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  can’t  smell,  can’t  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,  wegener’s  

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  can’t  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,  Wharton’s  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  (Carhart’s  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