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Radiology · Paediatric radiology
Sample itemA 2-year-old child with a barking cough and inspiratory stridor has an anteroposterior neck radiograph showing symmetrical narrowing of the subglottic airway like the tip of a church steeple. What is the diagnosis?
Original practice item, not a recalled exam question. Nothing here is recorded.
The answer and the reasoning
D. Croup (laryngotracheobronchitis)
Croup is a viral infection causing subglottic oedema, seen as the steeple (pencil-point) sign on the frontal neck film. It is usually diagnosed clinically, and imaging is not needed in typical cases. Treatment is with corticosteroids and nebulised adrenaline in more severe cases.
Option by option
A. Inhaled foreign body
An inhaled foreign body usually shows air trapping or an opacity, with sudden onset of choking.
B. Retropharyngeal abscess
A retropharyngeal abscess widens the prevertebral space on the lateral view.
C. Acute epiglottitis
Epiglottitis gives the thumb sign of the swollen epiglottis on the lateral view.
D. Croup (laryngotracheobronchitis) (correct)
Correct. Subglottic narrowing with the characteristic steeple shape reflects viral laryngeal oedema.
Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.
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