A 10-year-old girl has had a “cold” for 14 days. In the 2 days prior to the visit to your office, she has developed a fever of 39°C (102.2°F), purulent nasal discharge, facial pain, and a daytime cough. Examination of the nose after topical decongestants shows pus in the middle meatus. Which of the following is the most likely diagnosis?
a. Brain abscess
b. Maxillary sinusitis
c. Streptococcal throat infection
d. Sphenoid sinusitis
e. Middle-ear infection
the answer is below…
The United States Medical Licensing Examination, or USMLE for short, is a three-part licensing examination that is required in order to receive a license to practice medicine within the United States.
The USMLE assesses a physician’s ability to apply knowledge, concepts, and principles, and to determine fundamental patient-centered skills that are important in health and disease and that constitute the basis of safe and effective patient care.Examination committees composed of medical educators and clinicians from across the United States and its territories prepare the examination materials each year.
This exam is designed by the Federation of State Medical Boards and the National Board of Medical Examiners to determine whether or not an individual understands and can apply the knowledge necessary to practice medicine safely and intelligently.
The USMLE is actually comprised of three different exams that are referred to as steps, which examine the individual’s knowledge of specific topics related to the field of medicine such as basic science, medical knowledge, medical skills, clinical science, and the application of all of these skills and areas of knowledge in the medical field.
All three steps of the USMLE include a series of computerized multiple-choice questions, but the format of the exam and the information covered in each multiple-choice section is different for each step of the USMLE. The USMLE Step II also has a clinical skills portion that examines an individual’s ability to work with real patients and the USMLE Step III has a computerized patient simulation portion in addition to the multiple-choice section of the exam. In order for an individual to receive a license to practice medicine, the individual must pass all three steps of the USMLE.
The correct answer is b; Maxillary sinusitis.
Maxillary and ethmoid sinuses are large enough to harbor infections from infancy. Frontal sinuses are rarely large enough to harbor infections until the sixth to tenth year of life. Sphenoid sinuses do not become large until about the third to fifth year of life. In general, a “cold” lasting longer than 10 to 14 days with fever and facial pain is indicative of sinusitis. Examination of the nose can reveal pus draining from the middle meatus in maxillary, frontal, or anterior ethmoid sinusitis. Pus in the superior meatus indicates sphenoid or posterior ethmoid sinuses. Diagnosis is on clinical grounds and can be difficult. Positive findings on plain sinus films in a symptomatic child are supportive of sinusitis. CT scans are more sensitive, but are usually reserved for the more complicated cases. The treatment is usually oral antibiotics for 10 to 14 days. Decongestants and antihistamines have not been shown to be helpful or necessary.