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Nasal OSCE Examination Quiz
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You are checking nasal airflow. You block one nostril by pinching the soft lower part of the nose tightly, then ask the patient to breathe in through the other side. Airflow looks badly reduced, but you suspect your technique has caused this. What is the best correction?
- A Ask the patient to breathe in less forcefully through the tested nostril while you keep squeezing the soft lower part of the nose. You picked ✕
- B Ask the patient to sniff in sharply to open the nasal valve while you maintain the pinch on the lower nose. You picked ✕
- C Close one nostril at a time by pressing on its side, without squeezing the nasal valve. You picked ✓
- D Skip straight to anterior rhinoscopy, since airflow testing is unreliable when obstruction is suspected. You picked ✕
- E Ask the patient to breathe out through each nostril separately, compare the sound on each side, and use that as the corrected airflow test. You picked ✕
Correct!
Incorrect
The answer is C: Close one nostril at a time by pressing on its side, without squeezing the nasal valve.
Explanation
Why C is correct
See Inspection of the Nasal Cavity (Anterior Rhinoscopy). Option C is correct. Nasal patency, meaning how freely air passes through the nose, is tested one side at a time. You close one nostril and ask the patient to breathe in through the other, then repeat on the other side and compare the two. The skill is in how you close the nostril. Press on the side of the nostril, not on the soft lower part of the nose. Squeezing there pinches the nasal valve, the narrow part of the airway just inside the nostril where the soft outer walls (the alae) can be drawn inwards. Squeezing it narrows the airway mechanically, so you create an artificial blockage and then wrongly record it as obstruction. The same valve is what collapses in alar collapse, where the alae are drawn inwards as the patient breathes in, and that is a real cause of obstruction that gets worse with deeper breaths. A memory aid: block the nostril, do not squeeze the nose. If one side seems poor even with gentle technique, look inside for causes such as a deviated septum or polyps.
- Technique: close one nostril at a time and compare the two sides.
- Where to press: on the side of the nostril, not the soft lower part of the nose.
- Reason: squeezing the soft part pinches the nasal valve and creates an artificial blockage.
- Alar collapse: the same valve collapses on inspiration and is a real cause of obstruction.
A changes breathing effort but leaves the nasal valve squeezed, so it does not correct the mechanical narrowing. B asks for a sharp sniff while the lower nose is still squeezed, which may increase alar collapse and cannot open an externally compressed valve. E changes to an expiration test, which is not the same as correcting the inspiratory technique and may miss the obstruction caused by the squeeze. D abandons airflow testing for anterior rhinoscopy, but rhinoscopy shows causes of obstruction rather than how well air actually passes, so it adds to the airflow test rather than replacing it.
Why the other options are incorrect
- A. Ask the patient to breathe in less forcefully through the tested nostril while you keep squeezing the soft lower part of the nose.: This changes breathing effort but not the mechanical squeeze on the nasal valve. The soft lower part of the nose is still being compressed, so the artificial blockage remains; the correct step is to release it and press gently on the side of the nostril. Your answer
- B. Ask the patient to sniff in sharply to open the nasal valve while you maintain the pinch on the lower nose.: A sharp sniff generates negative pressure inside the nose, which tends to pull the alae inwards and worsen alar collapse; it cannot open a valve that is being squeezed shut from outside. The pinch must be moved to the side of the nostril. Your answer
- D. Skip straight to anterior rhinoscopy, since airflow testing is unreliable when obstruction is suspected.: Anterior rhinoscopy (looking into the front of the nose with a light) shows possible causes of blockage, but it does not replace testing airflow. Airflow testing is useful when done properly, so the answer is to correct the technique. Your answer
- E. Ask the patient to breathe out through each nostril separately, compare the sound on each side, and use that as the corrected airflow test.: Changing to an expiration test avoids the squeeze but does not test the inspiratory flow in the same way, so it can miss the obstruction produced by inspiration. The best correction is to change the hand position as described. Your answer
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More questions from this set. Start the quiz to answer them and see each explanation.
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1
A 45-year-old woman has persistent nasal blockage and reduced smell. After explanation and consent, anterior rhinoscopy shows pale grey, smooth, glistening swellings on both sides of the nasal cavity, separate from the recognisable inferior turbinates. What is the most likely explanation?
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2
After anterior rhinoscopy, what is the most appropriate way to complete a nasal examination?
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