BIOSOFT HELP FILES

These are daytime sleepiness, sleep attacks, insomnia, hypnagogic visual hallucinations (visual hallucinations while falling asleep), sleep paralysis

1)      Colds

2)      Flu

3)      Allergic rhinitis

4)      Sinusitis

5)      Bacterial infections 

1)      Following head injury

2) Foul-smelling, unilateral discharge

3)      Bloody unilateral discharge

4)      Symptoms continue for more than 3 weeks

5)      Fever

1)      Cyclical nasal obstruction – unilateral, alternating nasal obstruction lasting 1-4 hrs., Tx nasal steroid sprays

2)      Positional nasal obstruction – unilateral, dependent nostril block, Tx nasal steroid sprays

3)      Allergic rhinitis – recurrent attacks of nasal block, watery nasal discharge, itchy nose, itchy eyes, nose and throat, pale boggy nasal mucosa early stages, hyperemic and granular in chronic conditions, Tx with steroid nasal sprays, antihistamines, cromolyn sodium nasal solution, antileukotrienes

4)      Infectious rhinitis

5)      Atrophic rhinitis

6)      Vasomotor rhinitis

7)      Metabolic/Endocrine causes – pregnancy, menses, OC, hypothyroidism, DM, Tx with saline nasal sprays

8)      Polyps – allergy, chronic sinusitis, recurrent sinus infections,

9)      Drug-induced nasal obstruction

10)    Deviated septum

11)    Perforated septum – nasal trauma, frequent nose picking, nasal surgery, excessive nasal crusting, foul smell crusting, nasal obstruction, epistaxis, inspiratory nasal whistle, septal perforation, otolaryngology referral

12)    Septal hematoma/abscess – nasal septal surgery, nasal trauma, nasal obstruction, septal swelling, nasal pain, fever, otolaryngology referral

13)    Nasal valve collapse – commonest cause is septal deviation, aging, nasal valve scarring, nostril collapse in respiration,

14)    Turbinate Hypertrophy – longstanding allergic rhinitis, vasoconstrictor nasal drops abuse, persistent nasal obstruction, nasal obstruction unrelieved by nasal vasoconstrictors, antihistamines, if no response for steroid nasal drops otolaryngology referral

15)    Adenoid hypertrophy

16)    Nasal polyps

17)    Neoplasm

1)      Adenoid hypertrophy – nasal obstruction, nasal drainage, snoring, sleeping with open mouth, sleep apnea, if no response for antibiotics ENT referral for ? adenoidectomy

Notes :

1)      Asthma, nasal polyps and aspirin intolerance may be a marker of oral aspirin ingestion anaphylaxis

1)      Persistent unilateral nasal obstruction

2)      Persistent unilateral nasal discharge

3)      Offensive nasal discharge

4)      Bloody nasal discharge

5)      P/H nasal injury (septal deviation, septal perforation)

6)      Suspected child abuse

7)      Treatment-resistant nasal obstruction (septal deviation, mechanical obstruction)

8)      P/H nasal surgery (septal deviation, septal perforation)

9)      Cocaine use

10)    Unilateral epistaxis (neoplasms)

1)      Nasal polyps (may be a marker of cystic fibrosis in < 16 yrs)

2)      Persistent unilateral nasal discharge – unilateral choanal atresia

3)      Persistent unexplained unilateral nasal obstruction with/without discharge and/or bleeding

1)      Alvi A and Ching LM. Nasal obstruction: Common causes and manifestations. Postgraduate Medicine Online 2004;116;5;

1)      Unexplained neck lump of recent onset

2)      Unexplained persistent swelling in the parotid gland

3)      Unexplained persistent swelling in the submandibular gland

4)      Thyroid lumps with tracheal compression

5)      Thyroid swelling with a solitary nodule of increasing size

6)      Thyroid swelling with past neck irradiation

7)      Thyroid swelling with family history of endocrine tumor

8)      Thyroid swelling with unexplained hoarseness or voice changes

9)      Thyroid swelling with cervical lymphadenopathy

10)    Thyroid swelling in pre-pubertal patients

11)    Thyroid swelling in persons above 65 yrs

Notes :

1)      In patients with thyroid swelling and absence of any of above red flags do thyroid function tests.  Goiter with hyper or hypo thyroidism is unlikely to be malignant.

2)      See also under Goiter

1)      Cervical Sprain – Tx – Neck stretches, neck muscle strengthening exercises or neck isometrics,

2)      Myofascial pain syndrome - Neck pain spreading to the scapular region and the shoulder in levator scapulae MFPS, paraspinal neck pain spreading down to the upper posterior chest wall in multifidi MFPS, neck pain spreading along the paracervical region to the posterior chest wall upper scapular region in multifidi MFPS, neck pain at lower neck spreading up to the upper neck in splenius cervicis MFPS, lateral neck pain, ipsilateral head pain mainly at occiput, temporal, parietal regions, mandibular area of the face in trapezius MFPS, pain in the paraspinal region extending over an area from spineof scapula to the inferior angle of the scapula in trapezius MFPS.  See notes under myofascial pain syndrome for diagnostic criteria and therapy.

3)      Cervical Disc Prolapse – neck pain, central and bilateral, pain over the scapular region, pain radiating to the shoulder, upper arm, forearm, and chest, the pain made worse by laughing, sneezing, coughing, and straining, painful neck movements, neck muscle spasm, arm weakness

4)      Cervical radiculopathy – neck pain, neck pain shooting down the arm, forearm, numbness, tingling shooting down the arms, forearm, hand, shoulder pain, elbow pain, forearm pain, pain shooting down the arm, paresthesiae shooting down the arm, increased pain with Valsalva maneuver, nerve tension maneuvers positive – i) turn the neck to the opposite side of the lesion, extend the arm at shoulder keeping the elbow extended.  Grasp the patient’s hand palmar flex the wrist.  Feeling the pain in the posterior shoulder suggests cervical radiculopathy, alternatively you can also dorsiflex the wrist, in this instance, numbness and tingling of the elbow and hand suggests cervical radiculopathy, ii) Keep the ipsilateral arm on top of the head, then look down and contralaterally – this will reduce pain iii) Keep the ipsilateral arm on top of the head and then rotate and bend the head to the ipsilateral side – this will increase pain iv) Spurling’s sign – rotate the head to the contralateral side and side flex the head towards painful arm – pain shooting down the arm signifies a positive test,

5)      Whiplash injury – neck injury in an RTA – a sudden extension of the neck followed by flexion, pain, and symptoms tend to peak the day after the injursudden extension of the neck followed by flexion, pain, and symptoms tend to peak the day after the injury, unilateral or mostly bilateral neck pain hours to days after a minor RTA, may last weeks to months, natural history is  RTA and whiplash injury, pain peaks the second day, pain and symptoms resolve over the next 3-5 days, patient back to work after a week, – Neck exercises (N), NSAIDs

6)      Torticollis – acute onset neck pain usually on waking up in the morning, may last few days, painful neck movements, limitation of neck movements, Tx – Neck exercises (N) and NSAIDs,

7)      Myofascial pain syndromes -

8)      Cervical Syndrome of RSI – RSI criteria (N), repetitive shoulder movements, repetitive upper limb movements, particularly against gravity, all these require stability provided by neck and shoulder girdle muscles, pain in the neck with radiation into the arm, neck painful movements (3 at least out of 6), pain radiation into the arm on neck movements

9)      Tension Neck Syndrome of RSI – RSI criteria (N), repetitive shoulder movements, repetitive upper limb movements, particularly against gravity, all these require stability provided by neck and shoulder girdle muscles, neck pain, neck stiffness, headache radiating from the neck to the forehead, at least 2 tender spots in the neck muscles (cervical and trapezius muscles), palpable nodules in the neck muscles,