ENT OSCE

Question 1

FACE, NOSE, EARS - INSPECTION

Answer 1

INSPECTION

FACE = symmetry, swelling, hair distribution, scarring, skin

EYES = sclera, exophthalmos + skull deformations

NOSE = look straight-on aand look at side, check for profile of nose
+pyramid view, from behind ask patient to look up, centralisation of nose

*NASAL PATENCY

NASAL VESTIBULE
use torch to examine nostrils on both sides, and central colymela for NASAL DEVIATION

*using nasal speculum to assess septum and inferior turbinate (and middle turbinate)

EARS
shape of ears, skin of ears infront, behind and at pinna, scarring/swelling of mastoid process

*inspect ear canal @ level of patient, lift pinna upward and backwards, rotate inwards to inspect tympanic membrane

Question 2

FACE, NOSE, EARS - PALPATION

Answer 2

BONES OF FACE: ?pain, palpate symmetrically

1. ORBITAL RIM
2. NOSE - stability, tenderness
3. MAXILLA - sinuses, press on cheeks, pain *acute sinusitis
4. JAW - tenderness and mobility, steps in bone
5. TMJ - ask to open jaw and close
6. MASTOID PALPATION - pain and tenderness, swelling

Question 3

FACE, NOSE, EARS - HEARING TEST

Answer 3

explain to patient

RINNE’S - conduction
*mastoid bone Vs infront of ear (air)
= infront of ear = air>bone
= RINNE’S POSITIVE (normal)

WEBER'S - sensorineural
*forehead or vertex of skull
- can you hear the tuning fork
- is the sound more prominent 
= central = equal cochlear function

WHISPER VOICE TESTING

• mask other ear by rubbing tragus
• behind patient and conversational voice
• can go closer
• then whisperat arms length

Question 4

MOUTH, THROAT, NECK - INSPECTION

Answer 4

FACE symmetry

SKIN changes along neck, swelling, scarring (sx hx)

ORAL cavity - angular stomatitis, teeth, tongue surface and wasting

using tongue depressor for side of tongue
under surface of tongue and submandibular ducts

OROPHARYNX, press tongue down and examine soft palate, uvula, and both tonsils

• say aah = movement of soft palate
• move tongue side-to-side = CN IX

TEETH - bite of teeth

NECK - lumps?, swallow water (move upwards), scarring
midline swelling = ?move up w/ tongue protrusion = mobile = thyroglossal cyst

Question 5

MOUTH, THROAT, NECK - PALPATION

Answer 5

Tracheal central and suprasternal notch
?pain

LN - one side at a time, Z from under chin
SUBMENTAL
SUBMANDIBULAR

ANTERIOR CHAIN = UPPER, MIDDLE, LOWER THIRD
*deep cervical node (lower third)

SUPRACLVICULAR

POSTERIOR CHAAIN

OCCIPITAL NODES

PRE-AURICULAR NODES

POST-AURICULAR NODES

THYROID PALPATION @ upper trachea
* gulp and palpate for any mobile swelling between fingers

SALIVARY GLAND PALPATION
parotid
submandibular
sublingual

+parotid duct = ?calculus
+ submandibular = bimanaual palpation, lumps or tenderness
+ tongue substance
+ tonsil palpation

Question 6

LEVELS OF LN

Answer 6

I - submand/submental
II - superior deep cervical
III - smc
IV - inferior deep cervical
V - posterior triangle

levels used to describe sites of mets

Question 7

MOUTH, THROAT, NECK - PERCUSSION & AUSC.

Answer 7

RETROSTERNAL THYROID - detect change in resonance

THYROID BRUIT - ?overactive gland = increased flow

CAROTID BRUIT - in upperthird of neck