Deck 26: Pediatric Airway Disorders and Pulmonary Infections

Question 1

A 4-year-old child is brought into the emergency room (ER)by her parents,who state that an abrupt high fever developed along with a severe sore throat,dysphagia with drooling,and cough.In the ER the girl exhibits stridor,muffled voice without hoarseness,air hunger,and cyanosis.She also has suprasternal,substernal,and intercostal retractions,with nasal flaring,bradypnea,and dyspnea.The child is sitting upright with her chin thrust forward and her neck hyperextended in a tripod position.What condition is she likely exhibiting?

A)Laryngotracheobronchitis
B)Tracheomalacia
C)Bacterial tracheitis
D)Epiglottitis

Answer 1

D
Onset of bacterial epiglottitis is usually abrupt and associated with high fever;severe sore throat;dysphagia with drooling;cough,progressing rapidly over a few hours to stridor;muffled ("hot potato")voice without hoarseness;air hunger;and cyanosis.Suprasternal,substernal,and intercostal retractions,along with nasal flaring,bradypnea,and dyspnea,are frequently displayed.The child assumes a characteristic position of sitting upright with the chin thrust forward and with the neck hyperextended (sniffing position)in a tripod position.The streptococcal variant of epiglottitis may be associated with a longer prodrome lasting more than 24 hours.

Question 2

Which of the following radiographic techniques is best for determining the presence of a ball-valve type obstruction?

A)A standard portable A-P chest X-ray
B)A lateral neck radiograph
C)Either a right or left lateral decubitus film
D)Inspiratory and expiratory A-P chest X-rays

Answer 2

D
Asymmetric lung hyperinflation can result from a ball-valve effect of foreign material localized in a major bronchus.This defect is most often apparent on an expiratory film.Comparison between expiratory and inspiratory films can also yield the diagnosis but depends greatly on the cooperation of the child.

Question 3

The therapist has been asked to evaluate the chest radiograph of a 3-month-old boy with atelectasis.Which pulmonary lobe has the greatest tendency to collapse in young infants?

A)RUL
B)RML
C)Lingula
D)LUL

Answer 3

B
The right middle lobe,which has the poorest collateral air circulation and smallest bronchial opening of the major lung segments,is particularly prone to mucus plugging and collapse.Intubated patients,particularly young infants,have a propensity toward right upper lobe collapse.This is most likely related to their supine positioning and tendency toward obstruction of the right upper lobe bronchus (the most proximal of all the lobar bronchi)by a migrating ETT.

Question 4

Which of the following medications should be administered to a 4-year-old child who develops postextubation stridor?

A)Phenylephrine
B)Racemic epinephrine
C)Prednisolone
D)Antibiotics

Question 5

A 30-month-old child is brought to the emergency room (ER)by the parents.The child appears to have a sore throat along with dysphagia,fever,and voice changes.The child exhibits "hot potato voice." Visualization of the posterior pharynx reveals a displaced retropharynx.What condition does this child likely have?

A)Peritonsillar abscess
B)Retropharyngeal abscess
C)Tonsillar enlargement
D)Pierre Robin syndrome

Question 6

In the ER,a chest radiograph reveals dilation of the segmental and subsegmental bronchi.The patient complains of expectorating copious amounts of thick mucus and frequent lung infections over the last year.Which of the following conditions does this child likely have?

A)Atelectasis
B)Bronchiectasis
C)Foreign body aspiration
D)Postoperative laryngotracheobronchitis

Question 7

Relative to an adult's larynx,where is an infant's larynx situated?

A)C1-2
B)C2-3
C)C3-4
D)C4-5

Question 8

While performing auscultation on a 2-month-old child,the therapist hears wheezes equal in pitch across all regions of the chest;however,they seem loudest in the vicinity of the sternum.From which of the following anatomic structures is the wheezing likely originating?

A)Trachea
B)Terminal bronchioles
C)Segmental bronchi
D)Alveoli

Question 9

Which of the following lateral neck radiographic presentations is characteristic of laryngotracheobronchitis?

A)Posterior pharyngeal shadow
B)Thumb sign
C)Steeple sign
D)Penumbra effect

Question 10

As the therapist auscultates over an infant's larynx,he hears a very low-pitched sound.On the basis of this finding,what impression is he likely to have regarding the nature of the upper airway obstruction?

A)Mild obstruction
B)Moderate obstruction
C)Severe obstruction
D)Complete obstruction

Question 11

Tracheomalacia is a condition of dynamic tracheal collapse.Which of the following injurious events can be associated with this condition?

A)Neonatal ventilation with high pressures
B)Excessive use of racemic epinephrine
C)Tracheal trauma due to CPT
D)Neonatal ventilation with high oxygen concentrations

Question 12

An 11-month-old child has been treated with bronchodilators for persistent wheezing without a positive clinical response.Which of the following conditions should the therapist suspect?

A)Bronchitis
B)Aspergillosis
C)Bronchiolitis
D)Endobronchial compression

Question 13

Why does an infant's respiratory distress from choanal atresia seem to lessen when the infant cries?

A)Because the anterior nares widen more
B)Because the infant breathes more through the mouth
C)Because the infant is able to generate a stronger inspiratory effort
D)Because accessory muscles of ventilation help stabilize the chest wall

Question 14

A 3-year-old child has the following clinical presentations in the ER:
Profound nasal congestion and productive cough
Chest auscultation revealing diffuse coarse,"sticky" crackles (sounding like Velcro)
Chest radiograph revealing lung hyperinflation with flattened hemidiaphragms
What pulmonary condition does this infant likely have?

A)Bronchiectasis
B)Primary ciliary dyskinesia
C)Supralaryngeal obstruction
D)Bronchiolitis

Question 15

An 18-month-old child has been admitted with a diagnosis of bronchiolitis due to RSV.The therapist has administered a single dose of albuterol and racemic epinephrine,but the child shows no signs of improvement.What should the therapist suggest at this time?

A)Alternate albuterol and racemic epinephrine every 4 hours
B)Use albuterol every 1 hour for 4 hours and then space treatments to every 4 hours
C)Discontinue therapy
D)Add an inhaled corticosteroid to the albuterol every 12 hours

Question 16

A 10-month-old child has been brought into the emergency room (ER)by her parents,who state that after few days with low-grade fever,malaise,and rhinorrhea,their child presented with a "barking" cough and increased work of breathing.What condition is this child likely exhibiting?

A)Epiglottitis
B)Laryngotracheobronchitis (LTB)
C)Bronchitis
D)Bronchiolitis

Question 17

A 3-year-old child has been diagnosed with epiglottitis and was intubated due to severe respiratory distress.After 24 hours of antibiotics the therapist is considering extubation.What will be an acceptable leak before considering extubation?

A)£20 cm H₂O
B)21-30 cm H₂O
C)31-35 cm H₂O
D)An audible leak at any pressure level is enough to consider extubation.

Question 18

Why does a respiratory syncytial viral infection have little adverse effect on an older child but is often life threatening to a younger child?

A)The older child has a better developed immune system.
B)The younger child has a less effective cough mechanism.
C)The older child has a better developed mucociliary escalator.
D)The younger child has fewer respiratory bronchioles.

Question 19

A therapist has been asked to evaluate a child suspected of having foreign body aspiration.Which of the following clinical conditions would guide the therapist to the diagnosis?

A)Recurrent bronchitis
B)Wheezing partially responsive to bronchodilators
C)Unilateral wheezing
D)Stridor

Question 20

The therapist is evaluating a child in the emergency department who displays the following signs: inability to cry,ineffective cough,high-pitched inspiratory sound,and cyanosis.What should the therapist suspect?

A)Tracheomalacia
B)Severe or complete airway obstruction
C)Vascular ring
D)Status asthmaticus

Question 21

Which of the following clinical interventions are used to treat complications of sickle cell anemia?
I)Supplemental oxygen
II)Bronchodilators
III)Diuretics
IV)Red blood cell transfusions

A)I and IV only
B)II and III only
C)I,II,and IV only
D)II,III,and IV only

Question 22

Which of the following agents has been shown to significantly reduce bronchiolitis scores?

A)Prednisone
B)Nebulized 3% hypertonic saline
C)Dexamethasone
D)Theophylline

Question 23

Diagnosis of TB in children requires which of the following special considerations?

A)Three consecutive days of gastric washings
B)A positive skin test
C)A positive chest X-ray
D)One positive respiratory washing

Question 24

A child presents to the emergency department with fever,tachypnea,nasal flaring,and shallow breathing.The physical exam of the chest reveals the presence of crackles,increased tactile fremitus,and dullness to percussion.What should the therapist suspect the diagnosis is?

A)Bronchitis
B)Bronchiectasis
C)Bronchiolitis
D)Pneumonia