Common Colds

Question 1

What are the etiology of common cold?

Answer 1

The Common Cold
Etiology:
• Rhinoviruses
• Coronaviruses
• Respiratory syncytial viruses

Question 2

What are the complication of common cold?

Answer 2

The Common Cold
Complications:
• Otitis media
• Sinusitis
• asthma

Question 3

8 y/o male
recurrent cough and colds for a month
sneezing early in the morning
frequently rubs his eyes
(-) fever
PMHx: unremarkable
FHX: father – childhood asthma
PE: unremarkable

Answer 3

Allergic Rhinitis

Question 4

peaks in late childhood
• symptoms may appear during infancy
• established – 6 years old

Answer 4

Allergic Rhinitis

Question 5

part of “allergic march” during childhood
• AR – unusual before 2 years of age
• most prevalent during school age years

Answer 5

Allergic Rhinitis

Question 6

inflammatory disorder of the nasal
mucosa
• nasal congestion
• rhinorrhea
• itching
• sneezing
• conjunctival irritation

Answer 6

Allergic Rhinitis

Question 7

sensitivity to allergens
• presence of allergens in the environment
• intermittent AR - cyclical exacerbation
• persistent AR – all year round symptoms

Answer 7

Allergic Rhinitis

Question 8

What are the risk factors of Allergic Rhinitis

Answer 8

Risk factors:
- family history of atopy
- early introduction to food and formula
during infancy
- smoking
- heavy exposure to allergens

Question 9

4 years old male
Colds for 2 weeks
Foul smelling nasal secretions
(-) fever
PMHx: unremarkable
FHX: unremarkable
PE: (+) foul smelling nasal discharge
(+) whitish mass, right nostril

Answer 9

Foreign Body

Question 10

• local obstruction
• sneezing
• mild discomfort
• purulent, malodorous or bloody
discharge

Answer 10

Foreign Body

Question 11

Foreign Body
DX: unilateral nasal discharge
obstruction
TX: removal
decongestants
Complications: tetanus, perforation

Answer 11

Foreign Body

Question 12

10 y/o male
colds x 12 days
cough x 10 days
fever x 4 days
headache
yellowish nasal
discharge
Highly febrile
no tachypnea
purulent nasal
discharge
clear BS

Answer 12

SINUSITIS

Question 13

• common: children and adolescents
• potential for serious complications
• viral or bacterial

Answer 13

SINUSITIS

Question 14

What are the causative agents of Sinusitis

Answer 14

SINUSITIS
• S. pneumoniae
• H. influenzae
• M. catarrhalis

Question 15

CPG for the Diagnosis and Management
of Acute Bacterial Sinusitis in Children
Aged 1 to 18 years old (AAP 2013)

Key Action Statement 1:

Answer 15

Clinicians should make a presumptive diagnosis
of acute bacterial sinusitis when a child with
an acute URI presents with the ff:
• Persistent illness, ie, nasal discharge (of any
quality) or daytime cough or both lasting more
than 10 days without improvement
OR

worsening cough, ie, worsening or new onset
of nasal discharge, daytime cough or fever
after initial improvement
OR
• severe onset, ie, concurrent fever (temp >
39C) and purulent nasal discharge for at least
3 consecutive days ( Evidence Quality B;
Recommendation)

Question 16

Key Action Statement 2A:

Answer 16

Clinicians should not obtain imaging studies
(plain films, contrast enhanced CT, MRI or
ultrasonography) to distinguish acute
bacterial sinusitis from viral URI (Evidence
Quality B; Strong Recommendation)

Question 17

Key Action Statement 2B:

Answer 17

Clinicians should obtain contrast enhanced CT
of the paranasal sinuses and/or an MRI with
contrast whenever a child is suspected of
having orbital or CNS system complication of
acute bacterial sinusitis (Evidence Quality B;
Strong Recommendation)

Question 18

Initial management of Acute Bacterial Sinusitis
3A: s

Answer 18

evere onset and worsening course acute
bacterial sinusitis.
The clinician should prescribe antibiotic therapy
for acute bacterial sinusitis in children with
severe onset or worsening course (signs,
symptoms, or both) (Evidence Quality B:
Strong Recommendation)

Question 19

Key Action Statement 3:
Initial management of Acute Bacterial Sinusitis
3B:

Answer 19

“Persistent Illness”
The clinician should either prescribe antibiotic
therapy OR offer additional outpatient
observation for 3 days to children with
persistent illness (nasal discharge of any
quality or cough or both for at least 10 days
without evidence of improvement) (Evidence
Quality B: Strong Recommendation)

Question 20

Key Action Statement 4 :

Answer 20

Clinicians should prescribe amoxicillin with or
without clavulanate as first line treatment
when a decision has been made to initiate
antibiotic treatment of acute bacterial
sinusitis. (Evidence Quality B: Strong
Recommendation)

Question 21

Key Action Statement 5A :

Answer 21

Clinicians should reassess initial management if
there is either caregiver report of worsening
(progression of initial symptoms or
appearance of new signs/symptoms) OR
failure to improve (lack of reduction in all
presenting signs/symptoms) within 72 hours
of initial management. (Evidence Quality C:
Recommendation)

Question 22

Key Action Statement 5B :

Answer 22

If the diagnosis of acute bacterial sinusitis is
confirmed in a child with worsening symptoms
or failure to improve in 72 hours, then
clinicians may change the antibiotic therapy
for the child initially managed with antibiotic
OR initiate antibiotic treatment of the child
initially managed with observation (Evidence
Quality D; Option based on expert opinion,
case reports, and reasoning from first
principles)

Question 23

SINUSITIS Complications

• ___________- periorbital
cellulitis, orbital cellulitis
•______________– meningitis,
cavernous sinus thrombosis, brain
abscess, subdural empyema, and
epidural abscess

Answer 23

Orbital complications

Intracranial complications