The whole station in order, from the introduction through the one-minute case presentation. Examination maneuvers come from the PD1 Head, Ears, Nose and Throat lab checksheet, reduced to what a focused ENT encounter grades.
Once you have a diagnosis in mind, the ENT OSCE Disease Chart carries all 127 conditions — what the patient says, what you see, the exams that rule it in or out, the top three differentials, the tests and what a positive looks like, treatment and patient education.
Must be said out loud Performed — inspect / palpate / percuss / auscultate
Station — Tuesday 16 September 2026, 20–25 minutes. The chief complaint and
vital signs are given on a separate form. You may bring diagnostic equipment and a pen,
nothing else. The “patient” gives no verbal responses except identifying data —
the facilitator answers for them, and you should always be looking at and interacting with the
patient, not the facilitator. Faculty do not answer questions about the exam or technique once
testing has started.
01 Opening & Preparation
Every station opens the same way. The chief complaint and vital signs are given to you on a separate form — read them before you enter.
1Reviews the chief complaint and vital signs on the form before entering the room
2Knocks, enters, and introduces self by name and role"Hello, I am [name], a physician assistant student. I will be taking care of you today."
3Confirms the patient's identityPatient identifying data is the one thing the “patient” will answer directly. Everything else comes from the facilitator.
4Performs hand hygiene
5States the purpose of the visit and obtains permission to proceed"I am going to ask you some questions about what brought you in, and then examine you. Is that all right?"
6Ensures patient comfort and privacy before beginning
7Interprets the vital signs out loudDo not just read them back. Say whether each is normal and what an abnormal one would mean for an ear, nose and throat complaint.
02 Focused History of Present Illness
Take it focused. The chief complaint is on the form; this is where you build the story around it.
OLD CHARTS — Onset · Location · Duration · Character · Alleviating and aggravating factors · Radiation · Temporal pattern · Symptoms associated. Any of the four pain mnemonics is acceptable; use one and use it completely.
The seven attributes, applied to the chief complaint
8Onset — when it began, and what the patient was doing
9Location — where it is, and whether the patient can point to it
10Duration — constant or intermittent, and how long each episode lasts
11Character — what it feels like, in the patient's own words
12Alleviating and aggravating factors — what makes it better, what makes it worse
13Radiation — whether it moves anywhere
14Severity — on a scale of one to tenAnchor the scale. The number is meaningless until you ask what a ten is for this patient.
15Temporal pattern — better or worse at any time of day, or with any activity
Associated symptoms — Ear, nose and throat
16Ear pain — one side or both, and whether anything makes it worse
17Ear discharge — and its character
18Hearing change, and whether it came on suddenly or gradually
19Tinnitus
20Vertigo or dizzinessMake the patient describe it rather than accepting the word “dizzy”.
21Nasal congestion or obstruction
22Rhinorrhea — and its character
23Epistaxis
24Facial pain or pressure, and whether it worsens on bending forward
25Sore throat, and whether swallowing makes it worse
26Dysphagia or odynophagia
27Hoarseness or voice change
28Fever
29Recent upper respiratory infection, or sick contactsBugs, drugs, contact applies here as much as in dermatology.
03 Focused Review of Systems, Past Medical, Social & Family History
All of these are FOCUSED, not comprehensive. Ask what bears on this complaint and on your differential — that selection is itself part of what is being graded.
Focused review of systems
30Constitutional — fever, chills, fatigue, weight loss
31Head and neck — headache, neck stiffness, neck swelling
32Respiratory — cough, shortness of breath
33Gastrointestinal — nausea, vomiting, refluxReflux is a genuine cause of hoarseness and chronic sore throat.
34Denies symptoms outside the focused set, and says so out loud
Focused past medical history
35Prior episodes of the same problem, and what was done about them
36Chronic medical conditions
37Previous surgeries or procedures
38Hospitalizations
Medications and allergies
39Prescription medications, with dose and how long they have been taken
40Over-the-counter medications, supplements and herbal productsEasy to skip and easy to lose a point on. Ask it explicitly.
41Allergies, and the reaction to each“No known drug allergies” is an answer; “allergies?” with no follow-up is not.
Focused social history
42Tobacco use — current or past, and how much
43Alcohol and recreational drug use
44Occupation and relevant exposures
45Living situation and who is at home
Focused family history
46Conditions in first-degree relatives that bear on this complaint
Close the history
47Summarizes the history back to the patient and asks whether anything was missed"Let me make sure I have this right — [summary]. Is there anything else I should know?"
48Signals the transition to the examination and obtains permission"I would like to examine you now. Is that all right?"
04 Vital Signs & General Survey
Vitals are handed to you on the form. Interpreting them out loud is the graded part.
49Restates the vital signs and interprets each one
50Comments on any fever and what it adds to the differential
51Performs a general survey — level of distress, hydration, voice, work of breathing
05 Focused Physical Examination — Ear, Nose & Throat
Maneuvers from the PD1 Head, Ears, Nose and Throat lab checksheet, reduced to what a focused ENT station grades and ordered as you would perform it. Narrate as you go.
General
52Performs hand hygiene before touching the patient
53Performs a general survey — distress, voice quality, audible stridor or mouth breathingHoarseness or a muffled “hot potato” voice is a finding you get for free before you touch anything.
54Gathers equipment — otoscope with speculum, penlight, tongue depressor, gloves
Ears
55Inspects the auricle for deformities, discharge and lesions"I am inspecting the auricle for deformities, discharge, or lesions."
56Palpates the auricle, tragus and mastoid for tenderness"I am palpating the auricle, tragus, and mastoid for tenderness."Tragal tenderness points outward to the canal; mastoid tenderness points inward and is the worrying one.
57Chooses an appropriately sized speculum
58Pulls the auricle upward, outward and back to straighten the canal
59Verbalizes the structures assessed in the ear canal"I am noting the condition of the external canal, the amount of cerumen, and the presence of any inflammation, edema, or foreign bodies."
60Notes the color and contour of the tympanic membrane"I am noting the color and contour of the tympanic membrane as pearly gray."
61Identifies the landmarks and the light reflex"I am visualizing the malleus, umbo, pars tensa, pars flaccida, and the cone of light."
62Examines both ears — the unaffected side first
Hearing — cranial nerve VIII
63CN VIIIStates the cranial nerve number and name — VIII, Vestibulocochlear
64Verbalizes that the canals were confirmed patent first, with the otoscope
65Performs the whispered hearing test bilaterally, standing two feet away
66Verbalizes the follow-up if gross hearing is abnormal"If this test was abnormal, I would perform a Rinne and Weber test for bone versus air conduction."
Nose & sinuses
67Inspects the external nose for deformities"I am inspecting the nose for deformities."
68Evaluates nasal patency bilaterally — occludes one nostril and has the patient sniff
69Palpates the nose for tenderness
70Uses the otoscope with an appropriate speculum to inspect the nares"I am inspecting the condition of the nasal mucosa, the turbinates for polyps, and the nasal septum for septal deviation or perforations."
71Palpates the frontal and maxillary sinuses for tenderness
72Verbalizes transillumination of the sinuses if sinusitis is suspected
73CN IStates the cranial nerve number and name — I, OlfactoryTest it here if the complaint involves smell; otherwise verbalize that you would.
Oral cavity & pharynx
74Uses a penlight and tongue depressor, and gloves to palpate
75Inspects the lips, buccal mucosa, gingiva, floor of mouth and teeth"I am inspecting the nasolabial fold, lips, buccal mucosa, gingiva, floor of mouth, and teeth."
76Notes inflammation, lesions and the condition of the dentition"I am noting any inflammation or lesions and condition of dentition."
77Inspects the palate and oropharynx for inflammation and lesions"I am inspecting the palate and oropharynx for inflammation or lesions."
78Inspects the posterior pharynx, noting the condition of the tonsils"I am inspecting the posterior pharynx noting the condition of the tonsils."Note tonsillar size, exudate, and whether the uvula is midline — deviation is the finding that changes the plan.
79CN IX · XStates the cranial nerve numbers and names — IX Glossopharyngeal, X Vagus
80Asks the patient to say “AHH” while observing and listening"I am noting the phonation and symmetrical rise and fall of the soft palate and uvula."
81Verbalizes performance of the gag reflex
82CN XIIStates the cranial nerve number and name — XII, Hypoglossal
83Asks the patient to protrude the tongue and notes color, texture and whether it is midline"I am noting the color and texture of the tongue and assessing if it is midline."
Neck & lymph nodes
84Inspects the anterior neck for masses, asymmetry and thyromegaly"I am inspecting the anterior neck for masses, asymmetry, or thyromegaly."
85Inspects and palpates the position of the trachea"I am inspecting and palpating the position of the trachea."
86Palpates the thyroid isthmus and each lobe
87Verbalizes the names of the lymph nodes as they are palpated
88Palpates using the pads of the fingers in a circular motion
89Preauricular · posterior auricular · occipital
90Tonsillar · submandibular · submental
91Superficial cervical · posterior cervical · deep cervical chains
92Supraclavicular — asks the patient to take a deep breath during palpation
93Describes any node found — size, consistency, mobility, tendernessA tender, mobile, soft node reads infectious; a hard, fixed, non-tender one does not.
06 Differentials, Studies & Diagnosis
Spoken, not performed. This is the part that separates a strong station from a complete one, and it is where the small groups have been training you: every request needs a reason attached.
Differential diagnosis
94States a differential diagnosis out loudThree is a reasonable floor for an ENT station. Say them; do not leave them implied.
95Includes the worst-case diagnosis that must be excluded, even if it is unlikely“What must be examined to rule out the worst-case scenario?” is one of the two questions that decide the scope of a focused encounter.
96Justifies each differential against a specific finding from the history or examination"[Diagnosis] is on my differential because of [finding], and against it is [finding]."
Laboratory and imaging studies
97States which studies would be ordered
98Justifies each one — why it is needed and what it would tell you about the patientThis is the exact standard the small groups apply: a facilitator will not release information until the justification is given.
99States which differential each study would rule in or rule out
Diagnosis
100States the working diagnosis
101States the evidence from this encounter that supports it
07 Treatment Plan & Patient Education
The plan is a graded component in its own right, and patient education is named explicitly in the station's component list — it is not optional garnish.
Treatment plan
102States whether the condition is managed symptomatically or requires directed treatment
103Addresses pain control
104States whether an antimicrobial is indicated, and why or why notBeing able to justify NOT prescribing is as gradeable as prescribing.
105States any red flags that would change the plan or prompt referral
106States what would prompt referral to ear, nose and throat surgery
Patient education
107Explains the diagnosis in plain language, without medical jargonAdapting style and content to the patient is a graded professional behavior.
108Explains what the treatment is and why it is being recommended
109States return precautions — what would bring the patient back sooner
110Confirms understanding and invites questions"What questions do you have for me?"
Closure
111States the follow-up interval
112Thanks the patient and closes the encounter
113Performs hand hygiene on the way out
08 One-Minute Case Presentation
Delivered at the end of the station. A well-organized vignette that describes the patient and the clinical problem — not the note read aloud.
The test of a good presentation — it leads your facilitator to the same differential you formulated. If they reach a different one, the presentation failed even if every fact in it was true.
114Opens with the past medical history and the chief complaint"This is a [age]-year-old [patient] with a history of [past medical history] presenting with [chief complaint]."
115Gives the pertinent positives from the history
116Gives the pertinent negatives from the historyNegatives carry as much weight as positives. They are how the listener sees what you ruled out.
117Gives the pertinent positives and negatives from the ear, nose and throat examination
118Presents mostly in the order the history was obtained and the examination performed
119States the differential
120States the studies and the diagnosis
121States the plan
122Delivers it without reading from notesReading works directly against helping the listener visualize the patient.