Viral upper respiratory tract infection and the common cold — structured clinical encounter

Candidate tasks (12 minutes)

The candidate should take a focused, red-flag history from the parents of both children; explain the meaning of the purulent discharge and the expected natural history of the cold; counsel the parents on evidence-based symptomatic care and on why an antibiotic is not indicated; address the 6-week-old sibling's febrile illness and outline the appropriate next step; and provide a clear, specific safety-net for return. [1] [4]

Focused history to elicit

Elicit the onset, day of illness, peak of symptoms, fever pattern and response to antipyretics; the presence of red flags in the 3-year-old (work of breathing, stridor, fluid intake, urine output, drowsiness, fever duration, worsening after improvement); for the 6-week-old sibling the precise temperature, feeding, wet nappies, activity, irritability, cough or breathing difficulty, and any underlying prematurity or risk factors; and the social history of daycare attendance, siblings, smoke exposure, parental concern and expectation, and access to care. [1] [15]

Key teaching points to convey

Convey that the green discharge is inflammatory debris (neutrophil myeloperoxidase on sloughed cells), not bacterial infection, and that antibiotics do not shorten illness or prevent complications; that the expected course is 7 to 10 days for most symptoms, with a post-viral cough lasting up to two to three weeks; that effective symptomatic care is paracetamol 15 mg/kg/dose every 4 to 6 hours or ibuprofen 10 mg/kg/dose every 6 to 8 hours, honey 2 to 5 mL in a child over 1 year, saline drops, and fluids and rest; that over-the-counter cough and cold mixtures should be avoided under 6 years and honey under 1 year because of infant botulism; and that a 6-week-old sibling with any fever is investigated on the febrile-infant pathway regardless of coryza, because the risk of serious bacterial illness is high and clinical assessment is unreliable at this age. [3] [4] [8]

Safety-net to deliver

Tell the family to return promptly if either child has increased work of breathing, stridor, reduced fluid intake or fewer wet nappies, drowsiness or irritability, fever lasting beyond five days, or symptoms that worsen after first improving, and to bring the 6-week-old for assessment today given the reported fever. [1] [15]

Examiner's checklist

The candidate confirms the 3-year-old is well and free of red flags and documents the normal ear and chest examination; reframes the antibiotic request with a clear evidence-based rationale and offers a concrete alternative plan; recommends correct weight-based symptomatic remedies and respects the age cut-offs for honey and over-the-counter preparations; recognises the 6-week-old's fever as a separate, urgent problem requiring investigation on the febrile-infant pathway; and delivers a specific, written safety-net covering both children. [1] [4] [15]