Sinusitis

(M2.ET.4828) A 25-year-old man with a history of schizophrenia stable on his current antipsychotic regimen presents with a seizure. His mother noted that her son complained of a headache and feeling warm for the past ten days. The headache was exacerbated whenever he bent over. This morning, the mother brought him to the hospital after he fell from the top of the stairs and appeared to convulse his arms and legs. He takes quetiapine and a multivitamin. In the trauma bay, the patient appears to be breathing comfortably and follows the nurse's commands. His temperature is 100.9°F (38.3°C), blood pressure is 140/70 mmHg, pulse is 80/min, respirations are 15/min, and his oxygen saturation is 95% on room air. He complains of a headache over the top of his eyebrows. He has a few scrapes and bruises throughout his body. His left arm and leg are weaker than his right limbs. His cranial nerves are grossly intact bilaterally. Computed tomography of his head is shown in Figure A. Which of the following is the most likely cause of this patient's presentation? Review Topic

(M2.ET.4798) An 8-year-old female presents to her pediatrician with nasal congestion. Her mother reports that the patient has had nasal congestion and nighttime cough for almost two weeks. The patient’s 3-year-old brother had similar symptoms that began around the same time and have since resolved. The patient initially seemed to be improving, but four days ago she began developing worsening nasal discharge and fever to 102.6°F (39.2°C) at home. Her mother denies any change in appetite. The patient denies sore throat, ear pain, and headache. She is otherwise healthy. In the office, her temperature is 102.2°F (39.0°C), blood pressure is 96/71 mmHg, pulse is 128/min, and respirations are 18/min. On physical exam, the nasal turbinates are edematous and erythematous. She has a dry cough. Purulent mucous can be visualized dripping from the posterior nasopharynx. Her maxillary sinuses are tender to palpation.

Which of the following organisms is most likely to be causing this patient’s current condition? Review Topic

(M2.ET.4798) A 5-year-old male presents to the pediatrician with a 10-day history of cough that is worse at night. The patient has a history of mild intermittent asthma and has been using his albuterol inhaler without relief. He has also been complaining of headache and sore throat, and his mother has noticed worsening rhinorrhea. The patient’s past medical history is otherwise unremarkable, and he has no known drug allergies. In the office, his temperature is 101.8°F (38.8°C), blood pressure is 88/65 mmHg, pulse is 132/min, and respirations are 16/min. The patient has purulent mucus draining from the nares, and his face is tender to palpation over the maxillary sinuses. His pharynx is erythematous with symmetric swelling of the tonsils. On lung exam, he has moderate bilateral expiratory wheezing.

Which of the following is the best next step in management? Review Topic

(M2.ET.4798) A 54-year-old male presents to the emergency department with nasal congestion and sore throat. He also endorses ten days of fatigue, rhinorrhea and cough, which he reports are getting worse. For the last four days, he has also had facial pain and thicker nasal drainage. The patient’s past medical history includes obesity, type II diabetes mellitus, and mild intermittent asthma. His home medications include metformin and an albuterol inhaler as needed. The patient has a 40 pack-year smoking history and drinks 6-12 beers per week. His temperature is 102.8°F (39.3°C), blood pressure is 145/96 mmHg, pulse is 105/min, and respirations are 16/min. On physical exam, he has poor dentition. Purulent mucus is draining from his nares, and his oropharynx is erythematous. His maxillary sinuses are tender to palpation.

Which one of the following is the most common risk factor for this condition? Review Topic

(M2.ET.4694) A 30-year-old previously healthy male presents to your office with complaints of facial pressure and rhinorrhea for the past 3 weeks. The patient reports that several weeks prior, he had a “common cold” which resolved. However, he has since developed worsening facial pressure, especially over his cheeks and forehead. He reports over 1 week of green tinged rhinorrhea. His temperature is 100.1 deg F (37.8 deg C), blood pressure is 120/70 mmHg, pulse is 85/min, and respirations are 15/min. Nasal exam reveals edematous turbinates and purulent discharge. What is the most likely diagnosis? Review Topic

(M2.ET.163) An 8-year-old girl presents to the emergency department for a cough, fever, and a runny nose. The patient is an immigrant from Lebanon and has never seen a doctor before. She has been given antibiotics for infections every few months for similar symptoms in the past. She has seasonal allergies and has always been sick since she was a child. Her temperature is 101°F (38.3°C), blood pressure is 100/64 mmHg, pulse is 89/min, respirations are 18/min, and oxygen saturation is 96% on room air. Physical exam is notable for bilateral coarse breath sounds. She appears well otherwise. A chest radiograph is performed as seen in Figure A. Which of the following is the most likely diagnosis? Review Topic

(M3.ET.27) A 23-year-old man presents to his primary care physician with complaints of fatigue and cheek pain that started a day ago. He notes that he has nasal discharge that is yellow/green as well. Otherwise, he feels well and is generally healthy. The patient has a past medical history of type I diabetes mellitus and occasionally uses IV drugs. His temperature is 99.0°F (37.2°C), blood pressure is 120/84 mmHg, pulse is 70/min, respirations are 16/min, and oxygen saturation is 98% on room air. There is pain to palpation of the left and right maxilla. Pain is worsened when the patient bends over. Which of the following is the most appropriate initial step in management? Review Topic