American Board of Family Medicine (ABFM) Practice Exam 2026 – The All-In-One Guide to Master Your Certification!

The presentation of unilateral clear rhinorrhea that worsens with position change is characteristic of cerebrospinal fluid (CSF) rhinorrhea. This condition occurs when there is a leakage of CSF from the subarachnoid space through a defect in the skull base. When the patient changes positions, gravity can exacerbate the flow of CSF, leading to an increase in rhinorrhea.

In the context of this scenario, the clear nature of the rhinorrhea is significant because CSF is typically clear and watery, distinguishing it from other forms of nasal discharge which may be associated with infections or allergies that often present with thicker mucus or associated symptoms such as itchiness or sneezing. Additionally, unilateral discharge is an important factor; while allergic rhinitis and vasomotor rhinitis more commonly present bilaterally, CSF rhinorrhea is often localized to one side, correlating with the location of the defect in the skull.

The worsening symptoms with position change help to differentiate this condition from other nasal issues, as allergic rhinitis tends to be more consistent regardless of position and does not specifically increase with changing head positions. Understanding these distinctions is crucial in guiding appropriate diagnosis and subsequent management of the condition.