PANCE Blueprint EENT (9%)

Nasal foreign body (ReelDx)

VIDEO-CASE-PRESENTATION-REEL-DX

Patient will present with → A 4-year-old boy presents with purulent, foul-smelling nasal discharge for three days

Persistent foul smelling purulent unilateral nasal discharge in a young child should raise suspicion for retained nasal foreign body, even without history of witnessed foreign body insertion.

  • Indications for otolaryngology referral may include non-visualized posterior FBs, impacted FBs, or unsuccessful initial attempts at FB removal

Diagnosis is clinical

Prior to removal, the provider may consider using oxymetazoline drops to shrink the mucous membrane

Question 1
A 4 year-old boy presents with purulent, foul-smelling nasal discharge for three days. He has not had any other symptoms of respiratory illness, cough, wheeze, or fever. His activity level and appetite has been normal. On exam, he is afebrile. TM's have normal light reflex, canals are clear. Left nare is clear; there is considerable amount of purulent exudate from the right nare, and a bright reflection of light is noticed. Oropharynx is without inflammation or exudate. Neck is supple, without lymphadenopathy. Lungs are clear, with equal breath sounds and no wheezing. Heart has regular rhythm without murmurs. Which of the following is the most likely diagnosis?
A
Viral URI
Hint:
Viral URI does not present with foul-smelling nasal discharge.
B
Acute sinusitis
Hint:
Acute sinusitis may present with purulent nasal discharge, but the observation of a bright light reflection suggests a foreign body.
C
Allergic rhinitis
Hint:
Allergic rhinitis is seasonal, associated with sneezing and other allergy-related symptoms.
D
Nasal foreign body
Question 1 Explanation: 
Nasal foreign body is suggested by unilateral nasal obstruction or discharge .
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