A fully immunized 2-year-old presents to the emergency room with several days of low-grade fever, barking cough, and noisy breathing. Over the past few hours he has developed a fever of 40°C (104°F) and looks toxic. He has inspiratory and expiratory stridor. The family has not noticed drooling, and he seems to be drinking without pain. Direct laryngoscopy reveals a normal epiglottis. The management of this disease process includes which of the following?
a. Intubation and intravenous antibiotics
b. Inhaled epinephrine and oral steroids
c. Inhaled steroids
d. Observation in a cool mist tent
e. Oral antibiotics and outpatient follow-up
the answer is below…
The United States Medical Licensing Examination, or USMLE for short, is a three-part licensing examination that is required in order to receive a license to practice medicine within the United States.
The USMLE assesses a physician’s ability to apply knowledge, concepts, and principles, and to determine fundamental patient-centered skills that are important in health and disease and that constitute the basis of safe and effective patient care.Examination committees composed of medical educators and clinicians from across the United States and its territories prepare the examination materials each year.
This exam is designed by the Federation of State Medical Boards and the National Board of Medical Examiners to determine whether or not an individual understands and can apply the knowledge necessary to practice medicine safely and intelligently.
The USMLE is actually comprised of three different exams that are referred to as steps, which examine the individual’s knowledge of specific topics related to the field of medicine such as basic science, medical knowledge, medical skills, clinical science, and the application of all of these skills and areas of knowledge in the medical field.
All three steps of the USMLE include a series of computerized multiple-choice questions, but the format of the exam and the information covered in each multiple-choice section is different for each step of the USMLE. The USMLE Step II also has a clinical skills portion that examines an individual’s ability to work with real patients and the USMLE Step III has a computerized patient simulation portion in addition to the multiple-choice section of the exam. In order for an individual to receive a license to practice medicine, the individual must pass all three steps of the USMLE.
The correct answer is a; Intubation and intravenous antibiotics.
Bacterial tracheitis is an uncommon, but severe and life-threatening sequelae of a viral laryngotracheobronchitis. The typical story is that presented in the case, with several days of viral upper respiratory symptoms, followed by an acute elevation of temperature and an increase in respiratory distress. Inspiratory stridor is typical in croup; the biphasic stridor and high fever in this patient should be a clue to consider alternative diagnoses.
Children may also present acutely and without the initial viral symptoms. The differential must include epiglottitis; the lack of drooling and dysphagia (and the rarity of epiglottitis) help make this a case of tracheitis. Management for tracheitis includes establishing an airway with endotracheal intubation and IV antibiotics. Special attention is focused on preservation of the airway, as even intubated children with tracheitis can have secretions thick and copious enough to occlude the airway.