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Croup — MCCQE Part 1 MCQ

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HardSore ThroatCroupMCCQE Part 1

A 2-year-old boy has a barking cough, hoarse voice, inspiratory stridor at rest, and visible chest-wall indrawing. Temperature is 38.0°C, oxygen saturation is 96%, and he has no drooling or toxic appearance. Which emergency-department treatment is most appropriate?

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Correct answer: D — Dexamethasone plus nebulized epinephrine, followed by observation for recurrence

Barky cough, hoarseness, and stridor without drooling or toxicity indicate croup. Stridor and indrawing at rest make the episode at least moderate. Give a corticosteroid, usually a single oral dexamethasone dose, and nebulized epinephrine for rapid temporary improvement. Because epinephrine's clinical effect wanes, observe for 2 to 4 hours and discharge only if symptoms do not recur and the child otherwise meets safe-discharge criteria. Salbutamol targets lower-airway smooth muscle and is rarely useful in typical croup. Antibiotics and humidified mist are not routine effective treatments. Keep the child calm; unnecessary pharyngeal manipulation can worsen distress and is especially inappropriate when a dangerous alternate upper-airway diagnosis is possible.

Reference: Canadian Paediatric Society, Acute Management of Croup in the Emergency Department: https://cps.ca/en/documents/position/acute-management-of-croup