Which of the following are expected clinical manifestations of viral croup?
Stridor.
Barking cough.
Hoarseness.
Tripod positioning.
Drooling.
Correct Answer : A,B,C
Choice A rationale
Stridor is a high-pitched, inspiratory sound resulting from turbulent airflow through a partially obstructed upper airway, specifically the larynx or trachea. In viral croup (laryngotracheobronchitis), inflammation and edema of the subglottic region cause this characteristic narrowing, making stridor a key expected clinical manifestation, especially when the child is agitated or crying.
Choice B rationale
The barking or "seal-like" cough is the hallmark symptom of viral croup, primarily caused by the inflammation and edema localized to the larynx and vocal cords. The narrowed, swollen subglottic area below the vocal cords creates the distinctive resonant sound as air rushes past the restricted space during exhalation, often worsening at night.
Choice C rationale
Hoarseness is a direct result of the inflammatory process affecting the vocal cords within the larynx. The edema and irritation cause the vocal cords to vibrate abnormally, altering the voice's pitch and quality, leading to the rough or husky sound that is commonly observed in children with viral croup.
Choice D rationale
Tripod positioning (sitting upright, leaning forward, with the neck extended) is a compensatory posture typically associated with severe respiratory distress from epiglottitis or a foreign body, indicating imminent airway collapse, but is generally not an expected early finding in the milder upper airway obstruction of viral croup.
Choice E rationale
Drooling results from the inability to swallow secretions due to severe pain and swelling of the epiglottis, making it a cardinal sign of epiglottitis, a bacterial infection. In contrast, viral croup typically involves inflammation lower down in the subglottic area, so drooling is not an expected clinical feature.
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Related Questions
Correct Answer is B
Explanation
Choice A rationale
A mild headache is a very common and expected symptom following a concussion, resulting from the temporary biomechanical injury to brain tissue or surrounding structures. This symptom alone typically does not indicate an immediate neurological deterioration or an expanding intracranial lesion, provided it doesn't rapidly worsen in severity or become refractory to simple analgesics. Management generally involves rest and observation.
Choice B rationale
Vomiting, especially if persistent or projectile, suggests a significant increase in intracranial pressure (ICP) due to brain swelling or an intracranial hemorrhage. This pressure irritates the vomiting center in the medulla, a critical area of the brainstem. Given that normal ICP is 5-15 mmHg in adults and slightly lower in children, new or worsening emesis warrants prompt clinical and possibly neuroimaging reevaluation.
Choice C rationale
Alertness indicates an intact reticular activating system (RAS), which is crucial for consciousness. Maintaining an alert mental status is a positive sign that suggests the primary brain centers are functioning adequately and the ICP is not critically elevated. A decreased level of consciousness would be a much more concerning indicator of neurological decline.
Choice D rationale
A normal gait reflects proper coordination of motor, sensory, and cerebellar functions. Gross neurological integrity suggests that the cerebral and cerebellar pathways, which govern balance and movement, are not significantly compromised. An abnormal gait, like ataxia, would be a sign of focal neurological deficit or severe intracranial pressure.
Correct Answer is D
Explanation
Choice A rationale
Stroke (either ischemic or hemorrhagic) is a less common cause of isolated subdural hematoma (SDH) in infants compared to trauma. While some hemorrhagic strokes can cause SDH, a stroke generally involves a disruption of blood flow within the brain parenchyma, distinct from the tearing of bridging veins that causes a typical subdural bleed.
Choice B rationale
Sports injury is an improbable cause of SDH in infants, as they are not involved in contact sports. Sports-related head trauma is a frequent cause of SDH in older children and adolescents, but the mechanism is irrelevant to the unique vulnerabilities of the infant skull and brain.
Choice C rationale
Motor vehicle accidents (MVA) can certainly cause SDH in infants due to significant impact, but they are not the most common cause. Non-accidental trauma (abusive head trauma) is statistically the leading cause of SDH in this age group, followed by the relatively less forceful trauma of a difficult delivery.
Choice D rationale
Birth trauma, specifically the forces exerted during delivery, especially difficult or assisted ones, can lead to the stretching and tearing of the delicate bridging veins that cross the subdural space, resulting in a SDH. The infant's brain is pliable, and the skull bones are mobile, making this mechanism a common cause of SDH in the neonatal period.
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