Croup Flashcards
Croup also known as laryngotracheobronchitis (larynx, trachea and bronchi) refers to inflammation of the upper airways and large bronchi. Which of the following is NOT part of the upper airway?
1 - trachea
2 - larynx
3 - pharynx
4 - nasal cavity
1 - trachea
Croup typically affects upper airway, but can spread to lower airway as well
Croup also known as laryngotracheobronchitis (larynx, trachea and bronchi) refers to inflammation of the upper airways. Which age group are most susceptible to croup?
1 - >75
2 - 50-65
3 - 10-50
4 - 1-5
4 - 1-5
Croup also known as laryngotracheobronchitis (larynx, trachea and bronchi) refers to inflammation of the upper airways. What is the incidence of croup?
1 - 2.5 cases per 100,000
2 - 25 cases per 100,000
3 - 250 cases per 100,000
4 - 2500 cases per 100,000
3 - 250 cases per 100,000
- slightly more common in males
What time of the year does the number of cases of croup peak?
1 - Jan - May
2 - August - Dec
3 - Oct - March
4 - Dec - April
3 - Oct - March
Is croup more commonly caused by viruses or bacteria?
- viruses
All of the following can cause croup. But which of the following viruses is most common?
1 - Parainfluenza
2 - Influenza A and B
3 - Measles
4 - Adenovirus
5 - Respiratory syncytial virus (RSV).
1 - Parainfluenza
- Accounts for 75% of cases
Bacteria can also cause croup. Which of the following bacteria is NOT associated with croup?
1 - Staphylococcus aureus
2 - Escherichia coli
3 - Streptococcus pneumoniae
4 - Haemophilus influenza
5 - Moraxella catarrhalis.
2 - Escherichia coli
- Typically found in the GI and most common cause of UTI
How do patients typically contract croup?
1 - kissing infected person
2 - skin to skin contact
3 - touching infected surface (few hours)
4 - inhaling air droplets
4 - inhaling air droplets
Most common, but all others can also cause infection as well
Patients who have croup typically have coryzal symptoms (nasal stuffiness, runny nose, sneezing, sore throat, and cough) for how long prior to croup infection?
1 - 12-24h
2 - 24-48h
3 - 49-72h
4 - 72-96h
2 - 24-48h
When a patient is infected with a virus, coryzal symptoms follow (nasal stuffiness, runny nose, sneezing, sore throat, and cough). This can lead to all of the following EXCEPT which one?
1 - inflammation
2 - increased mucus secretions
3 - haemoptysis
4 - oedema
3 - haemoptysis
When a patient has croup they have coryzal symptoms followed by inflammation, increased mucus secretions and oedema. All of the following can be affected, but which of the following is the most narrow and accounts for the inspiratory stridor (abnormal, high-pitched respiratory sound produced by irregular airflow and high pitched barking cough in a narrowed airway during the inspiration phase) in patients with croup?
1 - nasal cavity
2 - sub-glottis
3 - epiglottis
4 - trachea
2 - sub-glottis
- contains ring of cartilage that does not expand, making this narrow with inflammation, oedema and mucus secretions
This contains lower vocal cords and upper trachea
Following 24-48h of coryzal symptoms (nasal stuffiness, runny nose, sneezing, sore throat, and cough) patients can progress to all of the following, EXCEPT which of the following clinical features?
1 - high fever >38ºC
2 - Hoarseness
3 - Barking cough worse at night
4 - Insidious and progressive stridor
1 - high fever >38ºC
Patients typically have a low fever <38ºC
Does croup typically cause an inspiratory or expiratory stridor? (high pitched wheeze due to turbulent air flow)
- inspiratory
Which of the following can occur in a patient once they have developed croup?
1 - Tachypnoea
2 - Cyanosis
3 - Head bobbing
4 - Nasal flaring
5 - Subcostal and intercostal recession
7 - Suprasternal and sternal recession
8 - Diaphragmatic breathing
9 - Use of accessory muscles
10 - all of the above
10 - all of the above
According to NICE which of the following matches the a moderate severity of croup?
1 - Seal-like barking cough with stridor and sternal recession at rest; no agitation or lethargy.
2 - Seal-like barking cough but no stridor or sternal/intercostal recession at rest.
3 - Seal-like barking cough with stridor and sternal/intercostal recession associated with agitation or lethargy.
1 - Seal-like barking cough with stridor and sternal recession at rest; no agitation or lethargy.
According to NICE which of the following matches the a severe severity of croup?
1 - Seal-like barking cough with stridor and sternal recession at rest; no agitation or lethargy.
2 - Seal-like barking cough but no stridor or sternal/intercostal recession at rest.
3 - Seal-like barking cough with stridor and sternal/intercostal recession associated with agitation or lethargy.
3 - Seal-like barking cough with stridor and sternal/intercostal recession associated with agitation or lethargy.
According to NICE which of the following matches the a mild severity of croup?
1 - Seal-like barking cough with stridor and sternal recession at rest; no agitation or lethargy.
2 - Seal-like barking cough but no stridor or sternal/intercostal recession at rest.
3 - Seal-like barking cough with stridor and sternal/intercostal recession associated with agitation or lethargy.
2 - Seal-like barking cough but no stridor or sternal/intercostal recession at rest.
Croup can be classified as being mild, moderate or severe and all should receive dexamethasone. However, moderate and severe croup may need to be prescribed which 2 of the following?
1 - salbutamol
2 - budesonide
3 - adrenaline
4 - ipratropium
2 - budesonide
3 - adrenaline
Severe croup may require IV steroids, repeated doses of adrenaline and admission for respiratory support
If a patient develops severe croup, what can this lead to if not addressed?
1 - respiratory alkalosis
2 - respiratory and metabolic alkalosis
3 - respiratory acidosis
4 - respiratory and metabolic acidosis
3 - respiratory acidosis
How is croup typically diagnosed?
1 - throat swab and viral PCR
2 - chest X-ray
3 - clinical diagnosis
4 - FBC and blood culture
3 - clinical diagnosis
Barking cough and stridor are the key features
X-ray may be used to rule out other diagnoses, BUT can show a steeple sign
Which of the following is the least likely differential for croup?
1 - Viral upper respiratory tract infection (URTI)
2 - Bronchitis
3 - Bronchiolitis
4 - Epiglottitis
5 - Foreign body
2 - Bronchitis
- affects upper bronchi
If a parent presents with their child primary care and they have mild croup, which if the following is the most suitable course of action?
1 - call 999 and give salbutamol
2 - supportive care, signpost and oral dexamethasone
3 - provide antibiotics and signpost
4 - call 999 and admit to hospital, oral dexamethasone, nebulised epinephrine, supplemental oxygen
2 - supportive care, signpost and oral dexamethasone
If a parent presents with their child primary care and they have moderate or severe croup, which if the following is the most suitable course of action?
1 - call 999 and give salbutamol
2 - supportive care, signpost and oral dexamethasone
3 - provide antibiotics and signpost
4 - call 999 and admit to hospital, oral dexamethasone, nebulised epinephrine, supplemental oxygen
4 - call 999 and admit to hospital, oral dexamethasone, nebulised epinephrine, supplemental oxygen
If patient stabilises they can often be discharged home the same day
All of the following are common complications of croup, but which is the most common and often most severe?
1 - Pneumonia
2 - Respiratory distress
3 - Pulmonary oedema
4 - Epiglottitis
5 - Bacterial tracheitis
2 - Respiratory distress
May progress to respiratory failure in some cases and even death.
All complications in croup are due to airway obstruction caused by oedema
In a patient with suspected croup, should a throat examination be performed?
- no increased risk of airway obstruction
If the throat examination is performed, it should be performed by an ENT doctor
