Deck 39: Croup Syndrome: Laryngotracheobronchitis and Acute Epiglottitis

Question 1

In evaluating a 16- month-old boy you find 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, what do you think is the boy's probable diagnosis?

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

Answer 1

LTB

Question 2

The medication racemic epinephrine (Micro-Nefrin, 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 2

causes mucosal vasoconstriction.

Question 3

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

A) Secretions blocking the trachea
B)The epiglottis will bleed.
C)Laryngeal inlet covered by the epiglottis
D)The vocal cords will spasm and close.

Answer 3

Laryngeal inlet covered by the epiglottis

Question 4

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

Question 5

Childhood vaccination is done to prevent the following possible cause of epiglottitis:

A) Haemophilus influenza, type B.
B)Streptococcus pneumoniae.
C)diphtheria.
D)parainfluenza viruses.

Question 6

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

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

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

You are the respiratory therapist working in 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. You would 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 9

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 10

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 11

The diagnosis of epiglottitis is made 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/her tongue.

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

Question 12

Your 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 13

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 14

Which of the following is 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 15

When a patient has laryngotracheobronchitis (LTB) what 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