<prompt> Thumb printing sign is seen inAcute epiglotitisAcute largnotracheobronchitisAcute LaryngitisCarcinoma vocal cords  <response>: Acute epiglottitis: 309-Dhingra 5th; 599-P-Hazarika 3rdeditionACUTE EPIGLOTTITISSyn - Acute supraglottic laryngitis Caused by Hemophilus influenza type BClinical FeaturesSymptomsSignsGeneral - usually starts as URTISigns High grade fever General - fever, toxic appearance and flushed skin, lethargic Dribbling saliva On auscultation decreased air entry Local Sore throad Dysphagiaodynophagia Muffled Hot potato voice F B sensation in the throat Breathing difficulty -Inspiratory stridor is variably present and may be associated with expiratory rottles ORAL Pharynx is usually congested and pooling of saliva Red and edematous epiglottis popping up Cherry red epiglottis Stridor is inspiratory and increases on supine position. Patient tends it sit up leaning forward supporting on upper limbs Tripod sign which relieves stridor to some extent Inspiratory stritor if severe causes intermittent retraction, active accessory respiratory muscles and perioral cyanosis Differences between acute epiglottis and acute laryngo-tracheo-bronchitis in children Acute epiglottisAcute laryngo-tracheo-bronchitis or group Causative organismHaemophilus influenza type BParainfluenza virus type I and II Age2-7 years3 months to 3 years PathologySupraglottic larynxSubglottic area Prodromal symptomsAbsentPresent OnsetSuddenSlow FeverHighLow grade or no fever Patients lookToxicNon-toxic CoughUsually absentPresent, Barking seal-like StridorPresent and may be markedPresent OdynophagiaPresent with drooling of secretionsUsually absent RadiologyThumb sign on lateral viewSteeple sign on anteroposterior view of neck TreatmentHumidified oxygen, third generation cephalosporin ceftriaxone or amoxicillinHumidified 02 tent, steroids 