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Thread: 24-year-old man with sinus congestion and yellow-green six days

  1. #1
    Join Date
    Dec 2006
    Mauritius (SSRMC)
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    Thumbs up 24-year-old man with sinus congestion and yellow-green six days

    A 24-year-old man calls the office to report bilateral maxillary sinus congestion, pain, and discharge that initially was clear, but now is disturbingly yellow-green six days into the illness. He states that this condition feels exactly like the sinusitis he had several years ago, which responded well to an antibiotic. He feels feverish and achy with mild headache. He feels no better, but not clearly worse off than when the
    discharge was clear. Which of the following is correct based on current guidelines?

    A. Amoxicillin is suggested for 10 days since no other antibiotic has been shown to be superior for uncomplicated acute bacterial sinusitis (ABS)
    B. The greenish tinge to the purulent discharge may suggest a gram-negative organism such as Pseudomonas aeruginosa.
    C. Continued observation is suggested because this is likely viral and will resolve without antimicrobial treatment
    D. Arrange for a CT scan of the sinuses to prove whether an air-fluid level exists in a sinus.
    E. Arrange for otolaryngology consultation
    Answer: C. Since the symptoms have existed for only six days and are not clearly worsening, the symptom complex is likely virally based and will resolve with only symptomatic care. Most mild ABS is self-limiting. If symptoms persist beyond 10 days or are worsening after 5 to 7 days then antimicrobial treatment may be considered for ABS. The character of the discharge had no bearing, since viral or bacterial infections can produce such purulence. Radioimaging is not recommended
    as part of the evaluation of initial, uncomplicated ABS. Currently, ABS remains a clinical diagnosis for in which laboratory or radiological testing haplays a smalls little role. Specialty consultation may be useful in cases refractory to standard therapy in order to aspirate sinuses for culture.[/hide]

  2. #2
    Join Date
    Oct 2007
    New Delhi
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    Its c...

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