Assignment
Sandy is a 64-year-old patient with a 10-year history of recurrent sinusitis. She presents to your primary care clinic today complaining of "head congestion." She also reports that she had a "cold" last week with symptoms of cough and "runny nose." Two days ago, she developed a headache that was "worse" when bending over but improved with Tylenol. She describes the headache as a "3 out of 10" and says it is primarily a "frontal headache." She also reports that her nasal congestion has become worse; she has been blowing her nose even more; and the discharge from her nose has become thicker, with a yellow-green color. She has been taking pseudo-ephedrine for the past 48 hours with little relief of her nasal congestion. She denies tooth pain or pain on chewing. She has no past history of seasonal allergies, although she was treated for sinusitis 6 mo ago in your clinic as well as approx. 1 yr ago.
The remainder of her medical history is essentially negative. Her temp taken at the clinic is 99.6°F. On physical examination, she has tenderness to palpation in the frontal area, no maxillary tenderness, nasal mucosa is erythematous as is her pharynx. Her submaxillary nodes are enlarged bilaterally, but there is no cervical lymphadenopathy. Her lungs are clear to auscultation. Her heart has a regular rate and rhythm and is negative for murmurs, gallops, and rubs. Her vital signs are: blood pressure: 128/88; Pulse: 78 and regular; Respiratory rate: 20 p/min, non-labored.
Task
A. What is your diagnosis of Sandy?
B. What is your plan of treatment (both nonpharmacological and pharmacological)?
C. Be sure to review the literature on sinusitis. What symptoms and signs are most indicative of a diagnosis for sinusitis? Which are not? How many of these symptoms/signs does Sandy have?
D. What are some other things you might do to better assess Sandy?
E. Discuss viral versus bacterial infections. What are the different presentations? Which organism is involved if it is bacterial?
F. What follow-up do you need to do on Sandy?
G. Let's say this is a viral cold, discuss ways on what to do if a patient is insistent on receiving an antibiotic prescription, even when it may not be indicated.