Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

MKSAP: 32-year-old man with cough and nasal congestion

mksap
Conditions
September 14, 2014
Share
Tweet
Share

Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians.

A 32-year-old man is evaluated for a 3-day history of productive cough, sore throat, coryza, rhinorrhea, nasal congestion, generalized myalgia, and fatigue. His sputum is slightly yellow. His two children (ages 3 years and 1 year) had similar symptoms 1 week ago. He is a nonsmoker and has no history of asthma.

On physical examination, temperature is 37.5 °C (99.4 °F), blood pressure is 128/76 mm Hg, pulse rate is 92/min, and respiration rate is 14/min. There is bilateral conjunctival injection. The nasal mucosa is boggy, with clear drainage. The oropharynx is erythematous without tonsillar enlargement or exudates. The tympanic membranes and external auditory canals are normal. Lungs are clear to auscultation. There is no rash or lymphadenopathy.

Which of the following is the most appropriate treatment?

A: Albuterol
B: Amoxicillin
C: Chlorpheniramine
D: Codeine

MKSAP Answer and Critique

The correct answer is C: Chlorpheniramine.

Treatment with chlorpheniramine may be considered for this patient. The common cold, or rhinosinusitis, presents with acute cough, nasal congestion, rhinorrhea, and occasionally, low-grade fever. Targeted treatment is aimed at symptom relief.

Antihistamines, such as chlorpheniramine, and antihistamine-decongestant combinations have been shown to decrease congestion and rhinorrhea with variable effects on cough suppression. Second-generation nonsedating antihistamines are generally ineffective for rhinosinusitis symptoms.

Albuterol does not relieve symptoms of rhinosinusitis unless wheezing is present. The patient did not report wheezing or shortness of breath, and wheezes were not heard on examination.

Because rhinosinusitis is caused by viruses, routine antibiotic treatment in immunocompetent hosts is not recommended. Antibiotics do not improve symptoms, illness duration, or patient satisfaction with medical care. Contrary to common belief, purulent sputum does not reliably predict bacterial infection or superinfection. Therefore, sputum purulence should not be used as a criterion for antibiotic administration.

Evidence-based guidelines from the Infectious Diseases Society of America suggest that if bacterial rhinosinusitis is highly suspected, based on the presence of persistent symptoms or signs lasting more than 10 days without evidence of clinical improvement, onset with severe symptoms (fever >39.0 °C [102.2 °F]), or onset with worsening symptoms or signs (new fever, headache, or upper respiratory tract infection symptoms that were initially improving), the antibiotic of choice is amoxicillin-clavulanate.

Multiple studies have found little if any improvement in acute cough associated with acute upper respiratory tract infections by using codeine, dextromethorphan, or moguisteine antitussive therapy. The American College of Chest Physicians does not recommend treatment with these medications. Codeine may be effective in patients with chronic cough; however, it is not indicated in this patient with acute rhinosinusitis.

Other treatments that may relieve symptoms of rhinosinusitis include intranasal ipratropium (rhinorrhea and sneezing), intranasal cromolyn (rhinorrhea, cough, throat pain), and short-term topical nasal decongestants (nasal obstruction). Consistent high-quality data on the use of zinc, echinacea, and vitamin C do not support the use of these over-the-counter products for the treatment or prevention of rhinosinusitis.

ADVERTISEMENT

Key Point

  • Antibiotics are not recommended for the treatment of acute rhinosinusitis.

This content is excerpted from MKSAP 16 with permission from the American College of Physicians (ACP). Use is restricted in the same manner as that defined in the MKSAP 16 Digital license agreement. This material should never be used as a substitute for clinical judgment and does not represent an official position of ACP. All content is licensed to KevinMD.com on an “AS IS” basis without any warranty of any nature. The publisher, ACP, shall not be liable for any damage or loss of any kind arising out of or resulting from use of content, regardless of whether such liability is based in tort, contract or otherwise.

Prev

Nonprofit hospitals: The potential for conflict of interest is huge

September 14, 2014 Kevin 3
…
Next

5 things people get wrong about Canada’s health system

September 14, 2014 Kevin 12
…

Tagged as: Primary Care

Post navigation

< Previous Post
Nonprofit hospitals: The potential for conflict of interest is huge
Next Post >
5 things people get wrong about Canada’s health system

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

More by mksap

  • a desk with keyboard and ipad with the kevinmd logo

    MKSAP: 26-year-old man with back pain

    mksap
  • a desk with keyboard and ipad with the kevinmd logo

    MKSAP: 36-year-old man with abdominal cramping, diarrhea, malaise, and nausea

    mksap
  • a desk with keyboard and ipad with the kevinmd logo

    MKSAP: 52-year-old woman with osteoarthritis of the right hip

    mksap

More in Conditions

  • Earwax could hold secrets to cancer, Alzheimer’s, and heart disease

    Sandra Vamos, EdD and Domenic Alaimo
  • Why male fertility needs to be part of every health conversation

    Hoag Memorial Hospital Presbyterian
  • Why health care must adapt to meet the needs of older adults with disabilities

    Lynn A. Schaefer, PhD
  • 4 traits every new attending physician needs to thrive

    Sarah Epstein
  • When the diagnosis is personal: What my mother’s Alzheimer’s taught me about healing

    Pearl Jones, MD
  • Why local cardiac CT scans could save your life

    Benjamin Cohen, MD
  • Most Popular

  • Past Week

    • What the world must learn from the life and death of Hind Rajab

      Saba Qaiser, RN | Conditions
    • Why Medicaid cuts should alarm every doctor

      Ilan Shapiro, MD | Policy
    • When the diagnosis is personal: What my mother’s Alzheimer’s taught me about healing

      Pearl Jones, MD | Conditions
    • Key strategies for smooth EHR transitions in health care

      Sandra Johnson | Tech
    • Reassessing the impact of CDC’s opioid guidelines on chronic pain care [PODCAST]

      The Podcast by KevinMD | Podcast
    • Why flashy AI tools won’t fix health care without real infrastructure

      David Carmouche, MD | Tech
  • Past 6 Months

    • Why tracking cognitive load could save doctors and patients

      Hiba Fatima Hamid | Education
    • How dismantling DEI endangers the future of medical care

      Shashank Madhu and Christian Tallo | Education
    • What the world must learn from the life and death of Hind Rajab

      Saba Qaiser, RN | Conditions
    • How scales of justice saved a doctor-patient relationship

      Neil Baum, MD | Physician
    • The silent toll of ICE raids on U.S. patient care

      Carlin Lockwood | Policy
    • Why shared decision-making in medicine often fails

      M. Bennet Broner, PhD | Conditions
  • Recent Posts

    • How locum tenens work helps physicians and APPs reclaim control

      Brian Sutter | Policy
    • The hidden incentives driving frivolous malpractice lawsuits

      Howard Smith, MD | Physician
    • Why what doctors say matters more than you think [PODCAST]

      The Podcast by KevinMD | Podcast
    • How Mark Twain would dismantle today’s flawed medical AI

      Neil Baum, MD and Mark Ibsen, MD | Tech
    • Mastering medical presentations: Elevating your impact

      Harvey Castro, MD, MBA | Physician
    • Marketing as a clinician isn’t about selling. It’s about trust.

      Kara Pepper, MD | Physician

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

Leave a Comment

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

  • Most Popular

  • Past Week

    • What the world must learn from the life and death of Hind Rajab

      Saba Qaiser, RN | Conditions
    • Why Medicaid cuts should alarm every doctor

      Ilan Shapiro, MD | Policy
    • When the diagnosis is personal: What my mother’s Alzheimer’s taught me about healing

      Pearl Jones, MD | Conditions
    • Key strategies for smooth EHR transitions in health care

      Sandra Johnson | Tech
    • Reassessing the impact of CDC’s opioid guidelines on chronic pain care [PODCAST]

      The Podcast by KevinMD | Podcast
    • Why flashy AI tools won’t fix health care without real infrastructure

      David Carmouche, MD | Tech
  • Past 6 Months

    • Why tracking cognitive load could save doctors and patients

      Hiba Fatima Hamid | Education
    • How dismantling DEI endangers the future of medical care

      Shashank Madhu and Christian Tallo | Education
    • What the world must learn from the life and death of Hind Rajab

      Saba Qaiser, RN | Conditions
    • How scales of justice saved a doctor-patient relationship

      Neil Baum, MD | Physician
    • The silent toll of ICE raids on U.S. patient care

      Carlin Lockwood | Policy
    • Why shared decision-making in medicine often fails

      M. Bennet Broner, PhD | Conditions
  • Recent Posts

    • How locum tenens work helps physicians and APPs reclaim control

      Brian Sutter | Policy
    • The hidden incentives driving frivolous malpractice lawsuits

      Howard Smith, MD | Physician
    • Why what doctors say matters more than you think [PODCAST]

      The Podcast by KevinMD | Podcast
    • How Mark Twain would dismantle today’s flawed medical AI

      Neil Baum, MD and Mark Ibsen, MD | Tech
    • Mastering medical presentations: Elevating your impact

      Harvey Castro, MD, MBA | Physician
    • Marketing as a clinician isn’t about selling. It’s about trust.

      Kara Pepper, MD | Physician

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Leave a Comment

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...