Croup

Question 1

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

Answer 1

1 - trachea

Croup typically affects upper airway, but can spread to lower airway as well

Question 2

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

Answer 2

4 - 1-5

Question 3

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

Answer 3

3 - 250 cases per 100,000
- slightly more common in males

Question 4

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

Answer 4

3 - Oct - March

Question 5

Is croup more commonly caused by viruses or bacteria?

Answer 5

• viruses

Question 6

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).

Answer 6

1 - Parainfluenza
- Accounts for 75% of cases

Question 7

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.

Answer 7

2 - Escherichia coli
- Typically found in the GI and most common cause of UTI

Question 8

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

Answer 8

4 - inhaling air droplets

Most common, but all others can also cause infection as well

Question 9

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

Answer 9

2 - 24-48h

Question 10

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

Answer 10

3 - haemoptysis

Question 11

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

Answer 11

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

Question 12

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

Answer 12

1 - high fever >38ºC

Patients typically have a low fever <38ºC

Question 13

Does croup typically cause an inspiratory or expiratory stridor? (high pitched wheeze due to turbulent air flow)

Answer 13

• inspiratory

Question 14

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

Answer 14

10 - all of the above

Question 15

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.

Answer 15

1 - Seal-like barking cough with stridor and sternal recession at rest; no agitation or lethargy.

Question 16

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.

Answer 16

3 - Seal-like barking cough with stridor and sternal/intercostal recession associated with agitation or lethargy.

Question 17

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.

Answer 17

2 - Seal-like barking cough but no stridor or sternal/intercostal recession at rest.

Question 18

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

Answer 18

2 - budesonide
3 - adrenaline

Severe croup may require IV steroids, repeated doses of adrenaline and admission for respiratory support

Question 19

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

Answer 19

3 - respiratory acidosis

Question 20

How is croup typically diagnosed?

1 - throat swab and viral PCR
2 - chest X-ray
3 - clinical diagnosis
4 - FBC and blood culture

Answer 20

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

Question 21

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

Answer 21

2 - Bronchitis

• affects upper bronchi

Question 22

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

Answer 22

2 - supportive care, signpost and oral dexamethasone

Question 23

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

Answer 23

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

Question 24

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

Answer 24

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

Question 25

In a patient with suspected croup, should a throat examination be performed?

Answer 25

• no increased risk of airway obstruction

If the throat examination is performed, it should be performed by an ENT doctor