Croup — RACGP Fellowship MCQ

Instant feedback + full explanation. One question, done properly.

ModeratePaediatrics and adolescentCroupRACGP Fellowship

A 4-year-old boy has a barking cough and inspiratory stridor when upset. He is afebrile, drinking, oxygen saturation is 98% and there is no drooling. What is the most appropriate management?

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

Reveal the answer and explanation

Correct answer: D — Give oral dexamethasone and provide safety-net advice

This child presents with classic viral croup of mild severity: barking cough, inspiratory stridor only when upset (not at rest), afebrile, adequate hydration, normal SpO₂, no signs of severe airway obstruction. The diagnosis is clinical. Option D is correct: corticosteroids (oral dexamethasone 0.15 mg/kg) are recommended even for mild croup to reduce symptoms and prevent escalation. Option A (antibiotics) is inappropriate—croup is viral; bacterial tracheitis would present with toxicity. Option B (throat examination) risks precipitating airway obstruction and is not needed for clinical diagnosis. Option E (CXR) is not indicated for typical croup and delays treatment. Option C (salbutamol) is a low-value intervention not supported by evidence-based guidelines; it should not be first-line. Safety-net advice regarding warning signs (persistent stridor at rest, cyanosis, respiratory distress, lethargy) is essential for primary care management.

Reference: RACGP Evidence based guideline for the management of croup (2008); Australian Prescriber: Drug treatments of childhood coughs (2014); https://www.racgp.org.au/getattachment/d1325a70-ffbd-4d13-858c-e6ad92046f13/attachment.aspx