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Croup — USMLE Step 3 MCQ

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HardPediatricsCroupUSMLE Step 3

A 2-year-old has a barking cough, hoarse voice, stridor at rest, and moderate subcostal retractions. Oxygen saturation is 95%, and there is no drooling or toxic appearance. Which management and disposition plan is most appropriate?

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Correct answer: A — Give dexamethasone and nebulized epinephrine, then observe for recurrent stridor

The best answer is “Give dexamethasone and nebulized epinephrine, then observe for recurrent stridor”. Stridor at rest and retractions indicate at least moderate croup, so dexamethasone and nebulized epinephrine are indicated. Because epinephrine benefit wanes after roughly 2 hours, observation is required to detect recurrence before discharge.

Reference: American Academy of Family Physicians: Croup Diagnosis and Management: https://www.aafp.org/pubs/afp/issues/2018/0501/p575.html