Infectious Diseases

Question 1

Which of the following is true of croup?

a) It occurs commonly in those over 5 years
b) The temperature is high grade
c) Steeple sign can be seen on X-ray
d) Prodromal symptoms come on over minutes to hours
e) Group A strep is responsible

Answer 1

C.

It comonly occur in those 6 months to 6 years, they will have a low grade fever, barking cough and there is usually a prodrome over days. Parainfluenza is usually repsonsible and treatment involves steroids and occasioanlly adrenaline. It is rare to intubate. Patients can drool but rarely look toxic and antibiotics are not indicated.

Question 2

Which of the following statements is true about bacterial tracheitis?

a) These patients have a low grade fever
b) A barking cough is present
c) Occurs in the very young <2 years of age
d) Antibitoics are not indicated
e) Steeple sign is seen on x-ray

Answer 2

B.

Bacterial tracheitis occurs in the 5-10 year age group, has a prodrome of hours to days. It can present similar to croup with a barking cough and in the early part of the disease maybe miss diagnosed. Later children have high grade fevers, look toxic and exudates in the trachea might be seen on imaging. S. aureus and group A strep are responsible so antibiotics are required and some patients will equire intubation.

Question 3

Which of the following statements is true of epiglottitis?

a) Parainfluenza is responsilbe.
b) Patients have a low grade temp and drooling.
c) They appear toxic with a barking cough.
d) All patients should have an oral exam
e) Thumb sign can be seen on X-ray

Answer 3

E.

Epiglottitis occurs on the 2-8 yr range and typically in the unimmunised as H.influenzae type B is commonly responsible. A barking cough is usually not present but drooling and a toxic appearing child is. The prodromal period is rapid (minutes to hours), they have a high temp and a thumb sign can be seen on X-ray. Antibiotic, ICU and intubation are the mainstay of treatment. No oral exam should be attempted and ENT should be consulted.

The 4 D’s:

Drooling, dyspnoea, dysphagia and dysphonia (also tripod sitting).