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Questions and Answers
What is the primary treatment for a patient diagnosed with foreign body aspiration?
What is the primary treatment for a patient diagnosed with foreign body aspiration?
Which of these pathogens is commonly associated with sinusitis?
Which of these pathogens is commonly associated with sinusitis?
Which diagnostic method is considered the most accurate for fully delineating upper airway anatomy in suspected cases of obstruction?
Which diagnostic method is considered the most accurate for fully delineating upper airway anatomy in suspected cases of obstruction?
In children, what is the most common site of foreign body aspiration?
In children, what is the most common site of foreign body aspiration?
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What symptom typically indicates acute inflammatory upper airway obstruction in infants?
What symptom typically indicates acute inflammatory upper airway obstruction in infants?
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What duration of persistent URI symptoms could suggest bacterial sinusitis?
What duration of persistent URI symptoms could suggest bacterial sinusitis?
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What is the provisional diagnosis for an infant who becomes cyanotic but then pinks up upon crying?
What is the provisional diagnosis for an infant who becomes cyanotic but then pinks up upon crying?
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Which condition may lead to secondary complications such as infection, erosion, or obstruction when a foreign body is present?
Which condition may lead to secondary complications such as infection, erosion, or obstruction when a foreign body is present?
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What is the primary treatment method for laryngomalacia in infants?
What is the primary treatment method for laryngomalacia in infants?
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Which diagnostic technique is most commonly used for identifying subglottic stenosis?
Which diagnostic technique is most commonly used for identifying subglottic stenosis?
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In the case of foreign body aspiration, which clinical sign is most indicative of distress?
In the case of foreign body aspiration, which clinical sign is most indicative of distress?
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What is the most frequent cause of stridor in infants?
What is the most frequent cause of stridor in infants?
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Which treatment method is indicated for severe subglottic stenosis?
Which treatment method is indicated for severe subglottic stenosis?
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What clinical presentation is often associated with vocal cord paralysis?
What clinical presentation is often associated with vocal cord paralysis?
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In a clinical setting, what observation might suggest acute inflammatory airway obstruction in a toddler?
In a clinical setting, what observation might suggest acute inflammatory airway obstruction in a toddler?
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What is an expected clinical outcome in most children with laryngomalacia?
What is an expected clinical outcome in most children with laryngomalacia?
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What is the first line of treatment for a patient with severe respiratory distress due to acute epiglottitis?
What is the first line of treatment for a patient with severe respiratory distress due to acute epiglottitis?
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Which pathogen is traditionally known as a common cause of epiglottitis in children?
Which pathogen is traditionally known as a common cause of epiglottitis in children?
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What is the recommended diagnostic approach for suspected acute epiglottitis?
What is the recommended diagnostic approach for suspected acute epiglottitis?
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What position is typical for a child experiencing severe respiratory distress due to epiglottitis?
What position is typical for a child experiencing severe respiratory distress due to epiglottitis?
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What is the most serious complication that can arise from untreated acute epiglottitis?
What is the most serious complication that can arise from untreated acute epiglottitis?
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In cases of moderate croup where respiratory distress worsens, what is the recommended additional treatment?
In cases of moderate croup where respiratory distress worsens, what is the recommended additional treatment?
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What urgent measure is indicated for a patient with acute epiglottitis to ensure safety during treatment?
What urgent measure is indicated for a patient with acute epiglottitis to ensure safety during treatment?
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What can be the outcome if a child with acute epiglottitis is not treated promptly?
What can be the outcome if a child with acute epiglottitis is not treated promptly?
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Study Notes
Upper Airway Disorders in Pediatrics
- Upper airway disorders affect the nasal cavity, paranasal sinuses, pharynx, and larynx.
- These disorders can be caused by mechanical obstruction (e.g., foreign body aspiration, structural defects like laryngomalacia) or inflammation.
Intended Learning Objectives
- Identify various upper airway disorders in pediatric patients.
- Describe the clinical presentation of each disorder.
- Differentiate between different upper airway disorders.
- Understand management options for upper airway disorders in pediatrics.
Mechanical Upper Airway Obstruction
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Laryngeomalacia is a congenital abnormality of the laryngeal cartilages.
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Shortened aryepiglottic folds cause laryngeal shape to obstruct airflow.
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Symptoms include inspiratory stridor, worse in supine position, and difficulty breathing. Symptoms peak in the first few weeks after birth, and peak again around 6 months, and often resolve by 12-18 months old.
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Diagnosis may involve laryngoscopy or bronchoscopy to visualize the airway.
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Foreign body aspiration is a common cause of airway obstruction.
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Objects lodged in the airway create breathing difficulties which can range from moderate to severe breathing distress.
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Symptoms can include choking, coughing, drooling, gagging, and inspiratory stridor.
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Prompt diagnosis and intervention are crucial.
Foreign Body Aspiration
- Larynx is the most common site in children age 1 year
- Trachea or right mainstem bronchus in children age >1 year
- In the nose, symptoms include unilateral, foul-smelling rhinorrhea and epistaxis.
- Symptoms of partial obstruction can include coughing, drooling, and inspiratory stridor.
- Symptoms of complete obstruction include inability to cough, speak, and pass out.
- Diagnosis can be done via chest x-ray or CT scan to view the lodged object.
- Laryngoscopy is used to visualize and remove the foreign body.
- Basic life saving maneuvers are critical for infants
Acute Inflammatory Upper Airway Obstruction
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Rhinitis, sinusitis, pharyngitis, epiglottitis, and laryngitis are common inflammatory conditions.
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Rhinitis: can be allergic or infectious. Infectious rhinitis is caused by viruses (rhinovirus, influenza, RSV, parainfluenza, adenovirus) or bacteria (Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis, Staphylococcus aureus).
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Sinusitis: Caused by S. pneumoniae, H. influenzae, M. catarrhalis. Predisposing factors include immune deficiency, ciliary dysfunction, cleft palate, nasal polyps, foreign body, URI, allergy, and cigarette smoke.
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Pharyngitis: typically uncommon in children under age 3; more common in 3-14 year olds. Caused by viruses (rhinovirus, coronavirus) or bacteria (group A Streptococcus).
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Epiglottitis: a serious infection of the epiglottis. Caused by bacteria such as Streptococcus pyogenes, Streptococcus pneumoniae, Staphylococcus aureus, and Mycoplasma; and Haemophilus influenzae type B (HiB). Risk factors include adults and unimmunized children. Toxic appearance, high fever, sore throat, difficulty swallowing, drooling and progressive dyspnea (difficult breathing and shortness of breath). Can lead to complete airway obstruction.
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Laryngitis: inflammation of the larynx. Common causes include viruses such as parainfluenza viruses 1, 2, and 3. More common in winter.
Otitis Externa (Swimmer's Ear)
- Causes include excessive wetness, dryness, skin pathology, and trauma.
- Symptoms include significant pain (especially with manipulation), conductive hearing loss, edema, erythema, thick otorrhea, and preauricular nodes.
Otitis Media
- Common in the first 2 years of life.
- Etiology: bacterial (pneumococcus, nontypeable H. influenzae, Moraxella catarrhalis) and viral.
- Risk factors include low socioeconomic status, lack of breast milk, tobacco smoke, exposure to other children, cold weather, and other congenital anomalies (palatal clefts, Down syndrome). inflammation causes middle ear effusion. Clinical findings may be variable.
- Pneumatic otoscopy is critical for diagnosing. The mobility of the tympanic membrane (eardrum) is assessed.
Other relevant information
- The images shown are medical illustrations and x-rays related to pediatric upper airway diseases.
- These notes summarize information from the provided images and text.
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