Upper Airway Obstruction: Croup vs. Epiglottitis
Distinguishing between Croup and Epiglottitis is a classic MCCQE objective. While both present with respiratory distress and stridor, their clinical course and management differ significantly.
- Croup (Laryngotracheobronchitis): Usually viral (Parainfluenza), presents with a "barking" cough and low-grade fever. The "steeple sign" on X-ray is characteristic. Management includes dexamethasone and, in severe cases, nebulized epinephrine.
- Epiglottitis: A true medical emergency, often bacterial (Hib). Presents with high fever, drooling, and a "tripod" position. The "thumbprint sign" is seen on X-ray. Crucial: Do not examine the throat unless in a controlled setting (OR) as it may trigger total airway obstruction.
Clinical Alert: Any child with drooling, muffled voice, and respiratory distress should be suspected of having Epiglottitis. Immediate airway stabilization is the priority.
Kawasaki Disease: Preventing Complications
Kawasaki disease is a medium-vessel vasculitis that primarily affects children under 5. Diagnosis is clinical, requiring fever for ≥5 days plus at least 4 of the following: conjunctivitis, rash, extremity changes, adenopathy, and mucosal changes (strawberry tongue).
The primary goal of treatment is preventing coronary artery aneurysms. High-dose Aspirin and IVIG should be administered within 10 days of fever onset.
Gastrointestinal Emergencies
The MCCQE frequently tests the diagnosis of projectile vomiting and colicky pain in infants.
- Pyloric Stenosis: Presents at 3-6 weeks with non-bilious projectile vomiting and an "olive-shaped" mass. Look for hypochloremic hypokalemic metabolic alkalosis.
- Intussusception: Presents with sudden onset colicky pain and "currant jelly" stools. Ultrasound shows a "target sign." Management is typically non-surgical via air or contrast enema reduction.