A 13-year-old girl comes to the physician for evaluation of her third episode of maxillary sinusitis during the past 7 months. She complains of fever, headache, nasal congestion, and facial pain that began 3 days ago. Except for previous sinusitis episodes, her medical history is unremarkable. The patient has no known allergies. Her family history is unremarkable, but both parents smoke cigarettes. On examination, she has maxillary sinus tenderness and purulent nasal discharge. The remainder of the examination is normal. Computed tomography scan demonstrates mucosal thickening, opacification, and air-fluid levels in the maxillary sinuses. Which of the following should the physician say to the patient's parents?

Question

A 13-year-old girl comes to the physician for evaluation of her third episode of maxillary sinusitis during the past 7 months.  She complains of fever, headache, nasal congestion, and facial pain that began 3 days ago.  Except for previous sinusitis episodes, her medical history is unremarkable.  The patient has no known allergies.  Her family history is unremarkable, but both parents smoke cigarettes.  On examination, she has maxillary sinus tenderness and purulent nasal discharge.  The remainder of the examination is normal.  Computed tomography scan demonstrates mucosal thickening, opacification, and air-fluid levels in the maxillary sinuses. Which of the following should the physician say to the patient's parents?

Quizplus · Accepted Answer

Explanation: This patient presents with recurrent sinusitis, most likely due to secondhand smoke exposure. Cigarette smoke and air pollution can damage the cilia responsible for moving mucus through the sinuses. The mucus builds up and obstructs the sinuses, resulting in secondary bacterial overgrowth. Other common causes of recurrent sinusitis in otherwise healthy people include inadequately treated acute sinusitis, structural abnormalities of the nasal septum or palate, and allergic rhinitis. (Choice A) Granulomatosis with polyangiitis (Wegener's) is a systemic necrotizing vasculitis marked by glomerulonephritis, chronic pneumonitis, and recurrent sinusitis/otitis media. It occurs most commonly in older adults and is unlikely in this patient. (Choice B) Hereditary immunodeficiencies are usually recessive or X-linked and marked by multiple sites of recurrent infection. This patient has no other recurrent infections and an unremarkable family history, making this diagnosis unlikely. (Choice C) Cocaine abuse may cause chronic or recurrent sinusitis. This patient does not have other associated symptoms, such as nosebleeds, agitation, hypertension, and weight loss. It is inappropriate to declare this suspicion to the parents without further evaluation (eg, drug testing) and discussion with the patient. (Choice E) Kartagener syndrome is an autosomal recessive disorder consisting of situs inversus, chronic sinusitis, and airway disease leading to bronchiectasis. It is a subgroup of a congenital mucociliary disorder known as primary ciliary dyskinesia. This patient has no other recurrent infections, making this diagnosis unlikely. situs inversus Educational objective: Exposure to cigarette smoke and air pollution causes recurrent or chronic sinusitis by damaging the cilia responsible for moving mucus through the sinuses. Other common causes of chronic or recurrent sinusitis include inadequately treated acute sinusitis, structural abnormalities of the nasal septum or palate, and allergic rhinitis. References: Relationship between passive smoking, recurrent respiratory tract infections and otitis media in children. (http://www.ncbi.nlm.nih.gov/pubmed/10577820)

A 13-Year-Old Girl Comes to the Physician for Evaluation of Her