Brief about the various cases in ENT

1. OSCE

2. OTOLOGY OSCE

3. a. Identify the
otoscopy
findings seen in
the figure
b. Name two
etiological
factors for the
same

4. • a – Serous otitis media/ otitis media with effusion
• b – Eustachian tube dysfunction, allergy,
unresolved acute otitis media, viral infections

5. a. Identify the
labelled device
b. Name two
indications for the
same

6. • a - Grommet
• b - Otitis media with effusion, recurrent otitis
media, patulous Eustachian tube, for drug
delivery

7. a. Identify the tuning
fork test being
performed
b. Give two reasons
for choosing 512
Hz tuning fork over
others?

8. • a – Webers test
• b –
• Tone decay is optimal & produces less overtone
• is present in mid speech frequency
• sound is more auditory than tactile

9. a. Identify the
condition shown in
the picture?
b. Name four causes
for this condition.

10. • a – Facial nerve paralysis
• b –
– Idiopathic (bells paralysis, melkerson syndrome)
- Infections (csom, herpes zoster oticus, malignant otitis
externa)
- Trauma
- Neoplasms (malignancies of external and middle ear,
parotid malignancy, glomus tumours, facial nerve
neuroma)

11. a. Identify the
condition shown in
the picture
b. Give 4 differential
diagnosis for the
same

12. • a – Aural polyp
• b –
– Inflammatory polyp
- Tumours arising from external ear, middle ear
- Brain herniation
- Glomus

13. A 4 year old child
presents with 3 days
history of coryzal
symptoms, left sided
otalgia and fever
a. What is the likely
diagnosis?
b. List 4
complications that
can occur as a result
of this condition

14. • a – Acute mastoiditis
• b –
– Mastoid abscess
- Bezolds abscess
- Lucs abscess
- Petrositis
- Intracranial complications( extradural abscess, subdural abscess, brain
abscess,lateral sinus thrombosis)

15. a. Identify the test
being performed?
b. What pathology can
be identified and
which canal is
being tested?

16. • a - Dix hallpike manoeuvre
• b - Benign Paroxysmal Positional Vertigo & Posterior Semi-
circular canal

17. a. Name the
instrument
b. Mention its uses
(any 2)

18. • a – Seigels pneumatic speculum
• b –
– To check the mobility of tympanic membrane
– Used for fistula test

19. a. Identify the type of
temporal bone fracture.
b. What type of hearing
loss is seen in this
fracture?

20. • a – Longitudinal temporal bone fracture
• b – Conductive hearing loss

21. a. Name this characteristic
feature seen in this
PTA.
b. Mention the condition
in which this type of
graph is seen.

22. • a – Carhart’s notch
• b - Otosclerosis

23. Given here is the picture
of otoscopic findings in
patients ear.
a. Mention the condition
b. Most common
Organism causing the
condition

24. a. Otomycosis
b. Aspergillus niger

25. a) Describe the otoscopic
findings in the patient
b) Give the probable
diagnosis

26. a) Findings:
– Loss of cone of light
– Prominent handle of malleus
– Retraction of tympanic membrane
– Loss of tympanic membrane mobility on seigelisation
b) Probable diagnosis:
– Adhesive otitis media

27. Name the numbered
structures below

28. The numbered structures are
1) Round window
2) Stapedial tendon
3) Pyramid
4) Long process of incus

29. • A 50 year old female
presented to ENT opd
with complaints of
– Tinnitus since 3 years
– Decreased hearing since
2 years
• Describe Otoscopic
findings and probable
diagnosis

30. • Otoscopic findings-
– Rising sun sign (the red mass behind the intact tympanic
membrane)
– On siegalisation the mass behind the tympanic membrane
blanches ( Brown’s sign)
• Diagnosis- GLOMUS JUGULARE

31. a) Identify the tuning fork
test being performed
b) Describe how you
perform the test

32. a) The tuning fork test being performed is Absolute
Bone Conduction test
b) PROCEDURE:
– The patient’s external auditory canal is blocked by pressing
over tragus while putting the vibrating tuning fork on
mastoid.
– When patient no longer hears any sound , the same tuning
fork to be shifted examiners mastoid of same ear to
compare
– The result of ABC is interpretted as normal or short

33. 1. Name the condition
seen on otoscopy
2. Name three causes for
it

34. 1. The above mentioned condition is
TYMPANOSCLEROSIS
2. The causes for tympanosclerosis include
1) Resolved otitis media
2) Trauma
3) Iatrogenic ( grommet insertion)

35. • A 65 years old male
known diabetic
presented with c/o
severe pain in left ear
with facial nerve palsy .
Image shows
a) What could be the
probable diagnosis
b) Most common organism
causing the condition
c) Drug of choice

36. a) The probable diagnosis is MALIGNANT OTITIS
EXTERNA
b) Most common organism causing malignant otitis
externa is Pseudomonas aeruginosa
c) Drug of choice is IV generation cephalosporins

37. a) Identify the type of
temporal bone
fracture
b) What type of hearing
loss can be seen in
such fracture?

38. a) Type of temporal bone fracture is TRANSVERSE
FRACTURE
b) Patient presents with sensorineural hearing loss

39. A 2 year old child was
brought to ENT opd with
– complaints of ear pain
since 1 day
– Urti since 2 days
– Otoscopy as shown:
a) Probable diagnosis
b) Stages of the disease

40. a) Probable diagnosis is Acute otitis media
b) Stages of acute otitis media are
1)Stage of tubal occlusion/ hyperemia
2)Stage of pre-suppuration/ exudative
3)Stage of suppuration
4)Stage of resolution / complication

41. a) What could be the possible
diagnosis?
b) Classify this condition?

42. a) CSOM with cholesteatoma
b) Classified into
• Congenital
• Acquired, Primary
• Acquired, Secondary

43. •30 years old male patient
came with c/o pain right ear
- 1 week blocking sensation
right ear - 10 days mild
discharge from right ear - 1
week Otoscopy shows:
a) Enumerate otoscopic
findings?
b) Mention the possible
diagnosis?

44. a) Whitish mass admixed with wax can be seen
in the external canal
b) Keratosis obturans

45. a) Name the type of pinna
seen here
b) Name some drugs which
when ingested during
pregnancy would cause
this condition

46. a) Microtia
b) Warfarin, Folic acid
antagonists like methotrexate
and aminopterin

47. a) Why is this external auditory
canal narrow ?
b) What could be the cause ?
c) What could be the clinical
problems faced by the patient ?
d) What surgery should be
performed in this patient ?

48. a) Exostosis of external auditory canal.
b) It is common in swimmers.
c) These patients have conductive deafness, cerumen
impaction.Cerumen impaction is caused by abnormal
self cleansing mechanism of the skin lining external
canal in these patients.
d) Canalplasty

49. a) What is the diagnosis?
b) What is the cause of this
condition?
c) How will you manage the
case?

50. a) Pre auricular sinus
b) Congenital anomaly due to faulty union of hillocks of first
and second branchial arches during development of pinna –
sinus at root of helix
c) Antibiotics and Surgical excision of the tract

51. a) Name the test performed?
b) Name the condition the test
to be positive ?
c) Name the condition the test
to be negative?

52. a) Rinnes Test
b) Positive test- Normal hearing ear or Sensorineural
hearing loss
c) Rinnes negative- Conductive hearing loss

53. a) What is the view depicted in
this CT Scan?
b) What could be the probable
diagnosis?

54. a) CT Axial view of temporal bone
b) Showing sclerosis of mastoid air cells on the right side-
Possibly due to mastoiditis and Normal mastoid air cell
pneumatization on the left side

55. a) Name the incision?
b) Why is this area preferred?

56. a) Endaural Incision used for Mastoidectomy
b) The area is devoid of cartilage

57. a) Identify the instrument
b) State two Uses ?

58. a) MOLLISON’S self retaining hemostatic mastoid retractor
b) Uses-
a) To expose the mastoid cortex and hold the soft tissue apart
b) to harvest temporalis fascia graft
c) Hemostatic effect- It holds the soft tissue and skin apart
and the pressure keeps area blood free

59. a) What type of Hearing loss
is shown in this Pure tone
Audiogram?
b) What is the probable
diagnosis?

60. a) Sensorineural hearing loss
b) Meniere’s Disease

61. a) Aural seroma
b) Needle aspiration with application of
compression dressing to prevent
reaccumulation

62. OSCE-RHINOLOGY

63. a) What are the materials
commonly used to test
olfaction?
b) Why ammonia is not
used to test olfaction?

64. a) Materials commonly used to test olfaction include clove oil,
peppermint, coffee and rose essence.
b) Ammonia is an irritant and it stimulates the trigeminal nerve
hence not used to test olfaction.

65. a) Name the test/ maneuver.
b) Explain the inference.
c) What are the boundaries of
nasal valve?

66. a) Cottle’s test
b) Subjective improvement in nasal obstruction on upward and
lateral traction of skin lateral to the nostril indicates
obstruction at the nasal valve.
c) Boundaries of nasal valve:
– Medial: nasal septum
– Lateral and superior: caudal margin of upper lateral cartilage.
– Inferior: Floor of pyriform aperture

67. a) Name the test.
b) Why is it performed?
c) Name an alternative test
which can be performed
for the same?

68. a) Cold spatula test
b) Performed to test nasal patency
c) Alternatively cotton wisp test can be done to
test for nasal patency.

69. a) Which is the artery of
epistaxis?
b) How is Kiesselbach
plexus formed?
c) How would you treat
uncontrolled posterior
epistaxis?

70. a) Sphenopalatine artery is the artery of
epistaxis
b) Anterior ethmoidal, septal branch of superior
labial, septal branch of sphenopalatine and
greater palatine anastomose in Little’s area to
form Kiesselbach’s plexus.
c) Arterial ligation of sphenopalatine/maxillary
artery.

71. a) Name the instrument
b) Mention 3 complications of
SMR (Submucosal resection
of septum)

72. a) Killian’s long bladed nasal speculum
b) Supratip depression, Collumella retraction, septal
perforation.

73. a) Name the instrument.
b) What structures should be
visualized during the
procedure ?

74. a) St.Claire Thompson posterior rhinoscopy mirror.
b) Posterior end of turbinates, posterior border of nasal
septum, fossa of rosenmuller, torus tubarius, opening of
eustachian tube, upper surfece of soft palate, adenoids.

75. a) Mention 2 indications for
Diagnostic nasal
endoscopy?
b) What are the structures to
be visualised during First
Pass?

76. a) Indications: To diagnose any disease of the nose and PNS, to
diagnose source of bleeding in epistaxis, to assess response
to medical/surgical treatment, to take a precise biopsy from
nose and nasopharynx.
b) Structures visualized
a) nasal septum
b) opening of eustachian tube
c) walls of nasopharynx
d) upper surface of soft palate and uvula
e) opening of nasolacrimal duct

77. a) Name the Xray view.
b) What are the structures
that can be visualised?

78. a) X-Ray PNS Water’s view
b) Frontal, ethmoidal and maxillary sinuses, nasal septum,
inferior turbinate, zygomatic arch and mandible can be
visualised.

79. a) Name the X-Ray view.
b) What are the structures
seen?

80. a) Caldwell view
b) Frontal and ethmoidal sinuses, orbit, orbital rim, medial
orbital wall, nasal bone, septum, zygomatic bone, mandible

81. a) What is the Xray view?
b) What is the
abnormality noted?
c) Explain the typical
‘facies’ associated with
the condition.
d) Mention 4 clinical
features of the
condition.

82. a) X-ray nasopharynx-lateral view
b) Showing adenoid hypertrophy
c) Adenoid facies-elonated face with dull expression, open
mouth, prominent and crowded upper teeth, hitched-up
upper lip, pinched in appearance of nose, high arched hard
palate.
d) Symptoms-nasal obstruction, features of acute otitis media,
snoring, change in voice, features of PAH.

83. a) Identify the condition
b) 2. Name the organism
which causes this
condition
c) 3. Management

84. a) Atrophic rhinitis
b) Coccobacillus, Bacillus mucosus,
Coccobacillus foetidus ozaenae, Diptheroid
bacillus and Klebsiella ozanae
c) Modified Young’s operation

85. a) Identify
b) Site of origin and names its parts
c) Management

86. 1. Antrochoanal Polyp
2. Arised From The Mucosa Of The Maxillary
Antrum Near Its Accessory Ostium, Comes
Out And Grows Into Choana And Nasal
Cavity.
Parts: 1. Antral: Thin Stalk
2. Choanal: Round And Globular
3. Nasal: Flat From Both Sides
3. Polypectomy/ Endoscopic Removal

87. a) Identify the
condition.
b) Name few
symptoms
associated with it.
c) Name the surgeries
that can be used in
this condition.

88. a) Deviated nasal septum
b) Nasal block, Recurrent cold, headache,
anosmia, epistaxis.
c) Septoplasty, SMR ( Submucosal resection of
nasal septum)

89. a) WHAT COULD BE THE PROBABLE LESION?
b) COMMENT ON ITS HISTOLOGY
c) NAME THE ORGANISM CAUSING IT

90. a) Rhinosporidiosis
b) Sporangia are located in stroma of the
mucosal polyp.
c) This is caused by Rhinosporidium seeberi

91. a) Identify the condition
b) Name few
predisposing factors.
c) Comment on its
mode of spread
d) What is he drug of
choice.

92. 1. Mucormycosis
2. Immunocompromised –
Diabetes ( diabetic ketoacidosis), Organ transplant,
Stem cell transplant, chemotherapy, neutropenia,
Long term corticosteroid use.
3. Vascular invasion
4. Amphotericin B

93. a) Identify the condition.
b) Name two Causes
c) How do you manage it.

94. a) Saddle Nose
b) Causes:
– Nasal Trauma – Any Sort Of Injury Or Trauma To The Nose Can Damage
The Septal Cartilage Along The Bridge And Compromise Important
Support Structures.
– Surgical Causes – Rhinoplasty Surgery That Is Overaggressive Can Be A
Contributing Cause If Excess Cartilage Is Removed From The Nose In An
Attempt To Reduce The Height Of The Septal Cartilage.
– Intranasal Cocaine Usage – Cocaine Causes Vasoconstriction, Which Is A
Narrowing Of The Blood Vessels Leading To Decreased Blood Supply
And Deteriorated The Septal Cartilage.
c) Augmentation Rhinoplasty

95. a) Identify the
condition
b) Name the
Organism
causing it
c) What is the
management

96. a) VESTIBULITIS
b) Staphylococcus aureus.
c) Application of Topical Antibiotic- Bacitracin
for 14 days.

97. a) Identify the
abnormality
b) What is the most
common cause for
this
c) Enumerate the plan
of management

98. a) Nasal bone Fracture.
b) Trauma
c) Simple fracture no displacement: No treatment.
– Closed reduction:
• interfered by presence of oedema
• best time is before the appearance of oedema or after it
subsides.
• Difficult after 2 weeks because it heals.
– Open reduction: rare

99. a) What type of fracture
is this?
b) Name one synonym
for this type of
fracture?
c) What is the status of
palate in this patient?

100. a) It’s A Lefort Type I Fracture.
b) Its Also Known As Guerin’s Fracture
c) Palate In These Patients Float Into The Oral
Cavity.

101. This patient came with c/o
swelling over left forehead
- 15 years duration
Swelling over left orbit -
20 years duration
a) Enumerate the clinical
findings
b) What could be the
possible diagnosis ?

102. a) Findings-
1. Soft boggy swelling over left forehead.
2. Proptosis with left eye pushed downwards and
outwards
3. Ocular movements full / vision normal
b) DIAGNOSIS: Frontoethmoidal mucocele left side

103. a) Identify the
instrument being used
b) Name the procedure
being done
c) Mention 2 precautions
you will take during
the above procedure.

104. a) Thudicum nasal speculum
b) Anterior rhinoscopy
c) Close the speculum before put in the nose.
Don’t close it when withdraw from nose.
Aseptic measure. Make sure no anterior
nasal pathology.

105. An 15-year-old boy presents
with left sided nasal
obstruction since one year
and nasal endoscopy showed
the following picture.
a) What is your diagnosis?
b) What is the surgical
treatment?

106. a) Nasal polyp
b) Polypectomy

107. a) Identify the
instrument
b) Mention two of its
uses

108. a) Tongue depressor
b) Uses:
a) Examination of Oral Cavity & Oropharynx
b) Cold spatula test for patency of airway
c) Used in posterior rhinoscopy

109. A 5-year-old child presents with
chronic nasal obstruction,
mouth breathing & snoring and
bilateral recurrent ear aches.
a) What is your most probable
diagnosis?
b) Name 2 investigations
which will help you confirm
the diagnosis.
c) What is the surgical
treatment?

110. A. Adenoiditis
B. Nasal endoscopy, Plain x ray lateral view of neck
C. Adenoidectomy

111. A 36-year-old male presents
with watery rhinorrhoea,
sneezing spells and hyposmia
since 2 years. Nasal endoscopy
shows the following picture.
a) What is your diagnosis?
b) Name 4 differences
between nasal polyp and
turbinate.
c) Name 2 drugs that may
relieve the patients
symptoms.

112. a) Nasal polyp( ethmoidal)
b) Nasal polyp: insensitive to touch, pale in
color, soft, probe test positive. Turbinate:
may bleed to touch, reddish in color, firm,
probe test negative.
c) Drugs: Antihistamines, Steroidal Nasal
Sprays.

113. A 40-year-old male presents
with left sided nasal
obstruction since 9 years and
examination of the nose
showed the following picture.
a) What are the findings?
b) Name 2 complications of
this condition.
c) What is the surgical
treatment of this
condition?

114. a) Deviated nasal septum with spur to
the right
b) Epistaxis, anosmia
c) Septoplasty

115. a) Name the
instruments
b) Mention the
use of each
1.
2.

116. a) Asch’s Forceps- Used for reducing procedures in
cases of nasal septum fractures
b) Walsham Forceps- For reduction of fractured lateral
wall of nose and disimpaction and repositioning of
bony fragments

117. a) Identify the line
marked in red
b) Mention the
clinical
significance of this
line.

118. a) Ohngren’s line – It is is a line that connects the medial
canthus of the eye to the angle of the mandible.
b) Tumours that arise below Ohngren's line, generally
have a better prognosis than those above.

119. a) Identify the instrument
b) Name the surgery in
which it is used

120. a) Freer’s Elevator
b) Septoplasty, FESS

121. LARYNGOLOGY
OSCE

122. a) Identify the instrument
b) Mention the hidden
areas during the
procedure

123. a) Indirect Laryngoscopy mirror
b) Apex of Pyriform sinus, subglottis, Ventricles

124. a) Comment on this
laryngoscopic finding
b) What is the most
common causative
organism causing the
condition?

125. a) Acute epiglottitis
b) Haemophillus Influenza type b

126. 52 year old man presented to OPD
with c/o hoarseness of voice since one
month, Patient gives history of chronic
smoking.
a) What is the most probable
diagnosis ?
b) What is the management?

127. a) Rinke’s edema
b) Cessation of smoking, Voice therapy,
Microlaryngoscopy & stripping

128. a) What is the diagnosis ?
b) What could be the
optimal treatment
modality?

129. a) Left mucosal cyst of Vocal cord
b) Voice therapy and Microlaryngoscopy

130. A- What is the diagnosis ?
B- What is most common cause ?

131. a) Vocal Nodule
b) Voice Abuse

132. A- What is the diagnosis ?
B- Most common virus
associated

133. • Respiratory Papillomatosis
• Human Papilloma virus

134. a) Identify the muscle?
b) Mention its action

135. a) Posterior cricoarytenoid muscle
b) Abduction of vocal cords

136. a) Identify the cartilage ?
b) Name the membranes
attached to it

137. a) Cricoid cartilage
b) Cricothyroid membrane

138. a) Identify the nerve ?
b) Mention the muscles it
supplies

139. a) Recurrent laryngeal nerve
b) All Intrinsic muscles of larynx except
Cricothyroid muscle

140. a) Name the device.
b) Mention the different
types of tubes
available?

141. a) Single lumen Cuffed Tracheostomy tube
b) Portex cuffed/uncuffed tracheostomy tube,
Fenestrated tubes, Double lumen tubes,
Metal tracheostomy tubes

142. a) Identify the instrument
b) Diagnostic indications
c) Any one contraindication

143. a) Chevalier Jackson Direct laryngoscope
b) Direct Laryngoscopy & visualization of Larynx
and Hypopharynx. Biopsy for suspected
malignancy larynx
c) Cervical spine pathology, aortic aneurysm

144. Label the diagram A B
C D

145. A. Epiglottis
B. Vocal cords
C. Aryepiglottic folds
D. Tracheal rings

146. A child of age 4 months came
with complaints of stridor and
feeding difficulties(cough,
regurgitation). Endoscopic
picture – shows omega
epiglottis.
a) What is your diagnosis ?
b) Mention 3 other causes of
congenital stridor ?

147. a) Larygomalacia
b) Laryngeal webs, Laryngeal stenosis,
Haemangioma larynx

148. a) What is this surgical
position called ?
b) Name the advantages of
this position.

149. a) Rose position (Flexion at the atlanto axial
joint and hyper-extension of neck)
b) Good exposure of the surgical field
(oropharynx)

150. 13 years old boy came with c/o
pain in the throat (intense) 4
days, on examination found to
be febrile.
a) Describe this lesion.
b) Mention two differential
diagnosis

151. a) White patch on tonsil (Membranous
Tonsillits)
b) Staphylococcal membranous tonsillitis,
Diphteria, Vincents angina, Infectious
mononucleosis, Candidiasis, Agranulocytosis

152. a) What is the probable
diagnosis?
b) What are the cardinal features
of this condition?

153. a) Chronic tonsillitis
b) Flushing of anterior pillars, Positive Erwin
Moore’s sign, palpable nontender
Jugulodigastric lymphnode.

154. a) Identify the instrument?
b) What are the
complications of the
procedure in which it is
used?

155. a) Eve’s Tonsillar snare
b) Hemorrhage (Primary, Secondary,
Reactionary), Damage to Surrounding
structures, Infection, Coroner’s clot
(Aspiration)

156. a) Name the sign ?
b) Condition in which it is
seen ?

157. a) Steeple’s Sign
b) Acute Laryngotraceobronchitis (Croup)

158. Identify A & B in the
given Histopathological
specimen A
B

159. A. Pseudostratified ciliated columnar epithelium
B. Hyaline cartilage

160. a) Name the sign ?
b) Condition in which it is
seen ?

161. a) Thumb sign
b) Acute epiglottitis

162. Label the levels of lymph
nodes of neck

163. • Level I: Submental and submandibular nodes
– Level Ia: Submental
– Level Ib: Submandibular
• Level II: Upper jugular nodes
– Level IIa & Level IIb
• Level III: Middle jugular nodes -
• Level IV: Lower jugular nodes -
• Level V: Posterior triangle nodes –
– Level VA: Above the horizontal plane formed by the inferior border of the
anterior cricoid arch, including the spinal accessory nodes.
– Level VB: Lymph nodes below this plane, including the transverse cervical
nodes and supraclavicular nodes (except Virchow's node which is in IV).
• Level VI: Anterior compartment nodes - Pretracheal, paratracheal, precricoid
(Delphian) and perithyroid nodes

164. a) Identify the location
where the foreign
body is lodged ?
b) What is the next line
of management ?

165. a) Esophagus
b) Rigid Esophagoscopy & Removal of Foreign
body

166. A
B
C
D
Identify the
structures

167. A. Pharyngeal tonsil
B. Tubal tonsil
C. Palatine tonsil
D. Lingual tonsil

168. a) What is the diagnosis ?
b) What is the
management

169. a) Tonsillolith
b) Medical- Antibiotics, Antiseptic gargles.
Surgical- Tonsillectomy

170. 58 year old female presented to EMD
with difficulty in swallowing,
sensation of food getting stick in
throat & regurgitation. Barium
swallow was done and following
finding was seen.
a) What is the diagnosis ?
b) What is the next line of
management ?

171. a) Pharyngeal Pouch (zenker’s diverticulum)
b) Endoscopic excision, Dohlman’s procedure

172. OSPE

173. STATION I
• A 36 year old lady presents to the ENT OPD with complaints of a
neck swelling on the left side of the anterior aspect of neck, since 2
years, insidious in onset and gradually progressing in size. She
gives no h/o weight loss/gain, no h/o cold/heat intolerance, no h/o
sleep disturbances, fatigue, bowel disturbances or menstrual
irregularities. No c/o difficulty in breathing or swallowing or
change in voice.
a) Demonstrate the appropriate procedure of examining the neck
swelling in this patient
b) State your probable diagnosis

174. ANSWER KEY – STATION I
a) Neck examination – under adequate lighting
and exposure, patient’s neck is slightly
hyperextended. Examining physician is to
stand behind the patient and palpate for the
thyroid gland margins. Patient is asked to
swallow. Thyroid isthmus is palpated,
followed by the margins of the gland.
b) Probable diagnosis – Multinodular goitre
with dominant nodule on the left and
clinically euthyroid state

175. STATION II
• A 23-year old man is comes to the ENT OPD, with complains of
swelling below the angle of the mandible, anterior to the left
sternocleidomastoid since 1 year, which was insidious in onset,
soft in consistency, painless and gradually progressive in size.
a) Demonstrate the appropriate procedure of examining the neck
swelling in this patient
b) State your probable diagnosis

176. ANSWER KEY – STATION II
a) Neck examination – under adequate lighting and exposure, patient’s
neck is slightly flexed to the side of examination. Examining physician
is to stand behind the patient and palpate for the swelling margins.
Margins of the swelling is palpated, look for size, number, shape,
tenderness, consistency, mobility/ fixity, plane of the swelling,
fluctuation.
b) Branchial cyst, Paramedian thyroglossal cyst, cystic lymph node,
Neurogenic tumors (schwannoma, neurofibroma), cervical dermoid
cyst, cavernous lymphangioma

177. STATION III
A 39 year-old woman diagnosed with colloid goitre of the left lobe of
the thyroid, underwent left hemithyroidectomy. During the post-
operative period, patient developed hoarseness of voice, with
occasional aspiration on drinking fluids.
a) Perform the examination using given instrument?
b) Interpret your findings?

178. ANSWER KEY – STATION III
a) Procedure
– Warm the mirror to avoid fogging
– Ask the patient to protrude his/her tongue and hold the
tongue with a gauze.
– Direct the patient to breathe through his/her mouth.
– Introduce the mirror into the oral cavity with the mirror
facing downwards.
– Bring the mirror to rest against the uvula, without touching
the posterior pharyngeal wall.
– Once the laryngeal inlet is visualized, the patient is asked
to produce a ‘eee’ sound to assess the movement of the
vocal cords.

179. STATION IV
Perform examination using this
instrument

180. EXAMINING THE THROAT INCLUDING THE USE OF
A TONGUE DEPRESSOR- CHECK LIST
ANSWER KEY – STATION IV
Greeting/hand shake yes no
Introduction of self yes no
Explaining the procedure with clear instructions yes no
Consent if taken yes no
Ability to perform Throat examination correctly
Position of the patient / examiner yes no
Washes hands yes no
Wears non-sterile gloves. yes no
Ask the patient to remove dentures, if any yes no
Evaluates for Mouth Opening yes no
Inspect the oral cavity yes no

181. Holds the tongue depressor appropriately to inspect
the Oral cavity/Oropharynx
yes no
Examines their mouth systemically :
Tongue, buccal mucosa, parotid duct, hard and soft
palate, tonsillar fossa, gingivolabial/gingivobuccal sulci,
floor of mouth/undersurface of tongue ,alveolar
ridges& retromolar trigone.
yes no
Ask the patient to say Ah and observe for Gag reflex yes no
Describes & documents any abnormality yes no
Thanks the patient yes no

182. ANSWER KEY – STATION IV
c) Procedure
– Hold the instrument by the narrower blade that acts as a handle
and insert the other blade into the oral cavity.
– First retract the cheek so you can examine the vestibule, buccal
mucosa and gums and repeat the same on the other side.
– Place the blade flatly on the dorsum of the tongue and press it
down – this will allow you to examine the palate, tonsillar pillars,
the tonsils and the posterior pharyngeal wall.
– Take care to depress only the anterior two-thirds of the tongue
with this instrument.