Viral upper respiratory tract infection and the common cold — branching viva

Branching viva from a well 3-year-old with a cold and purulent nasal discharge, through the natural history and the rationale against antibiotics, the symptomatic care that works, the red flags that escalate, and the management of an infant under three months who presents with coryza and fever.

branching clinical structured oral2 min readVerification in progress

Prompt

You are the general paediatric registrar in clinic. A previously well 3-year-old presents on day 4 of a cold; the nasal discharge has turned thick and yellow-green and the parent requests an antibiotic. The examiner releases information in stages about the meaning of purulent discharge, the natural history of a cold, the evidence against antibiotics, the symptomatic care that works, the red flags that escalate, and finally pivots to a 6-week-old sibling with coryza and a temperature of 38.3°C.

Branch 1 — The meaning of purulent discharge

The discharge has turned green. The parent says "this is infected, he needs an antibiotic." The opening question asks whether the colour change indicates bacterial infection, and the probes explore the mechanism behind the colour change (neutrophil myeloperoxidase staining sloughed epithelial cells and inflammatory debris), the Cochrane conclusion on antibiotics for the common cold and acute purulent rhinitis (no benefit, no shortening of illness, no prevention of complications, with added side effects and resistance), and how to explain this to a parent without dismissing their concern. [1] [4]

Paediatrics Fellowship Pro

You have read the opening of this viva. The complete unit — every section and its primary-source references — is part of the Paediatrics Fellowship fellowship atlas.

References5Show ledger

[1]Heikkinen T, Järvinen A. The common cold. Lancet, 2003.PMID 12517470
[4]Kenealy T, Arroll B. Antibiotics for the common cold and acute purulent rhinitis. Cochrane database of systematic reviews, 2013.PMID 23733381
[3]Fashner J, Ericson K, Werner S. Treatment of the common cold in children and adults. American family physician, 2012.PMID 22962927
[8]Oduwole O, Udoh EE, Oyo-Ita A, et al. Honey for acute cough in children. Cochrane database of systematic reviews, 2018.PMID 29633783
[15]Lieberthal AS, Carroll AE, Chonmaitree T, et al. The diagnosis and management of acute otitis media. Pediatrics, 2013.PMID 23439909