URTI

Question 1

What is the normal airflow through the upper airways?

Answer 1

Laminar

A moving column of air produces slight negative pressure on the airway walls.

Question 2

What effect does inflammation from infection have on the airway?

Answer 2

Causes airway narrowing

This increases flow rate through the narrowed segment (Venturi effect) and reduces pressure exerted on the airway wall (Bernoulli principle).

Question 3

What sound is produced by rapid, turbulent airflow through a narrowed segment of a large airway?

Answer 3

Stridor

Stridor is most often loud, medium or low pitch, and inspiratory.

Question 4

Where is stridor typically originating from?

Answer 4

Larynx, upper trachea, hypopharynx

Question 5

What happens to the sound of stridor as the disease progresses?

Answer 5

It may become softer, higher-pitched, and biphasic.

Question 6

What is the narrowest segment of the pediatric airway?

Answer 6

Subglottic region

It is encircled by the rigid cricoid cartilage ring.

Question 7

What law states that airflow is directly proportional to the airway radius to the fourth power?

Answer 7

Poiseuille’s law

Question 8

What is the most common cause of infective upper airway obstruction in the pediatric age group?

Answer 8

Viral Laryngotracheobronchitis (LTB)

Question 9

What is the peak incidence age for viral LTB?

Answer 9

18 to 24 months

Question 10

What is the annual incidence rate of viral LTB in preschool children?

Answer 10

1.5% to 6%

Question 11

What virus is most frequently associated with viral LTB?

Answer 11

Parainfluenza virus (PIV) type 1

Question 12

What is the typical mode of transmission for viral LTB?

Answer 12

Droplet spread or direct inoculation from the hands.

Question 13

What are the common clinical features of viral LTB?

Answer 13

Coryza, low-grade fever, barking cough, hoarse cry, respiratory distress

Question 14

What is the role of laboratory tests or radiography in assessing acute airway obstruction?

Answer 14

No role

Question 15

What is the most common noninfective cause of acute airway obstruction in children?

Answer 15

Foreign body inhalation

Question 16

What are the symptoms of foreign body inhalation?

Answer 16

Mimic viral LTB, depend on location, degree of obstruction, nature of foreign body

Question 17

What supportive care is recommended for viral LTB?

Answer 17

Fluids, antipyretics, humidification

Question 18

What corticosteroid is commonly used for viral LTB?

Answer 18

Oral dexamethasone

Question 19

What is the recommended dose of nebulized epinephrine for severe symptoms?

Answer 19

0.4 to 0.5 mL/kg (to a maximum of 5 mL) of the 1:1000 preparation

Question 20

What is the most significant risk factor for recurrence of croup?

Answer 20

Family history of croup

Question 21

What is the primary organism responsible for epiglottitis in children?

Answer 21

Haemophilus influenzae type B (HiB)

Question 22

What is the classic position that children with epiglottitis adopt?

Answer 22

Tripod position

Question 23

What are the symptoms of epiglottitis?

Answer 23

Fever, severe throat pain, stridor, respiratory distress

Question 24

What is the recommended management priority for epiglottitis?

Answer 24

Secure the airway in a controlled environment

Question 25

What intravenous antibiotics are commonly used for epiglottitis?

Answer 25

3rd generation cephalosporins (ceftriaxone, cefotaxime)

Question 26

What is the duration of IV antibiotic treatment for epiglottitis?

Answer 26

7 to 10 days

Question 27

What is bacterial tracheitis also known as?

Answer 27

Bacterial, or membranous LTB

Question 28

What is the peak incidence season for bacterial tracheitis?

Answer 28

Fall and winter

Question 29

What organisms are commonly associated with bacterial tracheitis?

Answer 29

S. aureus, HiB, α-hemolytic Streptococcus, Pneumococcus

Question 30

What are the clinical features of bacterial tracheitis?

Answer 30

Similar to viral LTB, but condition deteriorates rapidly

Question 31

What is the typical age range affected by bacterial tracheitis?

Answer 31

6 months to 8 years

Question 32

What are the characteristics of the tracheal surface in bacterial tracheitis?

Answer 32

Thick, mucopurulent tracheal secretions obstructing the lumen ## Footnote The thick exudate and sloughed mucosa frequently obstruct the lumen of the trachea and the mainstem bronchi.

Question 33

What is the typical appearance of the epiglottis and arytenoids in bacterial tracheitis?

Answer 33

Usually normal, though epiglottitis and bacterial tracheitis may coexist ## Footnote The epiglottis and arytenoids are usually normal in appearance.

Question 34

What are the initial clinical features of bacterial tracheitis?

Answer 34

Mild fever, cough, and stridor for several days ## Footnote Similar to that of viral LTB.

Question 35

How does the patient's condition progress in bacterial tracheitis?

Answer 35

Rapid deterioration with high fever, toxic appearance, respiratory distress, and airway obstruction ## Footnote Other symptoms include choking episodes, orthopnea, dysphagia, and neck pain.

Question 36

How does the onset of symptoms in bacterial tracheitis compare to epiglottitis?

Answer 36

More insidious onset with a brassy cough ## Footnote Patients are more able to lie flat and tend not to drool.

Question 37

What defines the clinical severity of bacterial tracheitis compared to simple viral LTB?

Answer 37

More ill and do not respond to expected therapies ## Footnote Expected therapies include corticosteroids or nebulized epinephrine.

Question 38

What laboratory findings are indicative of bacterial tracheitis?

Answer 38

Polymorphonuclear leukocytosis and left shift ## Footnote A lateral neck radiograph may show a hazy tracheal air column.

Question 39

What is the mortality rate for bacterial tracheitis?

Answer 39

Estimated at 3% ## Footnote Mortality is now uncommon.

Question 40

What is the causative agent of diphtheria?

Answer 40

Corynebacterium diphtheriae ## Footnote May be isolated in bacterial culture of nasal and pharyngeal swabs.

Question 41

What are the clinical features of classic respiratory diphtheria?

Answer 41

Insidious onset, fever, membranous pharyngitis, cervical lymphadenopathy ## Footnote Characterized by a gray, thick, fibrinous membrane that may bleed on removal.

Question 42

What complications can arise from diphtheria?

Answer 42

Secondary pneumonia, myocarditis, neuritis, adrenal failure ## Footnote Complications can include airway obstruction and death.

Question 43

What is the first-line treatment for diphtheria?

Answer 43

Diphtheria antitoxin and intravenous penicillin or erythromycin ## Footnote Treatment helps eradicate the organism and stop toxin production.

Question 44

What is a retropharyngeal abscess?

Answer 44

An abscess in the retropharyngeal space due to mixed flora infections ## Footnote Common in children under 6 years of age.

Question 45

What are the clinical features of a retropharyngeal abscess?

Answer 45

High fever, sore throat, dysphagia, neck pain, and stiffness ## Footnote May present as a visible mass in the mouth.

Question 46

What is the management for a retropharyngeal abscess?

Answer 46

Intravenous antibiotics and surgical drainage ## Footnote Percutaneous CT-guided aspiration may also be used.

Question 47

What is the most common deep-space head and neck infection?

Answer 47

Peritonsillar abscess (Quinsy) ## Footnote More common in young adults.

Question 48

What is the predominant organism in peritonsillar abscess?

Answer 48

Streptococcus pyogenes ## Footnote Usually a complication of acute tonsillitis.

Question 49

What are the clinical features of peritonsillar abscess?

Answer 49

High fever, severe sore throat, neck pain, marked dysphagia ## Footnote Uvula is edematous and deviated to one side.

Question 50

What is the management approach for peritonsillar abscess?

Answer 50

Intravenous fluids and antibiotics, with potential drainage ## Footnote Analgesia is also important.

Question 51

What is the causative virus of infectious mononucleosis?

Answer 51

Epstein-Barr virus (EBV) ## Footnote Common in adolescents and young adults.

Question 52

What are the typical symptoms of infectious mononucleosis?

Answer 52

Fever, fatigue, malaise, lymphadenopathy, sore throat ## Footnote Diagnosis is confirmed with positive EBV serology.

Question 53

What is the usual course of treatment for infectious mononucleosis?

Answer 53

Supportive care, with systemic corticosteroids if obstruction is present ## Footnote Most cases are self-limiting.