Fast Five Quiz: Sinusitis With Nasal Polyps

Fast Five Quiz: Sinusitis With Nasal Polyps

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Arlen D. Meyers, MD, MBA

December 29, 2020

Chronic rhinosinusitis (CRS) is one of the most common medical disorders worldwide. It is believed to affect nearly 12% of the adult population and is characterized by inflammation of the nose and sinus cavities that persists for a minimum of 12 weeks. Approximately 20% of patients with CRS have nasal polyps, or chronic rhinosinusitis with nasal polyps (CRSwNP). CRSwNP has been associated with significant morbidity, discomfort and healthcare costs. Without proper treatment, it can significantly diminish the productivity and quality of life of affected individuals.

How familiar are you with CRSwNP? Refresh your knowledge with this quick quiz.

Medscape © 2020 WebMD, LLC

Any views expressed above are the author’s own and do not necessarily reflect the views of WebMD or Medscape.

Cite this: Arlen D. Meyers. Fast Five Quiz: Sinusitis With Nasal Polyps – Medscape – Dec 29, 2020.

Professor of Otolaryngology, Dentistry, and Engineering, University of Colorado School of Medicine, Aurora, Colorado

Disclosure: Arlen D. Meyers, MD, MBA, has disclosed the following relevant financial relationships:
Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: CereScan; RxRevu; Cliexa; The Physicians Edge; Sync-n-Scale; mCharts
Received income in an amount equal to or greater than $250 from: The Physicians Edge; Cliexa
Received stock from: RxRevu
Received ownership interest from: CereScan, for consulting

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Fast Five Quiz: Sinusitis With Nasal Polyps

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Fast Five Quiz: Test Your Knowledge About Fall Allergies

Fast Five Quiz: Test Your Knowledge About Fall Allergies

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Michael A. Kaliner, MD

July 06, 2020

Allergic rhinitis, also known as “hay fever,” is often associated with symptoms that flare during autumn. According to the US Centers for Disease Control and Prevention, 19.2 million adults in the United States were diagnosed with hay fever in the past 12-month period. Although allergic rhinitis is not a life-threatening condition, it is responsible for a significant and often underappreciated health burden for individuals and society.

The fall can be an especially difficult season for people who are sensitive to mold, ragweed pollen, and dust mites. Short ragweed, which is a common cause of allergic rhinitis in much of the United States, is most prominent in the late summer and fall. Individuals with mold allergies can also have worse symptoms in the fall, as damp leaves pile up and create an ideal breeding ground for mold. Moreover, dust mites, which are common during the humid summer months, can get stirred into the air the first time that heating systems are run in the fall.

Test your knowledge about fall allergies with this short quiz.

Medscape © 2020  WebMD, LLC

Any views expressed above are the author’s own and do not necessarily reflect the views of WebMD or Medscape.

Cite this: Michael A. Kaliner. Fast Five Quiz: Test Your Knowledge About Fall Allergies – Medscape – Jul 06, 2020.

Clinical Professor of Medicine, George Washington University School of Medicine; Medical Director, Institute for Asthma and Allergy, Chevy Chase, Maryland

Disclosure: Michael A. Kaliner, MD, has disclosed no relevant financial relationships.

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A 5-Year-Old Girl With High Fever and Nonproductive Cough

A 5-Year-Old Girl With High Fever and Nonproductive Cough

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Nicholas J. Bennett, MB BChir, PhD

May 08, 2020

Editor’s Note:
The Case Challenge series includes difficult-to-diagnose conditions, some of which are not frequently encountered by most clinicians but are nonetheless important to accurately recognize. Test your diagnostic and treatment skills using the following patient scenario and corresponding questions. If you have a case that you would like to suggest for a future Case Challenge, please contact us.

A normally well 5-year-old girl presents with a 2- to 3-week history of fever, cough, and occasional posttussive emesis. She was seen one week ago and was diagnosed with a viral upper respiratory infection after an unremarkable physical examination. Testing for respiratory viral infections was not performed at that time, and symptomatic care was recommended.

After that visit, the patient improved, and 5 days ago, she was afebrile and well enough to return to school. Two days ago, however, the fever and cough returned worse than before. She is now experiencing pain in her right shoulder. Her mother reports that she “just isn’t herself” and has brought her back for reevaluation.

The patient had one episode of vomiting with coughing 2 days ago, with no diarrhea. She has had decreased appetite and activity when febrile. Her fevers have been as high as 104°F (40°C) at home. Her cough is nonproductive. Her mother has given her acetaminophen two or three times to control the fever, but otherwise she takes no medications.

The patient is a normally healthy child with no significant medical history, and her immunizations are up to date, including a seasonal influenza vaccine last month. She has no siblings and lives with her parents, who do not smoke. No known contact with people exposed to tuberculosis (TB) and no significant travel history are noted.

Upon physical examination, the patient is a slightly ill-appearing young girl in no acute distress. Her temperature is 102.6°F (39.2°C), respiratory rate is 28 breaths/min, heart rate is 152 beats/min, and blood pressure is 103/62 mm Hg. The pulse oximetry reading is 98% while she is breathing room air. Her lungs sound clear bilaterally, with normal percussion and no areas of decreased breath sounds, rales, or wheezing.

The patient has normal heart sounds without any murmur, a soft abdomen without organomegaly, mild cervical adenopathy, and no rashes. Her extremities are warm and well-perfused, with a capillary refill time of 2 seconds. No other lymph nodes are palpable in her axillae or groin.

Because of the recurrent fever and cough, a chest radiograph is obtained (Figure 1), which reveals a right upper-lobe opacification and an area of increased lucency. CT of the chest clarifies the diagnosis (Figures 2 and 3).

Figure 1.

Figure 2.

Figure 3.

Medscape © 2020  WebMD, LLC

Any views expressed above are the author’s own and do not necessarily reflect the views of WebMD or Medscape.

Cite this: Nicholas J. Bennett. A 5-Year-Old Girl With High Fever and Nonproductive Cough – Medscape – May 08, 2020.

Staff Physician, Department of Pediatrics, Golisano Children’s Hospital, Upstate Medical University, State University of New York, Syracuse, New York

Disclosure: Nicholas J. Bennett, MB BChir, PhD, has disclosed no relevant financial relationships.

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Figure 2.

Figure 3.

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Drinking Beer Worsens Nasal Symptoms in a 35-Year-Old Man

Drinking Beer Worsens Nasal Symptoms in a 35-Year-Old Man

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Thomas S. Higgins, Jr, MD, MSPH

March 12, 2020

The Case Challenge series includes difficult-to-diagnose conditions, some of which are not frequently encountered by most clinicians but are nonetheless important to accurately recognize. Test your diagnostic and treatment skills using the following patient scenario and corresponding questions. If you have a case that you would like to suggest for a future Case Challenge, please contact us.

A 35-year-old man with a history of adult-onset asthma has had nasal obstruction and smelling loss for 4 months. He also reports postnasal drainage, cough, rhinorrhea, and facial pressure. He has no history of asthma or allergies as a child. He also has no history of previous nasal or paranasal sinus surgery. His symptoms worsen after drinking certain beers and also after using ibuprofen or aspirin.

Over the past 4 months, he has been given three courses of antibiotics, including amoxicillin, azithromycin, and amoxicillin-clavulanate with minimal effect on his symptoms. He has used nasal steroid spray one spray twice a day for 2 months, with partial improvement in symptoms of nasal congestion. He has had two courses of methylprednisolone, which had a significant effect on his symptoms; however, the effect was transient.

Upon physical examination, the patient is alert, oriented, and in no acute distress. Vital signs include an oral temperature of 97.9 °F (36.6 °C), a blood pressure of 115/83 mm Hg, a heart rate of 65 beats/min, and a respiratory rate of 14 breaths/min. Head, ear, throat, and neck examination findings are unremarkable. Nasal examination shows large nasal polyps that fill the nasal cavities bilaterally, large inferior turbinates, and clear mucoid secretions (Figure 1). No crusting or scarring is observed.

Figure 1.

Auscultation of the lungs demonstrates mild expiratory wheezing bilaterally. Allergy skin testing reveals no reactions. Spirometry revealed a forced expiratory volume in the first second of expiration (FEV1) of 75%. Chest radiography findings are normal.

CT scan of the paranasal sinuses reveals severe pansinusitis with complete to near-complete opacification of the paranasal sinus cavities and nasal cavities (Figure 2).

Figure 2.

Mild osteitis of the paranasal sinus bone is observed, with no dehiscence of the lamina papyracea or skull base. Surgical pathology of the lesion reveals findings similar to the image shown below (Figure 3).

Figure 3.

Medscape © 2020 WebMD, LLC

Any views expressed above are the author’s own and do not necessarily reflect the views of WebMD or Medscape.

Cite this: Thomas S. Higgins. Drinking Beer Worsens Nasal Symptoms in a 35-Year-Old Man – Medscape – Mar 12, 2020.

Research Director, Rhinology, Sinus & Skull Base, Kentuckiana ENT; Clinical Assistant Professor, Department of Otolaryngology – Head and Neck Surgery and Communicative Disorders, University of Louisville School of Medicine, Louisville, Kentucky

Disclosure: Thomas S. Higgins, Jr, MD, MSPH, has disclosed no relevant financial relationships.

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An Unvaccinated Girl With Wheezing After Foreign Body Removal

An Unvaccinated Girl With Wheezing After Foreign Body Removal

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Jesse Borke, MD

February 10, 2020

Editor’s Note:
The Case Challenge series includes difficult-to-diagnose conditions, some of which are not frequently encountered by most clinicians but are nonetheless important to accurately recognize. Test your diagnostic and treatment skills using the following patient scenario and corresponding questions. If you have a case that you would like to suggest for a future Case Challenge, please contact us.

A 4-year-old girl with a history of developmental delay is brought to the emergency department (ED) by her parents for wheezing. According to her parents, the patient started wheezing about an hour before her arrival in the ED. They state that she felt warm to touch at home; however, her maximum temperature was 99°F (37.2°C).

The parents did not notice any abnormal breathing pattern or increased work of breathing. They state that the child was never cyanotic and that she has had no rash, pallor, or jaundice. They report that the child is tolerating oral intake and has otherwise been normal in affect and behavior. She has not had a runny nose, vomiting, diarrhea, or any other specific complaints. The parents state they are not aware of any sick contacts.

A review of the patient’s electronic medical record shows that she has had three recent visits to the same ED: one a month prior for fever, which was thought to be due to a viral illness; one 2.5 weeks prior for “just not acting right”; and one a week prior for swallowing a foreign body, which turned out to be a button battery that was removed endoscopically. She has had no prior visits for wheezing or respiratory symptoms.

The patient was born full-term, without complications. Other than developmental delay (not otherwise specified), she is not known to have any chronic medical problems. She is not on any medications and has no known allergies. The child’s parents have refused the recommended vaccination schedule and state spontaneously that they would not like to discuss childhood vaccinations further at this time.

Upon physical examination, the patient is a well-appearing, well-developed girl with weight and height in the 80th and 60th percentiles, respectively. Her oral temperature is 99.1°F (37.3°C), her heart rate is 118 beats/min and regular, and her respiratory rate is 30 breaths/min. Blood pressure has not yet been documented at the time the patient presents to you.

The patient is alert and interactive. She responds well to instructions from the examiner and has a normal-sounding voice when coaxed to speak by the parents. Her breathing shows good excursions. She has no nasal flaring or stridor and no retractions. Upon lung examination, expiratory wheezing and occasional scant crackles are noted bilaterally and are heard best in the upper lung fields. Her skin is normal in color; she is not pale, cyanotic, or mottled.

Upon further examination, the neck is supple, with no adenopathy, stiffness, or meningismus. The posterior pharynx is nonerythematous. No swelling, lesion, exudate, or pooling of secretions is noted. Auscultation of the heart shows regular rate and rhythm S1 and S2. No jugular vein distention is observed. No murmurs are heard. Her abdomen is soft, flat, and nontender. Capillary refill is < 2 sec. Neurologically, the patient is alert. Her parents describe the patient as being at her neurologic and behavioral baseline.

The patient is given nebulized albuterol, and a chest x-ray is obtained. Findings are similar to those shown in the example image below.

Figure 1.

Medscape © 2020 WebMD, LLC

Any views expressed above are the author’s own and do not necessarily reflect the views of WebMD or Medscape.

Cite this: Jesse Borke. An Unvaccinated Girl With Wheezing After Foreign Body Removal – Medscape – Feb 10, 2020.

Associate Medical Director, Department of Emergency Medicine, Los Alamitos Medical Center, Los Alamitos, California

Disclosure: Jesse Borke, MD, has disclosed no relevant financial relationships.

Figure 1.

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A 24-Year-Old Man With Ear Pain, Dizziness, and a Rash

A 24-Year-Old Man With Ear Pain, Dizziness, and a Rash

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D. Brady Pregerson, MD

December 11, 2019

Editor’s Note:
The Case Challenge series includes difficult-to-diagnose conditions, some of which are not frequently encountered by most clinicians but are nonetheless important to accurately recognize. Test your diagnostic and treatment skills using the following patient scenario and corresponding questions. If you have a case that you would like to suggest for a future Case Challenge, please contact us.

A 24-year-old man who was recently diagnosed with HIV presents to the emergency department with a chief complaint of left ear pain that has lasted for the past 24 hours. Yesterday, the patient visited his primary care provider and was informed that his ear appeared normal, without any evidence of infection. However, he now reports that the pain is significantly more intense, and his ear is now red and swollen. He also states that he has vomited twice today and he feels “dizzy.” He describes the dizziness as a feeling that the room is spinning, and it is made worse with any movement of his head.

In addition, the patient states that his hearing in his left ear is muffled compared with that in his right ear. He denies experiencing any fever, chills, headache, or generalized weakness. He also denies scratching his ear or placing foreign bodies (such as cotton swabs) into his ear. He has no history of trauma. The patient has no known medical conditions other than HIV infection and no allergies. He has not yet started taking any medications for HIV or other conditions.

Medscape © 2019 
WebMD, LLC

Cite this: A 24-Year-Old Man With Ear Pain, Dizziness, and a Rash – Medscape – Dec 11, 2019.

Department of Emergency Medicine, Cedars-Sinai Medical Center, Los Angeles, California; Department of Emergency Medicine, Tri-City Medical Center, Oceanside, California

Disclosure: D. Brady Pregerson, MD, has disclosed no relevant financial relationships.

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A 44-Year-Old With a Headache, Photophobia, and Phonophobia

A 44-Year-Old With a Headache, Photophobia, and Phonophobia

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James Lee, MD; Stephanie Oh, PhD; Gaurav Gupta, MD

November 13, 2019

The Case Challenge series includes difficult-to-diagnose conditions, some of which are not frequently encountered by most clinicians but are nonetheless important to accurately recognize. Test your diagnostic and treatment skills using the following patient scenario and corresponding questions. If you have a case that you would like to suggest for a future Case Challenge, please contact us.

A 44-year-old, right-handed woman presents to an outpatient clinic 1 month after being diagnosed with influenza, for which she received treatment with oseltamivir. She reports that 2 weeks after her illness, she began experiencing an insidious headache along her left occipital region. She also describes left ear hyperacusis, difficulty furrowing her left eyebrow and closing her left eye, left-sided tongue numbness, and left facial asymmetry. At that time, she presented to her primary care physician, who indicated that it was probably due to the effects of her viral illness. She prescribed the patient prednisone and valganciclovir for 1 week, with no improvement in her symptoms. She was also given an eye patch and eye drops, as well as a prescription for physical therapy.

The patient reports having photophobia, phonophobia, and lightheadedness associated with her symptoms. She reports using ibuprofen, with moderate improvement in the aforementioned headache. She denies any history of similar headaches. The patient otherwise also denies any history of recent travel, hiking, or tick exposure, as well as any fevers, rashes, or joint pain.

Her medical history is significant for irregular menstrual periods, for which she is on oral estrogen-based contraception. She also has a history of Raynaud syndrome-associated bilateral leg pain, for which she was successfully treated with verapamil and pregabalin, with resolution of her symptoms.

She describes no significant surgical history. In terms of her family, she is a married, heterosexual woman with two healthy children. Her parents are both alive, in their 70s, with a history of hyperlipidemia. She denies any known family history of cancer, thyroid issues, or autoimmune disease.

Medscape © 2019 WebMD, LLC

Any views expressed above are the author’s own and do not necessarily reflect the views of WebMD or Medscape.

Cite this: James Lee, Stephanie Oh, Gaurav Gupta. A 44-Year-Old With a Headache, Photophobia, and Phonophobia – Medscape – Nov 13, 2019.

Fellow, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania

Disclosure: James Lee, MD, has disclosed no relevant financial relationships.

Medical student, Rutgers Robert Wood Johnson Medical School, Piscataway, New Jersey

Disclosure: Stephanie Oh, PhD, has disclosed no relevant financial relationships.

Associate Professor, Rutgers Robert Wood Johnson Medical School, Piscataway, New Jersey

Disclosure: Gaurav Gupta, MD, has disclosed no relevant financial relationships.

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Fast Five Quiz: Sore Throat

Fast Five Quiz: Sore Throat

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Arlen D. Meyers, MD, MBA

November 06, 2019

Sore throats are among the more commonly reported symptoms. Viruses are responsible for 85%-95% of sore throats in adults, 70% in children aged 5-16 years, and 95% in children younger than 5 years. Although most cases resolve spontaneously, it is important to be able to recognize and diagnose significant associated conditions and follow recommended best practices. Do you know key aspects and proper approaches associated with pharyngitis, tonsillitis, and laryngitis? Test yourself with this quick quiz.

Medscape © 2019 WebMD, LLC

Any views expressed above are the author’s own and do not necessarily reflect the views of WebMD or Medscape.

Cite this: Arlen D. Meyers. Fast Five Quiz: Sore Throat – Medscape – Nov 06, 2019.

Professor of Otolaryngology, Dentistry, and Engineering, University of Colorado School of Medicine, Aurora, Colorado

Disclosure: Arlen D. Meyers, MD, MBA, has disclosed the following relevant financial relationships:
Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Cerescan; RxRevu; Cliexa; The Physicians Edge; Sync-n-Scale; mCharts
Received income in an amount equal to or greater than $250 from: The Physicians Edge; Cliexa
Received stock from: RxRevu
Received ownership interest from: Cerescan, for consulting

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