Ics_Pediatric Respiratory Disorders

Front 1

Extra thoracic Airway Obstruction

Back 1

block of the upper airways: nose, mouth, pharynx, larynx, glottis, trachea

Front 2

Intra thoracic airway obstruction

Back 2

middle: lower trachea, mainstem bronchi
lower: bronchi subdivisions, bronchioles, alveoli

Front 3

what kind of obstruction leads to noisy breath sounds?

Back 3

partial obstruction!
Complete obs. = no airflow and no breath sounds.

Front 4

What are the categories of things can cause obstruction?

Back 4

1.External Compression
(vascular ring, mass)
2. Airway structural abnormality
(congenital malacias, inflam. thickening)
3. material in the lumen
(foreign bodies, mucus(

Front 5

What kind of obstruction causes stridor?

Back 5

stridor: flow limited during inspiration

caused by variable extra thoracic obstruction

Front 6

What kind of obstruction causes wheezing?

Back 6

Wheezing: flow limited during expiration

Caused by Variable intrathoracic obstruction.

Front 7

What are the congenital causes of extra thoracic obstructions that we learned about?

Back 7

1. Choanal Atresia
2. Larygomalacia

Front 8

What are the aquired causes of thoracic airway obstruction?

Back 8

1. Infectious:
laryngotracheobronchitis
(viral croup)
bacterial tracheitis
(pseudomembranous croup)
acute epiglottitis (ER!)

2. Spasmodic Croup

Also:
- Laryngeal Trauma
- subglottic stenosis
(intub injury or foreign body)
- vocal cord paralysis
- anaphylaxis

Front 9

What is the most common cause of nasal obstruction in infants?

Back 9

Mesenchymal plate fails to atrophy, then ossifies to occlude post nasal aperture
(Choanal Atresia)

Front 10

Most common cause of non infectious, recurrent stridor in infants?

Back 10

Laryngomalacia:
collapse of supra glottic structures in inspiration.
(arytenoid cartilage + epiglottis)
- noisy breathing, worse supine
- 6mo -3yr
- caused by para flu, RSV, adenovirus, influenza, mycoplasma, rubeola

Front 11

Child comes in with a barking cough and inspiratory stridor.
low grade fever.

Back 11

laryngeotracheal bronchitis.
seasonal.
d/t to viral infexn (paraflu, RSV)

Front 12

child with subglottic narrowing on lateral neck films

Back 12

steeple sign --> laryngeotracheal bronchitis

Front 13

child comes in with an abrupt onset of brassy cough mostly at night, no fever.
family history of allergies.

Back 13

spasmodic croup.
not cause by anything viral.
not seasonal.

Front 14

toxic looking child with acute onset fever, drooling, muffled voice, sore throat, difficulty swallowing. insp. retractions, cyanosis, stridor

Back 14

epiglotittis!
This is a medical emergency
D.t:
HfluB(nontypable),
influenza,
strep pneumo, GAS,
staph, Niesseria

Front 15

thumbprint sign on xray

Back 15

epiglotittis

Front 16

collapse of supraglottic structures during inspiration

Back 16

laryngeomalacia

Front 17

child comes in with noisy breathing that is worse when supine. symptoms are bad on inspiration but releived on expiration. no fever.

Back 17

laryngeomalacia

Front 18

The most common causes of viral croup are

Back 18

parainfluenza, RSV, adenovirus, influenza, mycoplasma (+5yr), rubeola

Front 19

Pathological signs of laryngeotrachealbronchitis

Back 19

1. hypoxia
(airway inflam --> inc. secretion --> atelectasis --> v/Q mismatch --> hypoxia)
2.hypercarbia
(d/t lack of gas exchange)
3. pulmonary edema
(d/t super intense negative pressure)

Front 20

severe inflammatrion and swelling of supraglottic structure that can evolve into a life threatening obstruction

Back 20

epiglottitis

Front 21

2-3 day illness with barking cough, fever, inspiratory stridor
worsens to high fever, toxicity.
hoarse voice, no dysphagia.
doesn't respond to croup treatment.
left shift leukocytosis.

Back 21

bacterial trachietis!
(pseudomembranous croup)

tons of tracheal secretions cause upper airway obstructions from inflammation and purulent debris.

d/t: s. aureus, H flu, GAS, niesseria, moraxella

Front 22

lateral neck film with normal epiglottis, severe subglottic narrowing, irregularity of proximal trachea contour

Back 22

bacterial trachietis

Front 23

young boy presents with stridor. keeps failing extubation and also has a history of prolonged, severe episodes of croup.

Back 23

could be subglottic stenosis

Front 24

causes of vocal cord paralysis

Back 24

1. congenital
2. injury to recurrent laryngeal nerve secondary to surgery
3. trauma
4. mediastinal mass

Front 25

causes of subglottic stenosis

Back 25

1. congenital or
2. intubation injury (most common since that's the most narrow part of a kid's airway)
3. Foreign body aspiration
(usually in boys , under 5yr)

Front 26

causes of laryngeal trauma

Back 26

1. external - clothesline injury (near hanging)
2. internal- noxious inhalation.
thermal burn, caustin subs., intubation

Front 27

little boy presents with a wheeze, a cough and localized decrease breath sounds in the right lung.

Back 27

could be a foreign body aspiration --> subglottic stenosis

Front 28

What kind of obstruction causes wheezing?
(high pitched audible sound you can hear w/o a stethoscope)

Back 28

intra thoracic obstruction
(middle + lower airway)

middle: lower trachea, main stem bronchi
lower: bronchi subdivisions, bronchioles, alveoli

Front 29

What makes kids susceptible to lower airway obstructions?

Back 29

1. small caliber hi resistance peripheral airways
2. soft cartilagenous support can collapse w/ neg. pressure
3. they can have a decrease in lung elastin or increased compliance --> atelectasis

Front 30

Malacia

Back 30

congenital condition where cartilage of airways can't stay open.
-tracheomalacia
-bronchomalacia

can be congenital or d/t long term ventilation (premies)

Front 31

Congenital causes of intra thoracic obstruction

Back 31

- malacias:
tracheomalacia, bronchomalacia
- vascular rings :
double aortic arch
(can cause tracheal or esophageal compression)

Front 32

Bronchiolitis

Back 32

-viral LRT infxn
-acute inflam, edema, necrosis of epithelial cells in the bronchioles.
w/ inc. mucus secretion.
- most common cause of acute resp. illness in kids under 2.

- can cause atelectasis, bilateral perihilar infiltrates.

Front 33

Causes of bronchiolitis

Back 33

- RSV, adenovirus, paraflu, flu, pneumovirus, human metapneumovirus

Front 34

One year old kid comes in over xmas break.
Presents with bilateral wheezing and crackles.
labored respiration, nasal flaring. Hypoxia.
rhinorhea, coryza, cough. He's irritable, feeds poorly and is vomiting.
CXR: hyperinflation, subsegmental atelectasis, perhilar streaking

ddx?

Back 34

Bronchiolitis.
wheezing --> intrathoracic obstruction
Inflamation of the bronchioles