American Board of Family Medicine (ABFM) Practice Exam 2026 - Free ABFM Practice Questions and Study Guide

In the case of a 2-year-old child experiencing severe croup and distress, the most appropriate intervention is nebulizer treatment with racemic epinephrine. Severe croup often presents with stridor at rest, respiratory distress, and a barking cough. In such cases, quick relief of airway swelling is critical to ensure that the child can breathe adequately.

Racemic epinephrine, when administered via nebulization, works by causing vasoconstriction and reducing edema in the airway, leading to a rapid improvement in respiratory symptoms. This treatment is especially important in acute settings where immediate airway support is needed.

While a single dose of oral corticosteroids may also be indicated for managing croup, its effects are not immediate and would not address severe distress as effectively as nebulized epinephrine. Inhaled corticosteroids are typically used for long-term management of asthma or chronic conditions but are not the first line for acute severe croup. Hospitalization may be necessary if the child does not respond well to initial treatment or if there are concerns regarding the severity of respiratory distress, but the immediate intervention for distress is the nebulizer treatment with racemic epinephrine.