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.

The information suggests that Richard has allergic rhinitis. It is an allergic reaction to pollen dust and pet dander. All symptoms, including sneezing and rhinorhea, as well as postnasal draining are indicative of allergic rhinitis.

Richard touched the bridge of his nostril with his fingertips during the examination. He complained that he had not seen any improvement in his symptoms after taking Mucinex. This suggests that his nasal problems are affecting his quality of living. An allergic reaction is confirmed by the presence of a pale and thick nasal mucosa that produces clear, thin secretions. Also, there are enlarged nasal tubes.

Although his throat may appear mildly erythematous and his lungs seem clear, it is possible that his symptoms are confined to the upper respiratory tract.

On the basis of this examination, Richard may need to be referred for further treatment. This could include allergy testing and nasal corticosteroid spray. It may also be beneficial to advise Richard not to expose himself or others to environmental triggers.

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