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13 ENT > Pedia Stridor > Flashcards

Pedia Stridor Flashcards

1
Q

differences of pediatric airway from adult

A
  • 1/3 the size of adult’s larynx
  • smaller subglottis (5-7 mm in diameter)
  • consistency is softer and more flexible
  • arytenoids is 50% of framework (adults = 25%)
  • epiglottis rests on soft palate
  • cricoid at c4
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2
Q

narrowest portion in child’s and adults’ airway

A

child: subglottic region
adult: gottis

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3
Q

what is hagen poiseuille’s law

A

flow rate is proportional to radius to the fourth power

= small increase in internal diameter leads to dramatic increase in flow rate

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4
Q

t/f a decrease in mucosal swelling by a few mm can cause a significant decrease in luminal size and airway resistance

A

false, increase in mucosal swelling

pedia: small luminal size = small swelling can cause more airway resistance

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5
Q

associated with turbulent, high pitched, monophonic sound when breathing

A

stridor, signifies upper airway obstruction

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6
Q

conditions presenting early in childhood

A

laryngeal web
glottic atresia
congenital subglottic stenosis
congenital vocal cord paralysis

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7
Q

presentation of laryngeal web

A
  • weak voice with respiratory distress, stridor, and unusual cry
  • due to incomplete resorption of epithelial layer that normally obliterates at 6th aog
  • usually eliminated dby 10th week
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8
Q

t/f glottic atresia is incompatible with life

A

true

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9
Q

presentation of congenital subglottic stenosis

A
  • partial or complete narrowing of the airway
  • sob, stridor, hoarseness
  • can be incompatible with life
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10
Q

presentation of congenital vocal cord paralyss

A
  • moebius syndrome: weak cry or hardly any sound

- can be iatrogenic or neuromuscular dysfunction (gbs or mg)

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11
Q

most common cause of congenital stridor in children less than 1 yo

A

laryngomalacia

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12
Q

etiology of layngomalacia

A
  • redundant laryngeal soft tissue
  • poor cartilaginous support
  • inadequate neurologic support
  • narrow omega shaped epiglottis
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13
Q

diagnosis for laryngomalacia

A

awake flexible endoscopy

- stridor = supraglottic disorder

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14
Q

what is congenital laryngeal cysts or saccule

A
  • mucus producing gland

- appendage lying between false vocal fold and thyroid cartilage

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15
Q

what is laryngocoele

A
  • benign laryngeal lesions which may have an external component
  • manifests as lateral neck bulge or laryngeal mass on direct or indirect laryngoscopy
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16
Q

laryngocele vs saccular cyst

A

laryngocele: contains air

saccular cyst: fluid filled mass

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17
Q

what are laryngeal hemangiomas

A

benign vascular tumors

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18
Q

congenital vs adult laryngeal hemangioma

A

congenital: more common, <2 mos, resolves spontaneously in first 2 yrs
adult: irritation at the region, seen in endoscopy, tx is laser ablation

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19
Q

asleep vs awake stridor

A

asleep: supralaryngeal or pharyngeal (tonsils or adenoids)
awake: laryngea, tracheal, or bronchial; manifests as dyspnea on exertion

20
Q

inspiratory vs expiratory stridor

A

inspiration: extrathoracic (laryngomalacia, bilateral cord paralysis)
expiration: intrathoracic (asthma, tracheo or bronchomalacia, vascular rings)

21
Q

gold standard for diagnostics

A

laryngotracheobronchoscopy

22
Q

t/f acute epiglotitis is life threatening for children only

A

false, life threatening for both children and adults

23
Q

causes for acute epiglotitis

A

h influenzae b
pneumococci
b hemolytic strep

24
Q

presentation of acute epiglotitis

A
  • fever, drooling patient in respiratory distress
  • tripod position: jaw and mouth open and neck extended
  • thumb sign on lateral xray
25
Q

tx for acute epiglotitis

A
  • intubation for airway intervention
  • supportive: humidification, iv antibiotics, close observation and iv steroids
  • double set-up intubation, 3rd gen cephalosporing, systemic steroids, sedation
26
Q

presentation of croup or laryngotracheobronchitis

A
  • subglottic swelling
  • 6 mos to 3 yrs
  • biphasic stridor
  • > 90% are mild, subsides in 2-5 days
  • potential acute airway obstruction, intubation might be necessary
  • steeple sign on ap xray
27
Q

most common viral organisms associated with croup

A

parainfluenza, rsv, meases, vzv, rubella

28
Q

tx for croup

A

humidification, epi inhalation, steroids, systemic antibiotics, intubation (for severe airway compromise)

29
Q

most common cause of stridor among infants

A

laryngomalacia

30
Q

presentation of laryngomalacia

A
  • secondary to delayed maturation of supporting structures of the larynx or neuromuscular hypotonia
  • leads to collapse of supralaryngeal structures on inspiration
  • causes narrowing of airway and turbulent flow
  • dx: awake flexible endoscopy
31
Q

tx for laryngomalacia

A 
mild = observe
severe = secure airway with tracheostomy
32
Q

2nd most frequent cause for congenital stridor

A

congenital subglottic stenosis

33
Q

presentation and dx of subglottic stenosis

A
  • can be acquired or congenital
  • variants include soft stenosis and hard stenosis, associated with malformation of cricoid cartilage
  • dx gold standard: laryngoscopy
34
Q

tx for subglottic stenosis

A

(depends on length of stenosis and how small luminal circumference is)

  • cricoid split
  • pearson thyrotracheopexy
  • tracheostomy
  • co2 ablation
35
Q

most common benign laryngeal tumors in children

A

papilloma and laryngeal papillomatosis (hpv 6 and 11)

tx: co2 laser surgery

36
Q

presentation of vocal cord paralysis

A
  • weak cry, stridor, episodes of respiratory distress, dysphonia, aspiration
  • 65-70% resolve spontaneously
37
Q

tx for vocal cord paralysis

A

(depends on paralyzes and position)

medialization, cordectomy, arytenoidectomy

38
Q

most common age group for foreign body aspiration

A

1-3 yo

39
Q

presentation of foreign body aspiration

A
  • cough, wheezing, harsh or decreased breath sounds
  • right bronchus more common affected
  • most sensitive factor in hx: witness choking
40
Q

phases of foreign body aspiration

A

acute phase: life threatening, s/sx acute and severe coughing, choking, gagging, gasping, wheezing and/or stridor, perioral cyanosis

asymptomatic phase: irritation subsides

complication phase: reactive airway disease (hemoptysis, chronic cough, recurrent or persistent pneumonia, bronchitis)

41
Q

most common cause of death in foreign body aspiration requiring prompt management

A

laryngeal foreign body (at laryngeal inlet)

42
Q

manifestations of laryngeal foreign body

A
  • inappropriate food for age
  • mimic croup
  • respiratory distress (hoarseness, stridor, dyspnea)
43
Q

the power of bronchial obstruction to cause bronchial and pulmonary disease is ___ fold

A

3x fold

44
Q

types of bronchial obstruction

A

ball valve: flapper valve; in the reverse position =causes atelectasis and collapse in a few minutes

bypass valve: partial obstruction

check valve: obstructive emphysema

stop valve: complete obstruction, obstructive atelectasis, absorption of air by circulation takes 24 or more hours to cause atelectasis

45
Q

___ allows immediate removal of obstructions

A

diagnostic bronchoscopy

bronchoscopic aspiration for own secretions

46
Q

diagnostic of choice for foreign body aspiration

A

neck soft tissue anteroposterior lateral view

chest xray

13 ENT (18 decks)

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