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.

Based on the information provided, it appears that Richard is experiencing symptoms consistent with allergic rhinitis, which is an allergic reaction to environmental triggers such as pollen, dust, or pet dander. The symptoms of nasal congestion, sneezing, rhinorrhea, and postnasal drainage are all indicative of this condition.

During the exam, the fact that Richard touched his fingers to the bridge of his nose and complained of minimal improvement from taking Mucinex suggests that his nasal symptoms are bothering him and impacting his quality of life. The pale, boggy nasal mucosa with clear thin secretions and enlarged nasal turbinates further support the diagnosis of allergic rhinitis.

While his throat is mildly erythematous, his lungs are clear, suggesting that his symptoms are limited to his upper respiratory tract.

Based on this exam, it may be appropriate to recommend that Richard consider further evaluation and treatment for allergic rhinitis, such as allergy testing or a trial of nasal corticosteroid spray. In addition, advising him to avoid environmental triggers that may be exacerbating his symptoms could be helpful.