A 2-year-old with barking cough, hoarseness, and stridor; what is the initial diagnostic impression?

• A. Pneumonia
• B. Bronchiolitis
• C. Croup
• D. Asthma

Answer: (C)

Barking cough with hoarseness and stridor in a toddler points to inflammation of the larynx and upper trachea, causing subglottic narrowing. This combination is classic for viral croup (laryngotracheitis). The barky cough and hoarseness reflect laryngeal involvement, and inspiratory stridor indicates upper airway obstruction at the subglottic level. The age fits well, as croup commonly presents in children around 6 months to 3 years and often follows a mild viral URI, sometimes with symptoms worse at night.

Bronchiolitis tends to show diffuse wheezing and crackles with tachypnea in younger infants. Pneumonia usually presents with fever and focal lung findings. Asthma causes episodic wheeze rather than a prominent barky cough with stridor. So, the initial impression that best fits the presentation is viral croup.