Where you are:
You are an FY2 in GP.Who the patient is:
Jack Wilson, aged 45, has come with complaints of left side stuffy nose.What you should do:
Take history and address his concerns.
Opening, Paraphrase
ODIPARA
D: Are you feeling stuffy nose on the right side?
P: No (Unilateral)
Other symptoms:
Runny nose?
Feeling that mucus is slowly dripping down the back of your throat? (postnasal drip)
Reduced sense of smell or taste?
Snoring?
Nasal polyps can sometimes feel like a common cold. But common colds tend to clear up within a few days, whereas nasal polyps will not get better unless they're treated.
DDs
D: Any nosebleed?
P- Yes, on the left side occassionally (TRAC)
FLAWS + Nasal tumor symptoms:
D: Any recent Wt loss?
P: Yes (+ve finding)
D: How much?
Speech problem? Swallowing problem?
D: Any recent trauma to the nose? (nose picking)
MAFTOSA
HTN? bleeding disorders? on blood thinners?
Examine: Vitals, General physical, examine inside the nose
Pic of nose given:
Management
Diagnosis: Nasal polyp, they are fleshy swellings that slowly grow inside the nose or sinuses.
Referral to ENT: Suspected cancer pathway (2 weeks)
A unilateral polyp should be assumed to be neoplastic until proven otherwise.
Investigations:
Routine bloods, bleeding profile including INR, histological examination.
Treatment
- Steroid nose drops or a spray to shrink the polyps
- Steroid tablets, usually for up to 2 weeks, to help relieve symptoms.
- If there’s no sign of improvement after about 12 weeks, the GP may suggest surgery to remove your polyps.
- Most people who have surgery see an improvement, but it’s common for polyps to grow back, usually within a few years.
General advice
- salt water washes (called a saline rinse or nasal douche) to help unblock your nose
Safety netting
- Bleeding
- Recurrence
- Steroid use
Reference: