06-22-2007, 08:36 AM
A 4-year-old boy is admitted to the hospital with right eyelid swelling and redness. Approximately 3
days prior to admission he developed nasal discharge, fever, and then 24 hours prior, developed the
right eyelid swelling and erythema. He has a history of mild asthma and his vaccinations are up to date.
His temperature is 38.9 C (102 F), blood pressure 114/68 mm Hg, and pulse is 78/min. There is mild
proptosis on the right. Extraocular motor examination is remarkable for difficulty moving the right
medially, pupils are equally round and reactive to light. No lymphadenopathy is present. Laboratory
studies show: leukocyte count 18,000mm3, hematocrit 35%, blood urea nitrogen 10 mg/dL, creatinine
0.6 mg/dL, sodium 135 mg/dL, and potassium 4.1 mg/dL. Intravenous cefuroxime therapy is initiated.
The most appropriate next step in management is to
A. administer amphotericin B, intravenously
B. discharge him after 24 hours of antibiotics
C. order a CT scan of the orbits with intravenous contrast
D. prepare him for surgical exploration of the right orbit
E. prepare him for surgical exploration of the sinuses
days prior to admission he developed nasal discharge, fever, and then 24 hours prior, developed the
right eyelid swelling and erythema. He has a history of mild asthma and his vaccinations are up to date.
His temperature is 38.9 C (102 F), blood pressure 114/68 mm Hg, and pulse is 78/min. There is mild
proptosis on the right. Extraocular motor examination is remarkable for difficulty moving the right
medially, pupils are equally round and reactive to light. No lymphadenopathy is present. Laboratory
studies show: leukocyte count 18,000mm3, hematocrit 35%, blood urea nitrogen 10 mg/dL, creatinine
0.6 mg/dL, sodium 135 mg/dL, and potassium 4.1 mg/dL. Intravenous cefuroxime therapy is initiated.
The most appropriate next step in management is to
A. administer amphotericin B, intravenously
B. discharge him after 24 hours of antibiotics
C. order a CT scan of the orbits with intravenous contrast
D. prepare him for surgical exploration of the right orbit
E. prepare him for surgical exploration of the sinuses