American Board of Family Medicine (ABFM) Practice Exam

Considering a patient with a four-day history of hoarseness, cough with sputum, tender sinuses, and nasal congestion, what is the most likely diagnosis?

1. Acute laryngitis

2. Sinusitis

3. Allergic rhinitis

4. Pharyngitis

The correct answer is: Acute laryngitis

In this clinical scenario, the presence of hoarseness, cough with sputum production, tender sinuses, and nasal congestion points towards an upper respiratory tract infection. Acute laryngitis is characterized by inflammation of the larynx, which often presents with hoarseness as a prominent symptom. The patient's four-day history of hoarseness indicates that the vocal cords may be inflamed, likely due to a viral infection that commonly accompanies other upper respiratory symptoms such as cough and nasal congestion. The cough, along with sputum production, suggests irritation or inflammation in the respiratory tract, while tender sinuses can indicate concurrent sinus involvement. While sinusitis can cause sinus tenderness and nasal congestion, it typically presents with facial pain, pressure, or purulent nasal discharge rather than hoarseness as the primary symptom. Allergic rhinitis would cause nasal symptoms without the cough and sputum associated with an infection, and pharyngitis is more commonly associated with sore throat rather than hoarseness being the primary concern. Overall, the specific combination of hoarseness and respiratory symptoms in this case is most consistent with acute laryngitis, making it the most likely diagnosis.