q

Lateral Neck Radiograph (3)

A
  • haziness in the subglottic area (LTB & BT)
  • haziness in supraglottic area (epiglottitis)
  • classic “thumb sign”(epiglottitis)
46
Q

Anteroposterior (AP) Neck Radiograph

A

steeple pint or pencil point narrowing of the upper airway (LTB)

47
Q

Treatment is based on the cause of the

A

croup and croup-like syndrome

48
Q

LTB uses a score table that measures the pts

A

stridor, retractions, air movement, color and level of consciousness

49
Q

In sever BT, the administration of……. Are often required (3)

A
  • IV antibiotics
  • admission of ICU for intubation
  • Vent support
50
Q

The management of AE is

A

very specific

51
Q

Once the diagnosis is suspected or confirmed by the lateral neck radiograph, an examination or inspection of the

A

pharynx and larynx is to be done ONLY in the operating room under general anesthesia

52
Q

B/c hypoxemia and significant WOB is associated w/ LTB, BT, and AE, what tx may be required?

A

oxygen

53
Q

Aerosolized Racemic Epi is given to children w/ LTB based on the LTB scoring system:

A
  • age 3 to 5: consider racemic epi
  • 6 and greater: administer 0.5 mL in 3mL normal saline
54
Q

What does racemic epi do (pharmalogic)

A

it is used for vasoconstrictie effect on mucosal edema

55
Q

Pts who have LTB symptoms but have BT do not

A

generally improve w/ racemic epi

56
Q

What steroid have been shown to reduce the severity and duration of LTB in pts w/ moderate to severe symptoms?

A

dexamethasone

57
Q

What antibiotics are commonly prescribed for pts w/ AE (2)

A
  • Ceftriaxone (Rocephin)
  • ampicillin/ sulbactam (unasyn)
58
Q

What gas may be helpful in severe cases of LTB?

A

Heliox

59
Q

Heliox is combined w/

A

80% of helium and 20% oxygen, which has a lower density than room air

60
Q

Breathing helliox lowers the _______ throughout the breathing cycle, reducing the child’s _____ w/ __________ obstruction and preventing fatigue

A

Raw;
WOB;
airway

61
Q

Pts w/ this, intubation is frequently required to stabilize the airway

A

BT

62
Q

Questions from the back
The onset of LTB is usually:

A

24 to 48 hours

63
Q

What is associated with eppiglottitis? (Bacteria)

A

Haemophilus influenzae type B

64
Q

What clinical manifestation is associated w/ LTB

A

High-pitched and loud inspiratory stridor

65
Q

The signs and symptoms associated w/ epiglottitis usually develop within

A

2 to 4 hours

66
Q

Which of the following gas values are associated w/ mild to moderate LTB or epiglottitis

A
  • Decreased PaCO2
  • Increased pH
67
Q

Bacterial tracheitis is most commonly caused by

A

Staphylococcus aureus

68
Q

Inspection for croup (3)

A
  • cyanosis
  • use of accessory muscles during inspiration
  • substernal and intercostal retractions
69
Q

With Epiglottitis the pt usually maintains limited airway by

A

Sitting up and leaning forward w/ the chin protruding

70
Q

Having a pt with epiglottises lie down will cause complete

A

Airway obstruction within minutes

Cadiopulmonary Medicine (24 decks)

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