"Steeple sign" on X-ray is characteristic of: .jpeg )

Croup (laryngotracheobronchitis)

NORCET 9 Mains - 2025

Child Health Nursing (Pediatrics)

Easy

"Steeple sign" on X-ray is characteristic of:

Appeared in: NORCET 9 Mains - 2025

The steeple sign, visible on an anteroposterior (AP) neck X-ray, is the hallmark of croup (laryngotracheobronchitis).
This sign represents the conical narrowing of the subglottic trachea due to inflammation and edema caused by a viral infection.
The subglottic region is the narrowest part of the pediatric airway, so even minor swelling can cause significant obstruction and the characteristic stridor.

Option A: Epiglottitis is characterized by the "thumb sign" on a lateral neck X-ray, not the steeple sign.
Option C: Foreign body aspiration does not cause the symmetric, subglottic narrowing seen in the steeple sign.
Option D: Bronchiolitis is a lower airway disease and does not produce a steeple sign on a neck X-ray.

Clinical Relevance

Nursing practice connection: This is primarily an exam-oriented knowledge point with limited direct bedside application, so retain Radiological signs in pediatric airway obstruction as background academic context rather than a clinical decision trigger.
A nurse must be able to quickly differentiate between croup and epiglottitis based on clinical signs, as epiglottitis is a medical emergency requiring immediate airway protection.
Nursing care for a child with croup focuses on reducing anxiety, administering medications to decrease airway swelling, and closely monitoring for signs of worsening respiratory distress, which would require escalation of care.
What if? If the child presented with high fever, drooling, and was sitting in a tripod position, the priority would shift to suspecting epiglottitis. The nurse's immediate actions would be to avoid any examination of the throat, keep the child calm and upright, and prepare for emergency intubation by a specialist.

How to Approach the Question

First, identify the key term in the question: "Steeple sign" and note that it's an X-ray finding.
Recall or deduce the anatomical significance of this sign. The steeple shape implies a narrowing of the upper trachea.
Match this specific radiological sign to the correct underlying pathology. The steeple sign is pathognomonic for croup.
Review the other options to confirm they are incorrect. Epiglottitis has the 'thumb sign', foreign body aspiration has unilateral findings, and bronchiolitis affects the lower airways. This process of elimination confirms the answer.

Concept Tested & Keywords

Concept Tested: Radiological signs in pediatric airway obstruction
Stem keywords: Steeple sign, X-ray
Lead-in keywords: characteristic of
Clinical cues: The image shows a classic steeple sign, which is a key diagnostic clue.

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E6 Nelson Textbook of Pediatrics(2024) — Volume 2 p. 355-357

E6 Ghai Essential Pediatrics(pp 26-904 of 913) p. 391-393

Practise the full NORCET 9 Mains - 2025

Attempt every question from this paper in a timed mock, then review the full solution for each one.