Pediatric upper respiratory conditions

Question 1

what are the three types of sinusitis?

Answer 1

persistent
severe
worsening

Question 2

`when are antibiotics warranted?

Answer 2

10 days getting worse, no improvement (sinusitis)

Question 3

classic presentation: laryngotracheobronchitis

Answer 3

retractions of chest wall 
nostril flaring 
coryza - profuse nasal discharge 
barking cough - INSPIRATORY 
appears in the middle of the night 
prior URI for a few days 
variable fever 
sore throat

Question 4

during what ages is laryngotracheobronchitis infection most likely?

Answer 4

6 months - 6 years

Question 5

what are the etiologies of laryngotracheobronchitis (viral croup)? which is the most common?

Answer 5

parainfluenza virus type 1 (most common) 
parainfluenza virus type 2 
influenza A 
adenoviruses 
respiratory syncytial virus 
enteroviruses 
mycoplasma pneumo 
measles 
HSV 
corynebacterium diphtheria

Question 6

what is the steeple sign? why is it not as useful?

Answer 6

upon CXR, tapered subglottic airway

only 50% present

Question 7

what is the best medication therapy for true (rescue) airway distress in laryngotracheobronchitis (viral croup)? why?

Answer 7

racemic EPI

decrease in airway edema by vasoconstriction of airway blood vessels

Question 8

what is the most common, and useful, medication for laryngotracheobronchitis (viral croup) in a non-rescue situation? what is the route?

Answer 8

dexamethasone

IM or PO

Question 9

classic presentation: epiglottitis

Answer 9

anxious patient that prefers the sitting position, with neck in hyperextension and significant drooling

Question 10

what is the most common etiology of epiglottitis?

Answer 10

haemophilus influenza type B

Question 11

what is the treatment of epiglottitis?

Answer 11

anesthesia and endotracheal intubation
IV access
CBC, culture
abx

Question 12

bacterial tracheitis may follow what infection?

Answer 12

viral croup

Question 13

presentation: bacterial tracheitis

Answer 13

brassy cough, high fever, toxicity

Question 14

what is the most common causative agent of bacterial tracheitis?

Answer 14

staph aureus

Question 15

what is the major pathology associated with bacterial tracheitis?

Answer 15

mucosal swelling at cricoid level

thick, copious, purulent secretions

Question 16

diagnosis: bacterial tracheitis?

Answer 16

respiratory distress
high fever
copious secretions
leukocytosis with left shift

Question 17

treatment: bacterial tracheitis?

Answer 17

intubation

antistaphylococcal abx

Question 18

what is seen on expiratory film for foreign body aspiration? inspiratory film?

Answer 18

expiratory - air trapping on affected side, mediastinal shift to unaffected side

inspiratory - mediastinal shift to affected side as other lung aerates

Question 19

how are foreign bodies in the trachea visualized?

Answer 19

sagittal plane - lateral view

Question 20

how are foreign bodies in the esophagus visualized?

Answer 20

coronal plane - AP view

Question 21

what is a retropharyngeal abscess?

Answer 21

infection between buccopharyngeal fascia and prevertebral fascia - lymph nodes in this region most commonly suppurate from extension of a bacterial pharyngeal infection

Question 22

what are the most common causes of retropharyngeal abscess?

Answer 22

strep pyogenes
oral anaerobes
staph aureus

Question 23

presentation: retropharyngeal abscess

Answer 23

fever 
sore throat 
neck pain 
pregressive dysphagia 
respiratory distress 
torticollis 
trismus 
drooling 
stridor

Question 24

what is seen in the oropharynx for a retropharyngeal abscess?

Answer 24

posterior swelling which may be greater on one side than the other

Question 25

what is the treatment for retropharyngeal abscess?

Answer 25

drainage and abx that cover gram positive organisms and anaerobes

Question 26

what is the most common cause of stridor in infancy

Answer 26

laryngomalacia

Question 27

what are the causes of laryngomalacia?

Answer 27

1. immaturity of the supporting structures surrounding the larynx
2. abnormal neuromuscular development

Question 28

presentation: laryngomalacia

Answer 28

inspiratoryo stridor that is worse with crying and while in the supine position; improves in prone position

Question 29

what is the treatment for laryngomalacia?

Answer 29

1. reassurance to parents if no respiratory insufficiency or failure to thrive
2. surgical intervention sometimes necessary with epiglottoplasty or laser excision

Question 30

presentation: tracheomalacia

Answer 30

cause wheezing more often that stridor

Question 31

tracheomalacia may be associated with what condition?

Answer 31

TE fistula