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Yr 4 - Paediatrics > Upper Airway Obstruction Paeds > Flashcards

Upper Airway Obstruction Paeds Flashcards

1
Q

Management steps in acute management of unstable patient with upper airway obstruction?

A

1) Stabilise airway, breathing & circulation

2) +/- intubate or place a surgical airway

3) Obtain IV access

4) Continuous vital sign monitoring

5) +/- supplemental O2

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2
Q

Typical history in epiglottitis?

A
  • Rapid onset of high fever
  • Difficulty breathing & swallowing
  • Drooling
  • NO cough
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3
Q

What does exam typically reveal in epiglottitis?

A
  • Anxious-appearing child
  • Sitting forward w/ neck extended in a tripod position w/ chin forward.
  • Muffled voice
  • Audible stridor w/ laboured breathing
  • Cherry red epiglottis
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4
Q

What imaging can be ordered in susepcted epiglottitis?

A

Laternal neck XR

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5
Q

What will a lateral neck XR reveal in epiglottitis? (2)

A

1) Thumb sign

2) Swelling of epiglottic folds

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6
Q

Typical history in bacterial tracheitis?

A

1) Viral URTI

2) Rapid onset of:
- high fever
- progressive stridor
- respiratory distress
- hoarseness

3) Not responsive to nebulised adrenaline

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7
Q

Physical exam findings in bacterial tracheitis? (2)

A

1) Toxic appearing child

2) Biphasic stridor

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8
Q

What is a toxic appearing child?

A

Toxic appearance is a clinical presentation characterised by:

1) lethargy

2) poor perfusion

3) marked hypo/hyperventilation

4) cyanosis

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9
Q

What are 4 causes of nasopharyngeal obstruction?

A

1) Retropharyngeal abscess

2) Peritonsillar abscess

3) Tonsillitis

4) Adenotonsillar hypertrophy

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10
Q

Typical history in retropharyngeal abscess?

A

1) Typically a preceding viral URTI

2) Neck pain

3) Dysphagia –> poor oral intake

4) Chest pain +/- dyspnoea

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11
Q

Physcial exam findings in retropharyngeal abscess?

A

1) Anxious & ill appearing

2) Stiff neck & limited neck mobility

3) Palpable neck mass

4) Drooling

5) Respiratory distress

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12
Q

Position of child with epiglottitis vs retropharyngeal abscess?

A

Epiglottitis –> drool & lean forward in tripod position

Retropharyngeal abscess –> drool & hyperextend neck

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13
Q

Typical history in peritonsillar abscess?

A
  • Worsening sore throat
  • Decreased oral intake
  • Classic ‘hot potato’ voice
  • +/- dysphagia
  • +/- unilateral otalgia
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14
Q

Physical exam findings in peritonsillar abscess?

A

Unilateral tonsillar bulging +/- uvular deviation, drooling or trismus.

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15
Q

How is a diagnosis of peritonsillar abscess made?

A

Clinical –> doesn’t require imaging

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16
Q

Typical history of tonsillitis?

A
  • Sore throat
  • Constitutional symptoms: fever, fatigue
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17
Q

Physical exam findings in tonsillitis?

A
  • Erythematous pharynx
  • Enlarged tonsils often w/ exudates
  • +/- cervical lymphadenopathy
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18
Q

What is the most common cause of paediatric upper airway obstruction?

A

Adenotonsillar hypertrophy

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19
Q

What is adenotonsillar hypertrophy?

A

Abnormal growth of the pharyngeal tonsil and palatine tonsils.

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20
Q

Typical history in adenotonsillar hypertrophy?

A
  • Nightime snoring
  • Daytime sleepiness
  • Attention or behavioural problems
  • +/- apnoeic episodes
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21
Q

Physical exam findings in adenotonsillar hypertrophy?

A
  • Mouth breathing
  • Significantly enlarged tonsils
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22
Q

Some craniofacial malformations can cause upper airway obstruction shortly after birth.

Name 3

A

1) Bilateral choanal atresia –> causes neonatal respiratory distress during feeding (relieved w/ crying)

2) Nasal deformities e.g. cleft lip/palate

3) Micrognathia

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23
Q

Assess patient for stridor or wheezing.

If stridor during inspiration is present, what should you consider?

A

Supraglottic or glottic causes of upper airway obstruction.

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24
Q

What are 3 causes of supraglottic or glottic upper airway obstruction?

A

1) Croup

2) Laryngomalacia

3) Vocal cord dysfunction

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25
Q

Typical age of croup?

A

6 months to 3 years

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26
Q

Typical history in croup?

A
  • Low grade fever
  • URT symtoms e.g. rhinorrhoea, nasal congestion
  • Hoarseness
  • Barking/seal-like cough
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27
Q

What does physical exam reveal in croup?

A
  • Tachypnoea
  • Normal O2 sats
  • +/- suprasternal, intercostal & subcostal retractions
28
Q

What imaging can be done in suspected croup?

A

Lateral neck XR

29
Q

What is seen on a lateral neck XR in croup?

A

‘Steeple sign’ w/ suglottic narrowing

30
Q

What age is laryngomalacia typically seen?

A

3-5 months

31
Q

When is stridor worse in laryngomalacia?

A

During feeding, activity & supine position

32
Q

When does stridor improve in laryngomalacia?

A

In prone position (i.e. on tummies)

33
Q

Typical history in vocal cord obstruction?

A

Acute onset of dyspnoea - triggered by physical activity or strong emotions.

Laboured breathing.

34
Q

Key investigation in vocal cord dysfunction?

A

Flexible fiberoptic laryngoscopy

35
Q

Typical age of presentation of vocal cord dysfunction?

A

Older child or adolescent

36
Q

What will flexible fiberoptic laryngoscopy show in vocal cord dysfunction?

A

Inappropriate adduction of vocal cords during inspiration.

37
Q

What can vocal cord dysfunction ofen be confused with?

A

Asthma

38
Q

What does a biphasic stridor mean?

A

Present during inspiration and expiration.

39
Q

What should you consider as cause of obstruction in a biphasic stridor?

A

Subglottic causes of airway obstruction.

  • Vascular ring or sling
  • Subglottic stenosis
40
Q

What is a pulmonary sling?

A

The left pulmonary artery (transports oxygen-depleted blood from the heart to the lungs) has an unusual origin –> origin of the left pulmonary artery from the posterior aspect of the right pulmonary artery.

This anatomical vascular anomaly can compress nearby structures.

41
Q

What vessel is anomalous in pulmonary sling?

A

Left pulmonary artery

42
Q

Typical history in pulmonary sling?

A

1) Infant w/ dyspnoea & noisy breathing
- improves with neck extension
- worsens with neck flexion

2) Biphasic stridor

3) Monophonic wheeze

43
Q

Key investigation in pulmonary sling?

A

Barium swallow

44
Q

Mx of croup?

A

Single dose of dexamethasone

45
Q

What is the most common organism causing croup?

A

Parainfluenza

46
Q

What does barium swallow reveal in pulmonary sling?

A

Anterior indentation of oesophagus.

47
Q

Typical history in subglottic stenosis?

A
  • History of prolonged or recurrent intubation
  • Chronic barking cough
  • Biphasic stridor that is louder w/ increased respiratory effort
48
Q

Diagnostic investigation in subglottic stenosis?

A

Bronchoscopy

49
Q

What is a typical preceding factor in subglottic stensois?

A

Prolonged or recurrent intubation

50
Q

What will bronchoscopy show in subglottic stenosis?

A

Narrowing below vocal cords

51
Q

What is tracheomalacia?

A

The walls of trachea collapse (can happen because the walls of the windpipe are weak, or because something is pressing on it.).

52
Q

What age does tracheomalacia typically occur/resolve?

A

Occur –> 0-2y

Resolve –> 2y

53
Q

Typical history in tracheomalacia?

A

Cough & intermittent cyanotic episodes:
- worse after bronchodilator use
- improve with prone positioning

54
Q

Typical exam findings in tracheomalacia?

A

1) Monophonic, central expiratory wheeze

2) +/- audible biphasic stridor

55
Q

What is diagnostic investigation in tracheomalacia?

A

Bronchoscopy

56
Q

What is seen on bronchoscopy in tracheomalacia?

A

Collapse of the tracheobronchial tree

57
Q

1st line investigation in suspected foreign body inhalation?

A

Bronchoscopy

58
Q

3 typical causes of airway obstruction in UNSTABLE patients?

A

1) Epiglottitis

2) Bacterial tracheitis

3) Anaphylaxis

59
Q

ABCDE management of acute asthma?

A

1) ABCDE approach

2) O2 (keep sats >94%)

3) Nebulised salbutamol +/- ipratropium bromide

4) Steroids

5) IV therapy e.g. magnesium sulphate, salbutamol, aminophylline

60
Q

What are some signs of poor asthma control?

A
  • regular symptoms
  • multiple hospital admissions
  • poor exercise tolerance
  • faltering growth
  • missing school, poor educational achievement
  • risk of death
61
Q

What can be an unpleasant side effect of LTRA therapy (e.g. montelukast)?

A

Night terrors

62
Q

What time of the year is bronchiolitis typically seen?

A

Winter months

63
Q

Pathophysiology of bronchiolitis

A

Virus invades respiratory epithelium:

1) Increased mucus production

2) Bronchiolar obstruction

3) Pulmonary hyperinflation & atelectasis

64
Q

Features of croup?

A

1) Coryzal prodrome

2) Barking cough

3) Low grade fever

4) Inspiratory stridor

5) Hoarse voice

65
Q

Croup management?

A

1) ABCDE

2) Keep child calm, avoid throat exam

3) Steroids (oral dex)

4) Nebulised adrenaline

5) Intensive care

66
Q

What causes bacterial tracheitis?

A

HiB

67
Q
A

Yr 4 - Paediatrics (78 decks)

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