ENT

OSCE 2012 at PMC.

Questions were made by RCSI. Just remember that there will be questions for
each ENT components. For example here we have 2 nasal questions (saddle nose,
septal hematoma), 3 ear questions(cauliflower ear, middle ear effusion, hearing
loss/audiogram), 2 oral/throat questions(tongue cancer, submandibular stone),
3 head and neck questions (facial palsy, tracheostomy, laryngectomy). The
questions I wrote back here may not be complete since I could not recall
everything, but hopefully it will still be helpful and you guys can figure out the
rest.

1. Saddle nose, deviated nose
a. Signs/symptoms: nasal obstruction, cosmetically complaint,
anosmia
b. Cause = trauma, cancer, infection(syphilis, leprosy), relapsing
polychodritis, wegeners granulomatosis,ectodermal dysplasia
c. Complication
d. Treatment: rhinoplasty
e. Define oezena = atrophic rhinitis. Caused by klebsiella.
i. Primary due to infection??
ii. Secondary due to work related, trauma
f. Smell and taste come together. If cant smell, cant taste.

2. Nose growth/mass/polyps? Is actually septal haematoma
a. Symptoms nasal obstruction, bleeding, anosmia
b. Rx: incision and drainage, cover with IV antibiotic to prevent
saddle nose?
c. Complications: abscess, saddle nose, septal perforation(if cartilage
only affected), fibrosis/septaldeviation
d. Name 2 structures of cartilage

3. Granulomatous disease : TB, sarcoidosis, toxoplasmosis, wegeners
a. Actinomcosis silvr stain
b. Aetiology:
poor
dental
hygiene,
post
radiation,
immunocompromised
c. Rx: antibiotic (penicillin), surgical debridement
d. it was actinomycosis.description were non-caseating granuloma,
multiple sinus with discharge, sulphur granules found in pus
e. differentials cellulitis, furunculitis, carbuncle, sebaceous cyst

4. Cauliflower ear(auricular haematoma) due to trauma
a. Microtia: congenital
b. Common in where: boxing or sport injury? Also wrestler

5. Middle ear effusion
a. Can see air bubble
b. Rx: medically for 3 months.
c. Causes: allergic rhinitis, passive smoking, not breastfed
d. Grommet inserted at infant?

e. Temporofascia for tympanic membrane surgery?

6. Upper facial nerve palsy

a. Has not cross, so forehead sparred
b. Other associated symptoms of facial nerve palsy
i. Metallic taste (altered taste)
ii. Hearing very loud sound (due to stapedius muscle palsy)
iii. Decrease lacrimation
c. Ramsay hunt syndrome. = herpes zoster otticus
d. Classification of facial nerve palsy : House-Brackmann
classification
7. Electric larynx, surf box, iesophageal voice??
a. Laryngectomy : no sound production
i. Cant taste (because no linear of air?)
ii. Constipation
iii. Cant dliver baby
iv. Difficulty in lifting heavy weight
1. All because unable to increase intraabdominal
pressure
8. Pre-malignant condition for tongue cancer: erythroplakia, leukoplakia,
non healing ulcer
a. Ix: biopsy, CT
b. Aetiology: STD, sharp tooth, smoking, alcohol, betel nut
c. Rx: surgery, radiotherapy
d. Classification: TNM

9. Tracheostomy with tube

a. Indications
i. upper airways blockage,
ii. assist ventilation
iii. decrease dead space, eg: end stage COAD,
iv. forn bronchial toilet? In semiconscious/unconscious
patient
v. prophylaxis
vi. stroke,
vii. laryngectomy
b. Complications
i. Tube dislodge
ii. Bleeding
iii. Tube going to wrong place/ false track
iv. Pneumothorax
v. infection,
vi. inner tube- can be taken out and washed (to prevent block
due to phlegm)
vii. to do tracheostomy:
1. skin
2. split strap muscle

3. divide isthmus of the thyroid

4. make hole at neck = tracheostomy
c. Where do you insert endotracheal tube in patient with
laryngectomy
d. How to make it not move or stay still in position
e. Tracheostomy hole
i. Is it permanent?

10. Submandibular stone

a. Symptom: pain on eating (due to saliva cant flow), swelling during
eating
b. Rx: sialodonoscopy, remove the whole gland
c. Neural complication in patient????
i. Marginal mandibular?
ii. Hypoglossal
iii. Lingual (supply sensation of tongu. Risk chewing out of own
tongue??)
d. Rx: antibiotic, painkiller, antiinflammatory
e. Lesion indicates tumour?
f. Name the gland most commonly affected
g. Name the structure? Submandibular duct, Whartons duct
11. Pure tone audiometry
a. Occupational deafness
b. Noise-induces sensorineural loss because there was no air-borne
gap on the audiometry and there was a dip at 4000hz
c. Why 4000 Hz?

Here are the list of topics need to be covered:

1. Facial trauma
a. Saddle nose
b. Septal hematoma
c. Fractured nasal bone
2. Acute sinusitis with its complications (intra and extracranial)
3. Trauma ear (cauliflower ear)
a. Osteoma
4. Middle ear effusion
5. Adhesive otitis media
6. Perforated CSOM
a. Unsafe
b. Safe
7. Audiogram
a. Noise induced hearing loss/presbycussin (high frequency 4K/8K)
b. 2K (Carharts notch) for otosclerosis
8. Acoustic neuroma
9. Tongue cancer
10. Rehab laryngectomy
11. Infection
a. Mandible
b. Tonsil
c. Submandibular
12. Lateral neck swelling
a. Branchial cyst
b. Neck lump
13. Tracheostomy with complications
14. Nasopharyngeal carcinoma (NPC)
15. Parotid
a. Pain
i. Stone
ii. Abscess
iii. Infection
iv. Mumps
b. Painless
i. Tumour
16. Skin cancer
a. Basal cell carcinoma
b. Squamous cell carcinoma
c. Melanoma
17. Obstructive sleep apnea
18. Facial nerve palsy
a. Ramsay hunt syndrome
19. Foreign body
a. Esophagus
b. Bronchus/airway
20. Nasal polyps
21. Thyroid
22. Hearing loss