5 - ENT - Rhinology - Approach to the history

Question 1

questions about nasal obstruction

Answer 1

constant/intermittent?
unilateral/bilateral?
associated discharge?
relieving/exacerbating factors?
substance use/nasal medication?
previous surgery?

Question 2

Causes of constant obstruction

Answer 2

long standing deformity
deviated septum
polyps
enlarged turbinates

Question 3

causes of intermittent obstruction

Answer 3

allergic rhinosinusitis

common cold

Question 4

Nasal discharge - watery? yellow?

Answer 4

watery - infection unlikely, allergy, poss CSF

yellow - allergy, bact infection, FB

Question 5

Nasal discharge - green? blood stained?

Answer 5

green - infection

blood - tumours, trauma

Question 6

what trauma can cause epistaxis

Answer 6

major trauma
nose picking
surgery
infection

Question 7

what are some non trauma causes of epistaxis

Answer 7

HTN, anticoagulants, coagulation deficits, alcohol, hereditary telangiectasia

Question 8

sneezing - what to ask?

Answer 8

exacerbating factors?

associations? rhinorrheoa, itching

Question 9

disorders of smell - what conditions to screen for?

Answer 9

hyposmia/anosmia

CACOSMIA - perception of foul smell, commonly due to infection interfering with olfactory receptors

Question 10

Causes of nasal deformity?

Answer 10

cocaine use

previous trauma, surgery