The Common Cold (1)

SORE THROAT: CAUTIONS Caution re: epiglottitis: sore throat + dysphagia, respiratory distress, fever Caution re: pharyngitis in adolescents and young adults (ages 15-24 yrs) -Fusobacterium necrophorum - Gram-negative anaerobe that can cause Lemierre syndrome - Pharyngitis followed by suppurative (pus forming) thrombophlebitis of internal jugular vein, bacteria in blood, pulmonary abscess - Treat this age range with penicillin or cephalosporin (NOT a _______) if they have at least 3 of following: fever, tonsillar exudates, swollen & tender cervical lymph nodes, and lack of cough Another important guideline: a sore throat that has not resolved in 3-5 days requires further work-up

macrolide

Symptom: Fatigue Common cold: ______ Influenza ____, can last for a few _____

mild, severe, weeks

Symptom: onset Common cold: _____ Influenza ______

slow, sudden

Treatment of colds Goal of treatment is to reduce ____ and provide ____ ____

transmission, symptomatic relief

Sore throat: strep vs viral Center Score: 1 point for each of the following History of fever Tonsillar exudates Tender anterior cervical adenopathy Absence of cough Do not test or treat for strep if score ____ or ____ Treat with antibiotic if rapid test + for score of 2 Treat with antibiotic if rapid test + *OR* treat with antibiotics empirically for score of ______ Treat empirically for score of ______ The modified centor criteria (mclsaac score) add the patients age to the criteria Age <15 yrs add 1 point Age >44 yrs subtract 1 point

1, 2, 3, 4,

Exclusions for self treatment •Cough with thick yellow sputum or green phlegm •Fever >______ in adult •Unintended weight loss •Drenching night sweats •Hx of asthma, COPD, CHF •Infants < 3-9 months Foreign object aspiration •Duration > 7 days •Cough that worsens with self tx •Development of new s/s during self tx •Severe/unusual symptoms •Hemoptysis

101.5

• There are estimated to be over 800 different over-thecounter cough and cold formulations marketed in the United States. • In January 2008 the FDA advised that OTC cough and cold medications not be used in children less than _____ years old due to "risk of serious and potentially life threatening side effects."

2

Etiology The common cold is a viral illness which can be caused by over ____ different viruses Most common cause is ____ (up to 50% of cases) Other viral causes: picornavirus, coronoavirus, adenovirus, coxsackievirus, echovirus, myxovirus, coronavirus, parainfluenza virus, respiratory syncytial virus (mild in adults), non-flu orthomyxovirus, enterovirus, metapneumovirus

200, rhinovirus

Symptom: duration Common cold: ___-____ days Influenza ____ week

5-10, 1

Virus will bind to host respiratory tract ___-___ on epithelial cells

ICAM-1

_______ are not effective against colds

antibiotics

Complications Sinusitis Pneumonia Otitis media Asthma/COPD exacerbation approx 20% of colds are complicated by _____, are more severe, and require different treatment strategies

bacteria

Symptom: THROAT ____ both for both common cold and influenza

common

Symptom: *cough* ______/_____ combo

decongestant, antihistamine

Symptom: COUGH Common cold _____ cough, can be _____ Influenza: ____ cough, may become ____

hacking, severe, dry, severe

Prevention Avoid contact with people who have the common cold Wash hands frequently Avoid touching your face and mouth Throw out tissues _____ after use cover your cough/sneeze

immediately

Symptom: Temperature Common cold: ___ ____ fever +/- ______ Influenza _____ fever w/ _____

low grade, chills, high, chills

Symptom Appetite Common Cold ____ or somewhat _____ Influenza _____

normal, decreased, decreased

Symptom: MYALGIA Common cold Less Severe Influenza ________

prominent

Differential diagnosis Symptom: NOSE Common cold: ____, ____, _____ Influenza: ____ ___, sometimes _____

rhinorrhea, congestion, sneezing, less common, stuffy

Colds are the ______ most common diagnosis during office visits Most _____ illnesses in united states Usually ___-___, therefore treatment focuses on symptomatic relief

third, expensive, self-limiting

Symptom: ocular Common cold: ______ eyes Influenza: _______/______

watery, photophobia, pain