first appointment.Antibioticsshould also be initiated in patientswho have failed to improvewithin a seven-day period.Thepreferred antibioticisamoxicillin500 mg three times daily oramoxicillin-clavulanate500 mg/120 mg threetimes daily. Recurrence of symptoms within two weeks of response to initial treatment usually indicates inadequateeradication of infection.
Rinne test (A)is a hearing test commonly performed to evaluate bone conduction versus air conduction. The test isperformed by placing a tuning fork on the mastoid bone behind the ear. An abnormal result occurs when sound is at leastequally loud or louder when the fork is placed on bone as compared with when it is held next to the ear (indicating bone isbetter than air conduction). An abnormal Rinne test is consistent with conductive hearing loss.Sinus percussion (B)is acomponent of the physical exam used to evaluate for sinusitis. It does not involve a penlight. Instead, sinus pressure isapplied by tapping over the involved sinuses. A positive test is one that evokes pain, indicating acute sinusitis.Weber test(D)is used to identify sensorineural hearing loss. The test is performed by placing the handle of the tuning fork to the bridgeof the forehead or nose and asking the patient if the sound is louder in one ear or the other. The sound is heard equally inboth ears in patients with normal hearing or symmetric hearing loss. In patients complaining of a unilateral decrease inhearing, the Weber test suggests sensorineural hearing loss if the sound lateralizes to, or is louder on, the intact side, andconductive hearing loss is suspected if the sound lateralizes to the side of subjective hearing loss.Question:What findings are common on CT scan in a patient with sinusitis?Answer:Air-fluid levels, mucosal edema, and air bubbles within the sinuses.Sinusitis•Patient will be complaining of pain over sinuses•PE will show purulent rhinorrhea•Most commonly caused byviralURI•Treatment is supportive care•Comments: bacterial sinusitis - persistent symptoms for more than 10-14 days -amoxicillin-clavulanate
A 30-year-old man presents to the clinic with a tender lump under his tongue that is exacerbated by meals. Past medicalhistory is significant for recurrent sialadenitis. Examination of his mouth reveals local swelling and a large calculus on theanterior floor of his mouth. Which of the following is the most likely anatomic location of the calculus?•AFrenulum linguae•BStensen duct•CSublingual duct•DWharton ductCorrect AnswerCorrect Answer ( D )Explanation:Sialolithiasisis theformation of calculiin thesalivary glands. Themost common locationof sialolithiasis istheWharton duct.The Wharton duct is located on theanterior floorof themouth under the tongueanddrains thesubmandibular gland.Calculiin the Wharton duct appearlargeandradiopaque. Sialolithiasis ismore common inmenthat women. It is rare in children. Most cases of sialolithiasis occur between30-60 years of age.
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