OSCE ENT

Compiled by Carlous Shuga Chadwick

A. Identify this instrument
• L-shaped metallic tongue depressor

B. Name 2 uses of this instrument in the

examination of the nose
• posterior rhinoscopy to assess posterior part of
nasal cavity
• Cold spatula test to assess the patency of the airway

C. Name any 4 components of ‘Waldeyar’s ring

(pharyngeal lymphoid ring)
• Palatine tonsil
• Nasopharyngeal tonsil (adenoid)
• Lingual tonsil
• Tubal tonsil
A. Identify the instrument
• Otoscope

B. Mention 2 precautions you will take during

its use
• Ensure that both you and the patient are seated
comfortably, at the same level
• Ensure privacy is maintained.
• Examine the pinna, outer meatus and adjacent
scalp.

C. What is segalization?
A. Which tuning fork will you prefer?
• C-512

B. Give 2 reasons for your preference.

• Within the speech frequency,
• Less overtone
• Longer duration

C. Name 4 causes of conductive hearing loss.

• Meatal atresia, otitis externa, otitis media,
barotrauma, foreign bodies.
A. What is this instrument?
• Nasal Speculum

B. What is the name of the diagnostic procedure

that is made using this instrument?
• Anterior rhinoscopy (Nasal inspection)
A. Name the procedure done using this instrument
• Posterior Rhinoplasty: Used in examining the posterior part of the nasal cavity
and nasopharynx

B. Name 4 structures visualized by this instrument

• base of the tongue, valleculae, epiglottis, piriform sinuses, arytenoids, false and
true vocal cords, and if possible the larynx below the vocal cords.

C. What separates the oral cavity from the oropharynx?

• The oral cavity is also separated from the oropharynx by the circumvallate
papillae, soft palate, and anterior tonsillar pillars.
• The palatopharyngeus functionally divides the oral cavity from oropharynx.
A. Identify this radiograph and its view
• AP-view plain radiograph, od bone and soft
tissue of the head, showing paranasal sinuses
(water’s view)

B. What are the findings?

• Opacity in the Right maxillary sinus,
compared to the left
• Nasa septal deviation to the Right

C. What is your radiological diagnosis?

• Right maxillary sinusitis
A 13-year-old boy presents with acute right sided facial pain, purulent
nasal discharge and fever of 3 days duration. His X-ray is shown below.

A. Identify the radiograph and its view.

• Plain x-ray, occipito metal view

B. What is the finding?

• Opacity in the right maxillary sinus

C. How will you treat this case if refractory

to medical treatment.
• Surgical drainage- antral washout
A. Identify the X-ray and its view
• Plain x-ray, occipitomental view

B. What are the findings?

• Opacities in the right maxillary sinus and right
nasal cavity

C. What is your radiological diagnosis?

• Maxilary sinusitis
A. What is (a)?
• Maxillary sinus

B. What is (b)?
• Inferior turbinate (or inferior
meatus)

C. Where does the ethmoidal sinus

drain?
• Middle meatus
A. Mention 2 findings in this pure tone
audiogram.
• Air bone gap
• Both air conduction and bone conduction
threshold are raised

B. What is the type of hearing loss?

• Sensorineural hearing loss

C. Pure tone audiometry is both qualitative

and quantitative test (Mention
True/false).
• True
A. Name this investigation.
• Pure tone audiometry

B. What are the findings?

• No AB gap
• Both air and bone conduction
threshold are raised

C. What is your diagnosis?

• Sensorineural hearing loss
A. Patient presented with hearing
loss in his left ear. His Rinne's
test is negative in left ear and this
is his audiogram.

B. Mention 4 possible causes of

deafness in this patient.
• 4 causes of conductive
deafness:
A. Earwax block
B. Otitis Externa
C. Acute otitis media
D. Congenital atresia of external canal
E. Otosclerosis
F. Tympanic membrane perforation
A. Identify this test.
• Rinne test
• a tuning fork test that determines the difference between
sound transmission via air conduction and bone
conduction. It is a quick screening test that can be used to
evaluate hearing loss in one ear.
B. Why is 512 frequency preferred in otology?
• it provides the best balance of time of tone decay and
tactile vibration. Lower-frequency tuning forks like the 256-
Hz tuning fork provide greater tactile vibration. In other
words, they are better felt than heard.
C. Why does Weber lateralize to deafer ear in
conductive deafness?
• This is because in conductive hearing loss, the problem
lies in the outer or middle ear, which affects the
conduction of sound waves through air
A 4-year-old child presents with hoarseness of 4 months and moderate stridor of 4 days.

A. What is the most probable diagnosis?

• Juvenile laryngeal papillomatosis

B. Name 2 investigations you will do to confirm

the diagnosis.
• Flexible/ rigid laryngoscopy
• Microlaryngoscopy and excision for biopsy

C. What is THE surgical treatment for the above

condition
• Microlaryngoscopy and excision with microcautery.

D. What is its prognosis.

• Receurence rate is very high, may regress after
puberty
A 36-year-old male presents with watery rhinorrhoea, sneezing spells and hyposmia
since 2 years. Nasal endoscopy shows the following picture.

A. What is your diagnosis?

• Nasal polyp (ethmoidal)

B. Name 4 differences between nasal polyp and

turbinate.
• Nasal polyp: insensitive to touch, pale in colour, soft,
probe test positive
• Turbinate: may bleed to touch, reddish in colour, firm,
probe test negative.

C. Name 2 drugs that may relieve the patients

symptoms.
• Sodium cromoglycate, loratidine
6. A 30-year-old female presents with recurrent episodes of bilateral profuse ear discharge
since 5 years following upper respiratory tract infections. Otoscopy shows the following finding.

A. What is the finding?

• Perforated TM
• Possibly infected middle ear, with pus and fluid

B. What is your diagnosis?

• Otitis media with perforated TM

C. Name 4 relevant investigations you will do

in this case
• FBC
• Otoscopy
A 25-year-old patient presents with (R) ear discharge of 3 years duration and severe headache,
neck rigidity and vomiting of 4 days duration. Otoscopy showed the following findings.

A. What is the probable diagnosis?

• CSOM, atticoantral type

B. Give 2 appropriate investigations to

confirm your diagnosis.
• Examination under microscope
• x ray lateral view of mastoid

C. Name 2 types of brain abscess.

• Temporal lobe, cerebellar
 A 26-year-old female presents with itching in the right ear since 3 months associated
with serous discharge and blocked feeling. Otoscopy showed the following.

A. What is your most probable diagnosis?

• Otomycosis

B. Mention 2 causes of this condition.

• Aspergillus niger,
• A. fumigatus or Candida albicans

C. Name the drug you will prescribe in this

case.
• Candibiotic ear drops / (Nystatin, Amphotericin B,
Clotrimazole, Povidone iodine, 2% salicylate in alcohol)
 A 30-year-old female presents with recurrent episodes of bilateral profuse ear
discharge since 5 years following upper respiratory tract infections. Otoscopy shows
the following finding.

A. What is your most probable diagnosis?

• Carcinoma of the larynx

B. Mention 2 investigations to confirm the

disease.
• CT-scan
• Micro laryngoscopy with biopsy

C. Mention the 3 modalities of its treatment

• Surgery, radiotherapy, chemotherapy
 An 15-year-old boy presents with left sided-nasal obstruction since one
year and nasal endoscopy showed the following picture.
A. What is your diagnosis?
• Nasal polyp

B. Mention 2 differential diagnosis

• Blob of mucos
• Hypertrophied middle turbinate
• Angiofirbroma
• Malignancy

C. What is the surgical treatment?

• Intranasal ethmoidectomy, Intranasl avulsion
polypectomy, External ethmoidectomy,
Transantral ethmoidectomy
 A 12-year-old female presents with acute pain in throat since 3 days with
fever. Examination of the throat revealed the following picture.
A. What is your diagnosis?
• Grade 3 tonsillitis

B. Mention 2 differential diagnosis.

• Pharyngitis, Retropharyngeal abscess, Epiglottitis,
Ludwig angina

C. Name 2 drugs you will prescribe.

• Analgesia and oral hydration
• Steroids and NSAIDs
• Penicillins or r a single benzathine penicillin G
intramuscular injection
• Azithromycin, Cephalosporin, Clindamycin
 A young boy presented to you complaining of snoring. This
picture is seen on examining the child's throat.

A. What is your diagnosis?

• Grade 4 tonsilitis (Tonsilar hypertrophy grade 4)

B. What is your management?

• Tonsilectomy

C. Give 2 indications for your management.

• Recurrent infections
• Sleep apnea
• Dysphagia
 A 20-year-old male presents with right sided ear ache, itching and blocked
sensation since 2 months. Otoscopic findings are as below.

A. What is your diagnosis?

• Ear wax (impacted wax)

B. Name 2 etiological factors for this

condition.
• Genetic, excessive wax production
• Eczema, Age,
• Narrow or damaged ear canal

C. How will you treat this case?

• Wax solvent: sodium bicarbonate
• Syringing, instrument under microscope
A. What is (a)?
• Tympanosclerosis

B. What is (b)?
• Tympanic membrane perforation

C. What is the treatment of (b)?

• Tympanoplasty
A. Identify the structure marked ‘A’
• Eustachian Tube (pharyngotympanic tube)

B. Name 2 functions of this structure

• Equalize pressure on both sides of the eardrum
• Drain excess fluids and secretions from the
middle ear into the nasopharynx
• Protect middle ear from pathogens and sound
pressures

C. Name 4 conditions that can arise by

malfunction of this structure
• Vertigo, Edema in the middle ear, balance A
problems, Tinnitus, reduced hearing, Pain,
aural fulness
A. Identify the structure
• External auditory canal

B. What is its length?

• 24mm

C. Name 2 pathological conditions

which can affect this structure
• Exostosis, stenosis
A. Name the type of nasal packing.
• Anterior nasal packing

B. Name 2 important causes of epistaxis in

elderly patients.
• HPT, Trauma, CCF

C. Name the 4 arteries that form the

Kesselback's plexus.
• Anterior ethmoidal aa
• Posterior ethmoidal aa
• Sphenopalatine aa
• Greater palatine aa
• Septal branch of superior labial aa
A. Identify the instrument being used
• Nasal speculum

B. Name the procedure being done

• Anterior Rhinoscopy

C. Mention 2 precautions you will take

during the above procedure
• Close the speculum fully before inserting it
into the nasal cavity
• Do not close it when withdrawing from the
nose (keep the flanges slightly opened to
avoid pulling the vibrissae)
A. What is the name of this procedure?
• Anterior packing (note the strings
hanging from the other end)

B. Name one indication.

• Epistaxis

C. Name one complication.

• Infection / Nasal septum perforation.
 A 40-year-old male presents with left sided nasal obstruction since 9
years and examination of the nose showed the following picture.

A. What are the findings?

• Deviated nasal septum to the left
• Hypertrophy of middle and inferior turbinate of the
right

B. Name 2 complications of this condition.

• Epistaxis, Anosmia

C. What is THE surgical treatment of this

condition?
• Septoplasty
7. A 28-year-old male presents with bilateral nasal
obstruction since 4 years associated with sneezing
spells and anosmia. Anterior rhinoscopy revealed the
following finding.

A. What is your diagnosis?

B. How will you differentiate
this mass from a turbinate
(give 4 points)
C. Name 2 investigations to
confirm the diagnosis
• 1+2+1
A 5-year-old girl presents with mouth breathing more at night associated with
snoring and recurrent otalgia since 2 years.

A. What is the most probable diagnosis?

• Adenoiditis

B. Name 2 relevant investigations that will help to

confirm your diagnosis.
• Nasal endoscopy,
• Plain x-ray lateral view of the neck soft tissue exposure

C. What is its surgical treatment?

• Adenoidectomy
A 4-year-old child presents with right sided purulent, blood stained
nasal discharge since one month

A. What is your most probable diagnosis?

• Chronic Rhinosinusitis or Foreign body in the nose

B. Name 2 investigations to confirm your diagnosis?

• Nasal Endoscopy, Head X-ray, CT-scan

C. Name any 2 complications of the above condition.

• Spread of infection
• Impaired breathing
A 55-year-old male presents with a right sided hard painless neck swelling of 3
months duration associated with right sided tinnitus.

A. What is the most probable diagnosis?

• Nasopharyngeal cancer (NPC)

B. Name 2 appropriate investigations to confirm

the diagnosis.
• Nasal endoscopy
• FNAC

C. What is THE treatment of choice?

• chemoradiotherapy