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ENT · Paranasal sinuses
Sample itemA 15-year-old boy with acute frontal sinusitis develops a tender, doughy swelling over his forehead with fever. What is this swelling called and what does it represent?
Original practice item, not a recalled exam question. Nothing here is recorded.
The answer and the reasoning
B. Pott's puffy tumour, a subperiosteal abscess with osteomyelitis of the frontal bone
Acute frontal sinusitis can spread through the diploic veins to cause osteomyelitis of the frontal bone with a subperiosteal collection, seen as a puffy forehead swelling. It can extend intracranially to cause epidural or subdural abscess, so prompt drainage and antibiotics are required.
Option by option
A. Orbital cellulitis, infection posterior to the orbital septum
Orbital cellulitis presents with lid oedema, proptosis and painful eye movement rather than a forehead swelling.
B. Pott's puffy tumour, a subperiosteal abscess with osteomyelitis of the frontal bone (correct)
Spread through the frontal bone produces a tender forehead swelling that is the classic Pott's puffy tumour.
C. Frontal mucocele, a slowly expanding painless cyst
A mucocele grows slowly over months and is painless, which does not fit a febrile acute swelling.
D. Cavernous sinus thrombosis, a septic thrombosis of the dural venous sinus
Cavernous sinus thrombosis presents with bilateral eye signs and cranial nerve palsies, not a localised forehead swelling.
Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.
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