Croup (Laryngo-tracheo-bronchitis)-Epoglottitis-Laryngitis

Introduction to Croup in Children

Croup, also known as laryngotracheobronchitis, is an acute respiratory condition characterized by inflammation of the upper airway, particularly affecting the larynx, trachea, and bronchi. It is a common childhood illness that can cause significant respiratory distress.

Key points:

  • Most common in children 6 months to 3 years of age
  • Peak incidence occurs in the second year of life
  • More frequent in boys than girls (ratio approximately 3:2)
  • Typically occurs in fall and early winter
  • Can be mild to severe, with potential for airway obstruction in severe cases


Croup (Laryngo-tracheo-bronchitis)
  1. What is the typical age range for children affected by croup? 6 months to 3 years
  2. Which virus is the most common cause of croup? Parainfluenza virus
  3. What is the characteristic sound of croup? Barking cough
  4. In croup, which part of the airway becomes inflamed and narrowed? Subglottic region
  5. What time of day do croup symptoms typically worsen? Night
  6. Which of the following is NOT a common symptom of croup? High fever (>104°F/40°C)
  7. What is the Westley Croup Score used to assess? Severity of croup
  8. Which medication is commonly used to reduce airway inflammation in croup? Dexamethasone
  9. What is the primary goal of croup management? Maintaining airway patency
  10. How is mild croup typically managed? Supportive care at home
  11. What environmental factor can help alleviate croup symptoms? Cool mist or humidified air
  12. Which of the following is a potential complication of severe croup? Respiratory failure
  13. What is the typical duration of croup symptoms? 3-7 days
  14. In which season is croup most commonly seen? Fall and early winter
  15. What imaging study may be used to diagnose croup? Neck X-ray (steeple sign)
  16. Which of the following is contraindicated in croup management? Sedatives
  17. What is the role of antibiotics in most cases of croup? No role (viral etiology)
  18. How does croup affect the voice? Hoarseness
  19. What is the appropriate oxygen saturation target for children with croup? >92%
  20. Which of the following is a sign of severe croup? Stridor at rest
  21. What is the mechanism of action of racemic epinephrine in croup? Vasoconstriction and mucosal decongestion
  22. How quickly does dexamethasone typically improve croup symptoms? Within 6 hours
  23. What is the recommended dose of dexamethasone for croup? 0.15-0.6 mg/kg
  24. Which of the following is NOT a risk factor for croup? Female gender
  25. What is the role of heliox in croup management? Reduces work of breathing in severe cases
  26. How does positioning affect a child with croup? Upright position may improve symptoms
  27. What is the primary difference between viral and spasmodic croup? Presence of prodromal symptoms in viral croup
  28. Which of the following is a contraindication to home management of croup? Toxic appearance
  29. What is the appropriate route of administration for dexamethasone in croup? Oral or intramuscular
  30. How does croup affect the child's ability to swallow? Usually not affected
Laryngitis
  1. What is the primary symptom of laryngitis? Hoarseness or loss of voice
  2. Which of the following is the most common cause of acute laryngitis? Viral infection
  3. How long does acute laryngitis typically last? 1-3 weeks
  4. What is the definition of chronic laryngitis? Symptoms lasting more than 3 weeks
  5. Which of the following is NOT a common cause of chronic laryngitis? Viral infection
  6. What is the primary treatment for viral laryngitis? Voice rest and supportive care
  7. Which of the following professions is at higher risk for developing laryngitis? Teachers
  8. What is the role of antibiotics in most cases of acute laryngitis? No role (usually viral etiology)
  9. Which diagnostic test is most useful in evaluating chronic laryngitis? Laryngoscopy
  10. What is the recommended duration of voice rest for acute laryngitis? 3-7 days
  11. Which of the following is a risk factor for laryngitis? Smoking
  12. What is the primary difference between laryngitis and epiglottitis? Severity and potential for airway compromise
  13. How does laryngitis affect swallowing? Usually does not affect swallowing
  14. Which of the following is NOT a recommended home remedy for laryngitis? Gargling with hot water
  15. What is the role of corticosteroids in the treatment of acute laryngitis? Limited; may be used in severe cases or when rapid voice recovery is needed
  16. Which of the following is a potential complication of chronic laryngitis? Vocal cord lesions
  17. What is the appropriate management for laryngitis caused by vocal cord nodules? Voice therapy and possible surgical removal
  18. How does reflux contribute to laryngitis? Irritation of vocal cords by stomach acid
  19. What is the role of humidification in managing laryngitis? Helps moisturize and soothe the larynx
  20. Which of the following is NOT a typical symptom of laryngitis? High fever
  21. What is the primary difference between laryngitis in adults and children? Children are at higher risk for airway obstruction
  22. How does alcohol consumption affect laryngitis? Can exacerbate symptoms and delay healing
  23. What is the appropriate fluid intake recommendation for patients with laryngitis? Increased fluid intake
  24. Which of the following medications may contribute to laryngitis? Inhaled corticosteroids
  25. What is the role of voice amplification devices in managing chronic laryngitis? Can reduce vocal strain in susceptible individuals
  26. How does laryngitis affect singing voice? Reduced range and altered quality
  27. What is the primary cause of laryngitis in professional singers? Vocal overuse or misuse
  28. Which of the following is a sign of potentially serious underlying pathology in laryngitis? Unilateral vocal cord paralysis
  29. What is the role of antiviral medications in treating laryngitis? Generally not indicated
  30. How does laryngitis affect breathing? Usually does not affect breathing in adults
Epoglottitis
  1. What is the correct spelling of the condition often misnamed as "epoglottitis"? Epiglottitis
  2. Which bacteria was historically the most common cause of epiglottitis in children? Haemophilus influenzae type b (Hib)
  3. What age group is most commonly affected by epiglottitis in the post-Hib vaccine era? Adults
  4. Which of the following is NOT a classic symptom of epiglottitis? Barking cough
  5. What is the characteristic posture of a patient with epiglottitis? Tripod position (leaning forward with neck extended)
  6. Which diagnostic test is considered the gold standard for diagnosing epiglottitis? Direct visualization of the epiglottis
  7. What is the thumb sign on lateral neck X-ray indicative of in epiglottitis? Swollen epiglottis
  8. Which of the following is the most appropriate initial management step for suspected epiglottitis? Secure the airway
  9. What is the role of nebulized epinephrine in epiglottitis management? Temporary reduction of airway edema
  10. Which antibiotic is commonly used as empiric therapy for epiglottitis? Third-generation cephalosporin
  11. What is the typical duration of antibiotic treatment for epiglottitis? 7-10 days
  12. Which of the following is a potential complication of epiglottitis? Complete airway obstruction
  13. What is the mortality rate of epiglottitis with proper treatment? <1%
  14. How has the incidence of pediatric epiglottitis changed since the introduction of the Hib vaccine? Significantly decreased
  15. Which of the following is NOT a risk factor for adult epiglottitis? Obesity
  16. What is the role of corticosteroids in epiglottitis management? Reduce inflammation and edema
  17. Which imaging study is preferred in stable patients with suspected epiglottitis? Lateral neck X-ray
  18. What is the appropriate positioning for a child with suspected epiglottitis during transport? Allow child to assume position of comfort
  19. Which of the following procedures is contraindicated in initial management of epiglottitis? Blind nasopharyngeal intubation
  20. What is the role of blood cultures in epiglottitis management? Identify causative organism
  21. How does epiglottitis affect swallowing? Severe odynophagia (painful swallowing)
  22. Which of the following is a sign of impending respiratory failure in epiglottitis? Drooling
  23. What is the appropriate management of the airway in severe epiglottitis? Endotracheal intubation or tracheostomy
  24. How does epiglottitis differ from croup in terms of onset? Epiglottitis has a more rapid onset
  25. What is the role of fiber-optic nasolaryngoscopy in epiglottitis diagnosis? Allows visualization of the epiglottis without disturbing the airway
  26. Which of the following organisms is an increasing cause of epiglottitis in adults? Streptococcus pneumoniae
  27. What is the appropriate disposition for a patient diagnosed with epiglottitis? ICU admission
  28. How does vaccination status affect the management of suspected epiglottitis? Lower suspicion in fully vaccinated individuals, but does not rule out the condition
  29. What is the role of throat examination in suspected epiglottitis? Should be avoided due to risk of precipitating complete airway obstruction
  30. Which of the following is NOT typically elevated in the blood tests of patients with epiglottitis? Eosinophil count


Further Reading
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