A patient complains of pain and tenderness above and below the eyes with headache. On assessment, it is seen that there is fever, a stuffy nose, and thick mucus in the nose. Which condition does it indicate?

1. A

   Tension headache

2. B

   Migraine

3. C

   Hay fever

4. D

   Sinusitis

Appeared in: BTSC Staff Nurse 1 August-2025

Explanation

• The patient's presentation includes a cluster of symptoms that are classic for sinusitis: facial pain and tenderness over the sinus areas (above and below the eyes), fever, nasal congestion, and purulent (thick) nasal discharge.
• Sinusitis, also known as rhinosinusitis, is an inflammation of the paranasal sinuses and nasal cavity, which obstructs drainage and leads to mucus buildup.
• The presence of fever and thick, colored mucus specifically suggests acute bacterial rhinosinusitis (ABRS), distinguishing it from viral or allergic causes.

Why Other Options Were Wrong

• Option A: Tension headaches are typically described as a constant, band-like pressure around the head. They are not associated with fever, facial tenderness, or thick nasal discharge.
• Option B: Migraines are severe, often unilateral, throbbing headaches, commonly associated with nausea, vomiting, and sensitivity to light and sound. While nasal congestion can sometimes occur, fever and thick, purulent mucus are not typical features.
• Option C: Hay fever, or allergic rhinitis, is an allergic response. It is characterized by itchy eyes, sneezing, and a runny nose with thin, clear mucus. It does not typically cause fever or facial pain, although sinus pressure can occur.

Related Visual

Clinical Relevance

• Nursing practice connection: Use the key finding related to Differential diagnosis of facial pain and headache based on clinical symptoms to guide bedside assessment, documentation, and the next nursing action.
• A key nursing role is to assess and differentiate the cause of head and facial pain. Recognizing the signs of bacterial sinusitis (fever, purulent discharge, facial pain) is crucial for timely referral and treatment to prevent complications.
• Patient education is vital. Nurses should instruct patients on symptom management (e.g., warm compresses, hydration, saline nasal sprays) and the correct use of prescribed medications like antibiotics.
• What if? If the patient also reported severe headache, vision changes (like double vision), and swelling around the eye (periorbital edema), the nurse must suspect a serious complication like orbital cellulitis or an intracranial abscess and escalate care immediately.

How to Approach the Question

• First, analyze the patient's chief complaints: pain/tenderness above and below the eyes, and headache.
• Next, consider the associated signs and symptoms: fever, stuffy nose, and thick mucus. This cluster of symptoms points towards an infectious and inflammatory process.
• Evaluate each option against the symptom cluster. Tension headaches and migraines primarily involve head pain without the infectious signs (fever, thick mucus).
• Differentiate between sinusitis and hay fever. Hay fever involves clear, watery discharge and itching, whereas the patient has thick mucus and fever, which are characteristic of sinusitis.
• Conclude that sinusitis is the only condition that accounts for all the patient's symptoms: localized facial pain, headache, fever, and purulent nasal discharge.

Concept Tested & Keywords

• Concept Tested: Differential diagnosis of facial pain and headache based on clinical symptoms.
• Stem keywords: pain and tenderness above and below the eyes, headache, fever, stuffy nose, thick mucus
• Lead-in keywords: Which condition does it indicate?
• Clinical cues: The combination of localized facial pain, fever, and purulent discharge strongly points towards an infectious process in the sinuses.

Question ID

QaIgzKPvc3VL5mSSLEJCJ-

Copy ID

Reference Book

E6 Nursing Brunner Adult Health 3SA Vol 2 Part 1 p. 32-34

E6 Nelson Textbook of Pediatrics(2024) — Volume 2 p. 340-342