Mehl./UW. acute bacterial rhinosinusitis 04-01 (2)

Question 1

Mehl. School-age kid has a lingering fever after an upper respiratory tract infection (URTI) for 10-14+ days, Dx?

Answer 1

Sinusitis

Question 2

Mehl. Whenever a URTI lingers for more than ~10ish days, you want to think about????

Answer 2

sinusitis as a differentia

Question 3

Mehl. A 2CK vignette gives nocturnal cough (reflects aspiration; in this case, from the sinuses) and grey membranes in the oropharynx.

Answer 3

sinusitis

Question 4

Mehl. The grey oropharyngeal membranes detail sounds weird, since that is normally buzzy for Diphtheria, but it shows up on an NBME Q where the answer is sinusitis and Diphtheria isn’t listed.

Answer 4

.

Question 5

Mehl. - IgA deficiency Qs, which presents as recurrent sinopulmonary infections, can say patient has Hx of pneumonias + presents today with sore left cheek ->?

Answer 5

reflects sinusitis.

Question 6

Mehl. For 2CK, what is done if chronic sinusitis >12 weeks??

Answer 6

CT scan

Question 7

Mehl. if CT done for chronic sinusitis –> Tx next?

Answer 7

After CT is performed for chronic sinusitis, nasal endoscopy can be performed.

Question 8

Mehl. Tx?

Answer 8

Tx is amoxicillin/clavulanate (Augmentin).

Question 9

Mehl. Tx for sinusitis with amoxiclav is in contrast to OM and Strep pharyngitis, which are treated with just amoxicillin or penicillin alone, without the clavulanate (unless recurrent).

Answer 9

.

Question 10

UW. definition?

Answer 10

common infection of the paranasal sinuses that typically presents with >= 10 days of upper respiratory symptoms (cough, congestion, sore throat) with or without fever.
Palpation of sinuses can cause tenderness

Question 11

UW. complications?

Answer 11

Periorbital/orbital celulitis; meningitis; brain abscess

Question 12

Uw. in what Cp suspect that there is brain abcess?

Answer 12

persistent headache and early morning vomiting (occurs due to incr. ICP), also altered mental status, neck pain (indicates meningeal irritation), focal neurologic symptoms.

Question 13

UW. if suspected brain abcess, next step?

Answer 13

Do CT scan of head; ring-enhancing lesion confirms diagnosis.

Question 14

UW. if suspected brain abcess -> CT confirms, next step?

Answer 14

IV abs and surgical drainage

Question 15

UW. if suspected brain abcess. why not oral abs if sinusitis -> abscess suspected?

Answer 15

oral abs indicated in UNCOMPLICATED sinutis.

abcess = complicated, need IV abs

Question 16

UW. suspected brain abcess. why not culture from nasopharyngeal?

Answer 16

SINUS culture is often indicated in complicated sinusitis. BUT nasopharyngeal culture does not correlate with sinus culture.