How to differentiate clinically between LTB (croup) and epiglottitis

Which of the following best differentiates, by history, LTB (croup) from epiglottitis?

• (A) Temperature
• (B) Presence of inspiratory stridor
• (C) Length of time from onset to defining symptom
• (D) Lung field auscultation
• (E) Presence or absence of dyspnea

The answer is C.
Croup, laryngeotrachiobronchitis, a viral illness with subglottic involvement, typically exhibits the symptoms of inspiratory stridor only after 12 to 24 hours of coryza, typical of a viral “cold.” Epiglottitis, which is a much more serious condition, begins suddenly. Epiglottitis is caused by bacterial infection with supraglottic involvement, classically by H.influenzae but also by S.aureus and Corynebacterium diphtheriae.

Although epiglottitis is characterized more by high fever than is croup, this appears to be a weak factor on which to base a preliminary diagnosis. Whereas croup virtually always includes a cough, epiglottitis rarely
does so. Epiglottitis typically includes dysphagia while croup does not. The child with croup is comfortable in all positions, whereas the patient with epiglottitis will be sitting forward with the mouth open. Both conditions are characterized by inspiratory dyspnea. Croup is benign and epiglottitis is potentially critical.

Sesamoid bones, Functions and mechanism of action.

The sesamoid bone is a small rounded bone embedded within a tendon that usually passes over a joint (Sesamoid bones are the bones not connected to any other bone).The largest sesamoid bobe is the patella.

Latin........."ossa sesamoidea"

Sesamoid bones functions probably are to modify pressure, to diminish friction, and occasionally to alter the direction of a muscle pull.Sesamoid bones also prevent the tendon from flattening into the joint as tension increases and therefore also maintain a more consistent moment arm through a variety of possible tendon loads.
Sesamoid bones can be found in the knee, hand and foot...

Sesamoid bones at the distal end of the first metatarsal bone of the foot.

Sesamoids act like pulleys. They provide a smooth surface over which the tendons slide, so they increase the ability of the tendons to transmit muscle forces. The sesamoids in the forefoot also assist with weightbearing and help elevate the bones of the big toe.