NURP 532 Respiratory Exam
Latest Update
Croup - Answer acute viral infection of infants and children with obstruction of the
larynx, accompanied by barking cough and stridor
Recognize that child has stridor and stridor=airway obstruction. They may appear very
ill/toxic w/ abscess, drooling
Croup is common in children age 6 to 36 months, peaks in the second year of life, and is
rare prior to 3 months of age. In the Northern hemisphere, incidence rises in the late fall
and early winter.
Parainfluenza (types I, III) account for nearly 70% of cases, but respiratory syncytial
virus (RSV), influenza A, adenovirus, metapneumovirus, and measles can also cause
croup
stridor w/ croup - Answer -Inspiratory stridor is caused by pathology at or above the
level of the vocal cords (due to collapse of upper airway soft tissue with negative
pressure of inspiration), while expiratory stridor is caused by pathology below the level
of the cords (due to decreased airway diameter).
-Biphasic stridor is indicative of a fixed lesion (due to unchanging airway diameter).
Croup Tx - Answer Therapy recommendations are based on severity:
Mild=(no symptoms at rest, no respiratory distress, able to remain hydrated)
Home management with emphasis on hydration
Consider single oral dose in office of Dexamethasone
Moderate=(symptoms at rest, mild respiratory distress but normal mental status, no
hypoxia)
Single dose in office of Dexamethasone is indicated, may need IM
Consider racemic epinephrine; must be evaluated 3-4 hours later if given
Needs follow up in 24 hours
Severe=(severe symptoms at rest, moderate respiratory distress, change in mental
status, inability to maintain oral intake, or hypoxia)
Admission
, Cool mist is controversial, no definitive evidence
Epiglotitis - Answer severe stridor, hyperextended neck, drooling. Prevented by HIB
vaccine
Congenital stridor - Answer stridor that is limited to inspiration is most commonly due to
laryngomalacia. Vocal cord paralysis (due to neurologic disease or intubation from
trauma) is the second most common etiology. Subglottic hemangiomas in rapid phases
of proliferation should also be considered.
biphasic stridor - Answer fixed obstruction would be expected. This could be evaluated
with barium swallow.
What physical exam findings do you expect with the flu? - Answer -Appear ill
-Erythematous oropharynx
-Cough but lung sounds usually normal for flu alone (but consider co-existing
pneumonia, asthma/COPD exacerbations)
UNCOMMON to have dyspnea; need to consider Covid-19 or complication of flu if this
exists
How Accurate is the Rapid Antigen Test for Flu? - Answer Rapid tests for influenza have
high specificity (greater than 90%-95%) but are only moderately sensitive (50%-70%,
negative test may be false negative) when compared to culture or reverse transcription
polymerase chain reaction (RT-PCR)
If a negative test is not going to change your treatment, then a "clinical diagnosis" is
sufficient during high circulating flu season and no testing is necessary; furthermore, a
negative result should not preclude you from giving flu treatment - especially if high risk
High risk= >65 years old, < 2 years old, pregnant, asthma/COPD, diabetes,
immunocompromised
treatment options for flu - Answer This patient can be treated with Oseltamivir but
Zanamivir should be avoided in patients with asthma and COPD
Influenza antiviral medications should be started as soon as possible after symptom
onset. These medications have not been shown to be effective if administered more than
48 hours after onset of symptoms, although in someone at high risk for complications
there may still be some benefit to initiate after 48 hours of symptoms
Oseltamivir (Tamiflu) is approved for treatment in children as young as 2 weeks of age
and is active against both influenza A and B
Zanamivir (Relenza) is approved for treatment of people 7 years of age and older. It is
dispensed as an inhaled powder and is active against both influenza A and B. Zanamivir
is not recommended for persons with underlying airway disease (such as asthma or
Latest Update
Croup - Answer acute viral infection of infants and children with obstruction of the
larynx, accompanied by barking cough and stridor
Recognize that child has stridor and stridor=airway obstruction. They may appear very
ill/toxic w/ abscess, drooling
Croup is common in children age 6 to 36 months, peaks in the second year of life, and is
rare prior to 3 months of age. In the Northern hemisphere, incidence rises in the late fall
and early winter.
Parainfluenza (types I, III) account for nearly 70% of cases, but respiratory syncytial
virus (RSV), influenza A, adenovirus, metapneumovirus, and measles can also cause
croup
stridor w/ croup - Answer -Inspiratory stridor is caused by pathology at or above the
level of the vocal cords (due to collapse of upper airway soft tissue with negative
pressure of inspiration), while expiratory stridor is caused by pathology below the level
of the cords (due to decreased airway diameter).
-Biphasic stridor is indicative of a fixed lesion (due to unchanging airway diameter).
Croup Tx - Answer Therapy recommendations are based on severity:
Mild=(no symptoms at rest, no respiratory distress, able to remain hydrated)
Home management with emphasis on hydration
Consider single oral dose in office of Dexamethasone
Moderate=(symptoms at rest, mild respiratory distress but normal mental status, no
hypoxia)
Single dose in office of Dexamethasone is indicated, may need IM
Consider racemic epinephrine; must be evaluated 3-4 hours later if given
Needs follow up in 24 hours
Severe=(severe symptoms at rest, moderate respiratory distress, change in mental
status, inability to maintain oral intake, or hypoxia)
Admission
, Cool mist is controversial, no definitive evidence
Epiglotitis - Answer severe stridor, hyperextended neck, drooling. Prevented by HIB
vaccine
Congenital stridor - Answer stridor that is limited to inspiration is most commonly due to
laryngomalacia. Vocal cord paralysis (due to neurologic disease or intubation from
trauma) is the second most common etiology. Subglottic hemangiomas in rapid phases
of proliferation should also be considered.
biphasic stridor - Answer fixed obstruction would be expected. This could be evaluated
with barium swallow.
What physical exam findings do you expect with the flu? - Answer -Appear ill
-Erythematous oropharynx
-Cough but lung sounds usually normal for flu alone (but consider co-existing
pneumonia, asthma/COPD exacerbations)
UNCOMMON to have dyspnea; need to consider Covid-19 or complication of flu if this
exists
How Accurate is the Rapid Antigen Test for Flu? - Answer Rapid tests for influenza have
high specificity (greater than 90%-95%) but are only moderately sensitive (50%-70%,
negative test may be false negative) when compared to culture or reverse transcription
polymerase chain reaction (RT-PCR)
If a negative test is not going to change your treatment, then a "clinical diagnosis" is
sufficient during high circulating flu season and no testing is necessary; furthermore, a
negative result should not preclude you from giving flu treatment - especially if high risk
High risk= >65 years old, < 2 years old, pregnant, asthma/COPD, diabetes,
immunocompromised
treatment options for flu - Answer This patient can be treated with Oseltamivir but
Zanamivir should be avoided in patients with asthma and COPD
Influenza antiviral medications should be started as soon as possible after symptom
onset. These medications have not been shown to be effective if administered more than
48 hours after onset of symptoms, although in someone at high risk for complications
there may still be some benefit to initiate after 48 hours of symptoms
Oseltamivir (Tamiflu) is approved for treatment in children as young as 2 weeks of age
and is active against both influenza A and B
Zanamivir (Relenza) is approved for treatment of people 7 years of age and older. It is
dispensed as an inhaled powder and is active against both influenza A and B. Zanamivir
is not recommended for persons with underlying airway disease (such as asthma or
