A 31-year-old woman presents with purulent nasal drainage accompanied by nasal obstruction and facial pain. Which of the following findings would be most consistent with acute bacterial rhinosinusitis (ABRS)?

Choice A reason: Diminished lung sounds are a respiratory finding and not associated with rhinosinusitis. They may indicate pneumonia, pleural effusion, or other pulmonary conditions. Choice B reason: ABRS is diagnosed when symptoms such as purulent nasal discharge, nasal obstruction, and facial pain persist beyond 10 days or worsen after initial improvement (double worsening). This distinguishes bacterial from viral sinusitis. Choice C reason: Altered mental status is not a typical feature of uncomplicated ABRS. It may suggest complications such as intracranial extension or sepsis, which are rare and require urgent evaluation. Choice D reason: Low-grade fever may occur in ABRS but is not specific or diagnostic. It can also be present in viral infections or other inflammatory conditions. The persistence and progression of cardinal symptoms are more reliable indicators.