A nurse is caring for an 18-month-old toddler in the emergency department. 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.

Rationale: • Hypoxia: Hypoxia occurs in both epiglottitis and RSV due to airway obstruction or lower respiratory involvement. In epiglottitis, airway swelling can limit oxygen intake, whereas in RSV, lower airway inflammation and bronchiolitis cause oxygen desaturation. Streptococcal pharyngitis typically does not impair oxygenation. • Fever: Fever is a nonspecific finding seen in epiglottitis, RSV, and streptococcal pharyngitis. Infection-induced inflammation and immune response in all three conditions cause elevated temperatures. The degree and onset of fever can vary among the conditions. • Tachypnea: Tachypnea is a compensatory response to hypoxia and airway compromise. It is commonly observed in epiglottitis due to upper airway obstruction and in RSV due to bronchiolar inflammation. It is usually absent in isolated streptococcal pharyngitis. • Drooling: Drooling is a hallmark sign of epiglottitis due to painful swallowing and airway obstruction. It is not typical in RSV or streptococcal pharyngitis. Presence of drooling indicates urgent airway assessment. • Exudate on pharynx: Exudative pharyngitis is characteristic of streptococcal infections. It is rarely seen in epiglottitis and RSV. White or yellow exudates on the tonsils help differentiate bacterial pharyngitis from viral or upper airway conditions. • Wheezing upon auscultation: Wheezing is associated with lower airway involvement, commonly seen in RSV bronchiolitis. It is not typically present in epiglottitis or streptococcal pharyngitis. Wheezing reflects bronchospasm or airway inflammation.