A 4-year-old child presents with high fever, barking cough, inspiratory stridor at rest, and intercostal retractions. What is the most likely diagnosis, and what is the primary initial medical treatment for moderate-to-severe viral croup (laryngotracheobronchitis)?

Answer and explanation

Correct answer: D. Viral Croup; Single dose of oral/IM Dexamethasone plus nebulized racemic epinephrine

  1. Step 1: Viral croup (laryngotracheobronchitis, most commonly parainfluenza virus) causes subglottic airway narrowing (steeple sign on X-ray).
  2. Step 2: The treatment for stridor at rest is a single dose of systemic Dexamethasone (0.6 mg/kg) combined with nebulized racemic epinephrine, which induces mucosal alpha-adrenergic vasoconstriction, rapidly reducing edema.
Answer
Viral Croup; Single dose of oral/IM Dexamethasone plus nebulized racemic epinephrine.
Why not the others: 'Blind finger sweeps' are strictly contraindicated as they risk impacting the foreign body deeper into the laryngeal inlet; 'Oral amoxicillin at home' is ineffective for viral croup and dangerous for epiglottitis; 'Nebulized saline' does not provide pharmacologic subglottic decongestion.

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