OSCE ORL

Section 1

1. 58 years old malay man presented with nasal blockage and discharge for the past 3 days. She also
complained of fever and headache upon bending of head. Discharge noted yellowish ad greenish
sputum.

Kindly examine the patient nose.

- Inspection (use headlight and make sure eye level same with patient!
- Palpation over the nasal bridge and paranasal sinuses.
- Thudicum Speculum
- Cold Spatula Test

Was given AP Xray view of the nose. Noted pus discharge over the right maxillary sinus.

Give the management include treatment and investigation for this patient.

Investigation :

1. Xray AP view
2. Nasoendoscope

Management :

1. Intranasal steroid spray to reduce edema

2. Analgesic to relive pain
3. Antipyretic to relieve fever. Antihistamine (Loratadine)

Dx : Right acute sinusitis.

Section 2

2A. Was given 3 tuning fork. 512 Hz, 218 Hz and 156 Hz

i. Name the figure.

- Tuning fork
ii. Give two test when to use the figure.
- Rinne test
- Weber test
iii. What is the frequency use for test in ii.
- 512 Hz
iv. What are the test to know the hearing threshold in conductive deafness patient.
v. What are the test to know the type of pathology in hearing loss patient with intact tympanic
membrane.

2B.

i. List two findings in the figure

ii. Name the diagnosis
iii. Give two predisposing factors contribute to the condition
iv. Outline the management for this patient.
v. Give three complication that can arise if the condition is not treated.
Section 3

3A.

23 years old man was punched to his nose. He denied having any discharge and blood from the nose.

i. Describe the findings that you see in the diagram

ii. Name the condition
- Septal hematoma
iii. Outline the management for this patient
iv. What are the complications if the condition is not treated.

3B.

i. Name the figure 3B

ii. What condition need to use the figure 3B
iii. List five(5) first aid before start to use the figure 3B
iv. What are the complication can occur when use figure 3B
 Section 4

4A.

Laryngoscope was done in 8 years old boy

i. Give two abnormal finding found in this picture

ii. Name the diagnosis
- Epiglotitis
iii. Give five(5) symptoms that you suspect to use in this patient.
iv. Outline the management
v. List the investigation that can be done in this patient

4B. 60 years old man came to casualty because swelling at the neck region. He had history of 2nd
molar lower tooth infection.

i. Describe the intraoral findings

ii. Name the diagnosis
- Ludwig angina
iii. Outline the management
iv. Outline pathogenesis to the condition
v. Give the investigation that can be done to this patient.
Section 5

5A.

i. Name the parts of tracheostomy tube

ii. What is the function of pilot balloon
iii. What is the procedure require this device
iv. What are the late complication when use this tube.

5B. 58 years old man presented to casualty with neck swelling over the jugulodigastric upper region.

Dx: Nasopharyngeal carcinoma

i. Describe the abnormal findings

ii. Name the structure involve
iii. Outline the management
iv. Give the investigation
v. What are the complication if the situation is not treated.
OSCE OPTHALMOLOGY

Section 1

1. 40 years old woman with underlying DM, hypertension and hyperlipidemia came to casualty with
complaint of sudden onset painless blurring of vision for 3 days. She denied having any redness,
headache and discharge.

Kindly do the pupillary examination to the patient.

- TURN OFF THE LAMP!

- Inspection (pentorch from below, inspect the size and shape of pupil)
- Inspect the pupil, iris, lens, corneal reflex, cornea clear and conjunctiva, any swelling and
skin around the orbital area.
- Direct pupillary reflex
- Consensual light reflex
- RAPD/Swinging light test (-ve normal)

Was given video of positive left RAPD.

i. What are the condition positive RAPD

ii. What are your ddx for this patient
Section 2

2A. Parents noted there is abnormality seen at the patient right eyes. Patient is 3 years old.

i. Describe the abnormality findings of the patient

ii. What are the treatment can be done to the patient
iii. What are the complication will occur if the condition is not treated.

2B. Parent noted abnormality at the their child 2 years old boy left eyes.

i. What is the abnormality seen

ii. What are the differential diagnosis
iii. Give other 2 relevant history you will ask to get the diagnosis
iv. What are other investigation need to be done
v. What are the complication will occur if the condition is not treated.
Section 3

3A. 58 years old man presented to casualty with complaint of blurring of vision since 2 years ago.
Denied any redness and eye pain.

i. Describe the abnormal findings

ii. Give two procedure can do for this situation (cataract surgery)
iii. What are the complication after the surgery

3B.

i. State 2 abnormality seen at the figure 3B

ii. 3 causative agents that can cause situation in 3B
iii. Outline the management done in this patient.
Section 4

4A.

Patient came to casualty presented with sudden onset of eye pain and blurring of vision.

i. State the findings in figure 4A

ii. What are the other symptoms you expect patient to have
iii. Name the investigation you want to do to elicit that diagnosis
iv. Outline the management

4B.

i. State findings seen in the figure 4B

ii. Name 2 possible condition that can presented with condition figure 4B
iii. State 3 possible risk factors to this condition.
Section 5

5A.

i. State findings can be seen in figure 5A

ii. Name activities can cause this condition
iii. Outline the management
iv. State the complication from this condition

5B.

56 years old man presented with gradual blurring of vision diagnosed with DM 10 years ago.

i. State findings seen in the fundoscope

ii. What is the possible diagnosis
iii. Outline the management