Review Question - QID 109217

This patient presents with fever, purulent nasal discharge, tenderness of the maxillary sinuses (with likely gram-positive diplococci on gram stain), which suggests a diagnosis of acute bacterial rhinosinusitis (ABRS). Viral upper respiratory infection is the most common predisposing risk-factor for ABRS.

ABRS presents with fever, headache, nasal congestion, purulent nasal drainage, sore throat, and cough. It is most commonly caused by Streptococcus pneumonia, Haemophilus influenzae, and Moraxella catarrhalis, and the most common risk factor is a viral upper respiratory infection due to the mucosal inflammation and disruption of the mucociliary elevator. The treatment of choice is amoxicillin-clavulanic acid.

Incorrect Answers:
Answer 1: Asthma can be exacerbated by either acute viral or bacterial rhinosinusitis, but it is not itself a risk factor for development of acute bacterial rhinosinusitis.

Answer 2: Diabetes mellitus is a risk factor for invasive fungal rhinosinusitis, which is a possible diagnosis, but is not more likely than bacterial sinusitis. Fungal rhinosinusitis also classically presents with necrotic areas in the nares or oral cavity and cranial nerve involvement. Purulent nasal drainage is less common.

Answer 3: Poor dentition is a risk factor for odontogenic infections, which may lead to infections of the deep fascial spaces of the head and neck, and Ludwig's angina. It is not known to be a risk factor for acute bacterial rhinosinusitis.

Answer 4: Tobacco use predisposes to acute bacterial rhinosinusitis by causing mucosal irritation, but it is a less common predisposing risk-factor than viral upper respiratory infection.

Bullet Summary:
Viral upper respiratory infection is the most common predisposing risk-factor for acute bacterial rhinosinusitis due to disruption of the mucociliary elevator.