Croup and Epiglottitis

Chapter 108 Croup and Epiglottitis




Clinical Case Problem 1: An 18-Month-Old Infant with an Upper Respiratory Tract Infection


An 18-month-old is brought to the emergency department by his mother. He developed an upper respiratory tract infection 2   days ago and suddenly this evening developed a harsh, barky cough and difficulty breathing.


On examination, the child is coughing and his temperature is 38.5° C. His respiratory rate is 40 breaths/minute, and he is in some respiratory distress. The breath sounds that are heard appear to be transmitted from the upper airway. There are nasal flaring and suprasternal, infrasternal, and intercostal retractions.



Select the best answer to the following questions




1. What is the most likely diagnosis in this child?


a. viral pneumonia

b. acute epiglottitis

c. bronchiolitis

d. croup

e. bacterial pneumonia

2. The causative agent responsible for this child’s condition is most likely which of the following?


a. adenovirus

b. pneumococcus

c. parainfluenza virus

d. Haemophilus influenzae

e. respiratory syncytial virus (RSV)

3. What is the treatment of choice for moderate cases of the disorder described?


a. racemic epinephrine

b. aerosolized budesonide

c. humidification

d. dexamethasone intravenously

e. a, b, and c

4. The presence of which symptoms would increase the likelihood of admission and intubation?


a. stridor

b. cyanosis

c. tachycardia

d. sternal retractions

e. all of the above

5. Differentiation between viral croup and spasmodic croup can be challenging. What is the major differentiator?


a. spasmodic croup is less likely to have fever

b. viral croup is not associated with asthma

c. spasmodic croup does not have a family history component

d. spasmodic croup lasts much longer than viral croup

e. viral croup is seen in much younger patients


Clinical Case Problem 2: A 5-Year-Old Child Who Has Been Talking Strangely and Is Anorexic


A 5-year-old child is brought to the emergency department by his mother. The mother tells you that for the past 24 hours, the child has been “talking strangely” and drooling. He has had no appetite and has not been drinking.




6. On the basis of this history, what is the diagnosis of major concern?


a. viral pneumonia

b. acute epiglottitis

c. bronchiolitis

d. croup

e. bacterial pneumonia

7. Since the onset of widespread vaccination with H. influenzae type b, H. influenzae as a cause of epiglottitis has


a. disappeared

b. been replaced by Streptococcus pneumoniae and varicella-zoster

c. continued to be a causative organism but reduced in frequency by a factor of 1000%

d. not changed

e. been diagnosed only in immunocompromised patients

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Oct 1, 2016 | Posted by in GENERAL SURGERY | Comments Off on Croup and Epiglottitis

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