OSCE 2

A 50 year-old Chinese man who is chronic smoker, complained of left nasal obstruction for 3 months associated with rhinorrhea. He denied facial pain or blurring of vision. Nasoendoscope revealed a reddish mass inside left nasal cavity.

What is the likely diagnosis?

• Fungal sinusitis

• Maxillary sinus carcinoma

• Nasal inverted papilloma

• Antrochoanal polyp

• Juvenile angiofibroma

A 7 year old boy presented with 3 months history of recurrent left ear purulent discharge. The current episode lasted for 3 days. It was painless but foul smelling. Otoscopic examination showed mucopus discharge with central tympanic membrane perforation. No attic retraction seen.

What is the likely diagnosis?

• Acute otitis media

• Chronic active otitis media with cholesteatoma

• Chronic active otitis media without cholesteatoma

• Otitis media with effusion

• Chronic otitis externa

What is the most feared risk of nasal inverted papilloma if left untreated?

• Profuse epistaxis

• Anosmia

• Intracranial extension

• Blindness

• Malignant transformation

A 23 year-old Indonesian man complained of right neck swelling for 3 months. He denied nasal obstruction, voice changes or night sweats. There was significant weight loss of 5 kg. On examination, there were multiple matted nodes at right posterior triangle of neck, measured 2 x 3cm collectively. Flexible nasolaryngoscope revealed normal findings. The nodes were not tender, mobile and no overlying skin changes.

What could be the likely diagnosis?

• Branchial cleft cyst

• Thyroid adenoma

• Laryngeal carcinoma

• Thyroglossal duct cyst

• Tuberculous lymphadenitis

A 30 year old female presented with left ear discharge for four months associated with hearing loss. The discharge is copious and purulent. She also has fever, headache and vomiting. Examination found that she is drowsy. Otoscopy revealed left central tympanic membrane perforation with pus discharge from middle ear.

What is the most appropriate investigation at this moment?

• Pus culture and sensitivity

• Lumbar puncture

• HRCT temporal bone and brain

• BSER

• Mastoid X ray

23 year-old female presented with two weeks history of purulent nasal discharge associated with hyposmia and nasal block. She also experienced facial pain on stooping forward. Endoscopic examination showed mucopus discharge from left middle meatus.

What is the likely diagnosis?

• Chronic rhinosinusitis

• Acute rhinosinusitis

• Chronic rhinosinusitis with nasal polyposis

• Nasal inverted papilloma

• Sinonasal carcinoma

A 4 year old boy with left middle ear effusion. What is the expected tuning fork result?

• Positive Rinne bilateral, Weber central

• Negative Rinne bilateral, Weber central

• Left Rinne positive, Right Rinne negative, Weber lateralised to right

• Left Rinne negative, Right Rinne positive, Weber lateralised to left

• Left Rinne negative, Right Rinne positive, Weber lateralised to right

A 40 year old teacher presented with progressive hoarseness for 6 weeks. She denied dysphagia, difficulty in breathing or weight loss. Examination showed a smooth surface mass at left vocal cord. Both vocal cords are mobile. What is the likely diagnosis?

• Vocal cord tuberculosis

• Vocal cord nodule

• Vocal cord cyst

• Vocal cord carcinoma

• Acute laryngitis

What is the mainstay treatment for vocal cord nodules?

• Voice rest

• Speech therapy

• Endolaryngeal microsurgery

• Laryngectomy

• Laser cordectomy

A 5 year old boy complaint of right ear pain with mastoid swelling for 4 days. Otoscopic examination revealed oedematous ear canal, minimal mucopus with posterior wall sagging. Tympanic membrane is inflamed. What is your immediate investigation?

• pus swab C&S

• Mastoid X ray

• HRCT temporal bone

• Hearing assessment by PTA

• Full blood count