7/8/2013

7/8/2013

Answers:

What is the most common cause of stridor in the pediatric population?

A) Croup 

B) Foreign Body 

C) Laryngomalacia 

D) Epiglottitis

Laryngomalacia is the most common cause of stridor (60%).  In this case stridor is due to prolapse of supraglottic structures into laryngeal inlet on inspiration.

What is the difference between stridor and stertor?
 Stridor = harsh noise produced by turbulent airflow through partially obstructed airway.

        -can be respiratory(supraglottis/glottis)/expiratory (trachea) or both (biphasic/ from subglottis)

        -usually of laryngeal origin.

-Stertor = airway noise originating in the nose/nasopharynx or oropharynx.

MC Question:

All of the following present with a normal cry except. 
A) Laryngomalacia
B) Congenital Laryngeal Webs
C) Subglottic Hemangiomas
D) Juvenile onset papillomatosis
E) A and C
F) B and D
G) B and C

Free Response Questions:

In patients with laryngomalacia, what is the typical appearance on endoscopy?

Quick Facts:
Subglottic Stenosis

-Cricoid is only complete cartilaginous ring and is smallest portion of airway in kids

-Airflow in tube is proportional to radius to the fourth so small changes make a big difference.

-Myer Cotton grading system is used to describe severity:

        -measure largest ETT possible and compare to age appropriate tube.

        -Grade I = 50%

        -Grade II = 50-70%

        -Grade III = 70-99%

        -Grade IV = no detectable lumen