Chapter 79: Epiglottitis Buttaro: Primary Care: A Collaborative Practice, 6th Edition

Multiple Choice

1. The provider sees a child with a history of high fever and sore throat. When entering the exam room, the provider finds the child sitting in the tripod position and notes stridor, drooling, and anxiety. What is the initial action for this patient?

a. Administer empirical intravenous antibiotics and steroids.

b. Have the child lie down and administer high-flow, humidified oxygen.

c. Obtain an immediate consultation with an otolaryngologist.

d. Perform a thorough examination of the oropharynx.

ANS: C a. Blood cultures b. Complete blood count c. Fiberoptic nasopharyngoscopy d. Lateral neck film

Patients with suspected epiglottitis, with high fever, sore throat, stridor, drooling, and respiratory distress should be referred immediately to otolaryngology. Starting an IV or having the child lie down will increase distress and may precipitate laryngospasm. The throat should not be examined because it may cause laryngospasm.

2. An adult patient is seen in clinic with fever, sore throat, and dysphagia. Which diagnostic test will the provider order to confirm a diagnosis of epiglottitis?

ANS: C

NURSINGTB.COM a. Chloramphenicol b. Clindamycin c. Dexamethasone d. Metronidazole

Fiberoptic nasopharyngoscopy allows direct visualization of the epiglottis and is used increasingly with adult patients suspected of having epiglottitis. Blood cultures and a CBC may be drawn as part of the workup to help guide antimicrobial therapy but are not diagnostic. A lateral neck film is not always diagnostic with adults.

3. An adult patient is diagnosed with epiglottitis secondary to a chemical burn. Which medication will be given initially to prevent complications?

ANS: C

This case of epiglottitis does not have an infectious cause, so antibiotics are not given unless there are symptoms of infection. A corticosteroid can decrease the need for intubation.