Deck 41: Croup Syndrome: Laryngotracheobronchitis and Acute Epiglottitis

Question 1

When a patient has laryngotracheobronchitis (LTB), which of the following is the primary anatomic alteration that is found?

A) Edema of the mucous membranes
B) Airway smooth muscle contraction
C) Excessive alveolar fluid
D) Epiglottitis

Answer 1

Edema of the mucous membranes

Question 2

The barking sound heard in a patient with LTB is caused by which of the following?

A) Partial lower airway obstruction
B) Partial upper airway obstruction
C) Expiration against a partially closed glottis
D) Pharyngeal edema

Answer 2

Partial upper airway obstruction

Question 3

The medication racemic epinephrine (Micronefrin, Vaponefrin) is given to a patient with LTB because it:

A) is an effective bronchodilator.
B) causes mucosal vasoconstriction.
C) causes bradycardia.
D) has an appealing taste and smell.

Answer 3

causes mucosal vasoconstriction.

Question 4

A patient has been diagnosed with bacterial epiglottitis. Which of the following antibiotics should the respiratory therapist most likely recommend?

A) Amikacin (Amikin)
B) Tobramycin (Nebcin)
C) Cefalexin (Keflex)
D) Ampicillin/sulbactam (Unasyn)

Question 5

Which of the following is/are commonly seen on the lateral neck x-ray of a patient with LTB?
1) "Pencil point" narrowing of the upper airway
2) Haziness in the subglottic area
3) Classic "thumb sign"
4) "Steeple point" narrowing of the upper airway

A) 3
B) 2, 3
C) 1, 2, 4
D) 2, 3, 4

Question 6

Most cases of LTB occur during which season(s) of the year?
1) Spring
2) Summer
3) Fall
4) Winter

A) 1
B) 4
C) 3, 4
D) 1, 2, 3

Question 7

All of the following anatomic alterations may be found in a patient with LTB EXCEPT:

A) increased secretions.
B) ineffective cilia.
C) narrowed airway lumen.
D) excessive surfactant production.

Question 8

A patient has epiglottitis. This condition will affect which of the following?
1) Pharynx
2) Aryepiglottic folds
3) False vocal cords
4) Trachea

A) 1, 2
B) 2, 3
C) 1, 2, 3
D) 2, 3, 4

Question 9

In evaluating a 16-month-old boy, the respiratory therapist finds him to be in mild respiratory distress, without a fever, but with a barking-type cough. A lateral neck x-ray taken in the emergency department shows a "steeple point" narrowing of the trachea. Based on this information, which of the following would the respiratory therapist conclude is the most probable diagnosis?

A) Acute bronchitis
B) Epiglottitis
C) Bronchiolitis
D) LTB

Question 10

Management of LTB usually includes all of the following EXCEPT:

A) close observation for breathing difficulties.
B) having the child drink fluids.
C) placement into a cool aerosol tent.
D) endotracheal intubation.

Question 11

Childhood vaccination is done to prevent which of the following possible causes of epiglottitis?

A) Haemophilus influenza type B
B) Streptococcus pneumoniae
C) Diphtheria
D) Parainfluenza viruses

Question 12

All of the following would be expected during the assessment of a young child with LTB EXCEPT:

A) decreased respiratory rate.
B) diminished breath sounds.
C) use of accessory muscles.
D) hypoxemia.

Question 13

The diagnosis of epiglottitis is aided by:
1) laying the patient down and observing the throat with a tongue blade.
2) visualization of the throat during tracheal intubation.
3) observing if the patient can swallow.
4) observing how the patient holds his or her tongue.

A) 1, 2
B) 3, 4
C) 2, 3, 4
D) 1, 2, 3, 4

Question 14

The diagnosis of LTB is made by all of the following EXCEPT the child:

A) has inspiratory stridor and barking cough.
B) has a normal temperature or low fever.
C) has a significant fever.
D) can drink without difficulty.

Question 15

The respiratory therapist is assigned to the pediatric unit of the hospital. The physician who is caring for a 3-year-old boy with LTB asks what respiratory therapy treatments should be given. The respiratory therapist should suggest which of the following?
1) Racemic epinephrine
2) Cool mist tent
3) Antibiotics
4) Endotracheal or tracheostomy tube

A) 1, 2
B) 2, 4
C) 1, 2, 3
D) 1, 2, 3, 4

Question 16

What is the main clinical risk facing a patient with epiglottitis?

A) Secretions will block the trachea.
B) The epiglottis will bleed.
C) The laryngeal inlet may become covered by the epiglottis.
D) The vocal cords will spasm and close the laryngeal inlet.

Question 17

The treatment of epiglottitis includes:
1) antibiotics specific to the virus causing the illness.
2) antibiotics specific to the bacteria causing the illness.
3) supplemental oxygen by face mask.
4) endotracheal intubation.

A) 1
B) 4
C) 2, 4
D) 1, 3