Case 1: Nose Focused Exam Richard is a 50-year-old male with nasal congestion, sneezing, rhinorrhea, and postnasal drainage. Richard has struggled with an itchy nose, eyes, palate, and ears for 5 days. As you check his ears and throat for redness and inflammation, you notice him touch his fingers to the bridge of his nose to press and rub there. He says he’s taken Mucinex OTC the past two nights to help him breathe while he sleeps. When you ask if the Mucinex has helped at all, he sneers slightly and gestures that the improvement is only minimal. Richard is alert and oriented. He has pale, boggy nasal mucosa with clear thin secretions and enlarged nasal turbinates, which obstruct airway flow but his lungs are clear. His tonsils are not enlarged but his throat is mildly erythematous.

Richard’s symptoms are consistent with allergy rhinitis. An allergic reaction is triggered by environmental triggers, such as dust, pollen or pet hair. These symptoms include nasal congestion and sneezing. They may also cause rhinorrhea or postnasal discharge.

Richard touching his bridge of the nose during his exam and complaining of minimal improvements after taking Mucinex indicates that his nasal symptoms bother him and are impacting on his quality of living. This is further supported by the pale nasal mucosa, with thin clear secretions. The enlarged nasal turbinates also support an allergic rhinitis diagnosis.

The lungs of this patient are completely clear. This suggests that his symptoms only affect his upper respiratory tract.

On the basis of this examination, you may want to suggest that Richard undergo further testing and evaluation for allergic rhinitis. This could include allergy tests or nasal corticosteroid treatment. It may also be beneficial to advise him on how to avoid any environmental triggers which could be aggravating his symptoms.