Question

A child presents with stridor, barking cough and difficulty in breathing since 2 to 3 days. He has fever and elevated leukocyte count. All of the following statements about his condition are true, except:

• A. Subglottic stenosis and hypopharyngeal dilatation may be seen on X-rays
• B. Boys are more commonly affected than girls
• C. Symptoms are predominantly caused by involvement of the subglottis
• D. Antibiotics form the mainstay of treatment

Hint:

Barking cough and steeple sign mean viral croup. Steroids and adrenaline, not antibiotics, are the mainstay.

Answer 1

The Correct Option is D

Step 1: The picture of a young child with barking cough, stridor and breathing difficulty over a couple of days points to acute laryngotracheobronchitis, that is croup. Croup is almost always viral, most often due to parainfluenza virus.

Step 2: In croup the swelling and narrowing are maximal at the subglottis, the narrowest part of a child airway. The frontal neck X-ray classically shows the steeple or pencil sign from subglottic narrowing, and there can be ballooning or dilatation of the hypopharynx above the obstruction. So options A and C are correct.

Step 3: Croup has a recognised male predominance, so boys are affected more than girls. Option B is also correct.

Step 4: Because the cause is viral, antibiotics do not treat the underlying problem. The mainstay is supportive care with humidified air, nebulised adrenaline for moderate to severe cases, and corticosteroids such as dexamethasone to reduce airway oedema. Antibiotics are reserved only for proven bacterial superinfection. Hence the false statement is that antibiotics form the mainstay.

Answer: D. Antibiotics form the mainstay of treatment.