Acute Layngo-tracheo-bronchitis

Acute Layngo-tracheo-bronchitis

Q. 1

A 4 year old boy, with three days history of upper respiratory tract infection presents with stridor, which decreases on lying down. What is the most probable diagnosis?

 A

Acute Epiglottitis

 B

Laryngotracheobronchitis

 C

Foreign body Aspiration

 D

Retropharyngeal Abscess

Q. 1

A 4 year old boy, with three days history of upper respiratory tract infection presents with stridor, which decreases on lying down. What is the most probable diagnosis?

 A

Acute Epiglottitis

 B

Laryngotracheobronchitis

 C

Foreign body Aspiration

 D

Retropharyngeal Abscess

Ans. B

Explanation:

Prodromal symptoms of upper respiratory tract infection preceding sings of respiratory tract obstruction is characteristic of croup.

Ref: Nelson 17th Edition, Page 1405;1406,14; Respiratory Care: Principles And Practice By Dean Hess, Neil MacIntyre, Shelley Mishoe, William Galvin, 2011, Page 1019.


Q. 2

Laryngotracheobronchitis is caused most commonly by:

 A

Adenovirus

 B

Parainfluenza virus

 C

Rhinovirus

 D

None of the above

Q. 2

Laryngotracheobronchitis is caused most commonly by:

 A

Adenovirus

 B

Parainfluenza virus

 C

Rhinovirus

 D

None of the above

Ans. B

Explanation:

Laryngotracheobronchitis is the most common infectious cause of airway obstruction in children, usually occurring between the ages of 6 months and 3 years. It is a viral infection most commonly caused by the parainfluenza virus, although numerous other organisms have been reported.


Q. 3

Croup N most commonly due to –

 A

The respiratory syncytial virus 

 B

The para influenza virus

 C

The adenovirus

 D

The coronavirus

Q. 3

Croup N most commonly due to –

 A

The respiratory syncytial virus 

 B

The para influenza virus

 C

The adenovirus

 D

The coronavirus

Ans. B

Explanation:

Ans. is ‘b’ i.e., The para influenza virus 

Croup (Laryngotracheobronchitis)

  • Croup is a viral infection of upper respiratory tract.
  • Children between the age of 1-5 years are affected.
  • Para-influenza type I virus is the most common causative organism.
  • Other viruses implicated in causaction are RSV, influenza virus, Adneovirus and Rhinovirus.

Q. 4

Croup syndrome is usually caused by-

 A

Rhinoviruses

 B

Coxsackie A virus

 C

Coxsackie B virus

 D

All

Q. 4

Croup syndrome is usually caused by-

 A

Rhinoviruses

 B

Coxsackie A virus

 C

Coxsackie B virus

 D

All

Ans. A

Explanation:

Ans. is ‘a’ i.e., Rhinoviruses

Croup (Laryngotracheobronchitis)

o Croup is a viral infection of upper respiratory tract.

o Children between the age of 1-5 years are affected.


Q. 5

A child with three days history of upper respiratory tract infection presents with stridor, which decreases on lying down postion. What is the most probable diagnosis –

 A

Acute Epiglottitis

 B

Laryngotracheobronchitis

 C

Foreign body aspiration

 D

Retropharyngeal abscess

Q. 5

A child with three days history of upper respiratory tract infection presents with stridor, which decreases on lying down postion. What is the most probable diagnosis –

 A

Acute Epiglottitis

 B

Laryngotracheobronchitis

 C

Foreign body aspiration

 D

Retropharyngeal abscess

Ans. B

Explanation:

Ans. is ‘b’ i.e., Laryngotracheobronchitis

This child has : –

i)           3 days history of upper respiratory tract infection.

ii)          Followed by stridor

These features suggest the diagnosis of croup.

Clinical manifestations of Croup

  • Most patients have an upper respiratory tract infection with some combination of –
  • Rhinorrhea               
  • Pharyngitis
  • Mild cough               
  • Low grade fever

o After 1-3 days signs and symptoms of upper respiratory tract obstruction become apparent –

  • Barking cough  
  • Hoarseness  
  • Inspiratory stridor

Q. 6

A 4 yr old child has ‘seal barking’ like croupy cough. Management includes A/E –

 A

O2 inhalation

 B

Antibiotic

 C

Hydration

 D

ALL

Q. 6

A 4 yr old child has ‘seal barking’ like croupy cough. Management includes A/E –

 A

O2 inhalation

 B

Antibiotic

 C

Hydration

 D

ALL

Ans. B

Explanation:

Ans. is `b’ i.e., Antibiotic

o Seal barking like croupy cough is a feature of laryngotracheobronchitis (Croup).


Q. 7

Steeple sign is seen in:

 A

Croup

 B

Acute epiglottitis

 C

Laryngomalacia

 D

Quinsy

Q. 7

Steeple sign is seen in:

 A

Croup

 B

Acute epiglottitis

 C

Laryngomalacia

 D

Quinsy

Ans. A

Explanation:

 

 Chest X-ray in croup (Laryngotracheobronchitis) reveals a characteristic narrowing of the subglottic region called steeple sign.

– Current Otolaryngology 2nd/ed p 472


Q. 8

Most common cause of Croup ‑

 A

H influenza

 B

S pneumoniae

 C

Influenza virus

 D

Parainfluenza virus

Q. 8

Most common cause of Croup ‑

 A

H influenza

 B

S pneumoniae

 C

Influenza virus

 D

Parainfluenza virus

Ans. D

Explanation:

Ans. is `d.’ i.e., Parainfluenza virus

Croup (Laryngotracheobronchitis)

  • Laryngotracheobronchitis is the most common infectious cause of obstruction in children usually occurring between the ages of 6 months and 3 years.
  • Male children (boys) are characteristically more frequently involved than females (girls)

Etiology

  • It is a viral infection most frequently caused by Parainfluenza virus

Pathology

  • The most characteristic pathological feature is edema formation in the subglottic area
  • The loose areolar tissue in the subglottic area swells up and causes predominant signs of upper airway obstruction.

Presentation

  • Gradual onset with a prodrome of upper respiratory symptoms
  • Hoarseness and barking cough (croupy cough)
  • Stridor (initially inspiratory than biphasic)
  • Fever is usually low grade (or absent) although may occasionally be high grade
  • Droolings is characteristically absent and there is no dysphagia (seen in epiglottitis)
  • Imaging (X ray)
  • Symmetric ‘steeple’ or ‘funnel shaped’ narrowing of the subglottic region (steeple sign)
  • Hypopharyngeal widening or distension
  • Normal epiglottis and aryepiglottic folds

Treatment

  • Mild symptoms (barking cough but no stridor at rest)
  • Supportive therapy alone with humified oxygen, oral hydration and minimal handling.
  • Moderate symptoms (barking cough with stridor at rest)
  • Active intervention with humified oxygen, Nebulized racemic epinephrine and glucocorticoids (steroids).
  • Severe symptoms (impending respiratory failure)
  • Require an artificial airway (Intubation with endotracheal tube or tracheostomy may be required).
  • Antibiotics are not routinely indicated in the treatment of Acute Laryngotracheobronchitis. Their use is limited if there is evidence of secondary bacterial infection.


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