infectious disease/epiglottitis

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Question 1 / 3

686463876c78b8d82816dd35

Pediatrics

infectious disease

epiglottitis

Case History

A 7-year-old girl is brought to a local clinic by her parents, who report a sudden onset of severe sore throat and difficulty swallowing starting a few hours ago. Her symptoms have progressed rapidly, and she now struggles to breathe and is visibly distressed. Her immunization records are up-to-date, including all recommended childhood vaccinations. On examination, her temperature is 39.8°C, heart rate is 150/min, respiratory rate is 32/min, and oxygen saturation is 93% on room air. She appears anxious, is drooling, and is leaning forward in a tripod position, refusing to lie flat. Her voice is muffled, and she resists any attempt to inspect her oral cavity. There is no cough or hoarseness. Laboratory findings are pending. Based on this presentation, what is the most likely diagnosis and the immediate critical management step?

Lab Parameter	Value	Reference Range
White Blood Cell Count	18.5 x 10^9/L	4.5-13.5 x 10^9/L
Neutrophils	88%	40-70%
C-reactive protein	85 mg/L	<5 mg/L

A ) Viral laryngotracheobronchitis (Croup) and nebulized racemic epinephrine

B ) Bacterial epiglottitis due to Streptococcus pneumoniae and securing the airway via intubation in a controlled setting

C ) Retropharyngeal abscess and initiation of broad-spectrum intravenous antibiotics

D ) Peritonsillar abscess and emergent incision and drainage

E ) Bacterial tracheitis and empiric high-dose corticosteroids

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Question 2 / 3

686463876c78b8d82816dd36

Pediatrics

infectious disease

epiglottitis

Case History

A 4-month-old male is brought to a pediatric clinic by his parents due to chronic inspiratory stridor, described as a "whistling" sound, which has become more prominent over the past month. The noise is particularly noticeable during agitation or feeding. His parents also report increasing episodes of choking and regurgitation during bottle feeds, leading to concerns about his nutritional intake, though he is generally gaining weight. He was born at full-term via uncomplicated vaginal delivery and has no other significant past medical history. On physical examination, the infant is alert and interactive, without signs of acute respiratory distress. His temperature is 37.10C, blood pressure is 80/55 mmHg, heart rate is 125 beats/min, respiratory rate is 28 breaths/min, and oxygen saturation is 97% on room air. Auscultation reveals a persistent biphasic stridor that significantly attenuates when his neck is hyperextended. A subtle, continuous murmur is appreciated at the left upper sternal border. Lungs are clear to auscultation bilaterally. A comprehensive diagnostic workup, including a CT angiogram, has confirmed the presence of a double aortic arch compressing the trachea and esophagus. Given this confirmed diagnosis, what is the most appropriate definitive management, and what long-term complication does this intervention primarily aim to prevent?

Lab Parameter	Value	Reference Range
Hemoglobin	125 g/L	110-140 g/L
White Blood Cell Count	9.0 x 10^9/L	6.0-17.0 x 10^9/L

A ) Medical management with bronchodilators and prevention of recurrent aspiration pneumonia.

B ) Surgical ligation and division of the anomalous arch and prevention of persistent airway and esophageal compression.

C ) Endoscopic esophageal dilation and prevention of stricture formation.

D ) Close observation with serial imaging and prevention of associated cardiac anomalies.

E ) Tracheostomy placement and prevention of acute respiratory failure.

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Question 3 / 3

686463876c78b8d82816dd34

Pediatrics

infectious disease

epiglottitis

Case History

A 4-month-old female is brought to a general pediatric clinic by her parents due to persistent noisy breathing. They report that the stridor is predominantly inspiratory, has been present since about 2 months of age, and seems to worsen when she is lying flat on her back or during feeding. They have also noticed that the noise improves significantly when she is held upright or placed on her stomach. Her parents express concern about her recent feeding habits, noting she takes longer to feed and sometimes seems to struggle. She was born at 39 weeks gestation without complications. On physical examination, the infant appears well-nourished and in no acute distress, with a temperature of 36.8 C, heart rate of 125/min, respiratory rate of 30/min, and oxygen saturation of 99% on room air. Inspiratory stridor is audible, particularly when supine, which lessens when the infant is leaned forward. Lung fields are clear to auscultation. Given the patient's presentation and the likely clinical diagnosis, what is the most appropriate initial management strategy, and what potential long-term complication should be carefully monitored if conservative measures prove insufficient?

Lab Parameter	Value	Reference Range
Hemoglobin	11.5 g/dL	10.5-13.5 g/dL
White Blood Cell Count	9.2 x 10^9/L	5.0-15.0 x 10^9/L
Platelet Count	350 x 10^9/L	150-400 x 10^9/L
Sodium	138 mmol/L	135-145 mmol/L
Potassium	4.1 mmol/L	3.5-5.0 mmol/L
Chloride	102 mmol/L	98-107 mmol/L
Bicarbonate	24 mmol/L	22-29 mmol/L

A ) Supraglottoplasty and continuous positive airway pressure (CPAP) at night.

B ) Empiric antibiotics and admission for intravenous hydration.

C ) Observation with reflux precautions and monitoring for weight faltering.

D ) Emergency direct laryngoscopy and assessment for epiglottic edema.

E ) Aerosolized racemic epinephrine and oral corticosteroids.

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