Uw ped pulmo cases

Question 1

(1) Pneumo + pleuros skysčio tyimas = infeciniai požymiai. Žodžiu buvo tipine pneumo empyemos Dx pagal pleuros skysčio tyrimą.

Answer 1

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Question 2

(2) A 4-year-old boy is brought to the clinic due to fever for the past 5 days. He has also had a cough productive of yellow-green mucus. The patient had pneumonia a year ago that required hospitalization for hypoxia. Currently, he takes no daily medications other than acetaminophen as needed for fever. The patient has received all of his vaccinations except for an annual influenza vaccine. His family is originally from Peru, but he was born in the United States and has not traveled outside of the country. Temperature is 38.9 C (102 F), blood pressure is 90/60 mm Hg, pulse is 112/min, and respirations are 20/min. Pulse oximetry is 99% on room air. His weight is at the 75th percentile, and review of his medical records reveals that he is growing well. Physical examination reveals a young child with moist mucous membranes, rales and decreased breath sounds over the left lower lung, and comfortable work of breathing. Chest x-ray demonstrates an opacity over the lower left lung with minimal layering of fluid on lateral decubitus film. Which of the following is the most appropriate next step in management of this patient?

Answer 2

Oral abs

Question 3

(2) algorithm of parapneumonic effusions: xray - small effusion AND no respiratory distress - Tx?

Answer 3

Oral abs
close monitoring

Question 4

(2) algorithm of parapneumonic effusions: xray - moderate/large effusion OR respiratory distress OR hypoxia - Tx?

Answer 4

UG
Drainage
IV antibiotics

Question 5

(3) } An 11-year-old boy is brought to the emergency department by his mother due to a week of fever, malaise, productive cough, and worsening dyspnea. The patient has cystic fibrosis that was diagnosed at birth and has since had recurrent episodes of sinusitis and lung infections. He has no other chronic medical conditions and is up to date on all recommended vaccinations. Temperature is 38.5 C (101.3 F), pulse is 110/min, and respirations are 30/min. Oxygen saturation is 92% on room air. Auscultation of the lungs reveals bilateral fine crackles and rhonchi. The patient is admitted to the hospital, and broad-spectrum antibiotics are started. A week later, there is no improvement in symptoms. Laboratory studies reveal peripheral blood eosinophilia and an IgE level of 3,225 IU/mL. Which of the following is the most likely cause of this patient’s current condition? BRONCHOPULMONARY ASPERGILLOSIS

Answer 5

BRONCHOPULMONARY ASPERGILLOSIS

Question 6

(3) BRONCHOPULMONARY ASPERGILLOSIS -
Difficult to control asthma, thick mucus. Chest imaging findings.
Elevated IgE, positive aspergillus skin test, eosinophilia. What is Tx?

Answer 6

Systemic GK - to decr. allergic inflammation

Antifungal

Tx of underlying asthma

Question 7

(3) This patient with cystic fibrosis (CF) has nonresolving symptoms of lower respiratory inflammation, eosinophilia, and high IgE (eg, >1,000 IU/mL), findings consistent with allergic bronchopulmonary aspergillosis (ABPA).

Answer 7

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Question 8

(4). Chest xray of neonate – rodyklė į thymus – klausimas, kas pažymėta.

Answer 8

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Question 9

(5) A 2-year-old boy is brought to the emergency department due to difficulty breathing that started 6 hours earlier. The patient has had rhinorrhea, nasal congestion, and a dry cough that sounds “like a barking dog” for the past day. Temperature is 37.7 C (99.9 F), blood pressure is 92/64 mm Hg, pulse is 122/min, and respirations are 30/min. Pulse oximetry is 99% on room air. The patient has inspiratory stridor when crying. He is diagnosed with croup, administered oral dexamethasone, and observed in the emergency department. On reassessment 30 minutes later, oxygen saturation is 96% on room air and respirations are 40/min. The patient has inspiratory stridor at rest and subcostal and intercostal retractions. Which of the following is the best next step in management of this patient?

Answer 9

NEBULIZED RACEMIC EPINEHPRINE

Dx = croup (laryngotracheobronchitis)

Question 10

(5) croup (laryngotracheobronchitis) CAUSE?

Answer 10

Parainfluenxa virus

Question 11

(5) croup (laryngotracheobronchitis) CP?

Answer 11

age 6 mnths - 3 y.o
Barking cough, inspiratory stridor.

Dx - clinical

Question 12

(5) croup (laryngotracheobronchitis) Tx?

Answer 12

Mild - humidifier air +/- corticosteroids (to decr. airway edema)

Moderate/severe - corticosteroids + nebulized epinephrine

Question 13

(5) Stridor at rest (severe croup), such as in this patient, can develop in those with progressive airway swelling and obstruction; these patients are treated with nebulized epinephrine in addition to corticosteroids.

Answer 13

Nebulized epinephrine constricts mucosal arterioles in the upper airway and alters capillary hydrostatic pressure, leading to decreased airway edema and reduced secretions. After administration, patients are observed for 4 hours because symptoms can recur. Patients needing multiple doses of nebulized epinephrine typically require hospital admission.

Question 14

(5) croup (laryngotracheobronchitis) what if corticoisteroids and epinephrine fails?

Answer 14

intubation and ventilation

Question 15

(5) oxygen give if SpO2 < 92 proc.

Answer 15

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Question 16

(6) A 10-year-old boy is brought to the emergency department due to 2 days of rhinorrhea, congestion, cough, and wheezing that worsened over the 6 hours prior to arrival. Chest x-ray reveals hyperinflation and bronchial wall thickening. He receives nebulized albuterol and ipratropium, intravenous corticosteroids, and intravenous magnesium sulfate. Due to lack of significant improvement in symptoms, the patient is admitted to the intensive care unit and given continuous nebulized albuterol, intravenous terbutaline, and bilevel noninvasive positive airway pressure ventilation. After 2 hours, pulse oximetry shows 89% on 0.6 FiO2, and the patient becomes agitated. Breath sounds are diminished but equal bilaterally, and no wheezing or stridor is heard. The patient’s trachea is midline. ABG: Ph 7,30; PaO2 52; PaCO2 50. Which is the best next step in management of this patient?

Answer 16

ENDOTRACHEAL INTUBATION

Question 17

(6) Asthma Tx? drugs

Answer 17

Nebulized albuterol and ipratropium, IV corticosteroids +/- IV magnesium

Question 18

(6) Asthma Tx? ventilation

Answer 18

Short trial (<2h) of NIPPV
Intubation and ventilation (impending respiratory failure)

Question 19

(7) A 2-year-old boy was hospitalized 24 hours ago after a swimming pool drowning. The patient had no pulse when he was removed from the pool. Cardiopulmonary resuscitation was initiated at the scene and continued for 20 minutes before spontaneous circulation was restored. The patient is intubated and receiving mechanical ventilation. Over the past 2 hours, he has had persistently elevated blood pressure and bradycardia. Temperature is 37 C (98.6 F), blood pressure is 145/84 mm Hg, pulse is 59/min, and respirations are 16/min. Oxygen saturation is 96% on 70% oxygen, with the ventilator rate set at 16/min. The patient is not receiving any sedating or analgesic medications and exhibits no eye or extremity movement in response to stimulation. Jugular venous pressure is normal. The lungs have bilateral crackles. There is no peripheral edema. What is the most likely explanation for this patient’s hemodynamic abnormalities?

Answer 19

INCREASED INTRACRANIAL PRESSURE

hypoxic-ischemic brain injury (eg, no response to painful stimuli in the absence of sedation) accompanied by hypertension and bradycardia. Irregular respirations - occur due to impaired brainstem function. This presentation is concerning for severely increased intracranial pressure (ICP). CUSHING REFLEX

cerebral perfusion pressure (mean arterial pressure − ICP = cerebral perfusion pressure).

Question 20

(7) Cushing triad is a poor prognostic sign and often indicates cerebral herniation is imminent.

Answer 20

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Question 21

(8) A 6-year-old boy is brought to the emergency department by his mother due to new-onset chest pain. A week ago, he developed a low-grade fever with nasal congestion and a dry cough. Over the past few days, he has had paroxysms of coughing that seem to be worse at night. Last night, the patient developed pain in his chest that did not improve after he was given acetaminophen. He has no chronic medical conditions and takes no daily medications. Temperature is 37.3 C (99.1 F), blood pressure is 106/76 mm Hg, pulse is 130/min, respirations are 36/min, and pulse oximetry is 98% on room air. There is clear rhinorrhea. The posterior oropharynx and tonsils are erythematous. There is mild swelling of the neck and crepitus over the anterior chest. Pulmonary examination reveals clear and equal breath sounds bilaterally. Cardiac examination shows a normal S1 and S2 with no murmurs, rubs, or gallops. Which of the following is the best next step in evaluation of this patient?

Answer 21

CHEST XRAY

Dx = This patient has subcutaneous emphysema over the chest consistent with spontaneous pneumomediastinum (SPM)

Question 22

(9) A 3-year-old boy is brought to the emergency department by his parents for evaluation of sudden-onset abnormal breathing and shortness of breath. Yesterday morning, the patient developed a runny nose. Over the past 12 hours, he developed a fever and has had difficulty breathing. Temperature is 40 C (104 F) and respirations are 48/min. Pulse oximetry shows 86% on room air. On physical examination, the patient appears anxious and is sitting up, leaning forward, and drooling. Inspiratory stridor and suprasternal retractions are present. His lips are mildly cyanotic. Which of the following is the best next step in management of this patient?

Answer 22

INTUBATION

Question 23

(10) A 17-year-old girl is brought to the office due to chest tightness and dry cough for 4 weeks. The symptoms are worse in the middle of the night. Medical history is significant for homozygous sickle cell disease. The patient was admitted 6 months ago with acute chest syndrome and has previously had vasoocclusive episodes requiring blood transfusions. She takes hydroxyurea, folic acid, and a multivitamin. The patient has no known drug or seasonal allergies. She does not use tobacco, alcohol, or recreational drugs. Family history is significant for sickle cell disease and sarcoidosis. Vital signs are within normal limits. Examination shows clear lungs. Point of maximal impulse is in the fifth intercostal space at the left midclavicular line. Abdomen is soft and nontender. There is no peripheral edema. Chest x-ray is normal. Which of the following is the best next step in management of this patient? Dx?

Answer 23

SPIROMETRY (zymejau CT pulmonary angiogram)

Dx = This patient with chronic chest tightness and nighttime cough likely has obstructive airway disease due to asthma, a common comorbidity in children and adolescents with sickle cell disease (SCD).

Question 24

(10) Asthma should be suspected in any patient with SCD who has intermittent or chronic chest tightness, shortness of breath, or cough. Symptoms are often worse at night, during exercise, or with upper respiratory infections. Wheezing may not always be present on examination, particularly if symptoms are mild or intermittent.

Answer 24

Chest x-ray is often normal with asthma, and the first step in evaluation is spirometry, which shows airway obstruction that is reversible after bronchodilator administration. Management is similar to that of asthma in patients without SCD and includes inhaled bronchodilators and corticosteroids

Question 25

(10) table. Asthma = chronic wheezing, can be worse at night. Do spirometry PH = exertional dyspnea, right sided heart failure, Mx = do Cardio echo, arba increased pulmonary artery pressure in cardia catheterization Pulmonary fibrosis: exertional dyspnea, progressive. Do CT scan (honeycomb pattern). PFT = restriction

Answer 25

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Question 26

(11) A 16-year-old girl is brought to the clinic by her mother for asthma follow-up. The patient was hospitalized 2 weeks ago for her third asthma exacerbation in the past 6 months and requires her albuterol rescue inhaler at least once a day. She also uses a low-dose inhaled corticosteroid with long-acting beta agonist twice a day. Vital signs are normal. On examination today, a noticeable cigarette smell is present on the girl's sweatshirt. She has faint expiratory wheezes bilaterally. The remainder of the examination is normal. The patient's mother states that she is worried about her daughter's severe asthma symptoms and that the medications are not helping. Which of the following is the most appropriate response to the mother?

Answer 26

,,I would like to talk to your daughter privately and then we can talk together about treatment plan" Adolescents tend to place a high priority on confidentiality and are more likely to be honest if they believe that their privacy will be safeguarded. Therefore, in situations involving sensitive topics (eg, substance and tobacco use, sexual activity), physicians should interview the patient alone. However, physicians should avoid bringing up sensitive topics before addressing them confidentially with the patient (except in certain life-threatening or dangerous situations [eg, suicidality, child abuse]). This is because direct (eg, "your daughter may be smoking") or indirect (eg, "have you noticed her clothes smell like cigarettes?") accusations are likely to alienate the adolescent and shut down further communication.

Question 27

(12) A 2-day-old girl is in the neonatal intensive care unit due to prematurity and respiratory distress. The patient was born at 29 weeks gestation via spontaneous vaginal delivery to a 28-year-old primigravida mother. Her mother received a single dose of antenatal betamethasone before undergoing a precipitous delivery. Birth weight was 1.3 kg (2 lb 14 oz), and Apgar scores were 5 and 8 at 1 and 5 minutes, respectively. The patient received surfactant replacement and was placed on nasal continuous positive airway pressure (nCPAP) and has been receiving intravenous fluids. A few minutes ago, she developed an acute onset of grunting and increased work of breathing. Respiratory rate is 70/min and pulse oximetry is 80%. Lung examination shows decreased breath sounds on the left and intercostal retractions. Cardiac examination reveals heart sounds that are loudest over the right side of the chest and no murmurs. Bedside transillumination is performed, and the left chest shows increased brightness relative to the right. Which of the following is the best next step in management of this patient?

Answer 27

PERFORM NEEDLE THORACOSTOMY (zymejau discontinue nCPAP) Respiratory distress, unilaterally decreased breath sounds with increased brightness on transillumination—is consistent with pneumothorax.

Question 28

(12) NRDS + pneumothorax insufficient surfactant makes the alveoli less expandable and more prone to rupture. Mechanical ventilation (eg, nasal continuous positive airway pressure [nCPAP] in a neonate) also increases pneumothorax risk by increasing transpulmonary pressure.

Answer 28

Meconium aspiration syndrome (most common in postmature neonates) is associated with pneumothorax because meconium plugging of airways traps distal gas, promoting alveolar overdistension and rupture.

Question 29

(12) NRDS + pneumothorax. Management?

Answer 29

Do needle decompresion!!!!! Chest radiograph may be performed in hemodynamically stable patients or if the diagnosis remains unclear after transillumination (Choice E). This patient with hypoxia, severe respiratory distress, mediastinal deviation, and unilateral positive transillumination likely has a life-threatening tension pneumothorax, and emergency needle thoracostomy is required to evacuate the intrapleural air.

Question 30

(13) A 12-year-old previously healthy girl is evaluated 48 hours after being admitted to the hospital for pneumonia. She initially was brought to the emergency department due to worsening cough, shortness of breath, and fever at home for 3 days. Chest x-ray on admission revealed a right lower lobe infiltrate, and intravenous ampicillin was started immediately. A sputum culture is growing Streptococcus pneumoniae sensitive to ampicillin and ceftriaxone. Blood cultures have no growth. Current temperature is 39.4 C (102.9 F), blood pressure is 104/82 mm Hg, pulse is 110/min, and respirations are 28/min. On examination, heart sounds are normal. Dullness to percussion and diminished breath sounds are heard at the right lung base. The left lung is clear to auscultation. Which of the following is the best next step in management of this patient?

Answer 30

REPEAT CHEST X RAY Dx= uncomplicated community-acquired pneumonia typically improve within 48-72 hours of appropriate antibiotic therapy ====> REPEAT XRAY!!!!!!

Question 31

(14) A 13-day-old, full-term girl is brought to the office during winter due to a runny nose, cough, and fussiness over the past 2 days. Her birth history is unremarkable, and she has been feeding and growing well. The patient has a sibling in day care, where other children have been ill. Temperature is 37.8 C (100 F) and respirations are 70/min. Pulse oximetry is 95% on room air. Examination shows a crying infant with clear rhinorrhea. Auscultation reveals bilateral wheezes and crackles. This patient is at greatest risk of developing which of the following complications?

Answer 31

APNEA (zymejau bacteremia; kitas daznas ats buvo encephalitis) Bacteremia may complicate bacterial pneumonia, which typically presents with fever, cough, tachypnea, and focal crackles on examination. This patient is afebrile with diffuse wheezing, making viral infection more likely. Neonatal herpes simplex virus infection can cause encephalitis and seizures, but patients typically have mucocutaneous vesicles and/or sepsis (eg, lethargy, temperature instability). Isolated pulmonary findings (eg, diffuse wheezing, crackles) are not seen in herpes infection.

Question 32

(14) Broncholitis Tx?

Answer 32

Diagnosis is clinical, and treatment is supportive (eg, hydration, nasal saline and suction, supplemental oxygen). Most children fully recover within 1-2 weeks. Treatment for bronchiolitis is supportive, including suctioning the nares and maintaining adequate fluid intake. Patients who are well hydrated with adequate oxygenation (typically defined as >92% in bronchiolitis) and only mild/intermittent increased work of breathing, as in (15) case, can be managed as outpatients with close follow-up.

Question 33

(14) Bronchiolitis in very young infants (<2 months), complications?

Answer 33

bronchiolitis can be complicated by apnea and respiratory failure, particularly in infants age <2 months.

Question 34

(15) An 18-month-old boy is brought to the emergency department due to fever, cough, and nasal congestion. The patient developed a cough 6 days ago; it has increased in frequency over the past day and caused him to wake frequently at night. He has been intermittently febrile to 38.3 C (100.9 F) for 3 days. The patient takes no medications and has no significant medical history. Current temperature is 38.2 C (100.8 F), RR 45/min. SpO2 96%. Physical examination shows an active, alert, and playful toddler with mild tachypnea and intermittent suprasternal retractions. Auscultation demonstrates scattered wheezing and crackles over bilateral lung fields. The remainder of the examination is unremarkable. X-ray of the chest reveals bilateral increased interstitial markings and peribronchial cuffing. Which of the following is the best next step in management of this patient?

Answer 34

DISCHARGE WITH CLOSE FOLLOW-UP (zymejau inhaled bronchodilator trial and oral GK – cia atmetimo budu, nes kiti buvo Abs ir CT scan)

Question 35

(15) Bronchiolitis = a lower respiratory tract infection. What xray findings?

Answer 35

X-ray of the chest may be warranted to exclude other causes (eg, pneumonia) in patients with severe symptoms (eg, hypoxia, apnea) or atypical progression, such as this child with worsening symptoms after day 5 of illness. Common x-ray findings include increased interstitial markings and peribronchial cuffing (ie, bronchial wall haziness due to inflammation). Hyperinflation and atelectasis may be present, but focal consolidation is typically absent.

Question 36

(15) When might need CT in bronchiolitis?

Answer 36

CT scan of the chest may be warranted in children with bronchiolitis who have respiratory failure that does not improve despite respiratory support (eg, continuous positive airway pressure).

Question 37

(16) mindfuck case del time range. An 18-month-old girl is brought to the emergency department due to decreased energy. Over the last 2 months, the parents have noticed that she tires easily after play, and the fatigue has steadily worsened. The patient has been drinking 1,080 mL (36.5 oz) of cow's milk daily since transitioning from breast milk at age 12 months. She is a picky eater. Examination is unremarkable other than notable pallor. Hemoglobin is 2.3 g/dL. Stool occult blood is negative. The patient is admitted to the hospital for iron deficiency anemia due to poor dietary intake and receives 20 mL/kg of packed red blood cells over 3 hours. An hour after completion, she develops respiratory distress. Temperature is 37.1 C (98.8 F), blood pressure is 130/60 mm Hg, pulse is 160/min, and respirations are 44/min. Pulse oximetry is 89% on room air. The patient is grunting with retractions. Cardiac examination shows tachycardia with an S3 gallop but no friction rub. Lung examination shows diffuse crackles bilaterally. She is placed on oxygen. Which of the following is the best next step in management of this patient?

Answer 37

FUROSEMIDE (zymejau respiratory support only) Mx from table: furosemide, respiratory support (eg oxygen) Oxygen alone = wrong (nes cia yra cardiogenic symptoms) Dx = TACO. pas mehlmna yra kad TACO >6h; trali <6h. Cia uw lentelej rase kad taco yra within 6 h.

Question 38

(16) Respiratory support alone is the treatment for transfusion-related acute lung injury, a transfusion reaction characterized by respiratory distress caused by noncardiogenic pulmonary edema. This condition often presents with hypotension and does not cause circulatory overload (eg, S3 gallop, diffuse crackles).

Answer 38

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Question 39

(17) A 3-year-old girl is brought to the emergency department by ambulance after being found unresponsive in her family's pool an hour ago. She and her mother had been playing on the back porch until the mother went inside for less than 1 minute to answer the phone. When the mother came back outside, she found the girl floating face down in the pool. The mother immediately pulled her out and began rescue breathing, and the neighbor called an ambulance. The emergency medical team arrived 5 minutes later, at which time the patient was awake, alert, and coughing. She is an otherwise healthy girl with no prior hospitalizations. On arrival, temperature is 36.7 C (98.1 F), blood pressure is 100/60 mm Hg, pulse is 104/min, and respirations are 20/min; pulse oximetry is 99% on room air. Physical examination shows a smiling, alert young girl running around the room. Heart rate and rhythm are regular, and the lungs are clear to auscultation with no adventitious sounds or increased work of breathing. Which of the following complications is this patient at greatest risk of developing?

Answer 39

ARDS kitos komplikacijos: cerebral edema, arrythmia

Question 40

(18) A newborn boy is being evaluated in the delivery room. He was born a few minutes ago at 28 weeks gestation via spontaneous vaginal delivery to a 27-year-old primigravida. The mother received antenatal corticosteroids. The patient required bag valve mask ventilatory support shortly after birth due to minimal respiratory effort with an initial APGAR score of 3 at 1 minute. Following resuscitation, temp. 36.9 C, pulse 140/min, RR 56/min, SpO2 94% on room air. The infant is now crying and breathing spontaneously. He has expiratory grunting, but breath sounds are present and equal bilaterally. The abdomen is soft without organomegaly. Skin examination shows cyanosis in the hands and feet. The infant moves all extremities. There is no edema, and pulses are strong. The trunk and head appear pink and well perfused. Chest radiograph shows a diffuse ground glass appearance bilaterally with low lung volume and air bronchograms.Which of the following is the best next step in management of this patient?

Answer 40

PROVIDE NASAL CPAP * Patients with minimal respiratory drive and poor cardiac response require more invasive support with intubation and mechanical ventilation (Choice D). * In contrast, in those with improved cardiopulmonary status (such as this patient), noninvasive positive airway pressure (eg, nasal continuous positive airway pressure) is provided to maintain alveolar patency due to the risk of collapse

Question 41

(19) An 18-month-old girl is brought to the office by her parents due to difficulty breathing. The patient has had a runny nose and congestion since yesterday. Coughing started last night and has worsened throughout the day. The patient is drinking fluids and voiding normally. She was hospitalized at age 4 months for bronchiolitis and had a recent urgent care visit after putting a bead in her nose. The patient takes no daily medications and vaccinations are up to date. Temperature is 37.8 C (100 F), blood pressure is 90/60 mm Hg, pulse is 110/min, and respirations are 30/min. Pulse oximetry is 97% on room air. During examination, the patient coughs and cries but is easily consoled. The cough is harsh, and inspiratory stridor is heard when she is crying but resolves at rest. The lungs are clear to auscultation. Which of the following is the most likely cause of the patient's symptoms?

Answer 41

EDEMA AND NARROWING OF THE PROXIMAL TRACHEA This patient with upper respiratory symptoms (eg, congestion, rhinorrhea) now has a harsh cough and inspiratory stridor, symptoms suggestive of croup.

Question 42

(19) Croup is a common viral infection in young children (age 6 months to 3 years) predominantly caused by parainfluenza virus. The virus spreads from the nasopharyngeal mucosa to the larynx (eg, subglottis) and proximal trachea, causing edema and narrowing. Inflammation of the cricoid cartilage within the larynx creates a partial upper airway obstruction, resulting in a high-pitched noise during inspiration (stridor), hoarseness, and a barky cough.

Answer 42

Treatment includes corticosteroids to reduce subglottic edema as well as nebulized racemic epinephrine for severe cases (ie, stridor at rest). Mehl. rase kad supportive, jeigu liepia konkretu gydyma, tai tada racemic epinephrine

Question 43

(20) A 4-month-old boy is brought to the office for evaluation of noisy breathing that began shortly after birth. The noisy breathing worsens when the patient cries or eats. He has no cough, rhinorrhea, or hoarseness. The patient is fed cow's milk–based formula; the mother says feeding seems to tire him, so it takes him about 40 minutes to finish each bottle. He does not cough or choke during feeds but spits up after most bottles. He has normal wet diapers and stools daily. The patient was born at 37 weeks gestation via spontaneous vaginal delivery. He is at the 20th percentile for length and weight. The patient is afebrile with normal vital signs. Physical examination is notable for biphasic stridor that is louder on exhalation. The stridor improves with extension of the neck but does not improve with prone positioning. There are no skin lesions. Which of the following is the most likely cause of this patient's symptoms?

Answer 43

Vascular ring

Question 44

(20) table. laryngomalacia = stirdor worsens supine, mitigates prone.

Answer 44

vascular ring = mitigates on neck extension, biphasic stridor

Question 45

(20) table. airway hemangioma. Growth in the first few weeks of life -> progressive biphasic stridor. Concurrent skin hemangiomas (beard distribution) common

Answer 45

Airway hemangiomas present with progressively worsening biphasic stridor over the first 1-2 months of life due to rapid proliferation of the vascular lesion. Stridor does not generally improve with neck extension because the airway narrowing is intrinsic rather than the result of external compression. In addition, hoarseness is an expected symptom with vocal cord involvement, and skin hemangiomas of the chin/neck are often present.