A 2-year-old child presents with high fever, toxic appearance, drooling, muffled voice, and holds head extended (sniffing position). There is no barking cough. The most likely diagnosis and the safest immediate step is:

• A Croup (viral laryngotracheobronchitis) — give nebulized epinephrine
• B Peritonsillar abscess — needle aspiration under direct vision
• C Bacterial tracheitis — intubate in ICU and give IV antibiotics
• D Acute epiglottitis (supraglottitis) — do NOT examine oropharynx; secure airway in OR; give IV ceftriaxone for Haemophilus influenzae type b ✓

Explanation

Acute epiglottitis presents with the classic tripod/sniffing position, drooling, muffled voice, high fever, and rapidly progressive airway obstruction — most commonly caused by H. influenzae type b (reduced since Hib vaccination). The critical rule is: do NOT examine the throat or attempt laryngoscopy in the ward — this can precipitate complete airway obstruction via vagal stimulation and epiglottic spasm. The child must be taken directly to the operating room or ICU for controlled intubation. IV cefotaxime or ceftriaxone is the antibiotic of choice.

Reference: Ghai Essential Pediatrics, 10th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.