2-year old boy is brought to the emergency depart - elbamaritza

[ArchivalUser]

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

[ArchivalUser]

D.

[ArchivalUser]

its "D"!!!
thumb sign is in epiglottitis!

[ArchivalUser]

E.

[ArchivalUser]

its a tricky q.....the answer would be based on the view of x ray..frontal or lateral

[ArchivalUser]

D I THINK.

[ArchivalUser]

Episodic coughing, barking cough, stridor=> Croup (laryngotracheobronchitis)...Subglottic swelling on lat Xray (vs Thumb sign seen on neck Xray=> Epiglottitis)
Answer D

[ArchivalUser]

Explanation:

The correct answer is D. This child's clinical picture is most consistent with infectious croup (laryngotracheobronchitis), commonly caused by parainfluenza viruses. The prodrome of upper respiratory illness with fever followed by a spasmodic, barking cough, is typical of this diagnosis. The classic sign on chest x-ray is the subglottic swelling ( "steeple sign,"), which is the result of viral-induced swelling of the subglottic tissue. This swelling can cause an incomplete airway obstruction, leading to stridor either at rest or during crying. Stridor at rest is an indication for treatment with steroids to decrease inflammation.