URTI Overview - Cold Facts First
- Etiology (Common Viruses):
- Rhinovirus (most frequent agent)
- Adenovirus, RSV, Coronavirus
- Influenza, Parainfluenza viruses
- Clinical Features:
- Rhinorrhea (clear to mucopurulent)
- Cough, sore throat
- Nasal congestion, sneezing
- Low-grade fever (typically < 38.5°C), malaise
- Symptomatic Management:
- Adequate hydration (oral fluids)
- Antipyretics (e.g., Paracetamol) for fever/pain
- Saline nasal drops or spray for congestion
- Rest; humidified air
- Red Flags ⚠️ (Indicating Complications):
- High fever (> 39°C) or fever persisting > 3 days
- Respiratory distress (tachypnea, retractions, nasal flaring)
- Severe ear pain (otitis media), facial pain/swelling (sinusitis)
- Lethargy, irritability, poor oral intake, dehydration
- Symptoms worsening or no improvement after 7-10 days
⭐ Rhinovirus is the most common cause of the common cold.
Pharyngitis - Strep Throat Drama
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Otitis & Sinusitis - Ear-itating Pains
Acute Otitis Media (AOM):
- Pathogens: S. pneumoniae, H. influenzae, M. catarrhalis (📌 SHiM).
- Features: Otalgia, fever, red bulging Tympanic Membrane (TM).
- Management: Analgesia. Amoxicillin 80-90 mg/kg/day if severe/bilateral <2yrs/no improvement after observation.
⭐ Most common bacterial pathogens in AOM are Streptococcus pneumoniae, non-typeable Haemophilus influenzae, and Moraxella catarrhalis.
AOM Management Algorithm:
AOM vs. Otitis Media with Effusion (OME):
| Feature | AOM | OME |
|---|---|---|
| Symptoms | Acute otalgia, fever | Hearing loss, fullness, often asymptomatic |
| TM | Bulging, erythematous, ↓ mobility | Retracted/neutral, air-fluid levels, ↓ mobility |
- Pathogens: Viral (most common); Bacterial: S. pneumoniae, H. influenzae.
- Features: Persistent (>10 days) purulent nasal discharge, facial pain/pressure, fever.
- Management: Symptomatic. Amoxicillin-clavulanate for suspected bacterial cases.
Laryngeal Alerts - Bark, Stridor, Action!
Croup (Laryngotracheobronchitis) vs. Epiglottitis
| Feature | Croup (Laryngotracheobronchitis) | Epiglottitis |
|---|---|---|
| Etiology | Parainfluenza virus (commonest) | Strep/Staph (post-Hib era) |
| Onset | Gradual (days) | Rapid (hours) |
| Cough | Barking (📌 SEAL-like) | Minimal/absent |
| Stridor | Inspiratory | Inspiratory, muffled cry/voice |
| Fever | Low-grade | High |
| Drooling | Uncommon | Prominent (📌 4 D's: Dysphagia, Dysphonia, Drooling, Distress) |
| Dysphagia | Mild | Severe |
| Position | Variable | Tripod/Sniffing |
| X-ray (Neck) | Steeple sign (AP view) | Thumbprint sign (Lateral view) |
| Management | Dexamethasone (0.6 mg/kg), Neb. Epinephrine (for mod-severe) | ⚠️ Airway emergency! Intubate in OR, IV Abx (e.g., Ceftriaxone) |
⭐ The 'thumbprint sign' on lateral neck X-ray is characteristic of epiglottitis.
Approach to Stridor:
High‑Yield Points - ⚡ Biggest Takeaways
- Common cold (rhinovirus): Most frequent URTI, symptomatic treatment.
- AOM: Often post-viral URTI; S. pneumoniae is a key pathogen.
- GAS Pharyngitis: Treat with Penicillin V to prevent rheumatic fever; Centor criteria aid.
- Epiglottitis: 3Ds (Drooling, Dysphagia, Distress), tripod position, thumb sign; airway emergency.
- Croup: Parainfluenza virus; barking cough, inspiratory stridor, steeple sign.
- Diphtheria: Greyish pseudomembrane, bull neck; antitoxin + antibiotics vital.
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