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Pediatric Rounds Review Questions

Headache and Forehead Swelling in a 9-Year-Old
Boy with Sinusitis

Samuel C. Blackman, MD, PhD and Mark R. Schleiss, MD

Dr. Blackman is a fellow in pediatric oncology, Dana-Farber Cancer Institute, Boston, MA. Dr. Schleiss is American Legion Chair of Pediatrics and director, division of Pediatric Infectious Diseases, University of Minnesota Medical School,Minneapolis, MN.

The questions below are based on the February 2005 Pediatric Rounds article, “A Headache and Forehead Swelling in a 9-Year-Old Boy with Sinusitis”

Choose the single best answer for each question.

1. What is the earliest complication of frontal sinusitis that is associated with impairment of visual acuity?
  1. Periorbital (preseptal) cellulitis
  2. Orbital (postseptal) cellulitis
  3. Subperiosteal abscess
  4. Orbital abscess
  5. Cavernous sinus thrombosis
Click here to compare your answer.

2. You are seeing a 14-year-old girl who has been receiving treatment for a clinical diagnosis of sinusitis. She now complains of fever and a right eye that is swollen shut. What is the most appropriate imaging study to order?

  1. Bone scan
  2. Computed tomography (CT) of the brain, including orbits and sinuses
  3. Magnetic resonance imaging (MRI) of the brain
  4. Skull radiographs
  5. Ultrasound evaluation of the sinuses
Click here to compare your answer.

3. Which of the following symptoms most likely indicates a poor prognosis in patients with intracranial complications of frontal sinusitis?

  1. Altered level of consciousness
  2. Headache
  3. Papilledema
  4. Seizures
  5. Vomiting
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4. Which of the following antibiotic combinations provides LESS coverage for organisms found in Pott’s puffy tumor?
  1. Cefazolin/gentamicin
  2. Clindamycin/metronidazole
  3. Metronidazole/nafcillin
  4. Nafcillin/ceftazidime
  5. Ticarcillin/clavulanic acid
Click here to compare your answer.

5. Sir Percivall Pott provided initial descriptions of all of the following conditions EXCEPT:

  1. Coal tar-induced cancer of the skin, particularly localized to the scrotum
  2. Contracture of the palmar fascia causing the ring and little fingers to bend into the palm so they cannot be extended
  3. Extradural abscess as the result of head injury
  4. Fracture dislocation of the ankle
  5. Tubercular disease of the vertebral body
Click here to compare your answer.


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