Instructions
You are a medical student on placement in general practice. Your next patient is Graham Fraser, 52, an accountant presenting with two years of a blocked nose and no sense of smell.
Perform an ENT examination
Outline to the examiner:
- Your most likely diagnosis and differentials
- Next steps in management, including relevant investigations
- You do not need to take a further history
- You do not need to summarise your findings
- Please verbalise your examination; findings will be provided on request
Past history
Asthma since age 45, well controlled; budesonide with formoterol 200/6 micrograms, two inhalations twice daily
Adverse reactions
Ibuprofen, three years ago: severe wheeze within an hour, treated in the emergency department
Other medicines
Oxymetazoline decongestant spray from the pharmacy, used a few days at a time when blocked