ENT OSCEs-A Guide to Passing the MRCS (ENT) OSCE

Data and Picture Interpretation Stations

CASE 39

Q 1. What is this?
Q 2. Name one advantage over a grommet.
Q3. Name one disadvantage compared with a grommet.

180

Case 39

CASE 39 ANSWERS

Q1. What is this?
T Tube
Q 2. Name one advantage over a grommet.
Remains in the tympanic membrane for longer
Q3. Name one disadvantage compared with a grommet.
Higher risk of residual tympanic perforation

181

Data and Picture Interpretation Stations

CASE 40

Q 1. What is this?
Q 2. What is the smallest of the above three components made from and why?
Q 3. Name two situations where this would be more appropriate than a conventional

hearing aid.

182

Case 40

CASE 40 ANSWERS

Q 1. What is this?
Bone anchored hearing aid
Q 2. What is the smallest of the above three components made from and why?
Titanium as it osseointegrates
Q 3. Name two situations where this would be more appropriate than a conventional

hearing aid.
Congenital malformations of the middle or external ear, microtia, chronically

discharging ear

183

Data and Picture Interpretation Stations

CASE 41

Q 1. What is the most common type of thyroid cancer?
Q2. Which thyroid cancer would give an elevated calcitonin level?
Q3. Which wider group of disorders is this type associated with?
Q4. What is typically the most aggressive form of thyroid cancer?
Q5. What is the primary investigation for a patient with a thyroid lump?
Q 6. How would you proceed with a U4 Thy3f result and why?
Q 7. How would you proceed with a Thy1 result and why?

184

Case 41

CASE 41 ANSWERS

Q 1. What is the most common type of thyroid cancer?
Papillary thyroid cancer
Q2. Which thyroid cancer would give an elevated calcitonin level?
Medullary thyroid cancer
Q3. Which wider group of disorders is this type associated with?
Multiple endocrine neoplasia type 2 (MEN2)
Q 4. What is typically the most aggressive form of thyroid cancer?
Anaplastic thyroid cancer
Q5. What is the primary investigation for a patient with a thyroid lump?
Ultrasound and fine needle aspiration
Q6. How would you proceed with a U4 Thy3f result and why?
Diagnostic hemithyroidectomy due to being unable to differentiate on cytology alone
Q7. How would you proceed with a Thy1 result and why?
Repeat FNA as inadequate result

185

Data and Picture Interpretation Stations

CASE 42

Q 1. Describe object A.
Q 2. What is object B and what is its use?
Q3. What is object C and what is its use?
Q 4. Name four indications for tracheostomy insertion.
Q5. What is object D and how does it work?

(a) (c)

(b)

(d)

186

Case 42

CASE 42 ANSWERS

Q 1. Describe object A.
Cuffed fenestrated size 8 tracheostomy tube
Q 2. What is object B and what is its use?
Non-fenestrated inner tube – to aid cleaning
Q3. What is object C and what is its use?
Introducer – to aid insertion of tracheostomy
Q4. Name four indications for tracheostomy insertion.

To secure an airway if compromised secondary to obstruction (infection/tumour/
trauma), to secure an airway in anticipation of airway compromise, to facilitate
weaning for prolonged ventilation, to aid removal of respiratory secretions/protect
from aspiration, severe sleep apnoea not responsive to continuous positive airway
pressure

Q5. What is object D and how does it work?
Fenestrated inner tube – to allow voice production and to aid weaning from
tracheostomy

187



Index

A C

ACE, see Angiotensin-converting enzyme Catarrh and post-nasal drip, 17–18; see also
Acoustic neuroma, 94–95 History stations
Acute otitis media (AOM), 22
Adenotonsillectomy operation note, 99–100 CBT, see Cognitive behavioural therapy
Adult Central nervous system (CNS), 25
Cerebellar testing, 76; see also Vestibular
with itchy, painful ear, 31–32
with non-acute hearing loss, 33–34 assessment
with sudden hearing loss, 35–36 Cerebrospinal fluid (CSF), 84
Angiotensin-converting enzyme (ACE), 28 Chest X-ray (CXR), 15, 115
Anterior Child with recurrent ear infections, 22–23;
epistaxis, 128–129
nasal septal perforation, 104–105 see also History stations
AOAEs, see Automated otoacoustic emissions CHL, see Conductive hearing loss
AOM, see Acute otitis media Cholesteatoma, 91–92
Attic crust, 106–107 Chronic suppurative otitis media (CSOM), 20
Audiogram, 160–161 Churg–Strauss syndrome (CS), 39
Auditory canal, bony exostoses of, 170–171 CNS, see Central nervous system
Automated otoacoustic emissions (AOAEs), Cognitive behavioural therapy (CBT), 13
Communication skills stations, 81
29
Axial computed tomography of temporal acoustic neuroma, 94–95
benign paroxysmal positional vertigo, 90–91
bones, 118–119 breaking bad news, 96–97
cholesteatoma, 91–92
B consent, 81–89
discharge letter, 98
Benign paroxysmal positional vertigo (BPPV), ear sections, 82
41, 78, 90–91; see also Vestibular example mark scheme, 83
assessment explanation, 90–95
functional endoscopic sinus surgery, 83–84
example mark scheme, 91 grommets, 81–83
nystagmus in, 79 microlaryngoscopy, 85–86
Biopsy myringoplasty, 86–87
operation note, 101 operation note, 99–101
risks of, 82 panendoscopy, 85–86
BIPP, 163 parotid surgery, 87–88
Birkett straight forceps, 162, 163 septoplasty, 84–85
Blom-Singer valve, 176–177 septum, 85
Bone anchored hearing aid, 182–183 sinuses, 83
Bony exostoses of auditory canal, 170–171 submandibular surgery, 89
BPPV, see Benign paroxysmal positional Thy3F thyroid nodule, 92–94
Computed tomography (CT), 4, 92
vertigo paranasal sinuses, 154–155
Breaking bad news, 96–97; see also

Communication skills stations

189

Index

Conductive hearing loss (CHL), 92 areas to look, 55
Consent, 81–89; see also Communication skills examination pearl, 61
free field hearing test, 58, 59
stations holding otoscope, 56
Cranial nerve VII, see Facial nerve mark scheme, 61
CS, see Churg–Strauss syndrome mastoid examination, 56
CSF, see Cerebrospinal fluid using otoscope, 57
CSOM, see Chronic suppurative otitis media pulling ear posterosuperiorly, 57
CT, see Computed tomography pulling pinna posterosuperiorly, 55
Cuffed fenestrated size 8 tracheostomy tube, Rinne and Weber Tests, 60, 61
tympanic membrane, 58
186, 187 Weber test, 60
CXR, see Chest X-ray Ear, nose and throat (ENT), 22
ENT, see Ear, nose and throat
D Epistaxis, 5
adult, 7
Data and picture interpretation stations, see anterior, 128–129
Interpretation stations, data and cause of, 5
picture objects used in management, 162–163
Erythrocyte sedimentation rate (ESR), 28
Diploma of Otolaryngology–Head and Neck ESR, see Erythrocyte sedimentation rate
Surgery (DO-HNS), 53 Examination stations, 53; see also History

Discharge letter, 98; see also Communication stations; see also Interpretation
skills stations stations, data and picture
ear examination, 55–61
Dix–Hallpike test, 78, 79; see also Vestibular flexible nasendoscopy, 73–74
assessment neck examination, 65–69
nose examination, 62–64
Dizziness, 41 oral cavity examination, 70–72
drug history, 42 rules for examinations, 53
explanation and planning, 42–43 vestibular assessment, 75–79
family history, 42 Explanation, 90–95; see also Communication
general structure of consultation, 41 skills stations
history and systems review, 42 External auditory canal (EAC), 31, 55
social history, 42
specific questions, 41 F

DO-HNS, see Diploma of Otolaryngology– Facial nerve, 24
Head and Neck Surgery Facial weakness, 24; see also History stations

Dry mouth, 9; see also History stations drug history, 25
drug history, 10 explanation and planning, 25–26
explanation and planning, 10–11 family history, 25
family history, 10 general structure of consultation, 24
history and systems review, 10 history and systems review, 25
social history, 10 social history, 25
specific questions, 9–10 specific questions, 24–25
structure of consultation, 9 Feeling of something in the throat (FOSIT),

Dysphonia, 14 12
Fenestrated inner tube, 186, 187
E Fine needle aspiration (FNA), 26, 92

EAC, see External auditory canal
Ear; see also History stations

recurrent infections, 22–23
sections, 82, 87
Eardrum, 87
Ear examination, 55; see also Examination stations

190

Index

Flexible nasendoscopy (FNE), 15, 73; see also olfactory dysfunction, 2–4
Examination stations otalgia, 37–38
recurrent ear infections, 22–23
manoeuvres, 74 recurrent tonsillitis, 48–49
view of cords, 114–115 septal perforation, 27–28
vocal tract, 74 snoring, 46–47
Floor of mouth, 144–145 tinnitus, 19–21
Fluid behind tympanic membrane, 120–121 udden hearing loss, 35–36
FNA, see Fine needle aspiration Hitselberger sign, 25
FNE, see Flexible nasendoscopy HIV, see Human immunodeficiency virus
Foramen magnum, 152–153 Hoarse voice, 14; see also History stations
Foramen ovale, 152–153 drug history, 15
FOSIT, see Feeling of something in the throat explanation and planning, 15–16
Fractured nasal bones, 156–157 family history, 15
Functional endoscopic sinus surgery, 83–84 history and systems review, 15
Fungal otitis externa/otomycosis, 112–113 social history, 15
specific questions, 14–15
G structure of consultation, 14
Human immunodeficiency virus (HIV), 9
General practitioner (GP), 31 Human voice, 14
Glomus tympanicum, 150–151
GP, see General practitioner I
Grade, roughness, breathiness, asthenia,
IAM, see Internal auditory meatus
strain, see GRBAS ICP, see Intracranial pressure
GRBAS (Grade, roughness, breathiness, Internal auditory meatus (IAM), 94
Interpretation stations, data and picture, 103
asthenia, strain), 15
Grommets, 81–83 anterior epistaxis, 128–129
anterior nasal septal perforation, 104–105
insertion operation note, 100 attic crust, 106–107
audiogram, 160–161
H axial computed tomography of temporal

Hashimoto thyroiditis, 148–149 bones, 118–119
Hearing loss, 33 BIPP, 163
Birkett straight forceps, 162, 163
in child, 29–30; see also History stations Blom-Singer valve, 176–177
right conductive, 108–109 bone anchored hearing aid, 182–183
Heel–toe gait, 78; see also Vestibular assessment bony exostoses of auditory canal, 170–171
Herpes zoster oticus, 26, 110–111 CT paranasal sinuses, 154–155
History stations, 1; see also Examination fenestrated tracheostomy tube, 186, 187
fluid behind tympanic membrane, 120–121
stations foramen magnum, 152–153
catarrh and post-nasal drip, 17–18 foramen ovale, 152–153
dizziness, 41–43 fractured nasal bones, 156–157
dry mouth, 9–10 fungal otitis externa/otomycosis, 112–113
facial weakness, 24–26 glomus tympanicum, 150–151
hearing loss in child, 29–30 Hashimoto thyroiditis, 148–149
hoarse voice, 14–16 herpes zoster oticus, 110–111
itchy painful ear, 31–32 introducer, 186, 187
lump in throat, 12–13 Jobson-Horne probe, 166, 167
nasal crusting, 39–40
nasal obstruction, 50–51
neck lump, 44–45
non-acute hearing loss, 33–34
nosebleeds, 5–8

191

Index

Interpretation stations, data and J
picture (Continued)
Jobson-Horne probe, 166, 167
laryngomalacia, 116–117 Jugular venous pulse (JVP), 65
lateral soft tissue neck radiograph, 174–175 JVP, see Jugular venous pulse
left acute mastoiditis, 172–173
left parotid lump, 138–139 L
left vocal cord palsy, 114–115
lesion in neck, 124–125 Laryngomalacia, 116–117
mastoid process, 152–153 Laryngopharyngeal reflux (LPR), 13
MRI with gadolinium enhancement, Lateral soft tissue neck radiograph,

134–135 174–175
nasal polyp, 146–147 Left acute mastoiditis, 172–173
non-fenestrated inner tube, 186, 187 Left parotid lump, 138–139
objects used in epistaxis management, Left vocal cord palsy, 114–115
Lesion in neck, 124–125
162–163 LMN, see Lower motor neuron
objects used in tonsillectomy, 164, 165 Lower motor neuron (LMN), 25
oral candidiasis, 122–123 LPR, see Laryngopharyngeal reflux
papilloma of anterior commissure of larynx, Lump in throat, 12–13; see also History stations

132–133 M
pharyngeal pouch, 136–137
plain X-ray of floor of mouth, 144–145 Magnetic resonance imaging (MRI), 4, 93
Pope wick, 166, 167 with gadolinium enhancement, 134–135
reissner’s membrane, 142–143
retracted tympanic membrane, 120–121 MALT, see Mucosa-associated lymphoid tissue
right conductive hearing loss, 108–109 Mastoidectomy, 92
right pyriform fossa ulcerative lesion, Mastoid process, 152–153
MDT, see Multidisciplinary team
158–159 MEN2, see Multiple endocrine neoplasia type 2
right-sided tongue squamous cell Microlaryngoscopy, 85–86

carcinoma, 140–141 operation note, 101
rigid oesophagoscope, 166, 167 MRI, see Magnetic resonance imaging
scala media, 142–143 Mucosa-associated lymphoid tissue (MALT),
scala tympani, 142–143
scala vestibule, 142–143 48
stapes prosthesis, 178–179 Multidisciplinary team (MDT), 92
stria vascularis, 142–143 Multiple endocrine neoplasia type 2 (MEN2),
styloid process, 152–153
tectorial membrane, 142–143 185
thyroid cancer, 184–185 Myringoplasty, 86–87
tonsil grasping forceps, 162, 163
tonsillitis, 126–127 operation note, 100
tracheostomy insertion, 186, 187
T tube, 180–181 N
ulcerative growth from right vocal cord,
Nasal crusting, 39–40; see also History stations
130–131 Nasal obstruction, 50–51; see also History
ventilating bronchoscope, 166, 167
watch battery, 168–169 stations
wax hook, 166, 167 Nasal polyp, 146–147
Intracranial pressure (ICP), 3 Nasal polypectomy discharge letter, 98
Introducer, 186, 187 Neck

lesion in, 124–125
lump, 44–45; see also History stations
Neck examination, 65; see also Examination

stations

192

Index

checking trachea, 66 P
palpating trachea and nodes, 66, 67, 68
palpation of parotid, 69 Paediatric intensive care unit (PICU), 46
swallow test, 65 Panendoscopy, 85–86
tongue protrusion, 66 Papilloma of anterior commissure of larynx,
Non-fenestrated inner tube, 186, 187
Nosebleeds; see also History stations 132–133
in adults, 5–6 Parotid
in children, 7–8
Nose examination, 62; see also Examination glands, 88
lumps, 88
stations surgery, 87–88
areas to comment on, 62 Pharyngeal pouch, 136–137
examining nasal vestibules with columella PICU, see Paediatric intensive care unit
Plain X-ray of floor of mouth, 144–145
retraction, 63 PNS, see Post-nasal space
inspection, 62 Pope wick, 166, 167
performance of Cottle’s test, 64 Post-nasal space (PNS), 18, 60
use of Thudicum speculum, 63 PPIs, see Proton-pump inhibitors
Proton-pump inhibitors (PPIs), 13
O PTA, see Pure-tone audiometry
Pure-tone audiometry (PTA), 26, 92
Objects
used in management of epistaxis, R
162–163
used in tonsillectomy, 164, 165 Ramsay Hunt syndrome, see Herpes zoster
oticus
Obstructive sleep apnoea (OSA), 46
OD, see Olfactory dysfunction Recurrent tonsillitis, 48–49; see also History
OE, see Otitis externa stations
Oesophagoscopy, 86
Olfactory dysfunction (OD), 2; see also History Reissner’s membrane, 142–143
Retracted tympanic membrane, 120–121
stations Right conductive hearing loss, 108–109
drug history, 3 Right pyriform fossa ulcerative lesion, 158–159
explanation and planning, 4 Right-sided tongue squamous cell carcinoma,
family history, 4
history and systems review, 3 140–141
social history, 4 Rigid oesophagoscope, 166, 167
specific questions, 2 Rinne test, 60
structure of consultation, 2
OME, see Otitis media with effusion with tuning fork on mastoid process, 61
Operation note, 99–101; see also Romberg test, 76, 77; see also Vestibular

Communication skills stations assessment
Oral candidiasis, 122–123
Oral cavity examination, 70; see also S

Examination stations Saliva, 9
bimanual palpation, 71, 72 Scala media, 142–143
gross inspection, 70 Scala tympani, 142–143
use of Lack’s tongue depressor, 70, 71, 72 Scala vestibule, 142–143
OSA, see Obstructive sleep apnoea SCC, see Squamous cell carcinomas
Otalgia, 37–38; see also History stations Scottish Intercollegiate Guidelines Network
Otitis externa (OE), 22
Otitis media with effusion (OME), 22 (SIGN), 49
Sensorineural hearing loss (SNHL), 19, 92
Septal perforation, 27–28; see also History

stations
Septoplasty, 84–85

193

Index

Septum, 85 U
SIGN, see Scottish Intercollegiate Guidelines
U+Es, see Urea and electrolytes
Network Ulcerative growth from right vocal cord,
Sinuses, 83
Sleep-disordered breathing, 46 130–131
SNHL, see Sensorineural hearing loss Ultrasound scan (USS), 11, 125
Snoring in child, 46–47; see also History UMN, see Upper motor neuron
Unterberger step test, 76, 77; see also Vestibular
stations
Squamous cell carcinomas (SCC), 14 assessment
Upper motor neuron (UMN), 25
right-sided tongue, 140–141 Upper respiratory tract infections (URTIs), 22
Stapes prosthesis, 178–179 Urea and electrolytes (U+Es), 11
Stria vascularis, 142–143 URTIs, see Upper respiratory tract infections
Styloid process, 152–153 USS, see Ultrasound scan
Submandibular surgery, 89
V
T
Ventilating bronchoscope, 166, 167
TB, see Tuberculosis Vestibular assessment, 75; see also Examination
Tectorial membrane, 142–143
Temporal bone stations
cerebellar testing, 76
axial CT of, 118–119 Dix–Hallpike test, 78, 79
fractures, 25, 29, 33, 42 heel–toe gait, 78
Throat lump, 12–13 with patient on couch, 78
Thy3F thyroid nodule, 92–94 with patient sitting, 75
Thyroid cancer, 184–185 with patient standing, 76
Tinnitus, 19–21 Romberg test, 76, 77
TM, see Tympanic membrane smooth pursuit assessment, 75
Tonsil grasping forceps, 162, 163 unterberger step test, 76, 77
Tonsillectomy, 48 vestibular–ocular reflex testing, 76
adenotonsillectomy operation note, Vestibular–ocular reflex (VOR), 76; see also

99–100 Vestibular assessment
indications for, 49, 127 Vocal tract, 74
objects used in, 164, 165 VOR, see Vestibular–ocular reflex
Tonsillitis, 126–127
Tracheostomy, 133 W
insertion, 186, 187
tube, cuffed fenestrated, 186, 187 Watch battery, 168–169
T Tube, 180–181 Wax hook, 166, 167
Tuberculosis (TB), 27 Weber test, 60, 61
Tympanic membrane (TM), 22, 55 Wegener’s granulomatosis (WG), 27
WG, see Wegener’s granulomatosis

194