darkhorse
Forum Elite
Topics: 56
Posts: 275
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A 2-year old boy is brought to the emergency department at 2:00 a.m. because of episodic coughing "fits". He was well until one day earlier when he developed rhinorrhea and a temperature of 38.3 C (101 F). He has no prior history of respiratory illnesses, and no one else in the family is ill. On arrival to the hospital, he is coughing in a rapid, "barking" fashion, but appears otherwise well. His temperature is 38.2 C (100.8 F), heart rate is 120/min, respiratory rate is 50/min, and oxygen saturation is 96% on room air with coughing. Physical examination shows clear lungs, a normal cardiac and abdominal examination, and no rash. He continues to have repeated, episodic coughing with inspiratory stridor at rest. A frontal radiograph of the chest at this time is most likely to reveal
A. cardiomegaly with pulmonary venous congestion
B. left lower lobe infiltrate
C. pneumothorax
D. subglottic swelling
E. thumb-shaped epiglottis
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| MAGY17
Forum Elite
Topics: 30
Posts: 234
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D
this is croup or laryngotracheobronchitis
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| DrAlex_76
Forum Junior
Topics: 5
Posts: 43
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think of E - if there is severe sumptoms like high fever, drooling, aphonia, sniffing position! good Q !
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| Ivonne
Forum Guru
Topics: 51
Posts: 1,392
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Going with D Croup many factors:
1.-besides the cough and not that high fever he is otherwise well, in epiglotitis the patient is really toxic that we have to think about intubation ASAP
2.-inspiratory stridor
3.-age and onset of symptoms, in epiglotitis is faster
4.-CLUE: Subglotic swelling that in X ray will show narrowing of the airway "steeple sign"
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