Course Content
OSCE Station 1 — Sore Throat: Focused History, Examination and Initial Management
KMU clinical activities: History Taking • Examination of Sore Throat Patient • Conservative Management of Sore Throat Learning Objectives The student should be able to: • Obtain a focused history from a patient presenting with sore throat. • Perform relevant general physical examination. • Perform systematic local examination of the throat. • Perform relevant systemic examination. • Identify important clinical findings in a patient with sore throat. • Discuss a conservative management plan for acute follicular tonsillitis.
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Topic: OSCE Station 1 — Sore Throat: Focused History, Examination and Initial Management
OSCE Station 2 — Oral Cavity, Oropharynx, Nasopharynx and Hypopharynx Examination
KMU clinical activities: Nasopharyngeal Examination • Oral Cavity and Oropharynx Examination • Hypopharyngeal Examination • Oral/Oropharyngeal Mass Palpation • Biopsy from Oral Ulcer Learning Objectives The student should be able to: • Examine the oral cavity systematically. • Examine the oropharynx systematically. • Perform mirror examination of the nasopharynx. • Perform indirect hypopharyngoscopy using a mirror. • Demonstrate the method of palpating a mass in the oral cavity or oropharynx. • Describe the basic steps involved in assisting with biopsy of a tongue/oral ulcer. • Identify important abnormal findings during examination of the upper aerodigestive tract.
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Topic: OSCE Station 2 — Oral Cavity, Oropharynx, Nasopharynx and Hypopharynx Examination
OSCE Station 3 — Tonsillectomy: Consent, Instruments and Theatre Skills
KMU clinical activities: Mouth Gag and Tonsillectomy Instruments • Tonsillar Surgery • Tonsillectomy Consent • Scrubbing Technique Learning Objectives The student should be able to: • Identify and assemble the mouth gag used for tonsillectomy. • Identify common tonsillectomy instruments. • State the use of each instrument. • Recognize the important procedural steps of tonsillectomy. • Obtain appropriate pre-operative informed consent for tonsillectomy. • Explain the procedure, expected benefits and relevant patient information during consent. • Demonstrate correct surgical hand-scrubbing technique. • Use an appropriate scrubbing solution, sequence and duration.
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Topic: OSCE Station 3 — Tonsillectomy: Consent, Instruments and Theatre Skills
OSCE Station 4 — Dysphagia: Rigid Endoscopy System and Oesophagoscopy
KMU clinical activities: Rigid Endoscopy System • Oesophagoscopy Learning Objectives The student should be able to: • Identify the main instruments and equipment used in a rigid endoscopy system. • Describe the basic types and purposes of rigid endoscopy. • Identify a rigid oesophagoscope and associated equipment. • Describe the basic steps of rigid oesophagoscopy. • Explain its use in patients presenting with dysphagia or pharyngeal growth. • Recognize the important safety principles associated with rigid oesophagoscopy.
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Topic: OSCE Station 4 — Dysphagia: Rigid Endoscopy System and Oesophagoscopy
OSCE Station 5 — Hoarseness and Stridor: Focused History and Clinical Examination
KMU clinical activities: History Taking • Examination in Hoarseness and Stridor • Examination of Neck Learning Objectives The student should be able to: • Obtain a focused history of hoarseness. • Obtain a focused history of stridor. • Perform relevant general physical examination. • Perform appropriate local ENT examination. • Perform relevant systemic examination. • Perform a systematic examination of the neck. • Identify clinical features that require further laryngeal assessment.
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Topic: OSCE Station 5 — Hoarseness and Stridor: Focused History and Clinical Examination
OSCE Station 6 — Laryngeal Examination: Indirect, Video and Rigid Laryngoscopy
KMU clinical activities: Indirect Laryngoscopy • Investigations of Laryngeal Disease • Video Laryngoscopy • Rigid Laryngoscopy • Biopsy from Laryngeal Growth Learning Objectives The student should be able to: • Perform indirect mirror examination of the laryngopharynx. • Demonstrate correct patient and examiner positioning for indirect laryngoscopy. • Identify important structures seen during laryngeal examination. • Select appropriate investigations for laryngeal disease. • Complete or explain an appropriate investigation requisition. • Recognize the role of video laryngoscopy in a patient with hoarseness. • Identify important findings on a laryngoscopic image or video. • Identify the instruments used in rigid laryngoscopy under general anaesthesia. • Describe the basic procedure of rigid laryngoscopy. • Describe the basic steps involved in obtaining a biopsy from a laryngeal growth.
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Topic: OSCE Station 6 — Laryngeal Examination: Indirect, Video and Rigid Laryngoscopy
OSCE Station 7 — Voice Disorders and Laryngeal Patient Counselling
KMU clinical activities: Conservative Management of Hoarseness • Voice-Rest Counselling • Bilateral Abductor Vocal-Cord Paralysis Counselling • Laryngectomy Consent Learning Objectives The student should be able to: • Discuss conservative management of hoarseness due to voice abuse. • Counsel a patient regarding appropriate voice rest. • Explain practical measures for reducing further vocal strain. • Counsel a patient with bilateral abductor vocal-cord paralysis following thyroidectomy. • Discuss the relevant management principles for bilateral vocal-cord paralysis. • Communicate clearly and empathetically with a patient facing major laryngeal treatment. • Obtain appropriate informed consent for total laryngectomy.
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Topic: OSCE Station 7 — Voice Disorders and Laryngeal Patient Counselling
OSCE Station 8 — Tracheostomy and Emergency Airway Procedure
KMU clinical activity: Tracheostomy Learning Objectives The student should be able to: • Identify the important anatomical landmarks relevant to tracheostomy. • Identify essential instruments and equipment used for tracheostomy. • Demonstrate or describe the sequence of the tracheostomy procedure. • Explain appropriate positioning of the patient. • Describe the principle of establishing a surgical airway. • Recognize important immediate precautions during and after tracheostomy.
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Topic: OSCE Station 8 — Tracheostomy and Emergency Airway Procedure
OSCE Station 9 — Ear Examination: History, Otoscopy and Examination Under Microscope
KMU clinical activities: Ear History Taking • Local Examination • Otoscopy • Examination Under Microscope Learning Objectives The student should be able to: • Obtain a focused history from a patient with ear discharge, deafness or dizziness. • Perform systematic local examination of the ear. • Demonstrate correct handling of an otoscope. • Perform an otoscopic examination safely. • Identify the external auditory canal and tympanic membrane. • Recognize common abnormal otoscopic findings. • Explain the basic role of examination under microscope (EUM). • Describe how the student may assist during EUM.
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Topic: OSCE Station 9 — Ear Examination: History, Otoscopy and Examination Under Microscope
OSCE Station 10 — Hearing and Balance Assessment: Tuning Forks, Vestibular Tests and Audiology
KMU clinical activities: Tuning-Fork Tests • Balance Testing • Ear Investigations • Audiogram and Impedance Interpretation Learning Objectives The student should be able to: • Perform appropriate tuning-fork tests. • Demonstrate the correct technique of the Rinne test. • Demonstrate the correct technique of the Weber test. • Interpret common tuning-fork test patterns. • Perform appropriate clinical tests of balance. • Differentiate clinical findings suggesting peripheral versus central balance dysfunction. • Select appropriate investigations for common ear diseases. • Complete an appropriate investigation requisition. • Interpret a basic pure-tone audiogram. • Interpret basic impedance/tympanometry findings.
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Topic: OSCE Station 10 — Hearing and Balance Assessment: Tuning Forks, Vestibular Tests and Audiology
OSCE Station 11 — Nasal Obstruction: History, Nose and PNS Examination and Adenoid Assessment
KMU clinical activities: History Taking • Local Examination • Nasal Patency and Adenoid Facies Learning Objectives The student should be able to: • Obtain a focused history from a patient with nasal obstruction. • Perform systematic external examination of the nose. • Perform relevant clinical examination of the paranasal sinus region. • Assess nasal patency. • Compare airflow through both nasal cavities. • Recognize clinical features of adenoid facies. • Examine nasal patency in a patient with suspected enlarged adenoids.
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Topic: OSCE Station 11 — Nasal Obstruction: History, Nose and PNS Examination and Adenoid Assessment
OSCE Station 12 — Rhinoscopy and Nasal Procedures: Probe Test, Nasendoscopy and Nasal Swab
KMU clinical activities: Anterior Rhinoscopy • Posterior Rhinoscopy • Probe Test • Nasendoscopy • Pus Culture/Sensitivity Learning Objectives The student should be able to: • Perform anterior rhinoscopy systematically. • Demonstrate the technique of posterior rhinoscopy using a mirror. • Identify important structures visualized during rhinoscopy. • Perform or describe the probe test. • Explain the basic principles of nasendoscopy. • Describe how to assist during nasendoscopy. • Demonstrate the correct method of obtaining a nasal swab. • Explain appropriate specimen handling for culture and sensitivity.
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Topic: OSCE Station 12 — Rhinoscopy and Nasal Procedures: Probe Test, Nasendoscopy and Nasal Swab
OSCE Station 13 — Nose and Paranasal Sinus Imaging and Investigations
KMU clinical activities: X-Ray Nasopharynx/PNS • CT Nose and Nasopharynx • Investigation Requisition Learning Objectives The student should be able to: • Interpret a basic X-ray of the nasopharynx/PNS. • Identify an enlarged soft-tissue shadow associated with enlarged adenoids. • Approach a CT scan of the nose and nasopharynx systematically. • Recognize CT findings associated with juvenile nasopharyngeal angiofibroma. • Identify and explain the bowing sign. • Select appropriate investigations for diseases of the nose and paranasal sinuses. • Complete an appropriate investigation requisition form.
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Topic: OSCE Station 13 — Nose and Paranasal Sinus Imaging and Investigations
OSCE Station 14 — Adenoid and Nasopharyngeal Procedures
KMU clinical activities: Adenoid Surgery • Nasopharyngeal Biopsy Learning Objectives The student should be able to: • Identify the basic setup used for adenoid surgery. • Describe the major procedural steps of adenoidectomy as observed in theatre. • Identify important instruments used during adenoid surgery. • Describe the basic principles of obtaining a nasopharyngeal biopsy. • Identify the purpose of nasopharyngeal biopsy. • Recognize key safety considerations during procedures involving the nasopharynx.
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Topic: OSCE Station 14 — Adenoid and Nasopharyngeal Procedures
OSCE Station 15 — Neck Examination: Lymph Nodes, Neck Lump, Thyroid and Parotid
KMU clinical activities: Examination of Neck • Examination of Neck Nodes • Neck Lump Examination • Thyroid Examination • Parotid Examination Learning Objectives The student should be able to: • Perform a systematic examination of the neck. • Examine the major groups of cervical lymph nodes. • Describe the location of the major cervical nodal groups. • Perform systematic examination of a neck lump. • Assess the site, size, surface, consistency, mobility and associated features of a neck swelling. • Perform examination of the thyroid gland. • Assess thyroid enlargement anatomically. • Perform relevant functional assessment of the thyroid as required by the station. • Perform systematic examination of a parotid swelling. • Identify clinical features that help characterize a salivary-gland swelling.
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Topic: OSCE Station 15 — Neck Examination: Lymph Nodes, Neck Lump, Thyroid and Parotid
OSCE Station 16 — Pharyngeal and Peritonsillar Abscess: Drainage and Instruments
KMU clinical activities: Surgery on Pharyngeal Abscess • Pharyngeal Abscess Surgery-Related Instruments Learning Objectives The student should be able to: • Recognize the basic principles of surgical management of a pharyngeal abscess. • Describe the technique of drainage of a peritonsillar abscess. • Identify important instruments used for drainage of a pharyngeal or peritonsillar abscess. • State the use of each relevant instrument. • Describe appropriate patient positioning and preparation for drainage. • Recognize important precautions associated with abscess drainage in the upper airway.
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Topic: OSCE Station 16 — Pharyngeal and Peritonsillar Abscess: Drainage and Instruments
AIM OSPE/OSCE Lab — ENT Module | 4th Year MBBS
AIM OSCE / OSPE • MBBS

Station 2 — Oral Cavity, Oropharynx, Nasopharynx and Hypopharynx Examination

4th Year MBBS • Rapid Revision • Practical Skills • Viva

🎯 Candidate Task

Perform a systematic examination of the oral cavity and oropharynx, and demonstrate how you would examine the nasopharynx and hypopharynx using appropriate mirror techniques and palpate an oral/oropharyngeal mass. Describe the basic steps involved in assisting with biopsy of an oral or tongue ulcer and report important abnormal findings.

⚡ Model Station Answer

  • I would systematically inspect the lips, buccal mucosa, teeth and gums, tongue, floor of mouth, palate, tonsillar region and posterior oropharynx.
  • I would perform posterior mirror examination of the nasopharynx and indirect mirror examination of the hypopharyngeal region using a warmed mirror and correct positioning.
  • Any oral or oropharyngeal mass would be palpated gently with gloves, assessing its site, size, consistency, tenderness, mobility or fixation and surrounding tissue.
  • I would identify and report ulcers, mucosal lesions, asymmetry, masses, bleeding, fixation, pooling of secretions or other abnormal upper aerodigestive tract findings.
  • For biopsy assistance, I would prepare the required equipment, aid exposure and suction, handle the specimen correctly, assist haemostasis and ensure accurate specimen labelling.

🔎 How to Perform / Approach

1
Prepare the patient. Introduce yourself, confirm identity, explain the examination, obtain consent, perform hand hygiene and seat the patient upright in good illumination.
2
Inspect the oral cavity and oropharynx. Using a light and tongue depressor, systematically inspect the lips, buccal mucosa, teeth and gums, tongue including its undersurface, floor of mouth, palate, uvula, tonsillar regions and posterior pharyngeal wall.
3
Palpate any mass. Wear gloves and gently palpate the lesion directly; use bimanual palpation where appropriate and assess site, extent, consistency, tenderness, mobility/fixity and contact bleeding.
4
Examine the nasopharynx. Warm the postnasal mirror and check that it is not hot. Depress the tongue and introduce the mirror gently behind the soft palate without touching the posterior pharyngeal wall; inspect the choanae, posterior nasal structures, roof/posterior wall and Eustachian tube regions.
5
Examine the hypopharyngeal region. Ask the patient to protrude the tongue, hold it gently with gauze and position the warmed mirror against the soft palate. Obtain a reflected view while the patient breathes or phonates, inspecting the tongue base, valleculae, epiglottic region, pyriform fossae and laryngeal inlet for masses or pooling.
6
Recognize and report abnormalities. Comment on suspicious ulceration, mucosal irregularity, asymmetry, swelling or mass, bleeding, fixation and abnormal pooling of secretions.
7
Describe biopsy assistance and finish. Prepare PPE, illumination, suction, local-anaesthetic and biopsy equipment; assist exposure and specimen collection, support haemostasis, place the specimen promptly in the correctly labelled container, thank the patient and perform hand hygiene.

🖼️ Visual Learning

VISUAL 1

Upper Aerodigestive Tract Examination and Oral Lesion Assessment

🎥 Practical Demonstration

ENT Teaching: Examination I — Mirror Examination
University Hospital Münster teaching resource. Particularly useful from approximately 05:38 onward for nasopharyngeal, oral cavity and indirect laryngeal mirror examination.


Watch Demonstration

📝 Important Viva Questions

1. Why is the examination mirror warmed before use?
Warming reduces fogging from the patient’s breath. The temperature must be checked before insertion to avoid thermal injury.
2. What important structures are assessed during posterior mirror examination of the nasopharynx?
The posterior choanae, posterior ends of the turbinates, nasopharyngeal roof and posterior wall, and regions around the Eustachian tube openings are inspected.
3. How can you minimize gagging during mirror examination?
Use gentle controlled movements and avoid touching the tongue base or posterior pharyngeal wall with the mirror.
4. What features should you assess when palpating an oral or oropharyngeal mass?
Assess its site, size or extent, consistency, tenderness, mobility or fixation and any tendency to bleed on contact.
5. How should an oral-biopsy specimen be handled after removal?
Transfer it promptly to the appropriate correctly labelled specimen container, usually containing formalin for routine histopathology, and clearly document the biopsy site.

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