Chapter 74: Sinusitis Buttaro: Primary Care: A Collaborative Practice, 6th Edition

Multiple Choice

1. A patient presenting with nasal congestion, fever, purulent nasal discharge, headache, and facial pain begins treatment with amoxicillin-clavulanate. At a follow-up visit 10 days after initiation of treatment, the patient continues to have purulent discharge, congestion, and facial pain without fever. What is the next course of action for this patient?

a. A CT scan of the paranasal sinuses b. A referral to an otolaryngologist c. An antibiotic based on likely resistant organism d. A trial of azithromycin

ANS: C

Treatment failure is seen in patients who do not have symptom improvement and the provider has re-confirmed the diagnosis of ABRS and assessed for complications. In these patients, the choice of antibiotic treatment is based on likely resistant organisms. The lack of fever shows improvement, so this antibiotic may be used. CT scan is usually not performed in adults unless other complications are present or suspected. Referral to an otolaryngologist is necessary if no improvement after the second course of antibiotics. Azithromycin is not used in adults unless pregnant, due to resistance patterns.

2. A patient with allergic rhinitis develops acute sinusitis and begins treatment with an antibiotic. Which measure may help with symptomatic relief for patients with underlying allergic rhinitis?

NURSINGTB.COM a. Intranasal steroids b. Oral mucolytics c. Saline solution rinses d. Topical decongestants

ANS: A

Intranasal steroids should be considered for symptomatic relief for patients with sinusitis, especially those with allergic rhinitis. Oral mucolytics have little support in efficacy. Saline solution rinses may provide some relief, but there is no evidence to support their usefulness. Topical decongestants do decrease nasal congestion and edema, but the potential harm of rebound congestion requires recommendation with caution.

Multiple Response

1. Which are potential complications of chronic or recurrent sinusitis? (Select all that apply.)

a. Allergic rhinitis b. Asthma c. Meningitis d. Orbital infection e. Osteomyelitis

ANS: C, D, E

Complications of chronic or recurrent sinusitis include spread of infection to other tissues and may cause meningitis, orbital cellulitis, and osteomyelitis. Allergic rhinitis and asthma are associated with chronic sinusitis, but not complications of this condition.