darkhorse
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A 36-year-old male comes to his primary care physician complaining of 3 days of worsening headache, left frontal facial pain, and yellow nasal discharge. The patient reports that he has had nasal stuffiness and coryza for about 5 days. Past medical history is notable only for seasonal rhinitis. The physical examination is notable for a temperature of 37.9°C (100.2°F) and tenderness to palpation over the left maxillary sinus. The oropharynx has no exudates, and there is no lymphadenopathy.
Which of the following is the most appropriate next intervention?
A. Aspiration of the maxillary sinus
B. Nasal fluticasone
C. Oral amoxicillin
D. Serum antineutrophil cytoplasmic antibodies (ANCA)
E. Sinus CT scan
Edited by new_n_lost on 11/04/07 - 03:10 AM. Reason: Corrected the Format of the Question
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| doc_clotaire
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C. Oral amoxicillin ( Maxilary sinusitis is a clinical diagnosis )
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| darkhorse
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| neuroblastoma
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E. Sinus CT scan???
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| bax
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E
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| Justice
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It could be E, but this is not "intervention" in my understanding... However, it is needed in this case to rule out possible cranial complications.
My wife, who is ENT surgeon, said that she would do B. Nasal fluticasone - to open drainage from the sinus, if C is not a correct answer... If doesn't help then go with A. Aspiration of the maxillary sinus...
I am worried if its fair to ask Qs like this on a CK exam...
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| dr penicillin
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C
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| darkhorse
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The answer is B.
Antibiotics are tremendously overprescribed for the presumptive diagnosis of acute sinusitis. Acute
bacterial sinusitis is uncommon in patients with symptoms of less than 7 days' duration even in the
presence of purulent discharge. Most cases are due to viral infections. Decongestants and nasal lavage should be prescribed initially. In a patient with a known history of allergic rhinitis, nasal corticosteroids may be added.
Empirical antibiotic therapy may be prescribed for patients whose symptoms do not improve with conservative therapy after 1 week and patients with a known predisposition to sinus infection (e.g., cystic fibrosis).
Imaging of the sinuses should not be performed in routine cases. For recurrent or persistent sinusitis, CT is preferred to standard sinus radiography. Aspiration should be performed when there is known opacification of a sinus and empirical therapy has not been effective or the patient is at risk of opportunistic infection.
In the absence of nasal perforation, lung symptoms or signs, or renal disease that raises suspicion of vasculitis or Wegener's granulomatosis, measurement of serum ANCA is not warranted.
Edited by new_n_lost on 11/04/07 - 03:11 AM. Reason: Edited the format of the question
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| darkhorse
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this q was asked in real exam step 2 ck
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| new_n_lost
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darkhorse wrote:
this q was asked in real exam step 2 ck
I seriously hate to burst ur bubble if this was an actual CK exm question how did u get the detailed explanations. ??
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| darkhorse
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well....this q is not exactly the same...i have already finsihed my ck....almost similar q with steroid as answer was there....the reason why i mentioned it bcoz....i felt similar q with little different format might come in the exam
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