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Question: HEENT

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You are seeing a 12 year-old with 2 weeks of nasal congestion, rhinorrhea, sneezing, and sore throat, especially in the mornings. She has had no fever. On exam, her nasal turbinates are pale and boggy. She has a horizontal crease below the bridge of her nose and her lower eyelids are bluish and puffy.

The next appropriate step in emergency department management is:
9 votes

pemsou5_wp • August 31, 2021

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  1. Kelly August 31, 2021 - 11:21 pm Reply

    D) Prescribe intranasal steroids
    The patient has symptoms typical of allergic rhinitis. Some physical exam findings that may be seen include “allergic shiners” (dark, puffy, lower eyelids) and Morgan-Dennie lines (extra creases below the eyes), due to nasal congestion leading to venous congestion of the eyelids. The “allergic salute,” whereby children rub their itchy nose with the heel of their hands can lead to a transverse crease below the bridge of the nose. Signs of allergic conjunctivitis and pale boggy swollen nasal turbinates may be present. Sore throat and cobblestoning of the pharynx occurs due to post-nasal drip. The first-line treatments include intranasal steroids and second generation oral antihistamines.

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