General Practice and Primary Healthcare

Question 1

What is croup and what are its common causes?

Answer 1

Croup is a respiratory condition characterised by a barking cough, stridor, and hoarseness. It is commonly caused by viral infections, particularly the parainfluenza virus.

Question 2

Describe the typical age group affected by croup.

Answer 2

Croup typically affects children between 6 months and 3 years of age.

Question 3

What are the hallmark symptoms of croup?

Answer 3

The hallmark symptoms of croup include a barking cough, stridor (a high-pitched breathing sound), hoarseness, and respiratory distress.

Question 4

Explain the significance of stridor in croup.

Answer 4

Answer: Stridor indicates upper airway obstruction and is a key sign of croup severity. It is caused by inflammation and narrowing of the larynx and trachea.

Question 5

What are the signs of severe croup that require immediate medical attention?

Answer 5

Signs of severe croup include persistent stridor at rest, severe respiratory distress, cyanosis, lethargy, and decreased responsiveness.

Question 6

How is croup typically diagnosed in a clinical setting?

Answer 6

Croup is usually diagnosed based on clinical presentation, including the characteristic barking cough, stridor, and hoarseness. A thorough history and physical examination are essential.

Question 7

What role does a neck X-ray play in diagnosing croup?

Answer 7

A neck X-ray is not routinely required but can be used to rule out other conditions. It may show the “steeple sign,” which indicates subglottic narrowing.

Question 8

What are the first-line treatments for mild croup?

Answer 8

First-line treatments for mild croup include supportive care, such as keeping the child calm, providing humidified air, and ensuring adequate hydration.

Question 9

Describe the use of corticosteroids in the management of croup.

Answer 9

Corticosteroids, such as dexamethasone, are used to reduce airway inflammation. They are effective in decreasing the severity and duration of symptoms.

Question 10

When are nebulised epinephrine treatments indicated for croup?

Answer 10

Nebulised epinephrine is indicated for moderate to severe croup with significant stridor and respiratory distress. It provides rapid relief by reducing airway swelling.

Question 11

What are potential complications of untreated or severe croup?

Answer 11

Answer: Potential complications include respiratory failure, secondary bacterial infections, and, in rare cases, death.

Question 12

How can croup lead to respiratory distress?

Answer 12

Croup leads to respiratory distress due to inflammation and narrowing of the upper airway, making it difficult for the child to breathe.

Question 13

What preventative measures can reduce the risk of croup in children?

Answer 13

Preventative measures include good hand hygiene, avoiding contact with sick individuals, and ensuring children are up-to-date with vaccinations.

Question 14

What are the organisms that may implicated in croup?

Answer 14

Most common: parainfluenza.

Others include:
RSV
Adenovirus
Influenza virus
Rhinovirus

Question 15

Pathophysiology of croup.

Answer 15

Viral infection leads to inflammation and oedema of the subglottic region and subsequent narrowing of the upper airway.

This narrowing results in increased airway resistance, particularly during inspiration, leading to stridor.

The inflammation also causes a hoarse voice and the classic ‘barking’ cough due to vibration of the swollen vocal cords.

Severe cases: airway obstruction may lead to hypoxia and respiratory failure.

Question 16

During which periods of the year is croup most common?

Answer 16

Peaks in autumn and early winter.

Question 17

Investigations in a child with suspected croup.

Answer 17

Investigations are usually not required.
Pulse oximetry to assess oxygen saturation. Decreased O2 sats may indicate severe airway obstruction.

Question 18

Croup differentials.

Answer 18

> Epiglottitis. Absence of barking cough. Unlike in croup, the patient often sits upright and leans forward to breather (‘tripod position’).

> Bacterial tracheitis: severe toxic appearance with high fever and purulent secretions. The child appears more unwell compared to typical viral croup and may have rapidly progressing respiratory distress.

> Foreign body aspiration: sudden onset of stridor and respiratory distress, often in a previously well child, with a history of choking. There is typically no preceding viral illness.

> Allergic reaction (e.g., angioedema): can cause upper airway obstruction, but typically associated with history of allergen exposure, and swelling is often present in other areas (e.g., lips and face).

> Pertussis: prolonged coughing episodes followed by an inspiratory ‘whoop’. Symptoms tend to last longer and are not associated with the barking cough or stridor seen in croup.

Question 19

What is the management of croup?

Answer 19

Depends on severity, with most cases being mild and self-limiting, only requiring supportive care.

Mild croup (no stridor at rest, minimal respiratory distress).

Supportive care: advise parents on use of humidified air, adequate hydration, and monitoring for signs of deterioration.

Single dose of dexamethasone (0.15mg/kg): reduces airway inflammation and shortens the duration of symptoms. This is usually given in all cases, including mild croup, as it is highly effective.

Safety netting is very important— make sure families are aware of signs of deterioration.

Consider admitting children with a respiratory rate above 60 breaths per minute, high fever, or a generally ‘toxic’ appearance.

Moderate-to-severe croup (stridor at rest, marked respiratory distress):

Hospital admission.
Nebulised adrenaline: indicated for significant respiratory distress. Provides temporary relief by reducing airway swelling, but the effect wears off after 2 hours, so close monitoring is required.

Corticosteroids: as in mild croup, dexamethasone is preferred.

> Nebulised budesonide and IM dexamethasone are alternatives if the child cannot swallow.

Supplemental oxygen if SpO2 is less than 92%.

Refractory or life-threatening cases:
Intubation and mechanical ventilation may be required in rare, life-threatening cases where there is impending respiratory failure.