You are the flight surgeon at a busy southwestern U.S. fighter base. A 34-yr-old male fighter pilot presents with a 3-wk history of right nasal congestion and obstruction that has not improved with initial treatment of 3 d of Afrin, a 10-d course of amoxicillin, or a 5-d course of azithromy-cin. His past medical history is significant for hyperthyroidism/Graves' disease; he underwent a radioactive I-131 thyroid ablation 8 yr prior. Prior surgeries include wisdom teeth extraction and jaw surgery. He is currently taking 150 meg *d~(-1) of levothyroxine. He has no known drug allergies. Family history is only remarkable for a father with coronary artery disease at age 52.
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