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Croup — UKMLA MCQ

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HardPaediatricsCroupUKMLAMRCEM SBAPARAMRCP Part 1

A 4-year-old has recurrent wheeze and interval symptoms but cannot perform objective tests. A monitored trial of low-dose inhaled corticosteroid improves symptoms substantially. What is the appropriate diagnostic-management principle?

Educational content. Not a substitute for clinical judgement or local policy.

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Correct answer: E — Continue review and attempt objective testing when feasible

The best answer is “Continue review and attempt objective testing when feasible”. In children under 5, objective confirmation is often not feasible, so a monitored ICS trial and regular reassessment are appropriate. Improvement supports but does not permanently prove asthma because viral wheeze and natural variation can mimic response. Objective testing should be attempted when the child can perform it, usually from age 5 onward, and non-response or repeated admissions prompts specialist review. LABA monotherapy is unsafe, while invasive challenge under anaesthesia is not a routine substitute for longitudinal assessment.

Reference: BTS/NICE/SIGN NG245: Asthma diagnosis, monitoring and chronic management: https://www.nice.org.uk/guidance/ng245/chapter/Recommendations