What is the diagnosis and recommended management for a 20-year-old female (F) with a 1-day history of thick yellowish nasal discharge, followed by a productive cough and sore throat, and a wound on her hand, with a past medical history of a tetanus shot last year, and physical examination findings of swollen non-erythematous turbinates and 2 superficial lacerations on the palm of the left hand?

Diagnosis and Management

This patient has acute viral upper respiratory infection (URI) with superficial hand lacerations requiring wound care only—no antibiotics are indicated for either condition.

Primary Diagnosis: Acute Viral URI

The clinical presentation is classic for viral URI, not bacterial infection:

• Yellowish nasal discharge and sputum do NOT indicate bacterial infection—this reflects normal white blood cells and desquamated epithelium from viral inflammation 1
• The 1-day symptom duration with rhinorrhea, productive cough, and sore throat without fever fits the typical viral URI pattern 1
• Swollen non-erythematous turbinates on exam support viral etiology 2
• No criteria for bacterial rhinosinusitis are met: symptoms have not persisted >10 days, no high fever >39°C with severe facial pain, and no "double sickening" pattern 1, 3

Key Clinical Pitfall to Avoid

The presence of thick yellowish discharge commonly misleads clinicians into prescribing unnecessary antibiotics. This is the normal inflammatory response to viral infection and resolves spontaneously within 7-10 days 1, 4.

Secondary Issue: Hand Lacerations

The superficial lacerations are a minor wound care issue:

• Tetanus prophylaxis is NOT needed: the patient received tetanus vaccination within the past year, and for clean minor wounds, boosters are only required if >10 years have elapsed 5
• For contaminated or high-risk wounds, boosters are indicated only if >5 years have elapsed 5
• These superficial, partially healed lacerations do not meet criteria for high-risk wounds requiring immunoglobulin or additional vaccination 5, 6

Management Plan

For the Viral URI:

Symptomatic treatment only—antibiotics cause more harm than benefit 1:

• First-generation antihistamine (diphenhydramine or chlorpheniramine) PLUS oral decongestant (pseudoephedrine) for rhinorrhea and congestion 2, 1
• High-volume saline nasal irrigation for mucociliary clearance 3
• Topical decongestants (oxymetazoline) may be used but limit to 3-5 days maximum to prevent rebound congestion (rhinitis medicamentosa) 2, 1
• Intranasal ipratropium bromide if profuse watery rhinorrhea persists 1

For the Hand Lacerations:

• Standard wound care: cleansing, assessment for foreign bodies, and monitoring for signs of infection
• No tetanus booster required given recent vaccination 5
• No antibiotics needed for superficial, clean lacerations 5

Expected Course and Red Flags

Typical viral URI duration is 7-10 days, though symptoms may persist up to 2 weeks 1, 7:

• Cough may persist up to 10 days 7
• Sore throat may persist up to 12 days in 60% of patients 7

Return for re-evaluation if:

• Symptoms persist >10 days without improvement (suggests bacterial rhinosinusitis) 1, 3
• Worsening after initial improvement ("double sickening") 1, 7
• High fever >39°C with severe unilateral facial pain 1, 3
• Severe headache with neck stiffness, vision changes, or altered mental status 1
• Signs of wound infection (increasing pain, erythema, purulent drainage, fever) 5

Isolation and Return to Work

• Isolate at home for 7 days from symptom onset to reduce transmission risk 7
• Viral shedding peaks in first 2-3 days and substantially decreases by day 7-10 7
• Emphasize handwashing as the most effective transmission prevention method 7
• Patient may return to work after 7 days if symptoms are improving, even if mild symptoms persist 7