Bailey And Johnson - Chapter 79

Front 1

What is the first indication of the respiratory system? When does it occur?

Back 1

Day 20 - appearance o the median pharyngeal groove

Front 2

When does the pharynx appear as a distinct entity?

Back 2

Day 22 - laryngotracheal sulcus and pulmonary primordium

Front 3

When does the Right and Left lung divide? (what fetal day)

Back 3

Day 24

Front 4

Where does the margin of the cricoid cartilage reside in the infant?

Back 4

C2 - descends to C7 in the adult

Front 5

For how long is a child an obligate nasal breather?

Back 5

few months

Front 6

In the child what is the relationship of the skin to the trachea?

Back 6

60 degree angle; not parallel to the skin

Front 7

What are two congenital lesions that would give you Immediate respiratory distress at birth with obvious audible stridor?

Back 7

Choanal atresia, congenital subglottic stenosis

Front 8

What pathology causes stridor several weeks after birth?

Back 8

laryngomalacia, subglottic hemangioma

Front 9

How often do inflammatory disorder affect the newborn?

Back 9

Almost never

Front 10

What things should you think of causing sudden intense stridor?

Back 10

Inflammation, trauma or foreign body (especially toddler)

Front 11

Where is the likely pathology in newborn high pitched stridor that improves in the prone position?

Back 11

Supraglottic

Front 12

Five common congenital anomalies of the nose/nasopharynx?

Back 12

Choanal atresia, Choanal stenosis, Choanal stenosis, Septal deformity, Turbinate hypertrophy, Masses (glioma, encephalocele, and adenoid hyperplasia, even in newborn)

Front 13

Four common congenital anomalies of the oral cavity/oropharynx

Back 13

Macroglossia, Craniofacial deformity (Apert, Pierre Robin), Masses and cysts (thyroglossal, lingual, thyroid, lympohatic malformation), Neurologic deficit

Front 14

Seven common congenital anomalies of the supraglottic larynx

Back 14

Laryngomalacia, Cysts, Neoplasm, Vascular malformation, lymphatic malformation, cleft (bifid epiglottis), Web

Front 15

Four common congenital anomalies of the glottis

Back 15

Web (anterior and posterior), atresia, neurologic dysfunction, stenosis, cleft

Front 16

Five common congenital anomalies of the supglottis

Back 16

Cysts, hemangioma, stenosis, Web, Cleft

Front 17

Eight common congenital anomalies of the trachea

Back 17

Tracheoesophageal fistula, tracheomalacia, compression, congenital stenosis (complete rings), hemangioma, cyst, agenesis, tracheal bronchus

Front 18

Three common congenital anomalies of the esophagus

Back 18

Tracheoesophageal fistula, vascular decompression, duplication

Front 19

Where in the aerodigestive tract do lesions cause feeding difficulties?

Back 19

Nasal cavity, nasopharynx, pharynx

Front 20

What is a common first sign of hypoxia? Why isn't it always reliable?

Back 20

Circumoral pallor or cyanosis - can also been seen in cardiac anomalies

Front 21

Imaging modality of choice for diagnosis of choagnal atresia?

Back 21

CT

Front 22

What percentage of children have more than one lesion affecting different areas of the airway?

Back 22

12-18% have simultaneous lesions

Front 23

How is choanal atresia/stenosis managed in children?

Back 23

Bony atresia best corrected via transpalatal approach, transnasal endoscopic best suited to those with membranous atresia. Mild stenosis best managed with decongestants and wachful waiting - oral airway supplementation during sleep in young children

Front 24

How is a septal deformity managed in children?

Back 24

Septal repositioning

Front 25

What are common causes of bilateral vocal cord paralysis in children?

Back 25

Arnold-Chiari malformations

Front 26

Where are glottic webs typicall found?

Back 26

Anterior portion of the glottis

Front 27

How do laryngeal webs typically present?

Back 27

Aphonia

Front 28

How significant must a web be in order to require treatment?

Back 28

more than 50%

Front 29

At what age should formal correction of a laryngeal web take place

Back 29

anytime after 6 months

Front 30

At what diameter is diagnostic of congenital subglottic stenosis?

Back 30

AP diameter less than 4 mm

Front 31

At what age do subglottic hemangiomas become symptomatic?

Back 31

Generally after the third week of life - biphasic stridor that worsens with exertion or agitation

Front 32

What % of patients with a subglottic hemangioma have a cutaneous hemangioma?

Back 32

50%

Front 33

When does spontanous regression of a hemangioma typically occur?

Back 33

after 12th to 18th month

Front 34

How is the diagnosis of posterior cleft made?

Back 34

esophagram - showing contrast in the trachea - diagnosis best made with endoscopy

Front 35

How are major posterior clefts repaired?

Back 35

Lateral approach or laryngofissure

Front 36

Why does a posterior cleft form?

Back 36

tracheoesophageal septum fails to develop

Front 37

What does the acronym VACTERL stand for?

Back 37

Vetebral, anal, cardiac, tracheal, esophageal, renal and limb abnormalities

Front 38

How common is primary tracheomalacia in children?

Back 38

extremely rare

Front 39

What kind of stridor typicall seen with tracheomalacia?

Back 39

expiratory stidor

Front 40

What typically causes secondary tracheomalacia in children?

Back 40

extrinsic compression (vascular anomalies) or secondary to surgical intervention (TEF repair)

Front 41

What is the most common type of tracheoesophageal fistula?

Back 41

Proximal esophageal atresia with distal esophagus communicating with trachea (85%)

Front 42

How often do you see an isolated TEF (small communication)

Back 42

4%

Front 43

How often do you see esophageal atresia with a small proximal TEF, What about esophageal atresia with double TEF

Back 43

0.5% for both

Front 44

How does esophageal atresia present?

Back 44

immediate feeding difficulties and aspiration soon after birth

Front 45

What is the classic radiological finding assoaciated with esophageal atresia?

Back 45

classic radiologic finding of a curled tube in the pharynx and an air bubble in the stomach

Front 46

Wha are four vascular anomalies that can cause tracheal or esophageal obstruction?

Back 46

Anomalous subclavian, double aortic arch, right aortic arc, innominate artery compression

Front 47

What is an anomalous subclavian artery?

Back 47

Aberrant Right subclavian sometimes arises from the left descending aorta, passes behind the esophagus and trachea and then follows a normal right sided course

Front 48

What is a double aortic arch - what are the two forms?

Back 48

Complete vascular ring - two forms (larger anterior arch or posterior arch)

Front 49

Besides a double aortic arch - how else can a complete ring be formed?

Back 49

right aortic arch and a persistent ligamentum arteriosum or ductus arteriosus

Front 50

How do most esophageal duplications occur?

Back 50

foregut cysts in the superior or posterior mediastinum or as true duplications in or along the lower third of the esophagus