A nurse is caring for an 18-month-old toddler in the emergency department. Exhibits For each potential assessment finding, click to specify if the finding is consistent with Epiglottitis, Respiratory Syncytial Virus, or Acute Streptococcal Pharyngitis. Each finding may support more than 1 disease process.

Hypoxia: Hypoxia is a key feature of epiglottitis due to airway obstruction from supraglottic swelling. It also occurs in RSV, where inflammation and mucus obstruct small airways, reducing oxygen exchange. Both conditions can require supplemental oxygen and prompt respiratory support. Tachypnea: Increased respiratory rate is a compensatory mechanism for hypoxia and respiratory distress. In epiglottitis, it results from airway narrowing, while in RSV, it's due to bronchiolar inflammation, mucosal edema, and increased airway resistance. Fever: Fever is a nonspecific but consistent sign in all three conditions. In epiglottitis, it’s often high-grade and abrupt. In RSV, it tends to be low to moderate. In streptococcal pharyngitis, fever accompanies tonsillar inflammation and systemic infection. Exudate on pharynx: Purulent or white exudate on swollen tonsils is a hallmark of streptococcal pharyngitis, reflecting bacterial colonization and immune response. This finding is not typically seen in viral causes like RSV or in epiglottitis. Drooling: Drooling is classic for epiglottitis due to pain and difficulty swallowing. The inflamed, swollen epiglottis causes discomfort and obstruction, preventing normal handling of oral secretions. It's a red flag for impending airway compromise. Wheezing upon auscultation: RSV causes bronchiolitis, which leads to wheezing due to lower airway obstruction by mucus and inflammation. Wheezing is not a feature of epiglottitis (which affects the upper airway) or streptococcal pharyngitis (which affects the oropharynx).