OSCE Stations in

Oto-Rhino-Laryngology

Iqbal Hussain Udaipurwala

MBBS, DLO, FCPS.
Professor and Head of the ENT Department
Bahria University Medical and Dental College, Karachi
Fellow and Examiner, College of Physicians and Surgeons Pakistan
Editor, Pakistan Journal of Otolaryngology and Head and Neck Surgery
Associate Editor, Journal of Bahria University Medical and Dental College

Karachi | Lahore | Islamabad | Sukkur | Faisalabad | Peshawar | Abbottabad

 OSCE Stations in Oto-Rhino-Laryngology
by
Iqbal Hussain Udaipurwala

All rights reserved. No part of this publication may be reproduced, stored in a retrieval system,
or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or
otherwise, without the prior permission of the Copyright Holders.

This book is sold subject to the condition that it shall not, by way of trade or otherwise, be lent, resold,
hired out or otherwise circulated without the publisher’s prior consent in any form of binding or cover
other than that in which it is published and without a similar condition including this condition being
imposed on the subsequent purchaser.

Medical knowledge is constantly changing. As new information becomes available, changes in

treatment, procedures, equipment and the use of drugs become necessary. The editors, contributors
and the publishers have, as far as it is possible, taken care to ensure that the information given
in this text is accurate and up-to-date. However, readers are strongly advised to confirm that the
information, especially with regard to drug usage, complies with the latest legislation and standards
of practice. Neither the publisher nor the authors assume any responsibility for any loss or injury
and/or damage to person or property arising out of or related to any use of the material contained
in this handbook.

Copyright © 2016
All Rights Reserved

First Edition ........................................2016

152/O, Block-2, P.E.C.H.S., Karachi-75400.

Tel: +92-21-34310030, info@paramountbooks.com.pk
www.paramountbooks.com.pk

ISBN: 978-696-637-155-7
Printed in Pakistan
 Contents

SECTION–01
Ear
01 Mastoid Retractor 3

02 Periosteal Elevator 5

03 Otoscope 7

04 Ear Syringe 9

05 Myringotomy Knife 11

06 Jobson Horne Probe 13

07 X-ray Mastoid-for Labelling 15

08 X-ray Mastoid-Mastoiditis 17

09 Pure Tone Audiogram-Normal Hearing 19

10 Pure Tone Audiogram-Otosclerosis 21

11 Pure Tone Audiogram-Presbycusis 23

12 Pure Tone Audiogram-Mixed Deafness 25

13 Tympanogram-Type A 27

14 Tympanogram-Type As 29

15 Tympanogram-Type B 31

16 Tympanogram-Type Ad 33

17 Tympanogram-Type C 35

18 Brainstem Evoked Response Audiometry 37

19 Pre-Auricular Sinus 39

20 Haematoma of the Pinna 41

21 Cauliflower Ear 43
22 Keloid of the Pinna 45
23 Boil in the Ear 47
24 Otomycosis 49
25 Bullous Myringitis 51
26 Wax in the Ear 53
27 Ear Syringing 55
28 Acute Suppurative Otitis Media 57
29 Chronic Suppurative Otitis Media-Tubo-Tympanic Type 59
30 Chronic Suppurative Otitis Media with Cholesteatoma 61
31 Chronic Suppurative Otitis Media with Aural Polyp 63
32 Chronic Suppurative Otitis Media with Facial Paralysis 65
33 Otitis Media with Effusion 67
34 Otitis Media with Effusion-After Grommet Insertion 69
35 Mastoid Abscess 71
36 Post-Aural Fistula 73
37 Stapedotomy Operation 75
38 BTE Type Hearing Aid 77

SECTION–02
Nose and Paranasal Sinuses
39 Posterior Rhinoscopy Mirror 81
40 Killian’s Nasal Speculum 83
41 Tilley’s Forceps 85
42 Luc’s Forceps 87
43 SMR Dissector 89
44 Lichwitz’s Trocar and Cannula 91
45 Nasal Gouge 93
46 Ashe’s and Walsham Forceps 95

47 Double Action Septal Bone Punch 97

48 Suction Nozzle 99
49 Turbinectomy Scissors 101
50 Nasal Endoscope 103
51 Back Biting Forceps 105
52 Microdebrider 107
53 X-ray PNS-for Labelling 109
54 X-ray PNS-Maxillary Sinusitis 111
55 X-ray Nasal Bone-Fracture 113
56 X-ray Nose-Foreign Body 115
57 Coronal CT Scan of the Nose and PNS-for Labelling 117
58 Axial CT Scan of the Nose and PNS-for Labelling 119
59 Coronal CT Scan of the Nose and PNS-Allergic Fungal 121
Sinusitis
60 Axial CT Scan of the Nose and PNS-Nasal Polypi 123
61 CT Scan of the Nose and PNS-Angiofibroma 125
62 Coronal CT Scan of the Nose and PNS-Chronic Sinusitis 127
63 Carotid Angiography 129
64 Trauma Nose 131
65 Deviated Nasal Septum 133
66 Anterior Septal Dislocation 135
67 Anterior Nasal Packing with Airway 137
68 Saddle Nose Deformity 139
69 Septal Haematoma 141
70 Septal Perforation 143
71 Septal Adhesion 145
72 Sub-Mucosal Diathermy of the Inferior Turbinate 147

73 Antral Washout Operation-Proof Puncture 149

74 Nasal Polypi-Endoscopic Photograph 151
75 Septal Spur-Endoscopic Photograph 153
76 Inverted Papilloma-Endoscopic Photograph 155

SECTION–03
Oral Cavity and Pharynx
77 Boyle Davis Mouth Gag 159
78 Tonsil Holding Forceps 161
79 Draffin’s Suspension Rod 163
80 Tonsillar Dissector 165
81 Tonsillar Snare 167
82 Pharyngeal Suction Nozzle 169
83 Adenoid Currette 171
84 Crocodile Forceps 173
85 X-ray Nasopharynx-Enlarged Adenoids 175
86 Orthopentomogram-Normal 177
87 Orthopentomogram-Carcinoma Oral Cavity 179
88 X-ray Skull-Temporo-mandibular Joint Dislocation 181
89 X-ray Barium Swallow-Pharyngeal Web 183
90 Tongue Tie 185
91 Oral Thrush 187
92 Aphthous Ulcer 189
93 Acute Follicular Tonsillitis 191
94 Chronic Hypertrophic Tonsillitis 193
95 Rose’s Position 195
96 Adenoid Facies 197

97 Peritonsillar Abscess-Quinsy 199

98 Ranula 201
99 Mucocele of the Lower Lip 203
100 Leukoplakia Tongue 205
101 Oral Sub-Mucous Fibrosis 207
102 Carcinoma of the Tongue 209
103 Carcinoma of the Cheek 211

SECTION–04
Larynx and Trachea
104 Rigid Direct Laryngoscope 215
105 Flexible Fibre-Optic Direct Laryngoscope 217
106 Rigid Oesophagoscope 219
107 Rigid Bronchoscope 221
108 Tracheal Dilator 223
109 Portex Tracheostomy Tube 225
110 Shilley’s Tracheostomy Tube 227
111 Electrolarynx 229
112 X-ray Chest and Neck-Foreign Body Hypopharynx 231
113 X-ray Chest-Foreign Body Bronchus 233
114 X-ray Neck-Foreign Body Hypopharynx 235
115 X-ray Neck-Epiglottitis-Thumb’s Sign 237
116 Heimlich’s Maneuver 239
117 Flexible Fibre-Optic Direct Laryngoscopy 241
118 Microlaryngoscopy 243
119 Laryngomalacia 245
120 Laryngeal Papillomatosis 247

121 Vocal Nodules 249

122 Laryngocele 251
123 Vocal Cord Polyp 253
124 Carcinoma of the Larynx 255
125 Permanent Tracheostome 257

SECTION–05
Head and Neck
126 X-ray Floor of the Mouth-Salivary Calculi 261
127 X-ray Neck-Retropharyngeal Abscess 263
128 Sialogram-Normal 265
129 Acute Viral Parotitis-Mumps 267
130 Benign Parotid Gland Tumour 269
131 Multinodular Goiter 271
132 Cervical Lymphadenopathy 273
133 Thyroglossal Cyst 275
134 Branchial Cyst 277
135 Ludwig’s Angina 279
Index 281
 Dedicated to
My parents, family, teachers. collegues
students and patients
 Preface
It is a matter of great pleasure and contentment to present this book,
OSCE stations in Oto-rhino-laryngology. The trends in medical education
and evaluation are constantly changing every day. It is moving towards
greater objectivity. Objective Structured Clinical Examination (OSCE)
is a relatively newer method for the assessment of clinical skills. Some
students find it very difficult to appear in and pass OSCE examination.
Keeping this in mind, I have made an effort to write a book, so that medical
students can practice OSCE examination beforehand. Reading material in
this regard is very inadequate in almost every subject but it is truer in the
field of Oto-rhino-laryngology. Practicing with the OSCE station is in
itself a unique learning experience.
The format of this book is very simple. Whole subject of Oto-rhino-
laryngology is divided into five sections. Only the common problems
prevalent in our region are included in this book. The range of stations
given in the book encompasses the subject of ENT which a medical
graduate ought to know within a specific time. The format of OSCE
stations is almost the same as is being followed by most of the universities
in the region. A photograph of a clinical finding, X-ray, investigation,
procedure, surgical operation or an instrument is given, with or without a
short clinical scenario, and then a few questions are asked related to it. The
answers are shown overleaf in a precise bulleted format.

Iqbal Hussain Udaipurwala

 Acknowledgement
This work could not have been accomplished without the help and support
of so many people. I would like to express my sincerest appreciation to all
my teachers, colleagues and students who gave me their feedback during
the compilation of this book and gave helpful suggestions and directions. I
am deeply indebted to Dr Muhammad Shuja Farrukh, Associate Professor
of ENT at Dow University of Health Sciences, Professor Dr Sohail
Abdul Malik, Professor of ENT at Isra University and Dr Muhammad
Sajid Abbas Jaffri, Professor of medicine at Bahria University Medical and
Dental College for their wholehearted support and suggestions. I am very
much thankful to all the workers and staff of Paramount Books (Pvt.) Ltd.
who extended their support in publication of this book. Last but not the
least I am very much grateful to all my family members, especially my wife
Azra Iqbal and daughters Fatima, Saba and Zahra as without their support
and encouragement it would not have been possible to transform this idea
into reality.
I hope students will find this book very useful and practical in preparation
for their examination in the subject of ENT as well as in their clinical
practice. Your criticism and suggestions are always welcome to improve
the standard of this book.