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A 6-year-old boy is brought to the emergency room with a 3-h history of fever to 39.5 °C
(103.1 °F) and sore throat. The child appears alert
but anxious and toxic. He has mild inspiratory stridor and is drooling. You
should immediately
a. Examine the throat and obtain a culture
b. Obtain an arterial blood gas and start an IV line
c. Order a chest x-ray and lateral view of the neck
d. Prepare to establish an airway
e. Admit the child and place him in a mist tent

A 2-year-old boy is brought into the emergency department by ambulance at night with an
acute history of cough and stridor following a 2-day history of coryzal symptoms. On
examination, he is afebrile but has marked intercostal recession with stridor and a ‘barking
cough’ is heard. What is the most likely causative organism?
A. Adenovirus
B. Respiratory syncytial virus
C. Parainfluenza virus
D. Rhinovirus
E. Influenza virus

You are awakened in the night by your 2-year-old son, who has
developed noisy breathing on inspiration, marked retractions of the chest
wall, flaring of the nostrils, and a barking cough. He has had a mild upper
respiratory infection (URI) for 2 days. The most likely diagnosis is
a. Asthma
b. Epiglottitis
c. Bronchiolitis
d. Viral croup
e. Foreign body in the right mainstem bronchus
A 4-year-old previously healthy boy presents with fever to 102.5°F, sore throat, irritability,
and refusal to eat or drink. Symptoms began that morning and have progressed over the past
few hours. You note the child to be ill appearing, leaning forward, and drooling. There are no
ill contacts and the child has received all immunizations. You keep the child comfortable with
his mother and immediately contact anesthesia and otolaryngology to assist with further
management. If neck films were ordered, the most likely finding would be:
a. Thumbprint sign
b. No acute abnormality
c. Steeple sign
d. Reverse spine sign
e. Irregularity of the tracheal air column

A 3-year-old boy is brought in to your office by his mother with complaints of cough, wheeze,
and low grade fever. The child was well until the prior evening, when he developed sudden
onset of cough after dinner. He came to find his mother when he was coughing, but she is
unsure what he was doing just prior to that time. He has no signs of an upper respiratory
infection, no history of prior wheeze, and has had no abdominal complaints. Upon further
questioning, his older brother admits that they were playing a game, trying to catch peanuts
in their mouths when the younger boy began coughing. You have a high suspicion of foreign
body aspiration (FBA). You order a chest X-ray. The most likely finding is:
a. Unilateral hyperinflation of the right side
b. Right-sided bronchiectasis
c. Focal infiltrate in the left lower lobe
d. Left-sided atelectasis
e. Radiopaque foreign body in the trachea

Compare between croup and epiglottitis