Rhinology Case Challenge

Work through real ENT cases the way you would in an OSCE or the MLA — take the history, spot the red flags, and manage the patient step by step, with a teaching point after every decision. Six cases, each a few minutes.

For education only, aligned to the GMC Medical Licensing Assessment content map.

What the six cases cover

Each case follows a single patient from presentation to management, one decision at a time. The learning outcomes below are the points each case is built around, mapped to the relevant areas of clinical practice, presentations and conditions in the GMC Medical Licensing Assessment content map.

Case 1 — Nasal trauma

A young man assaulted on a night out, with a swollen, crooked nose.

Learning outcomes
  • Assess a patient with facial trauma using an ABCDE approach and exclude serious associated injuries.
  • Actively look for and manage a septal haematoma as an emergency.
  • Recognise CSF rhinorrhoea and understand why it matters after facial trauma.
  • Explain how and when an isolated nasal fracture is treated.

Case 2 — Allergic rhinitis

A child with a blocked, itchy, sneezy nose.

Learning outcomes
  • Recognise the clinical features of allergic rhinitis and the atopic tendency.
  • Identify common triggers and the role of allergen avoidance.
  • Outline a stepwise treatment plan using antihistamines and intranasal steroids.
  • Know when to consider allergy testing or specialist referral.

Case 3 — Chronic rhinosinusitis

Months of nasal blockage, facial pressure and poor sense of smell.

Learning outcomes
  • Apply the EPOS criteria to diagnose chronic rhinosinusitis.
  • Distinguish a nasal polyp from normal nasal structures on examination.
  • Choose appropriate investigations and understand the role of CT.
  • Describe stepwise medical management and the indications for surgery.
  • Recognise unilateral red-flag features that suggest a sinonasal tumour.

Case 4 — Periorbital swelling

A feverish toddler with a red, swollen eye.

Learning outcomes
  • Distinguish pre-septal from post-septal (orbital) cellulitis.
  • Identify the sight-threatening signs, including a relative afferent pupillary defect.
  • Select appropriate investigations and initial management.
  • Recognise the must-not-miss intracranial complications.

Case 5 — Loss of smell

A chef who lost his sense of smell after a cold.

Learning outcomes
  • Take a structured history for a patient with loss of smell.
  • Identify the common causes, including post-viral and sinonasal disease.
  • Explain the relevant anatomy and the appropriate investigations.
  • Discuss management, safety advice and prognosis.

Case 6 — Epistaxis

A heavy nosebleed in a patient taking an anticoagulant.

Learning outcomes
  • Manage acute epistaxis using an ABCDE approach and first-aid measures.
  • Identify Little's area and the arterial supply of the nasal septum.
  • Apply the escalation ladder from cautery to packing to surgery or embolisation.
  • Recognise airway compromise and other red flags.

The cases are illustrated with anatomical diagrams, endoscopic and radiological images and a short operative video, and every question is followed by a teaching point. Alignment to the MLA content map is indicative and is offered as a study aid, not as an official mapping. Written by Mr Zahir Mughal, Consultant ENT Surgeon, who also maintains a GP referral guide and a library of patient information on ENT conditions.