OSCE for VII semesterOSCE for VII semester13-11-200113-11-2001

The slide will change automatically in 2 The slide will change automatically in 2 minutesminutes

Each slide carries 4 marksEach slide carries 4 marks Answer to the pointAnswer to the point

A.A. Identify the instrumentIdentify the instrument

B.B. Mention 2 of its uses in Mention 2 of its uses in the examination of the the examination of the nosenose

C.C. Mention 4 causes of Mention 4 causes of white patch on the tonsilwhite patch on the tonsil

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Tongue depressorTongue depressor Uses: cold spatula test for patency of airwayUses: cold spatula test for patency of airway posterior rhinoscopy to assess posterior rhinoscopy to assess

posterior part of nasal cavityposterior part of nasal cavity 4 causes: vincent’s angina, infectious 4 causes: vincent’s angina, infectious

mononucleosis, diphtheria, agranulocytosis, mononucleosis, diphtheria, agranulocytosis, leukemia, malignancy tonsil.leukemia, malignancy tonsil.

A.A. Which tuning fork Which tuning fork will you prefer?will you prefer?

B.B. Give 2 reasons for Give 2 reasons for your preference.your preference.

C.C. Name 4 causes of Name 4 causes of conductive conductive hearing loss.hearing loss.

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C 512C 512 Reasons: within the speech frequency, less Reasons: within the speech frequency, less

overtone, longer duration.overtone, longer duration. 4 causes: meatal atresia, otitis externa, otitis 4 causes: meatal atresia, otitis externa, otitis

media, barotrauma, foreign bodies.media, barotrauma, foreign bodies.

A 4-year-old child presents with A 4-year-old child presents with hoarseness of 4 months and moderate hoarseness of 4 months and moderate stridor of 4 days.stridor of 4 days.

A.A. What is the most What is the most probable diagnosis?probable diagnosis?

B.B. Name 2 investigations Name 2 investigations you will do to confirm you will do to confirm the diagnosis.the diagnosis.

C.C. What is THE surgical What is THE surgical treatment for the above treatment for the above condition and what is its condition and what is its prognosis.prognosis.

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Juvenile laryngeal papillomatosisJuvenile laryngeal papillomatosis Flexible/ rigid laryngoscopyFlexible/ rigid laryngoscopy Microlaryngoscopy and excision for biopsyMicrolaryngoscopy and excision for biopsy Microlaryngoscopy and excision with Microlaryngoscopy and excision with

microcautery.microcautery. Receurence rate is very high, may regress Receurence rate is very high, may regress

after pubertyafter puberty

A 5-year-old child presents with A 5-year-old child presents with chronic nasal obstruction, mouth chronic nasal obstruction, mouth breathing & snoring and bilateral breathing & snoring and bilateral recurrent ear aches.recurrent ear aches.

A.A. What is your most probable What is your most probable diagnosis?diagnosis?

B.B. Name 2 investigations which Name 2 investigations which will help you confirm the will help you confirm the diagnosis.diagnosis.

C.C. What is THE surgical What is THE surgical treatment?treatment?

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AdenoiditisAdenoiditis Nasal endoscopy, plain x ray lateral view of Nasal endoscopy, plain x ray lateral view of

the neck- soft tissue exposurethe neck- soft tissue exposure adenoidectomyadenoidectomy

A 36-year-old male presents with watery A 36-year-old male presents with watery rhinorrhoea, sneezing spells and rhinorrhoea, sneezing spells and hyposmia since 2 years. Nasal hyposmia since 2 years. Nasal endoscopy shows the following picture.endoscopy shows the following picture.

A.A. What is your What is your diagnosis?diagnosis?

B.B. Name 4 differences Name 4 differences between nasal polyp between nasal polyp and turbinate.and turbinate.

C.C. Name 2 drugs that Name 2 drugs that may relieve the may relieve the patients symptoms.patients symptoms.

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Nasal poly( ethmoidal)Nasal poly( ethmoidal) Nasal polyp: insensitive to touch, pale in Nasal polyp: insensitive to touch, pale in

colour, soft, probe test positivecolour, soft, probe test positive Turbinate: may bleed to touch, reddish in Turbinate: may bleed to touch, reddish in

colour, firm, probe test negative.colour, firm, probe test negative. Drugs: sodium cromoglycate, loratidineDrugs: sodium cromoglycate, loratidine

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

A.A. What is the most What is the most probable diagnosis?probable diagnosis?

B.B. Name 2 appropriate Name 2 appropriate investigations to investigations to confirm the diagnosis.confirm the diagnosis.

C.C. What is THE treatment What is THE treatment of choice?of choice?

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NPCNPC Nasal endoscopy, FNACNasal endoscopy, FNAC Chemoradiotherapy.Chemoradiotherapy. 6500 rads, 250 per day 5 days a week for 5 6500 rads, 250 per day 5 days a week for 5

weeks. Cisplatin 5 fluorocilweeks. Cisplatin 5 fluorocil

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

A.A. What is the probable What is the probable diagnosis?diagnosis?

B.B. Give 2 appropriate Give 2 appropriate investigations to investigations to confirm your confirm your diagnosis.diagnosis.

C.C. Name 2 types of brain Name 2 types of brain abscess.abscess.

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CSOM, atticoantral typeCSOM, atticoantral type Examination under microscope, x ray Examination under microscope, x ray

lateral view of mastoidlateral view of mastoid Temporal lobe, cerebellarTemporal lobe, cerebellar

A.A. Name the type of Name the type of nasal packing.nasal packing.

B.B. Name 2 important Name 2 important causes of epistaxis in causes of epistaxis in elderly patients.elderly patients.

C.C. Name the 4 arteries Name the 4 arteries that form the that form the Kesselback’s plexus.Kesselback’s plexus.

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Anterior nasal packingAnterior nasal packing Hypertension, accident, CCFHypertension, accident, CCF Septal branches of : anterior ethmoid, Septal branches of : anterior ethmoid,

sphenopalatine, superior labial, greater sphenopalatine, superior labial, greater palatinepalatine

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

below.below. A.A. Identify the Identify the

radiograph and its radiograph and its view.view.

B.B. What is the finding?What is the finding?

C.C. How will you treat How will you treat this case if refractory this case if refractory to medical treatment.to medical treatment.

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Plain x ray, occipito metal viewPlain x ray, occipito metal view Opacity in the right maxillary sinusOpacity in the right maxillary sinus Surgical drainage- antral washoutSurgical drainage- antral washout

A.A. Mention 2 findings in Mention 2 findings in this pure tone this pure tone audiogram.audiogram.

B.B. What is the type of What is the type of hearing loss?hearing loss?

C.C. Pure tone audiometry Pure tone audiometry is both qualitative and is both qualitative and quantitative test quantitative test (Mention True/false).(Mention True/false).

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Air bone gap, both air conduction n bone Air bone gap, both air conduction n bone conduction threshold are raisedconduction threshold are raised

Sensorineural hearing lossSensorineural hearing loss truetrue

Please proceed for the clinical examination in the hospital