Rosh Pediatrics Practice Exam

In a case of croup with barking cough and stridor, what is the recommended treatment?

1. Amoxicillin and dexamethasone

2. Dexamethasone

3. Dexamethasone and nebulized epinephrine

4. Nebulized epinephrine

The correct answer is: Dexamethasone and nebulized epinephrine

In the management of croup, particularly when a patient presents with a barking cough and stridor, the recommended treatment focuses on reducing inflammation and alleviating symptoms. Dexamethasone is a key corticosteroid that effectively helps reduce airway inflammation, making it a vital part of treatment. The choice that includes both dexamethasone and nebulized epinephrine is particularly appropriate in cases where the croup is severe, characterized by moderate to severe stridor at rest and marked respiratory distress. Nebulized epinephrine acts as a bronchodilator, providing rapid relief from upper airway edema and improving airflow. Administering both dexamethasone and nebulized epinephrine allows for both the immediate effect of epinephrine to control acute symptoms and the longer-lasting anti-inflammatory effects of dexamethasone, making this combination effective in addressing the underlying cause as well as the acute presentation of croup. The other options, while they include dexamethasone, either lack the necessary additional support that nebulized epinephrine offers to manage acute symptoms or suggest the use of antibiotics, which are generally not indicated unless a bacterial superinfection is suspected.