Ans. is 'a' i.e., H. influnzae Epiglottitis It is the inflammation of epiglottis with inflammatory edema of hyopharynx. It is a true medical emergency. H.influenzae is the most common causative organism. Other organisms are Pneumococci, Streptococcus pyogenes, N.meningitidis, Staphylococcus Clinical manifestations Onset is sudden. Symptoms are- fever, dysphagia, drooling, muffled voice, inspiratory retractions, cyanosis and soft stridor. Patients often sit in sniffing dog position. Respiratory arrest may occur. Plain lateral soft tissue radiograph of neck Thickening of the epiglottis - the thumb sign Absence of a deep well defined vallecula - the vallecula sign "The risk of sudden death for persons is high due to sudden airway obstruction". Diagnosis of acute epiglottitis In most cases presumptive diagnosis can be made by typical clinical picture of the disease. The definitive diagnosis is made by direct inspection of the epiglottis, a procedure that should be done by an experienced airway specialist under controlled conditions (usually the operating room). The typical findings are cherry-red and swollen epiglottis and arytenoids. In children, the epiglottis can be seen by simple depression of tongue by tongue blade. In older children and adults, indirect or direct laryngoscopy usually is necessory to make a diagnosie"". Though the definitive diagnosis requires direct inspection of the epiglottis. Case management should be individualized. In the child with moderate or advanced disease, the clinical diagnosis should be apparent without an intraoral examination. In this situation, intraoral examination should not be performed, but the child should be prepared for the establishment of an airway. This preparation should be rapid but controlled so that intubation can be performed in an operating room. The diagnosis can also be established by the classical appearance on a lateral neck radiograph which shows the thumb sign and vellecula sign. Etiological diagnosis is made by culture of an organism from blood and from the specimen of the surface of epiglottis. Treatment of epiglottitis Once the diagnosis of epiglottitis is made, endotracheal intubation must be performed immediately. After an airway is established, cultures of the blood and epiglottis should be obtained and patient staed on appropriate intravenous antibiotics to cover H. influenzae (Ceftriaxone or equivalent cephalosporins). Ceftriaxone is the treatment of choice for epiglottitis". Other antibotic options are :- Ampicillin plus sulbactam Cefuroxime Clindamycin Chloramphenicol Cefotaxime Intravenous antibiotics should be continued for 2-3 days, followed by oral antibiotics to complete a 10 days course.