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Author [[PageAuthor::Ahmed Zaghw, M.D. [1]]]
Exam Type USMLE Step 2 CK
Main Category Pediatrics
Sub Category Head and Neck, Infectious Disease, Respiratory
Prompt A 3.5 year-old boy is brought to the hospital due to a cough and a whistling sound with breathing. Three days ago, he developed fever, a hoarse cry, rhinorrhea and a progressively worsening, barky cough. His immunizations are up-to-date. His 6-year-old brother also as cold symptoms. His temperature is 37.5C (99.5F),pulse is 140/min, and respirations are 36/min. On examination, he is conscious, in mild respiratory distress, has a dry barking cough. His pharynx is reddish and injected, but without enlargement or asymmetry. The lungs auscultation was clear. Lateral neck x-rays reveal a narrowed subglottic region. What is the most likely diagnosis?
Answer A Foreign body aspiration
Answer A Explanation Incorrect- Foreign body aspiration is suspected in cases of sudden onset stridor. A fever is not a symptom of foreign body aspiration.
Answer B Epiglottitis
Answer B Explanation [[AnswerBExp::Incorrect- Epiglottitis is seen in older children. The cough is not croupy in epiglottitis, and the patient appears more toxic, with high grade fever, tachypnea and tachycardia. Stridor and excessive drooling may be found in croup.]]
Answer C Laryngeal diphtheria
Answer C Explanation Incorrect- it can occur in older patient with no vaccination history
Answer D Croup
Answer D Explanation Correct- Laryngeal inflammation leading to hoarseness, a barking cough in a children typically less than 3 years of age is characteristic for croup.
Answer E Laryngo-tracheo-broncho pneumonitis
Answer E Explanation Incorrect-Bacterial laryngo-tracheo-broncho pneumonitis is manifested by wheezing, lower respiratory involvement and interstitial changes on chest x-rays.
Right Answer C
Explanation Croup, also known as laryngotracheitis or laryngo-tracheo-bronchitis (LTB), is characterized by laryngeal inflammation leading to hoarseness, a barking cough. The child is typically less than 3 years of age, and the most common agent is Parainfluenza virus. Croup is usually a clinical diagnosis. Lateral neck x-rays show subglottic narrowing

Croup commonly presents in children and is caused by Parainfluenza virus.
Educational Objective: Croup commonly presents in children and is caused by Parainfluenza virus.
References: First Aid USMLE 2CK

Approved No
Keyword Croup, Stridor
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