Rhinorrhea

Age: ‍ years old

Gender: ‍malefemale



HISTORY:

Presents with a ‍-‍day history of runny nose

Described as ‍clearcolored, ‍waterymucoidthick, ‍mildmoderateabundant

Pattern ‍constantintermittent

Worsening factors: ‍none

Alleviating factors: ‍none, ‍effectiveineffective



Associated symptoms: *Try using right-click for negatives*

‍nasal congestion

‍sneezing

‍postnasal drip

‍sinus pressure

‍itchy nose

‍watery eyes

‍cough, ‍non-productiveproductive of ‍clearcolored phlegm

‍sore throat

‍fatigue

‍headache, ‍diffuse, ‍persistentintermittent, ‍pressurethrobbing, ‍mild

‍earache

‍loss of smell

‍fever, up to ‍°, over ‍ ‍hoursdays

‍chills

‍malaise

‍difficulty breathing

‍wheezing



Contributing factors:

‍smokingpast smoking

‍exposure to allergens

‍similar symptoms in close contacts

‍occupational exposure to irritants

no history of: ‍allergic rhinitis, ‍sinusitis, ‍nasal polyps, ‍deviated septum, ‍upper respiratory infection





EXAM:

General appearance: ‍well-appearing, ‍apparent distress

Vital signs: ‍normal, BP ‍, HR ‍, RR ‍, SpO2 ‍ %, Temp ‍°

Ears: tympanic membranes ‍normal ‍, auditory canal ‍ on ‍rightleft, hearing ‍intact

Nose: ‍clear, discharge ‍clear, ‍

Throat: ‍normal, ‍erythema, ‍exudate, ‍

Neck: ‍normal, ‍lymphadenopathy, ‍, c-spine ‍

Heart: ‍RRR, ‍MRG, ‍normal S1 and S2

Lungs: ‍clear bilaterally, ‍abnormal sounds, ‍retractions





ASSESSMENT:

‍Rhinitis ‍likelysuspectedpossible

DDx: viral URI, common cold, sinusitis, allergic rhinitis, non-allergic rhinitis, nasal polyps, foreign body in the nose, deviated septum, drug-induced rhinitis, pregnancy-related rhinitis, environmental irritants, acute bacterial rhinosinusitis, chronic rhinosinusitis, COVID-19, influenza, CSF leak





PLAN:

Investigations:

- Allergy testing

- CT scan of the sinuses

Treatments:

- ‍Nasal saline irrigation

- ‍Nasal Steroids

- ‍Antihistamines

- ‍Decongestants

- ‍Montelukast

- Avoidance of irritants and allergens

Further care:

- Referral to allergist

- Referral to ENT specialist

- Follow-up in ‍ ‍daysweeks

- Return if symptoms worsen or if new symptoms develop such as facial pain, fever, or persistent headache