A 2-year-old boy presents with a 2-day history of low-grade fever, hoarseness, inspiratory stridor, and a characteristic 'barking' cough that worsens at night. His oxygen saturation is 97% on room air, and he has mild subcostal retractions. What is the diagnosis and primary first-line pharmacological treatment?

Answer and explanation

Correct answer: A. Viral croup (laryngotracheobronchitis); single dose of oral dexamethasone

  1. Step 1: Analyze presentation: Toddler with barking cough, hoarseness, and inspiratory stridor following viral upper respiratory symptoms signifies viral croup (laryngotracheobronchitis, most commonly parainfluenza virus).
  2. Step 2: Select evidence-based therapy: A single dose of oral dexamethasone (0.15-0.6 mg/kg) reduces airway edema, hospital admissions, and return visits.
  3. Step 3: Reserve nebulized epinephrine for moderate to severe stridor at rest.
Answer
Viral croup (laryngotracheobronchitis); single dose of oral dexamethasone.
Why not the others: 'Foreign body aspiration' has abrupt onset without fever and needs bronchoscopy; 'epiglottitis' presents toxic and drooling; 'bacterial tracheitis' follows croup with high fever and thick purulent secretions, not mild stridor with a good appearance.

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