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 6 — Laryngeal Examination: Indirect, Video and Rigid Laryngoscopy

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

🎯 Candidate Task

Demonstrate indirect laryngeal examination and identify the important laryngeal structures. Explain appropriate investigations for a patient with hoarseness, interpret the role of video laryngoscopy, and describe the instruments and basic steps of rigid laryngoscopy with biopsy of a laryngeal growth.

⚡ Model Station Answer

  • Indirect laryngoscopy: I would examine the seated patient using a warmed laryngeal mirror while gently holding the protruded tongue with gauze and avoiding the tongue base and posterior pharyngeal wall.
  • Structures: I would identify the epiglottis, valleculae, aryepiglottic folds, arytenoids, false cords, true vocal cords, pyriform fossae and assess vocal-cord movement during respiration and phonation.
  • Hoarseness: Video/flexible laryngoscopy provides magnified dynamic visualization of the vocal folds and may demonstrate a lesion, inflammation or impaired cord mobility.
  • Investigations: Depending on the findings I would request laryngoscopic assessment, appropriate imaging such as contrast CT of the neck for a suspicious growth, and histopathology when biopsy is obtained.
  • Rigid laryngoscopy: Under general anaesthesia the larynx is exposed with a rigid laryngoscope, inspected systematically and a representative biopsy may be taken from a growth with haemostasis and correct specimen handling.

🔎 How to Perform / Approach

1
Prepare for indirect laryngoscopy. Introduce yourself, obtain consent, perform hand hygiene, seat the patient upright facing you and provide good illumination.
2
Position the tongue and mirror. Ask the patient to protrude the tongue, wrap it gently in gauze and hold it forward. Warm the laryngeal mirror and check its temperature before insertion.
3
Obtain the laryngeal view. Introduce the mirror without touching the tongue base or posterior pharyngeal wall and rest it gently against the soft palate. Adjust the angle until the larynx is visualized.
4
Inspect systematically. Identify the epiglottis, valleculae, aryepiglottic folds, arytenoids, false and true vocal cords and pyriform fossae. Ask the patient to phonate and then breathe deeply to assess vocal-cord movement.
5
Assess video laryngoscopy. Review the image/video for mucosal lesions, vocal-fold symmetry, colour, surface abnormality and movement, especially in a patient presenting with persistent hoarseness.
6
Select and request investigations. Write patient identifiers, relevant history and examination findings, the suspected clinical problem and the specific investigation required; suspicious laryngeal disease may require endoscopic assessment, imaging and biopsy for histopathology.
7
Describe rigid laryngoscopy. Under general anaesthesia with monitoring and dental protection, introduce the rigid laryngoscope under direct vision, expose the larynx and systematically inspect the supraglottis, glottis and visible subglottic region.
8
Biopsy the growth. Using appropriate long laryngeal biopsy forceps, obtain representative tissue under direct visualization, control bleeding and place the specimen in a correctly labelled histopathology container.
Exam point: During mirror examination, avoid touching the tongue base and posterior pharyngeal wall because this commonly triggers gagging. During rigid laryngoscopy, avoid forceful insertion and excessive pressure on the teeth or surrounding tissues.

🖼️ Visual Learning

VISUAL 1

Indirect, Video and Rigid Laryngeal Examination

 

🎥 Practical Demonstration

Examination of the Larynx and Pharynx — NEJM Videos in Clinical Medicine
Practical demonstration of laryngeal and pharyngeal examination using indirect mirror examination and flexible endoscopic visualization.


Watch Demonstration

 

📝 Important Viva Questions

1. Why is the laryngeal mirror warmed before indirect laryngoscopy?
Warming prevents condensation and fogging on the mirror. Its temperature must be checked before insertion to avoid mucosal injury.
2. Which important structures should be identified during laryngeal examination?
The epiglottis, valleculae, aryepiglottic folds, arytenoids, false cords, true vocal cords and pyriform fossae should be assessed.
3. How do you assess vocal-cord mobility?
Observe both vocal cords during phonation and respiration. They normally adduct during phonation and abduct during inspiration.
4. What is the role of video laryngoscopy in a patient with persistent hoarseness?
It provides direct magnified visualization of the larynx and permits assessment of vocal-fold lesions, mucosal abnormalities and cord movement.
5. Why is rigid laryngoscopy useful when a laryngeal growth is suspected?
It provides detailed examination under general anaesthesia and permits a representative biopsy to be obtained for histopathological diagnosis.

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