[Expert Solution]: Chief Complaint: Facial Pain History of…

Chief Complaint: Facial Pain History of Present Illness: A 40 y.o. female comes to the clinic for a recheck following a 10-day course of antibiotics for sinusitis. She states that the fever has dissipated, but she continues to have pressure and stuffiness over the right eye. Her mucus is thick yellow, but she has no green or bloody mucous. HA is relieved by Tylenol or Advil. She has been using nasal spray and decongestants with minimal relief. She denies ST, cough, or sneezing as well as dental pain or sores of the gums. Past Medical History Allergies to trees, grasses, and molds per allergist Frequent sinus infections likely related to allergies TAH for fibroids in 2011 Tympanostomy tubes from age 4 to7, then removed NKDA Current Meds Flonase Nasal Spray—two sprays each nostril BID Mucinex D 600 mg Q12h Family History Father, age 75, HTN, tobacco use Mother, age 72, hypothyroidism secondary to hyperthyroidism with RAI ablation Sister, age 38, good health Psychosocial History Lives in single family home with husband and two children, ages 15 and 12. Nonsmoker and works as an office manager in nonsmoking environment. Exercises three to four times weekly for one hour. Occasional ETOH. Review of Systems General: Denies weight loss, fever, weakness, fatigue. HEENT: Had allergy testing and received allergy shots for 3 years with some success. Has postnasal drip, which is worse in fall and spring. Admits to frequent colds and sinus infections. CV: Denies HTN, chest pain, palpitations, murmur, edema, abnormal EKG. Respiratory: Denies chronic cough, SOB, DOE, paroxysmal nocturnal dyspnea, hemoptysis, history of asthma, emphysema, pneumonia, TB. Neuro: Admits to HAs and occasional dizziness with sinus infections and “allergy attacks.” Denies fainting, seizures, tremors, loss of consciousness, numbness or tingling. Physical Examination Vital signs: T 98.8, BP 117/78, HR 76, RR 16, BMI 25. General: Pale, somewhat listless, cooperative, no acute distress. HEENT: Posterior pharynx without inflammation, tonsils 1+. Nasal mucosa boggy with thin yellow discharge. Right frontal sinus slightly tender on firm palpation. Maxillary sinuses nontender. TMs shiny with good light reflex, canal without inflammation. Vision 20/25 OD, 20/20 OS. External ocular structures without inflammation, conjunctiva light pink, PERRLA, EOMs parallel with no nystagmus, peripheral vision full in all eight fields. Retina and disc clear, no papilledema, hemorrhages, A-V changes. Neck: No lymphadenopathy, thyroid not enlarged. CV: RR&R, no murmurs, clicks, snaps, splits. Peripheral pulses 2+ bilaterally, no temporal artery tenderness. No peripheral edema. Respiratory: Clear A&P, no adventitious sounds. Percussion resonant throughout. Neuro: CNs I to XII intact. Alert and oriented x 4. No nuchal rigidity. Immediate and remote memory accurate. Romberg negative. Motor 5/5 in all extremities. Stereognosis and proprioception appropriate. Case Study Discussion – Part I: Answer the following and post your response in the Case Study Part I by creating your own initial thread. Identify a minimum of three conditions that you would consider in your differential diagnosis, with the most likely condition listed first. Your third differential diagnosis should be a “can’t miss” or life threatening condition. Include at least 5-10 pertinent positives and negatives. Provide rationale for each differential with supporting evidence from the case study. Include underlying etiology, demographics, risk factors, clinical manifestations- signs (objective findings on exam) and symptoms (subjective findings), along with pertinent positives and negatives in your clinical reasoning narrative per differential diagnosis. What further history, further physical examination, and diagnostic studies should be considered in order to explore your differential diagnosis and confirm your suspicions? Provide rationale and supporting evidence based resources for each further history, examination and diagnostic studies.