Upper respiratory tract infections Quiz: Ace Your Exams

A 42-year-old woman presents to the clinic for evaluation of fever, nasal congestion, and drainage which started 12 days ago.  She has been doing saline nasal washes twice daily, and taking over-the-counter nasal decongestant medications. She had initial improvement in her symptoms; however, the symptoms worsened on day 8 when she developed a higher fever, increasing nasal drainage, facial pain, and loss of smell. Medical history is significant for diabetes mellitus type 2, nasal polyps, and hypothyroidism. Temperature is 38.5°C (101.3°F), pulse is 108/minute, respiratory rate is 12/minute, blood pressure is 124/76 mmHg, and oxygen saturation is 97% on room air. On physical examination, she is not in acute distress. Nasal examination is significant for dark green purulent drainage and enlarged, erythematous nasal turbinates. She has tenderness to palpation over the maxillary sinuses bilaterally. The lungs are clear to auscultation bilaterally. Which of the following historical elements supports a bacterial etiology as the cause of this patient’s presentation?