Nasal Congestion

I doubt that examination of the nose will be expected in an OSCE station (it is possible to ask you to inspect the external nose- for symmetry, masses, deformity etc- and to check air flow through each of the nostrils- simply close one and ask the patient to take a deep breath).  This is far more likely to be a history station.

• Introduce yourself, wash hands, check name and DOB etc
• HxPC
  • Any discharge blocking nose? (Check if watery, mucoid, purulent, bloody)
  • Chronic, recurrent, acute
  • Related to location, season, exposure
  • Foreign body?
  • Nose bleeds
• Systemic review
  • fever, facial pain (sinusitis)
  • watery, itchy eyes (allergies)
  • sore throat, malaise, fever, cough (URTI)
  • Headaches (can occur with Headaches with autonomic features)
  • Also ask about other ENT conditions/infections
• Red flags
  • Unilateral discharge, particularly if purulent or bloody
  • Facial pain, tenderness, or both
• PMHx/RHx
  • Atopy
  • Diabetes
  • Immunocomprimise
  • Decongestant/antihistamine/cortisol spray use
  • Broken nose/other trauma
  • Surgery (Facial)