Does This Patient Have Sinusitis?  Diagnosing Acute Sinusitis by History and Physical Examination

John W. Williams Jr, MD, MHS; David L. Simel, MD, MHS
JAMA. 1993;270(10):1242-1246. doi:10.1001/jama.1993.03510100092039.
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Clinical Scenario  The patient presents to your office with a "bad cold." Her symptoms began 5 days ago when a runny nose, a scratchy throat, generalized malaise, and a nonproductive cough developed. Her symptoms are gradually improving with an over-the-counter cough medicine, but during the past 24 hours a "sinus headache" has developed. The patient is concerned that she may have "sinus." Of note, it is the middle of "cold and flu" season, and this is the fifth patient you've seen today with upper respiratory-tract symptoms.

Why Is This an Important Question to Answer With a Clinical Examination?  The patient's story is familiar to primary care clinicians. Indeed, the most frequent diagnoses made by primary care practitioners include nasal problems such as allergic and infectious rhinitis, vasomotor rhinitis, and bacterial sinusitis.1 Given the constant assault of allergens, environmental pollutants, respiratory viruses, and rapid temperature


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The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
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