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.

According to the provided information, Richard may be experiencing allergic rhinitis. This is an allergic reaction that can occur due to exposures like pollen, dust or pet dander. All symptoms, including sneezing and rhinorhea, as well as postnasal draining are indicative of allergic rhinitis.

Richard touched his nose with his fingers during an exam. Richard also complained about a lack of improvement after taking Mucinex. It is clear that Richard’s nasal symptoms were affecting his quality and life. Further support for allergic rhinitis is the pale and boggy nasal mucosa, with thin nasal secretions and large nasal turbinates.

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.