OnlineMedEd: Pediatrics - "Upper Airway"

Question 1

Croup is caused by ____________.

Answer 1

Parainfluenza virus

Question 2

What age group is most affected by croup?

Answer 2

3 months to 3 years

Question 3

Croup generally follows what timeline/pattern of symptoms?

Answer 3

Viral prodrome (fever, malaise) followed by a cough with inspiratory stridor

Question 4

Kids with croup often get better when they ____________.

Answer 4

breathe colder air (such as might happen when they go outside on a cold night)

Question 5

Diagnostically, kids with viral croup will get better when you give them ____________.

Answer 5

racemic epinephrine

This can be helpful in diagnosing bacterial tracheitis because bacterial tracheitis will not improve with racemic epinephrine.

Question 6

Although x-rays of those with croup can show the ____________, it is not needed for diagnosis.

Answer 6

the steeple sign –narrowing of the supraglottic area –

Question 7

The best way to distinguish bacterial tracheitis from viral croup is _____________.

Answer 7

wait; viral croup usually improves on its own or with steroids/oxygen/epinephrine, while bacterial croup will not

Question 8

What age group is most common for epiglottitis?

Answer 8

3 - 7 year-olds.

Question 9

How is the course of illness for epiglottitis different from viral croup?

Answer 9

Epiglottitis is a much more rapid illness with high, spiking fevers.

Question 10

List the signs and symptoms of epiglottitis.

Answer 10

• Tripodding
• Drooling
• Accessory muscle use
• High, spiking fevers
• Rapid-onset illness
• Muffled voice

Question 11

The treatment for epiglottitis is _____________.

Answer 11

to secure the airway in the OR with endotracheal intubation

Note: do not try to visualize the airway in the clinic or ER. If you aggravate the airway with a laryngoscope, you can make it swell even more and compromise the patient. Thus, if you suspect epiglottitis based on the clinical picture, then page the OR and get an anesthesiologist and ENT to help intubate.

Question 12

What syndrome resembles epiglottitis (and how would you differentiate it)?

Answer 12

Retropharyngeal abscess

RA also presents with rapid-onset illness; high, spiking fevers; drooling; accessory muscle use; and a muffled voice. It is unique by having unilateral lymphadenopathy and a tender mass palpable in the throat.

Question 13

What bacteria usually causes retropharyngeal abscesses?

Answer 13

Generally a polymicrobial infection

Question 14

The definitive diagnosis of retropharyngeal abscess is made with ________.

Answer 14

CT scan

Question 15

How are retropharyngeal abscesses treated?

Answer 15

Incision and drainage with IV antibiotics afterward

Question 16

Peritonsillar abscesses usually cause ___________. If you see this, imaging is not required; antibiotics and I&D are sufficient.

Answer 16

uvular deviation

Otherwise, PA can mimic RA.