Graneto DSA

Question 1

Labs in bacterial tracheitis

Answer 1

may demonstrate a leukocytosis Left shift

Question 2

What accounts for 90% of stridor with fever affecting children most commonly from 6 months to 3 years?

Answer 2

Laryngotracheobronchitis (croup)

Question 3

if retropharyngeal abscess presents in older child, it is following what in many instances?

Answer 3

penetrating trauma to posterior oropharynx

Question 4

When should you give steroids for croup?

Answer 4

as early as possible (dexamethasone)

Question 5

This is an infection of the subglottic region and is more likely to cause respiratory failure than croup and epiglottitis combined

-give pseudomembrane formation

Answer 5

Bacterial tracheitis

Question 6

How may patients with upper airway compromise breathe

Answer 6

through an open mouth, which suggest dysphagia with inability to swallow secretions, or the general presence of air hunger

Question 7

Definite diagnosis of bacterial tracheitis occurs with visualization of what?

Answer 7

normal epiglottis and presence of pus, inflammation, and in some cases a pseudomembrane in subglottic region upon intubation

Question 8

What are the most common causes of acute upper airway obstruction?

Answer 8

• croup
• epiglottitis
• foreign-body obstruction

Question 9

Most peritonsillar abscesses are from what microbes

Answer 9

• Group A strep
• Peptostreptococcus
• Fusobacterium
• other mouth flora

Question 10

What do you do if a child younger than 1 has complete obstruction

Answer 10

4 back blows followed by chest thrusts

Question 11

What is by far the most reliable sign of respiratory failure in an infant or child?

Answer 11

an ineffective respiratory effort and an altered level of consciousness

Question 12

What is treatment for croup aimed at

Answer 12

solely at relieving symptoms

Question 13

What do you give any child with respiratory distress?

Answer 13

supplemental oxygen

Question 14

Start all patients with suspected retropharyngeal abscess on what antibiotic

Answer 14

clindamycin plus a 3rd gen cephalosporin as empiric treatment

Question 15

In patients with moderate croup score, whatt will usually result in symptomatic improbement for up to 2 hours

Answer 15

use of oxygen and racemic epinephrine delivered by nebulizer

Question 16

What are lab findings common with retropharyngeal abscess

Answer 16

leukocytosis with elevated acute phase reactants

Question 17

What can occur with staphylococcal tracheitis

Answer 17

Toxic Shock syndrome

Question 18

What is definitive therapy for retropharyngeal abscess?

Answer 18

intraoperative drainage of the abscess in the OR

Question 19

In most suspected cases of retropharyngeal abscess, what will identify any soft tissue infections and abscess formation

Answer 19

CT scan of neck

Question 20

What do you do if a child older than 1 has complete obstruction

Answer 20

repetitive abdominal thrusts

Question 21

What does “hot potato” phonation represent

Answer 21

splinting of the palatine muscles during normal speech

Question 22

Agents responsible for croup

Answer 22

• Parainfluenza types 1, 2, and 3 (most common)
• adenovirus
• RSV
• influenza

Question 23

What is the hallmark of upper airway compromise?

Answer 23

Stridor

Question 24

Most common symptoms and signs of hypoxemia in children?

Answer 24

• agitation
• irritability
• failure to maintain feeding effort

Question 25

Some cases of Peritonsillar abscess are superinfection of an existent _____

Answer 25

Epstein-Barr infection

Question 26

what do you give a patient with epiglottitis after intubation

Answer 26

ceftriaxone IV

Question 27

What may prevent the progression of croup to complete obstruction by decreasing the amount of swelling of laryngeal mucosa

Answer 27

corticosterioids

Question 28

Describe antibiotic treatment of bacterial tracheitis

Answer 28

Begin broad spectrum that includes coverage of S. aureus with a third gen cephalosporin such as ceftriaxone along with vancomycin until culture results are known

Question 29

These are seen predominantly in children younger than 3 years secondary to suppurative cervical lymphadenopathy

Answer 29

Retropharyngeal abscesses

Question 30

most common age group for epiglottitis?

Answer 30

2 to 5

Question 31

Classic presentation for croup

Answer 31

children usually present after several days of nonspecific upper respiratory infection (URI) symptoms with a characteristic brassy or barking cough -temperatures common

Question 32

Age group for peritonsillar abscess

Answer 32

children older than 8

Question 33

discharge patients with mild croup if what?

Answer 33

- parents are reliable - child is well hydrated and taking adequate fluids - child is older than 6 months

Question 34

presentation of retropharyngeal Abscess

Answer 34

- commonly cervical lymphadenitis and trismus - stiff neck or torticollis - often initially thought to be meningitis

Question 35

What may be necessary in addition to oxygen, epi, and corticosterioids, if croup is severe?

Answer 35

- maybe antibiotics | - maybe intubation

Question 36

Age group for foreign body aspiration

Answer 36

children under 5

Question 37

Cyanosis of respiratory origin tends to be what?

Answer 37

central

Question 38

Are blood cultures useful in bacterial tracheitis?

Answer 38

rarely

Question 39

position of comfort with epiglottitis

Answer 39

sitting upright, mouth open, with head, neck and jaw in extension

Question 40

most common microbes causing bacterial tracheitis

Answer 40

- S. aureus - S. pneumonii - H. influenza - psuedomonas - Moraxella

Question 41

What is seen on a lateral neck radiograph with bacterial tracheitis

Answer 41

subglottic and tracheal narrowing with a ragged tracheal border secondary to the pseudomembrane

Question 42

A secondary effect of cyanosis may be the development of what?

Answer 42

somnolence

Question 43

in a young infant, stridor is most often the result of a congenital anomaly of what 3 things?

Answer 43

- tongue (macroglossia) - Larynx (laryngomalacia) - trachea (tracheomalacia)

Question 44

Chest X ray with bacterial tracheitis

Answer 44

may demonstrate concomitant pneumonia

Question 45

position of comfort for lower airway disease

Answer 45

assume "tripod position" consisting of upright posture, leaning forward, and support of the upper thorax by use of extended arms

Question 46

microbes causing retropharyngeal abscess

Answer 46

- Group A hemolytic step - Staph - more frequently MRSA

Question 47

Position of comfort for children with stridor

Answer 47

- upright - lean forward - generate own jaw thrust maneuver to open upper airway

Question 48

What is the most common response of a child to increased respiratory needs?

Answer 48

tachypnea

Question 49

before sending a child home with mild croup, give dose of what?

Answer 49

oral decadron

Question 50

usual evolution of croup

Answer 50

worsening of symptoms for 3 to 5 days followed by resolution over a period of days

Question 51

presentation of of peritonsilar abscess

Answer 51

- increasing dysphagia - ipsalateral ear pain - progression to trismus, dysarthria and toxicity - Drooling common - "hot potato" phonation

Question 52

Lateral neck radiographs for retropharyngeal abscess

Answer 52

Prevertebral soft tissue swelling greater than 7 mm at the level of the second cervical vertebrae or greater than 14 mm at the level of the 6th vertebrae and a normal epiglottis and aryepiglottic folds