CNS/HN - Runny nose Flashcards
Differential DIagnosis - Runny Nose
- Common cold
- Hayfever - counselling
Differential Diagnosis
- Viral tonsillitis
- Bacterial tonsillitis
- Infectious mononucleosis
- URTI (common cold)
- HIV
History - Common cold
History
- HOPI - runny nose and sore throat
- which comes first?
- since when?
- getting worse?
Runny nose
- discharge color
- nose bleeding
- foul smelling
Sore throat
- pain when swallowing
- difficulty in swallowing
- noticed white materials in tonsils?
- hoarseness
Associated symptoms
- headache
- n/v
- fever
- cough
- ear pain
- facial pain
- joint pains
- waterworks and bowel works
RISK FACTORS/DDX
- Travel
- Occupation
- Pets and carpets
- Exposure
- Sexual hx
General
- PMH
- FH
- SADMA
Physical Examination - Common Colds
Physical Examination:
- General appearance: tired and irritated; pallor?
- Vital signs: T: 37.8, RR: 18, saturation, BP and PR normal
- ENT: nose is blocked; red, moderately enlarged tonsils; no pus with several enlarged cervical lymph nodes
- Other LAD? Rash?
- Chest, Heart, Abdomen: normal
Major joints: myalgia
Investigation - Common colds
Investigations:
FBE, monospot test, throat swab
Diagnosis - Common Colds
Condition -
Common colds - Upper respiratory tract infection
Common
Cause
Viral infection - Rhinovirus, influenza C, parainfluenza
Clinical feature Symptoms are what you are having - runny nose - sore throat - mild fever - cough - muscle aches
Complication
- otitis media, sinusitis, pneumonia
Management - Common colds
- Rest
- Diet: - Increase fluid intake, soft diet
- Diagnostic: FBE, Monospot test, Throat Swab
- Drugs: panadol > fever and body ache
- Steam inhalation for blocked nose
- Throat lozenges or gargles
- Vitamin C
- Disposition: SNAP
- Medical certificate
- Offer flu vaccine
- Review
- Reading Materials
- Redflags: Ear pain, Facial pain, cough are getting worse
History - treatment and medication - Hay fever
History
- HOPI - Runny nose
- Since when?
- is it continuous or on and off?
- any particular time of the day where you get the runny nose?
- anything that makes it better or worse?
- discharge? > color > nose bleeding> foul smelling
- pain?
- fever?
X FUNCTIONAL CLASSIFICATION: - Does it affect your - sleep - daily activities - problems at work/school
- Medication?
- how long?
- effect?
- side effect?
- is this your first consult?
Management - Hay fever
MANAGEMENT
First line:
- non-sedating antihistamines (tablets, syrups, nasal sprays, eye drops),
- intranasal corticosteroid(INCS) sprays,
- sprays containing a combination of INCS and antihistamine,
Additional treatment
- salt water nasal sprays and rinses.
- Intranasal chromones
- Intranasal anticholinergic sprays
- Oral leukotriene antagonists
Short term treatment
- Decongestants (oral or intranasal
- Systemic oral corticosteroids
- Combination treatments (Intranasal decongestant and antihistamine sprays)
For severe allergic rhinitis a referral to a
- clinical immunology/allergy specialist may be required for further assessment including allergy testing.
- If it is possible to confirm the allergen/s causing allergic rhinitis, then minimising exposure to the allergen/s may reduce symptoms.
Referral to a clinical immunology/allergy specialist should be considered if:
- Further allergy testing and interpretation is required to confirm diagnosis and facilitate allergen avoidance where possible.
- Severe or inadequately controlled allergic rhinitis despite therapy.
- Consideration if being made for allergen immunotherapy.
- Other atopic comorbidities require management.
Referral to an ENT specialist/surgeon should be considered if there is medically refractory nasal obstruction
Management - Hay fever
MANAGEMENT
First line: Acute Management
- non-sedating antihistamines (tablets, syrups, nasal sprays, eye drops),
- intranasal corticosteroid(INCS) sprays,
- sprays containing a combination of INCS and antihistamine,
Additional treatment
- salt water nasal sprays and rinses.
- Intranasal chromones
- Intranasal anticholinergic sprays
- Oral leukotriene antagonists
Short term treatment
- Decongestants (oral or intranasal
- Systemic oral corticosteroids
- Combination treatments (Intranasal decongestant and antihistamine sprays)
For severe allergic rhinitis a referral to a
1. clinical immunology/allergy specialist may be required for further assessment including allergy testing.
- If it is possible to confirm the allergen/s causing allergic rhinitis, then minimising exposure to the allergen/s may reduce symptoms.
Referral to a clinical immunology/allergy specialist should be considered if:
- Further allergy testing and interpretation is required to confirm diagnosis and facilitate allergen avoidance where possible.
- Severe or inadequately controlled allergic rhinitis despite therapy.
- Consideration if being made for allergen immunotherapy.
- Other atopic comorbidities require management.
Referral to an ENT specialist/surgeon should be considered if there is medically refractory nasal obstruction
