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Updated: Dec 22 2021

Common Cold

  • Snapshot
    • A 35-year-old gentleman presents to the urgent care center for a cough, runny nose, and sore throat of a week duration. Yesterday, his cough worsened, and he began coughing up yellow sputum. On physical exam, his lungs reveal rales in the right lower lobe. A chest radiograph demonstrates a right lower lobe infiltrate. He is started on antibiotics for pneumonia. (Coronavirus infection with bacterial superinfection)
  • Introduction
    • Clinical definition
      • acute infection of upper respiratory system often caused by viral agents
    • Prevention
      • no vaccines available
  • Epidemiology
    • Incidence
      • very common
    • Demographics
      • all ages
    • Risk factors
      • immunosuppression
      • sick contacts
      • smoking
      • recent travel on airplane
  • Etiology
    • Pathogenesis
      • depends on specific viral agent
      • viral replication often occurs in tracheobronchial epithelium (except rhinovirus, which replicates in the nasopharynx epithelium)
    • Rhinovirus (most common)
    • Coronavirus (second most common)
    • Influenza
    • Respiratory syncytial virus
    • Parainfluenza virus
    • Adenovirus
  • Presentation
    • Symptoms
      • rhinorrhea
      • congestion
      • cough
      • sore throat
      • malaise
    • Physical exam
      • low-grade fever
      • hoarse voice
      • lungs are usually clear to auscultation
  • Imaging
    • Chest radiography
      • indication
        • only if pneumonia is suspected (e.g., lung exam with rales or focal crackles/rhonchi)
      • findings
        • lobar consolidation
  • Studies
    • Making the diagnosis
      • based on clinical presentation
      • diagnosis of exclusion in patients with immunosuppression
  • Differential
    • Streptococcal pharyngitis
      • distinguishing factor
        • typically presents with erythematous pharynx, tonsillar exudates, petechiae, and tender lymphadenopathy
        • tests positive on a rapid strep test
    • Infectious mononucleosis
      • distinguishing factor
        • erythematous oropharyynx, tonsillar exudates, petechiae, posterior cervical lymphadenopathy, splenomegaly
        • tests positive on monospot test
    • Influenza
      • distinguishing factor
        • systemic symptoms usually predominate with high fever and general malaise
  • Treatment
    • Management approach
      • mainstay of treatment is supportive care
    • Conservative
      • supportive care
        • indication
          • all patients
        • modalities
          • hydration
          • analgesics
          • steroid nasal spray may help with rhinorrhea
  • Complications
    • Bacterial superinfection
    • Post-viral tussis
      • self-resolves
  • Prognosis
    • Self-limited but may last for 2 weeks
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