Rosh Emergency Medicine Practice Test

What is the common presentation of a patient suffering from sinusitis that is worsening with yellow nasal secretions?

1. Clear nasal secretions

2. Coughing less with persistent facial discomfort

3. Resolution of fever after 5 days

4. Persistent mucosal edema without discharge

The correct answer is: Coughing less with persistent facial discomfort

The presentation of a patient with worsening sinusitis often includes ongoing facial discomfort, which can manifest as pain or pressure in the areas around the eyes, cheeks, or forehead. Yellow nasal secretions indicate the presence of inflammation and infection, often associated with bacterial sinusitis. As the condition progresses, patients can experience persistent discomfort due to the blockage of sinus drainage pathways, leading to increased pressure and pain. In the scenario described, "coughing less with persistent facial discomfort" reflects the situation accurately. Initially, coughing may occur due to post-nasal drip from the nasal secretions, but as sinusitis worsens, the focus shifts more to the facial pain and pressure rather than a productive cough. This indicates an advanced stage of sinusitis where the primary symptom is the discomfort rather than other respiratory symptoms. Other choices depict conditions or symptoms that don’t align well with worsening sinusitis. Clear nasal secretions are typical of a viral upper respiratory infection rather than a bacterial sinusitis, while the resolution of fever after 5 days suggests recovery rather than worsening. Persistent mucosal edema without discharge might imply chronic sinusitis but does not correlate with the acute worsening described in the question.