NursingDiscussion postAdvanced health assessment

6512 Week 5 discussion: ears, nose and throat SOAP note

An episodic/focused SOAP note on one of three assigned ear, nose and throat cases — Richard's nasal congestion, Lily's sore throat, James's earache — with five justified differentials and literature support for the diagnostic tests. This guide covers the planted detail in each vignette, the exam manoeuvres that actually discriminate, and what the SOAP format does with data the case never supplies.

Aug 6, 2026Updated Aug 10, 2026

Editorial process

Last reviewed · August 6, 2026

Written by

Aaron Bishop

MA, Education

assignment interpretation and research-methods coaching across disciplines

Reviewed by

Dr. Nathan Cole

PhD, Rhetoric & Composition

Argumentation and thesis development

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Interpret the task
Assignment instructions
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Proposed outline
Research plan
Reference shortlist
Final review

Each vignette hides its answer outside the findings

All three vignettes hide their answer in a detail that is not a clinical finding. A boy has a prominent tan and has spent the summer in a pool. A student's campus has an outbreak. A man reports that the medicine he chose barely helped. Read past those and the exam findings alone will not get you there.

James's ear pain is the clearest example. He is eleven, the pain is on one side, it was worse as he fell asleep, and hearing is reduced — all of which fits middle ear infection, which is what most posts will write. But the case supplies the pool and the tan for a reason, and water exposure points at the ear canal rather than behind the drum. The two are separated at the bedside by manoeuvres, not by the history: pain on pulling the pinna or pressing the tragus belongs to the canal, and a bulging, immobile tympanic membrane on pneumatic otoscopy belongs behind it. So the physical exam section is where this case is won, and the exam you name has to be the one that discriminates rather than the one that is routine.

Richard's case works the same way through pharmacology. Pale, boggy nasal mucosa with clear thin secretions and enlarged turbinates is not the picture of infection, and the itch — nose, eyes, palate and ears — is the symptom viral illness does not produce. The detail that confirms it is that the guaifenesin he bought did almost nothing: an expectorant thins secretions and has no effect on the histamine-driven process causing his. A post that records the medication history without asking what it should have done has collected the data and not used it. The gesture at the bridge of his nose is the other free finding, and it is worth naming rather than describing. The two together — a mucosal appearance that is not inflammatory and a drug that acts on the wrong thing — are enough to carry the assessment without a single test result, which is what a focused note is meant to demonstrate.

Lily is the one where the wrong answer is dangerous rather than merely wrong. A twenty-year-old on a campus with an outbreak, three days of sore throat, decreased appetite, headache and pain on swallowing looks like a bacterial pharyngitis waiting for a prescription. But she also has rhinorrhoea and hoarseness and is not congested, and both of those argue away from streptococcal disease and toward a viral cause. The differential in her age group has to include infectious mononucleosis, and it has to include it for a practical reason: aminopenicillins given in mononucleosis commonly produce a rash. Naming the condition you must not miss, and saying what would go wrong if you did, is worth more than a longer list. The five-condition list is also where a bacterial cause still belongs, since arguing it down with the findings is stronger than leaving it off.

Then the format, which the brief states twice and which changes what the post looks like. It is an episodic or focused SOAP note, not narrative prose, and the note says every such note has specific data included in every patient case — meaning the template's fields get populated even where the vignette is silent. James's grandmother believes he feels warm but did not use a thermometer, so the objective section records that no temperature was obtained. That is the correct entry. Inventing a reading is not, and leaving the field out is not either. The same discipline applies to the five differentials: five genuinely different conditions, each with a justification, and the diagnostic tests each supported by literature rather than listed. Every field addressed, nothing invented, and the gaps named as gaps is what the template is actually assessing.

Case	The detail that is not a finding	Where it points	The exam that decides it
1 — Richard, 50	The OTC drug he chose barely helped	An expectorant does nothing for an allergic process	Nasal mucosa colour and turbinate appearance; ask about seasonality and triggers
2 — Lily, 20	A campus outbreak, plus hoarseness and rhinorrhoea	Away from streptococcal disease; mononucleosis must be on the list	Posterior cervical nodes, spleen, tonsillar appearance; rapid strep and heterophile testing
3 — James, 11	A prominent tan and a summer in the pool	The ear canal rather than the middle ear	Tragal pressure and pinna traction; pneumatic otoscopy for drum mobility

Likely learning objectives

Inferred from the brief — check these against your own rubric.

01
Read a case vignette for the contextual details that carry diagnostic weight.
02
Select physical examination manoeuvres that discriminate between competing diagnoses rather than routine ones.
03
Use a medication history as evidence by asking what the drug should have done.
04
Build a differential that includes the diagnosis whose consequences of being missed are worst.
05
Complete a structured note honestly where the source data is incomplete.

Assignment instructionsQuoted verbatim

Read the full question

Review every instruction before using the planning guidance that follows.

Most ear, nose, and throat conditions that arise in non-critical care settings are minor in nature. However, subtle symptoms can sometimes escalate into life-threatening conditions that require prompt assessment and treatment. Nurses conducting assessments of the ears, nose, and throat must be able to identify the small differences between life-threatening conditions and benign ones. For instance, if a patient with a sore throat and a runny nose also has inflamed lymph nodes, the inflammation is probably due to the pathogen causing the sore throat rather than a case of throat cancer. With this knowledge and a sufficient patient health history, a nurse would not need to escalate the assessment to a biopsy or an MRI of the lymph nodes, but would probably perform a simple strep test. In this Discussion, you consider case studies of abnormal findings from patients in a clinical setting. You determine what history should be collected from the patients, what physical exams and diagnostic tests should be conducted, and formulate a differential diagnosis with several possible conditions. Note: By Day 1 of this week, your Instructor will have assigned you to one of the following specific case studies for this Discussion. Also, your Discussion post should be in the Episodic/Focused SOAP Note format, rather than the traditional narrative style Discussion posting format. Refer to Chapter 2 of the Sullivan text and the Episodic/Focused SOAP Template in the Week 5 Learning Resources for guidance. Remember that all Episodic/Focused SOAP notes have specific data included in every patient case. Case 1: Nose Focused Exam Richard is a 50-year-old male with nasal congestion, sneezing, rhinorrhea, and postnasal drainage. Richard has struggled with an itchy nose, eyes, palate, and ears for 5 days. As you check his ears and throat for redness and inflammation, you notice him touch his fingers to the bridge of his nose to press and rub there. He says he’s taken Mucinex OTC the past two nights to help him breathe while he sleeps. When you ask if the Mucinex has helped at all, he sneers slightly and gestures that the improvement is only minimal. Richard is alert and oriented. He has pale, boggy nasal mucosa with clear thin secretions and enlarged nasal turbinates, which obstruct airway flow but his lungs are clear. His tonsils are not enlarged but his throat is mildly erythematous. 6512 Discussion Week 5 Case 2: Focused Throat Exam Lily is a 20-year-old student at the local community college. When some of her friends and classmates told her about an outbreak of flu-like symptoms sweeping her campus over the past two weeks, Lily figured she shouldn’t take her three-day sore throat lightly. Your clinic has treated a few cases similar to Lily’s. All the patients reported decreased appetite, headaches, and pain with swallowing. As Lily recounts these symptoms to you, you notice that she has a runny nose and a slight hoarseness in her voice but doesn’t sound congested. Case 3: Focused Ear Exam Martha brings her 11-year old grandson, James, to your clinic to have his right ear checked. He has complained to her about a mild earache for the past two days. His grandmother believes that he feels warm but did not verify this with a thermometer. James states that the pain was worse while he was falling asleep and that it was harder for him to hear. When you begin basic assessments, you notice that James has a prominent tan. When you ask him how he’s been spending his summer, James responds that he’s been spending a lot of time in the pool. To prepare: With regard to the case study you were assigned: · Review this week’s Learning Resources and consider the insights they provide. · Consider what history would be necessary to collect from the patient. · Consider what physical exams and diagnostic tests would be appropriate to gather more information about the patient’s condition. How would the results be used to make a diagnosis? · Identify at least 5 possible conditions that may be considered in a differential diagnosis for the patient. Note: Before you submit your initial post, replace the subject line (“Week 5 Discussion”) with “Review of Case Study ___,” identifying the number of the case study you were assigned. Post an episodic/focused note about the patient in the case study to which you were assigned using the episodic/focused note template provided in week 5 resources. Provide evidence from the literature to support diagnostic tests that would be appropriate for each case. List five different possible conditions for the patient’s differential diagnosis and justify why you selected each.

What the focused note and the differential have to contain

01
An episodic/focused SOAP note, not a narrative discussion post.
02
The episodic/focused note template from the Week 5 resources, with all its fields addressed.
03
Evidence from the literature supporting the diagnostic tests chosen.
04
Five different possible conditions for the differential diagnosis.
05
A justification for each of the five conditions.
06
The subject line replaced with 'Review of Case Study ___' and the assigned case number.

Working the case through the SOAP structure

Re-read the vignette for what is not a finding

Mark the exposures, settings, timings and prior treatments before touching the clinical data.

Subjective

Record the history given and name the history you would still collect — duration, seasonality, exposures, prior episodes, medication response.

Objective

Enter the findings supplied and the examinations you would perform, choosing manoeuvres that separate the leading differentials.

Diagnostic tests, with evidence

Name each test, say what result would change the diagnosis, and cite literature supporting its use here.

Assessment — five conditions, each justified

List five different possible conditions and tie each to specific findings for or against.

Plan, and the subject line

Set out management consistent with the leading diagnosis, then rename the post as instructed.

Where the discriminating findings and the test evidence live

Recommended databases

PubMed / NCBI Bookshelf
The Sullivan text, chapter 2, for the note format
CINAHL
Clinical practice guidance from specialty societies

Search sequence

1.
Look up the condition each vignette's planted detail points at before building the differential.
2.
Find the examination manoeuvre that discriminates your top two differentials, since that is what the objective section needs.
3.
Search for evidence on the diagnostic tests specifically, because the brief asks for literature support rather than a list.
4.
Check the treatment implications of the diagnosis you must not miss, which is what justifies keeping it on the list.

Sources for each condition the three cases point at

These are authoritative starting points, not a ready-made bibliography. A qualified reviewer must confirm that each source fits the assignment and supports the claim beside which it is cited.

Nothing here is cleared for citation until you have read it.

01
Allergic Rhinitis
StatPearls, NCBI Bookshelf, US National Library of Medicine · 2023
The mucosal appearance and symptom pattern that separate an allergic process from an infective one, and what treatment classes actually act on it. This is the reference behind Richard's boggy mucosa and his unhelpful expectorant.
02
Otitis Externa
StatPearls, NCBI Bookshelf, US National Library of Medicine · 2023
Risk factors including water exposure, and the examination findings that distinguish canal disease from middle ear disease. The source for making James's pool the diagnostic detail it was put there to be.
03
Mononucleosis
StatPearls, NCBI Bookshelf, US National Library of Medicine · 2023
Presentation in young adults, the testing sequence, and the rash that follows aminopenicillin exposure. This is why mononucleosis belongs on Lily's differential for a practical reason rather than a completist one.
04
Pharyngitis
StatPearls, NCBI Bookshelf, US National Library of Medicine · 2023
Which features raise and lower the probability of streptococcal disease, and when to test rather than treat. Use it to justify why hoarseness and rhinorrhoea argue against the diagnosis Lily's classmates would assume.

Before the note is posted

Common mistakes

Diagnosing James's earache from the symptoms and ignoring the pool and the tan, which are the case's own clue.
Naming a routine ear examination rather than the manoeuvres that separate canal from middle ear.
Recording Richard's Mucinex use without asking what an expectorant would and would not have done.
Treating Lily's presentation as bacterial and leaving mononucleosis off the differential entirely.
Writing the post as narrative prose when the brief specifies the SOAP format twice.
Inventing objective data the vignette does not supply, such as a temperature nobody measured.
Listing five conditions without justifying any of them, or listing fewer than five.
Giving five near-variants of one diagnosis instead of five different conditions.
Listing diagnostic tests with no literature cited to support them.
Leaving the default subject line in place.

Submission checklist

The post follows the episodic/focused SOAP template rather than narrative style.
Every template field is addressed; missing data is recorded as not obtained rather than invented.
The physical exam section names manoeuvres that discriminate between the leading differentials.
The case's contextual detail — exposure, setting, prior medication — appears in the assessment reasoning.
Five different conditions are listed.
Each condition carries a justification tied to a finding in the case.
At least one condition on the list is there because missing it would cause harm.
Each diagnostic test is supported by a cited source.
The subject line reads 'Review of Case Study' plus the assigned number.

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