A young child has had nasal congestion and a runny nose with a green discharge for 3 weeks. Which physical finding would be particularly worrisome and indicate the need for further evaluation?

A young child has had nasal congestion and a runny nose with a green discharge for 3 weeks. Which physical finding would be particularly worrisome and indicate the need for further evaluation?

• A. Unilateral nasal drainage
• B. Sporadic, loose cough
• C. A low-grade fever for 3 days
• D. Fussiness

Answer: (A)

Unilateral nasal drainage signals a localized nasal process that requires further evaluation. When discharge comes from only one nostril and lasts for weeks, it points to a problem on that side—such as a nasal foreign body, a localized infection like chronic sinusitis on one side, nasal polyps, or a mass. These possibilities can cause persistent symptoms and potential complications, so they merit closer assessment, often by an ENT specialist and possibly imaging if indicated. In contrast, the other findings are more typical of benign, widespread viral processes. A low-grade fever for a few days, a sporadic cough, or fussiness can accompany common colds or mild illnesses and don’t by themselves indicate a localized nasal pathology.

Unilateral nasal drainage signals a localized nasal process that requires further evaluation. When discharge comes from only one nostril and lasts for weeks, it points to a problem on that side—such as a nasal foreign body, a localized infection like chronic sinusitis on one side, nasal polyps, or a mass. These possibilities can cause persistent symptoms and potential complications, so they merit closer assessment, often by an ENT specialist and possibly imaging if indicated.

In contrast, the other findings are more typical of benign, widespread viral processes. A low-grade fever for a few days, a sporadic cough, or fussiness can accompany common colds or mild illnesses and don’t by themselves indicate a localized nasal pathology.