ENT- URI, common cold

Question 1

What is the most frequent acute illness in the US?

Answer 1

URI

500 million non-influenza viral respiratory infections annually

Question 2

Do children or adults experience URIs more?

Answer 2

Children!

Preschool children experience 5-7 episodes/year

Adults experience 2-3 episodes/year

Question 3

What is the most common etiology of the common cold?

Answer 3

30-50% of cases are caused by Rhinovirus

Question 4

How is the common cold transmitted?

Answer 4

Through direct contact and respiratory droplets

Question 5

What are the risk factors of the common cold?

Answer 5

1. Daycare
2. At home parents
3. Psychological stress
4. Poor sleep

Question 6

What are risk factors for more severe infections of the common cold?

Answer 6

1. Chronic disease
2. Immunodeficiency
3. Malnutrition
4. Cigarette smoking

Question 7

What are the symptoms of the common cold?

Answer 7

1. cough
2. rhinorrhea
3. fatigue
4. sore throat
5. body aches
6. +/- fever
7. +/- conjunctivitis
8. +/- Headache (mild)
9. +/- watery eyes

Question 8

What is the incubation time for the common cold?

Answer 8

2-3 days

Question 9

What is the typical clinical presentation of the common cold?

Answer 9

Day 1: sore throat

Day 2-3: Nasal congestion, rhinorrhea

Day 4-5: cough

(usually resolves in the same order with the cough being last)

Question 10

What is the typical duration of the common cold?

Answer 10

~7-10 days

Question 11

What are the physical exam findings?

Answer 11

1. Nasal mucosal edema
2. Nasal congestion
3. Pharyngeal erythema
4. +/- adenopathy
5. Lungs clear
6. +/- Conjunctival injection

Question 12

How do you diagnose the common cold?

Answer 12

Based on H&P!

Sinus imaging should not be needed unless sxs have persisted for months

Viral cultures should only be ordered if sxs are during flu season

CXR if concerned for PNA

Question 13

What are 6 complications of the common cold?

Answer 13

1. Viral sinusitis
2. Bacterial sinusitis
3. Lower respiratory disease (PNA is typically seen in people with comorbidities)
4. Acute asthma exacerbation
5. AOM
6. ETD/transient middle ear effusion

Question 14

How do you treat the common cold?

Answer 14

1. Supportive care- fluids and rest
2. Patient eduction

Question 15

What 10 medications can be used to treat the common cold?

Answer 15

1. Zinc, >75mg/day
2. Hypertonic nasal saline irrigation
3. Nasal decongestant sprays
4. Oral decongestants (Psudoephedrine, Phenylephrin)
5. Antihistimines (diphenhydramine, chlorpheniramine)
6. Intranasal ipratropim bromide (Atrovent)
7. Intranasal cromolyn sodium
8. Antitussives: dextromethorphan, codeine
9. Expectorants: Guafenesin
10. Analgesics: NSAIDS, acetaminophen

Question 16

What % of URI are viral?

Does color of mucous determine viral vs bacterial?

Answer 16

80 - 90%

NO!

Question 17

What would be the differential diagnosis for the common cold?

Answer 17

• Allergic Rhinitis
• Bacterial pharyngitis / tonsillitis
• Acute bacterial rhinosinusitis
• Influenza
• Acute bronchitis
• Asthma exacerbation
• Pneumonia
• Infectious mono
• Pertussis

**any respiratory infection can be in the Ddx*