Adult acute supraglottitis with threatened upper airway — MRCEM SBA MCQ

Correct answer: B — Summon anaesthetics and ENT immediately for a controlled airway plan while keeping him upright.

Rapidly progressive dysphagia, altered voice, inability to manage secretions and stridor suggest acute supraglottitis with a threatened upper airway. The SpO₂ of 96% does not remove the airway concern: stridor is strongly associated with the need for airway intervention in adult epiglottitis. The immediate priority is coordinated anaesthetic and ENT assessment, with a plan for difficult-airway management and surgical backup if required. Keep him upright, minimise disturbance and give oxygen as tolerated; intravenous antibiotics should follow promptly without delaying airway planning. ([england.nhs.uk](https://www.england.nhs.uk/patient-safety/patient-safety-insight/learning-from-patient-safety-events/how-we-acted-on-patient-safety-issues-you-recorded/diagnosis-and-management-of-supraglottitis/?utm_source=openai)) **A** is attractive because CT can investigate a deep-neck infection, but transfer and imaging must not precede assessment of this stridulous airway. **C** addresses the likely infection, but antibiotics and observation alone do not address possible sudden obstruction. **D** could help establish the diagnosis in an appropriately prepared setting; an examination undertaken before airway planning risks precipitating deterioration. **E** recognises the urgency, but induction without a coordinated rescue plan is hazardous when intubation may be difficult. Airway intervention is not mandatory for every adult with epiglottitis; the specialist assessment determines whether, where and how to secure this patient’s airway. ([nhsbsa.nhs.uk](https://www.nhsbsa.nhs.uk/sites/default/files/2025-09/PRN00936_ii_Pharmacy-First-Clinical-Pathways-v.1.6.pdf))

Reference: Diagnosis and management of supraglottitis (Undated; checked 27 September 2026) — https://www.england.nhs.uk/patient-safety/patient-safety-insight/learning-from-patient-safety-events/how-we-acted-on-patient-safety-issues-you-recorded/diagnosis-and-management-of-supraglottitis/ Pharmacy First clinical pathways, version 1.6: acute sore throat (September 2025) — https://www.nhsbsa.nhs.uk/sites/default/files/2025-09/PRN00936_ii_Pharmacy-First-Clinical-Pathways-v.1.6.pdf Epiglottitis (Undated; checked 27 September 2026) — https://www.nhs.uk/conditions/epiglottitis/