Snapshot A 5-year-old girl is brought to urgent care for difficulty breathing. For the past few days, she has had low-grade fevers, a runny nose, and a slight cough. On physical exam, she has a seal-like barking cough and audible inspiratory stridor. There is accessory muscle use with breathing. Her lung exam was normal without any wheezes. She is given the appropriate treatments for this condition, and the physician informs the family that this is likely viral and common in children. Introduction Clinical definition upper respiratory infection characterized by barking cough Epidemiology Incidence common Demographics children < 6 years of age boys > girls Etiology Parainfluenza virus (most common) a paramyxovirus RNA virus Influenza virus orthomyxovirus RNA virus Pathogenesis the virus causes inflammation of the upper airway edema, epithelial necrosis, and infiltration of inflammatory cells this causes narrowing of subglottic airway, resulting in stridor and increased work of breath Associated conditions bronchiolitis Presentation Symptoms “seal-like” deep barking cough difficulty breathing sore throat hoarseness congestion symptoms are worse at night Physical exam fever inspiratory stridor tachypnea accessory muscle use pulsus paradoxus with severe croup and upper airway obstruction Imaging Chest radiography indication all patients findings may show a steeple sign indicating subglottic narrowing Differential Acute epiglottitis distinguishing factors patients typically have muffled voice, drooling, high fever, and have dysphagia a medical emergency absence of barking cough Tracheal and subglottic stenosis distinguishing factors can be congenital or from prolonged intubation in critically ill patients inspiratory stridor hoarse voice absence of systemic symptoms including fever DIAGNOSIS Making the diagnosis based on clinical presentation Treatment Conservative supportive care indication all patients modalities supplemental oxygen hydration Medical single dose of steroids indication all patients nebulized epinephrine indications moderate-severe croup cool mist indications mild-moderate croup Complications Respiratory failure Pneumonia Prognosis Most cases resolve without complications
QUESTIONS 1 of 4 1 2 3 4 Previous Next Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK (M3.PD.16.72) A 4-year-old is brought into the emeregency room by his mother. The mother states that the child had a slight cough one week ago that has since worsened. The mother states the child's cough sounds like someone barking and states that he has also had mild fevers along with rhinorrhea. The patient's vitals are significant for a fever of 100.8 F, and his physical exam reveals inspiratory stridor. What is the most likely organism responsible? QID: 103363 Type & Select Correct Answer 1 Parainfluenza virus 100% (4/4) 2 Respiratory syncytial virus 0% (0/4) 3 Adenovirus 0% (0/4) 4 Ebstein barr virus 0% (0/4) 5 Influenza A virus 0% (0/4) M 10 Question Complexity D Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 1 Review Tested Concept Review Full Topic (M3.PD.16.70) A 2-year-old boy in respiratory distress is brought to the emergency department by his parents. They state that approximately one hour after putting their child to sleep, a "hacking" cough was heard from his bedroom. After entering his room the parents state their child appeared to be in distress, making a high pitched noise with every breath. Beyond a runny nose for the past few days, the child has been healthy. He has no toys in his bed or access to any other small objects. Physical exam demonstrates a 2-year-old child in respiratory distress. Which of the following choices is the proper management for this patient? QID: 103361 Type & Select Correct Answer 1 Humidified oxygen and dexamethasone; discharge if the patient improves 11% (1/9) 2 Discharge from the emergency department without treatment 0% (0/9) 3 Dexamethasome, racemic epinephrine and observation for 4 hours; discharge if stridor remits 67% (6/9) 4 Broncoscopy to remove a foreign body in the upper airway then discharge 11% (1/9) 5 Empiric intravenous (IV) antibiotics, intubate and admission 11% (1/9) M 11 Question Complexity D Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 3 Review Tested Concept Review Full Topic Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK
All Videos (1) Login to View Community Videos Login to View Community Videos Croup Keshav Mudgal Pediatrics - Croup D 11/3/2015 165 views 5.0 (6) Pediatrics | Croup Pediatrics - Croup Listen Now 11:41 min 12/25/2021 27 plays 5.0 (1)