Croup — CCFP MCQ

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EasyPaediatrics and adolescentCroupCCFP

A 3-year-old presents with a barky cough, hoarse voice, and inspiratory stridor that occurs only when he is upset. Oxygen saturation is 98%, there is no drooling, and he is drinking normally. What is the most appropriate next step in management?

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Correct answer: D — Give a single dose of dexamethasone and provide return precautions

This child has mild croup (barky cough, hoarse voice, inspiratory stridor) with no danger signs (good oxygenation, no drooling, able to drink). Canadian guidelines, including College of Family Physicians guidance and landmark Canadian trials (Bjornson et al.), establish that a single oral dose of dexamethasone 0.6 mg/kg is the cornerstone of croup management and is effective even in mild disease. Return precautions should be provided for any signs of deterioration. Option A is incorrect because epiglottitis is ruled out by the absence of drooling and the child's ability to drink; antibiotics have no role in viral croup. Option E (X-ray) delays definitive treatment and is unnecessary in straightforward croup. Option C (salbutamol) is not first-line for croup. Option B (intubation) is reserved for severe, life-threatening croup, which this child does not have.

Reference: College of Family Physicians of Canada. Croup. Canadian Family Physician. 2008;54(4):573–575. https://www.cfp.ca/content/54/4/573