Viral upper respiratory tract infection and the common cold — formative SAQs

SAQ 1 (10 marks)

A previously well 3-year-old is brought to the general paediatric clinic on day 4 of a viral cold. The nasal discharge has turned thick and yellow-green. The child is afebrile today, playing normally, drinking well, and has no respiratory distress. The parent asks for "an antibiotic to clear it up." ^{[1] [4]}

a) (3 marks) Explain why the change in discharge colour does not indicate bacterial infection. Purulent discharge reflects neutrophil myeloperoxidase staining sloughed epithelial cells and inflammatory debris; it is an expected part of the natural history, not evidence of bacterial infection, and antibiotics do not shorten the illness or prevent complications. ^{[1] [4]}

b) (3 marks) State the expected natural history of an uncomplicated cold, including the duration of nasal symptoms and the likely duration of cough. Symptoms peak on days 2 to 3 and resolve over 7 to 10 days; a post-viral cough may persist for 2 to 3 weeks and is normal; the well, drinking child with no red flags needs no follow-up for the cold itself. ^[1]

c) (4 marks) Outline the evidence-based symptomatic care you would recommend, naming two agents that help and one important age-restricted remedy to avoid. Give paracetamol 15 mg/kg/dose every 4 to 6 hours or ibuprofen 10 mg/kg/dose every 6 to 8 hours for fever and discomfort, and honey (2 to 5 mL) for cough in a child over 1 year, with saline drops or spray for the nose and fluids and rest. Avoid over-the-counter cough and cold mixtures (not recommended under 6 years) and remember honey is contraindicated under 1 year because of infant botulism. ^{[3] [8] [6]}