Pediatric Respiratory Conditions Quiz

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Questions and Answers

What is the most likely cause of the patient's nasal obstruction and snoring since birth?

Allergic rhinitis

Neurological disorder

Asthma

Nasal polyps (correct)

What symptom was reported to relieve the cyanotic episodes during feeding?

Yawning

Sitting upright

Crying (correct)

Feeding supine

Which of the following conditions is NOT suggested as a past medical history for this patient?

Skin changes with bluish discoloration

Chronic ear infection (correct)

Severe pneumonia

Frequent admissions for allergies

What was the outcome of the nasal surgery performed 9 months prior to the referral?

Temporary relief with subsequent recurrence (A) Signup and view all the answers

What is the significance of the patient's history of mouth breathing?

It suggests a possibility of obstructive sleep apnea (A) Signup and view all the answers

Which factor in the prenatal history could potentially affect the patient's respiratory health?

Maternal smoking (A) Signup and view all the answers

What type of nasal discharge did the patient experience?

Scant and mucopurulent (A) Signup and view all the answers

Which of the following is NOT mentioned in the review of symptoms (ROS) for this patient?

Joint pain (C) Signup and view all the answers

What is the primary reason for using a McGovern nipple in initial airway management for choanal atresia?

It allows for more effective airway maintenance. (A) Signup and view all the answers

What percentage of cases of choanal atresia is classified as unilateral?

65-75% (D) Signup and view all the answers

Which of the following complications is NOT associated with the trans nasal approach for choanal atresia repair?

Crossbite deformity. (C) Signup and view all the answers

Which of the following is NOT a risk factor linked to choanal atresia?

High intake of retinoic acid (A) Signup and view all the answers

What is a significant disadvantage of the trans palatal approach to definitive repair of choanal atresia?

High risk of postoperative restenosis. (B) Signup and view all the answers

What characteristic of patients with bilateral choanal atresia and CHARGE syndrome increases their risk of failing atresia repair?

Poor tongue/pharyngeal muscle control. (A) Signup and view all the answers

What is the most common surgical intervention required for bilateral choanal atresia in newborns?

Surgical perforation of the atretic choanae (C) Signup and view all the answers

Which airway management option should be considered if the McGovern nipple fails to maintain an adequate airway?

Endotracheal intubation. (B) Signup and view all the answers

At what gestational week do the nasal pits extend posteriorly to form the nasal cavity?

5th week GA (D) Signup and view all the answers

What anatomical structure is formed from the frontonasal process during the embryology of the nasal cavity?

Nasal septum (C) Signup and view all the answers

What method is recommended to prepare the nasal passages prior to the trans nasal endoscopic approach?

Topical decongestant and local anaesthesia. (B) Signup and view all the answers

Which factor makes surgical repair necessary in cases of choanal atresia?

Severe respiratory distress in the newborn. (A) Signup and view all the answers

Which of the following statements about choanal atresia is true?

Bilateral presentation of choanal atresia is considered a medical emergency. (C) Signup and view all the answers

Which bony component is NOT part of the anatomical boundaries of the posterior choanae?

Frontal bone (A) Signup and view all the answers

A key reason for delaying definitive surgery in choanal atresia management includes:

Presence of severe medical comorbidities. (A) Signup and view all the answers

What is the prevalence range of choanal atresia in live births?

1 in 5000 to 7000 (A) Signup and view all the answers

What is a significant difference in presentation between bilateral and unilateral choanal atresia?

Bilateral choanal atresia often causes cyanotic spells that are relieved by crying. (C) Signup and view all the answers

Which imaging modality is considered the best for diagnosing choanal atresia?

Axial/coronal CT of the paranasal sinuses (B) Signup and view all the answers

What is the primary goal of initial airway management in infants with bilateral choanal atresia?

Maintaining an adequate airway via the oral route (C) Signup and view all the answers

What symptom is most associated with unilateral choanal atresia in young children?

Chronic unilateral nasal obstruction (B) Signup and view all the answers

What is a crucial method for clinically diagnosing choanal atresia?

Failure to pass a nasal catheter more than 5.5 cm (B) Signup and view all the answers

What was the provisional diagnosis for the patient?

Bilateral choanal atresia (C) Signup and view all the answers

What abnormality was observed during the ear examination?

Pale grey tympanic membrane (D) Signup and view all the answers

Which theory explains the abnormal anatomy present in cases of choanal atresia?

Abnormal persistence of the nasobuccal membrane of Hochstetter (D) Signup and view all the answers

What is a common clinical feature seen in cases of bilateral choanal atresia?

Complete nasal obstruction (A) Signup and view all the answers

What procedure was performed to address the left choanal stenosis?

Release by perforater and forceps (C) Signup and view all the answers

What significant family history is noted in the patient's examination?

Three siblings died at a young age (B) Signup and view all the answers

What physical examination technique is essential for confirming the presence of an atretic plate in the nasal passage?

Flexible nasal endoscopy (C) Signup and view all the answers

What was the observation during the nasal patency test?

Failure to pass an NGT tube bilaterally (A) Signup and view all the answers

What was the patient's post-operative progress regarding the nostrils?

Right nostril was patent while the left remained obstructed (B) Signup and view all the answers

During the throat examination, which finding was specifically noted?

Normal posterior pharyngeal wall (B) Signup and view all the answers

What was the condition of the patient's respiratory and circulatory systems during the examination?

Normal cardiovascular and respiratory findings (D) Signup and view all the answers

What is a primary reason for considering post-operative stenting in choanal atresia repair?

To reduce the chance of restenosis (C) Signup and view all the answers

Which of the following is NOT a potential complication related to the use of a stent after choanal atresia repair?

Severe blood loss (A) Signup and view all the answers

What is the recommended postoperative management if no stent is present following choanal atresia repair?

Nasal saline drops and oral antibiotics (C) Signup and view all the answers

When should a repeat nasal endoscopy be performed to manage choanal atresia without stenting?

Within 7 days post-surgery (D) Signup and view all the answers

Which statement about revision surgeries in choanal atresia is accurate?

Bony atresia patients require more frequent revision surgeries. (B) Signup and view all the answers

What immediate action should be taken if bilateral choanal atresia is identified in a neonate?

Initiate stabilization measures (A) Signup and view all the answers

What is a major advantage of managing choanal atresia without stenting?

Reduction in discomfort and stent-related issues (C) Signup and view all the answers

Which of these is a key component of postoperative care in the non-stent group for choanal atresia repair?

Frequent nasal saline irrigation (D) Signup and view all the answers

Study Notes

Case Presentation: F.J.

Patient: Female, 12 years old
Residence: Chunya-Mbeya
Registration Number: M50-40-86
Date of Admission (DOA): May 2nd, 2021
Referral from: Mbeya Zonal Referral Hospital
Informant: Sister

Chief Complaints

Nasal obstruction: Since birth
Snoring: Since birth

History of Present Illness (HPI)

Bilateral nasal obstruction since birth, gradual onset and persistent.
No diurnal or positional variation.
Previous history of skin changes with bluish discoloration on lips and fingers, occurring during feeding, relieving on crying.
Bilateral nasal discharge (mucopurulent, scant, progressive, non-foul smelling).
History of snoring since birth, progressively more marked at night causing interrupted sleep and continuous mouth breathing throughout the day.
No history of ear pain, fullness, or hearing loss.
No history of nasal bleeding, sneezing, or post-nasal discharge.
No difficulty breathing on lying flat or with exertion.
No reported maternal history of cigarette smoking, alcohol intake, caffeine intake, or drug intake during pregnancy.
Multiple hospital admissions and diagnoses of allergy and severe pneumonia, treated with nasal drops and oral medications, with no improvement.
Underwent nasal surgery 9 months prior at Mbeya Zonal Referral Hospital.
Nasal tube inserted for 6 weeks post-surgery.
Patient reported improvement with tube in place, but symptoms recurred a month later.
Patient referred to MNH for further management.

Review of Systems (ROS)

CNS: No headache, loss of consciousness, muscle or joint pain, muscle weakness.
GIT: No problem with swallowing, change in appetite, abdominal pain.
GUS: No pain during urination.

Past Medical History (PMHx)

First admission was at MNH.
No personal or family history of asthma, diabetes mellitus (DM), hypertension (HTN), or other chronic illness.
No known history of food or drug allergies.
No history of birth trauma (BT).

Past Pediatric History (PPHx)

Prenatal history not well obtained.
Born by spontaneous vaginal delivery (SVD), home delivery.
Postnatal history of mouth breathing, nasal discharge, snoring, and difficulty with breathing and breastfeeding.
Achieved normal developmental milestones.
Normal school performance.

Family History (FSHx)

Last born of 7 children.
3 siblings died at an early age (unknown cause).
Parents are standard seven drop-outs, peasant farmers.
No family history of the same illness.

General Examination (On G/E)

Alert, oriented to person, place, and time (TPP).
Well-nourished.
Not dyspneic or cyanotic.
Not pale.
No lower limb (LL) edema.
Afebrile.
Adenoid facies observed.
Temperature: 36.9°C
Respiratory rate (RR): 18 breaths/minute
Heart rate (HR): 89 beats/minute
SpO2: 96% on room air

Ear, Nose, and Throat (ENT) Examination

Nose: Normal skin, loss of nasolabial fold, normal vestibule.
Anterior rhinoscopy: Pinkish, hypertrophied inferior turbinates bilaterally, normal middle turbinates bilaterally, normal anterior nasal septum.
Mucoid discharge bilaterally on nasal floor.
No crust or bleeding noted.
Nasal patency test: Negative (cotton wool, fogging mirror).
NGT tube could not pass bilaterally.
Throat: Open mouth, normal lips and angle of mouth, tooth alignment, buccal mucosa, normal tongue, high arched palate, normal palatine tonsils (grade I), non-hyperemic, normal posterior pharyngeal wall.
Indirect laryngoscopy: Normal
Ear: Normal pinna and external auditory canal (EAC) bilaterally, tympanic membrane (TM) pale grey with cone of light visible, mobility present bilaterally.

Systemic Examination

Cardiovascular System (CVS): Normal
Respiratory System (RS): Normal
Gastrointestinal Tract (GIT): Normal

Intra-operative Findings

Bilateral inferior turbinate hypertrophy.
Bilateral choanal atresia.
Bilateral partial inferior turbinectomy.
Bilateral choanal atresia release with Kerrison punch.
Cauterization done; no packing or stent placement.

Progress in the Ward

On day 7 post-surgery, the right nostril was patent.
Left nostril obstructed since day 1 post-op.
Irrigation, suctioning, and NGT placement failed to release the left nostril obstruction.
Plan: EUA and stenting.
Left choanal stenosis identified after NGT tube insertion failure.
Left choanal stenosis released with a perforator and curved arterial forceps.
Stent kept and secured.
Patient discharged three days post-op.
Ongoing follow-up at Mbeya Referral Hospital.

Provisional Diagnosis

Recurrent bilateral choanal atresia.
Differential Diagnoses: (DDx)
- Bilateral choanal stenosis.
- Adenoid hypertrophy.
- Deviated nasal septum.

Imaging

CT scan of paranasal sinuses (PNS) showing bilateral choanal atresia

Additional Information

Information regarding the patient's medical history, including pre-natal, natal and general family history, as well as details of treatment/ interventions

Conclusion

The case presented highlights a complex scenario.
The focus should be placed upon complete respiratory support and stabilization.
Follow-up measures should be meticulously documented and communicated.

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Description

Test your knowledge on various pediatric respiratory issues including nasal obstruction, choanal atresia, and related surgical outcomes. This quiz covers symptoms, medical history, and management strategies relevant to airway health in children. Discover the complexities of respiratory care through these targeted questions.