Seth is a 64-year-old patient with a 10-year history of recurrent sinusitis. He
presents to your primary care clinic today complaining of “head congestion.” He
also reports that he had a “cold” last week with symptoms of cough and “runny
nose.” Two days ago, he developed a headache that was “worse” when bending over
but improved with Tylenol. He describes the headache as a “3 out of 10” and says it
is primarily a “frontal headache.” He also reports that his nasal congestion has
become worse; he has been blowing his nose even more; and the discharge from his
nose has become thicker, with a yellow green color. He has been taking
pseudoephedrine for the past 48 hours with little relief of her nasal congestion. He
denies tooth pain or pain on chewing. He has no history of seasonal allergies,
although he was treated for sinusitis 6 months ago in your clinic as well as
approximately 1 year ago.
The remainder of his medical history is essentially negative. His temperature
taken at the clinic is 99.60F. On physical examination, he has tenderness to
palpation in the frontal area, no maxillary tenderness, nasal mucosa is erythematous
as is his pharynx. His submaxillary nodes are enlarged bilaterally, but there is no
cervical lymphadenopathy. His lungs are clear to auscultation. His heart has a
regular rate and rhythm and is negative for murmurs, gallops, and rubs. His vital
signs are blood pressure 128/88; Pulse 78 and regular; Respirations 20
breaths/min, non-labored.
1. What is your assessment of Seth?
2. What is your plan of treatment?
3. Be sure to review the literature on sinusitis. What symptoms and signs are most
indicative of a diagnosis of sinusitis? Which are not? How many of these
symptoms/signs does Seth have?
4. What are some other things you might do to better assess Seth?
5. What are your therapeutic options?
6. What follow-up do you need to do on Seth?