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Epiglottitis — MCCQE Part 1 MCQ

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HardChild with FeverEpiglottitisMCCQE Part 1

5-year-old incompletely immunised child presents with fever, drooling and respiratory distress. He sits leaning forward and has muffled voice. Which of the following is the most appropriate next step?

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Correct answer: B — Avoid throat examination, call anaesthesia/ENT and secure airway in controlled setting

Avoid throat examination, call anaesthesia/ENT and secure airway in controlled setting is best because drooling, tripod posture and muffled voice suggest epiglottitis. Wait for confirmatory testing before any stabilisation is suboptimal because resuscitation and time-critical treatment should not wait when instability is present; Discharge once symptoms temporarily improve is suboptimal because temporary improvement can precede deterioration; Give an adjunctive medication as the sole first-line treatment is suboptimal because adjuncts do not replace definitive stabilisation; Delay escalation until cardiac arrest or respiratory failure occurs is suboptimal because early escalation is central to emergency care. Agitating the child can precipitate obstruction.

Reference: Canadian Paediatric Society airway guidance