Question
A 3-year-old boy is brought with barking cough and noisy breathing of 2 days' duration. He has a history of running nose and some fever for the preceding 3-4 days. Examination reveals respiratory rate of 40 per min, subcostal retractions and stridor. The most important step in the management is:
This question was previously asked in
UPSC CMS 2026 Surgery, Gynaecology & Obstetrics, and PSM Question Paper (02-Aug-2026)
The correct answer is
Nebulized adrenaline
This clinical picture (barking cough, stridor at rest, subcostal retractions) is classic croup (laryngotracheobronchitis) with moderate-severe severity. The most important immediate step is nebulized (racemic) adrenaline, which rapidly reduces airway mucosal edema, along with systemic corticosteroids; salbutamol has no role since bronchospasm is not the pathology.
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Important Questions from Fever
- A previously well 2 year old boy presents with a brief generalized seizure. There is no past or family history of seizures. On examination, child is alert, active, febrile with axillary temperature of $39.4^\circ C$. Except for bilateral tonsillar enlargement and congestion, systemic examination is normal. Management at this time may include:
1. Immediate reduction of body temperature
2. Intravenous diazepam and phenytoin, followed by a lumbar puncture
3. Institution of phenytoin for maintenance therapy for at least one year
4. Rectal diazepam every 8 hourly for 2-3 days to reduce the risk of recurrence
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