Pediatrics SectionCongenital Heart Disease is included in the Angio-Interventional SectionThe following are True/False questions:1995, 1992Regarding croup and epiglottitis:1. croup characteristically narrows the supraglottic airway (95, 92)2. croup patients tend to be younger (92)3. croup is more urgent (92)4. croup is caused by H. influenza (92)5. subglottic tracheal narrowing is seen in up to 25% of patients with epiglottitis (95, 92)6. viral infection is the most common etiology of croup (95)7.
is the most common cause of membranous croup (95)*Epiglottitis narrows the epiglottis and aryepiglottic folds. Epiglottitis occurs in children older than 3 years,with the peak at 6 years. Epiglottitis is caused by bacteria -usually H. influenze, type B (less likely pneumococcus orStreptococcus Group A). The patient is in mortal danger of suffocation secondary to complete airway closure.Patients often require intubation. Edema can be so severe that it extends to the subglottic area in 25%Croup usually narrows the subglottic airway. Croup thickens the glottis and vocal cords. Croup occurs inchildren older than 6 months, with the peak at 2-3 years. Croup (acute laryngotracheobronchitis or acute viralspasmodic laryngitis) is usually caused by a virus(parainfluenza, respiratory syncytial virus) and is usually self-limiting. Bacterial croup is possible (called pseudomembranous croup, membranous croup, or bacterial tracheitis)and this can be severe, with the patients often needing tracheostomy. Staphylococcus aureus is usually thecausative organism.*Answer: 1. False 2. True 3. False 4. False 5. True 6. Tru 7. True1995, 1994, 1992Regarding necrotizing enterocolitis:8. it results in 60% mortality(95)9. it most commonly affects the descending colon (95)10. an air fluid level in the peritoneum indicates perforation (95)11. air in the portal venous system is always fatal (95)12. strictures occur in 10-25% of patients (95)13. term infants have better prognosis than premature infants14. barium enema can be helpful to exclude other diagnoses15. finding often confirmed by plain film16. pneumotosis indicates impending death*Necrotizing enterocolitis is a disease of bowel in infants subjected tohypoxic stress. Splancnic ischemicevents lead to indirect mucosal injury, which, in immature gut, allows bacterial overgrowth.Approximately 80% of patients with necrotizing enterocolitis are premature. Term infants or older infantswho develop necrotizing enterocolitis usually have severe underlying disease such as congenital heart disease orHirschsprung disease (do they do worse??)The most common finding in necrotizing enterocolitis is dilated bowel (due to ileus). Pneumatosis is thesecond most common findingAccording to Dahnert, barium enema is contraindicated, but “may be used judiciously in selected caseswhere there is radiologic and clinical doubt.”The Merck manual reports that 2/3 of patients with necrotizing enterocolitis will survive(33% mortality).Gore, Levine, and Laufer reports that the “majority survive.” The terminal ileum is the most common site. An air fluidlevel in the peritoneum indicates perforation, which is an indication for emergent surgery. However, air in the portalvein is not (necessarily) a preterminal event (unlike adults). In fact, it is not necessarily an indication for emergentsurgery. Strictures occur in 6-33% according to Gore, Levine, and Laufer.References: Kirks, pp. 869-876; Dahnert 1993, p. 530*Answer: 8. False 9. False 10. True 11. False 12. True 13. False? 14. Fals 15. True 16. False1995Regarding tracheoesophageal fistula:17. oligohydramnios18. greater than 90% present with a fistula19. ???*