ENT MCQs for NEET PG
1003 worked ENT questions across 102 areas. Each one has its own page with the reasoning for every option.
What this set is
ENT is a compact subject. Clinical features, tests like tuning forks, and the anatomy of the ear, nose and larynx cover most of it.
This page lists the 1003 ENT questions that have a full worked page: 741 application questions that put a fact to use on a patient or a finding, and 262 multi-step questions that combine two or more ideas. Plain one-fact recall items are left out here on purpose. The ENT practice bank in the app is larger, with 3,328 questions in all, and is where timed tests and daily practice draw from.
How to use it
- Pick an area you are weak in, below.
- Answer first, then read why each wrong option fails.
- Write a three-line note for every miss, and revisit it in a week.
- Move to a timed ENT test once an area feels steady.
These are original practice items, not recalled exam questions, and they are not yet reviewed by independent faculty. Confirm important facts in a standard textbook.
What ENT covers in the exam
- Ear and audiology
- Nose and paranasal sinuses
- Pharynx and tonsils
- Larynx and airway
- Head and neck tumours
- Vestibular disorders
A study map from the standard curriculum; the NBEMS bulletin is the authority. See the ENT study guide.
Worked questions by area
102 areas, largest first. Open an area to see its questions.
Ear and audiology110
- Ear and audiology: sensory supply of external ear · ApplicationA surgeon planning a block for the anterior wall of the external auditory canal and the tragus needs to know the sensory nerve to this area. Which nerve is it?
- Ear and audiology: fissures of Santorini · ApplicationA man with a furuncle in the cartilaginous external canal develops tender swelling in front of the tragus. Through which anatomical gaps can infection spread to the par…
- Ear and audiology: foramen of Huschke · ApplicationA 3-year-old child has a normal canal, and a defect is noted in the anteroinferior bony canal wall at the tympanic plate. Which statement about the foramen of Huschke i…
- Ear and audiology: nerve supply of middle ear muscles · ApplicationWhich pairing of middle ear muscle and nerve supply is correct?
- Ear and audiology: middle ear impedance transformer · ApplicationThe middle ear overcomes the impedance mismatch between air and cochlear fluid. What is the approximate overall transformer ratio?
- Ear and audiology: air-bone gap · ApplicationOn pure tone audiometry, a patient has bone conduction thresholds of 10 dB across frequencies and air conduction thresholds of 50 dB. What is the likely diagnosis?
- Ear and audiology: Schwabach test · ApplicationIn the Schwabach test, a 512 Hz fork is placed on the mastoid of the patient and then of the examiner, who has normal hearing. The patient stops hearing it earlier than…
- Ear and audiology: auditory brainstem implant · ApplicationA 24-year-old patient with neurofibromatosis type 2 has had both vestibular schwannomas removed with section of both cochlear nerves, leaving profound deafness. Which d…
- Ear and audiology: microtia reconstruction · ApplicationA 7-year-old boy has unilateral grade III microtia with canal atresia and a normal contralateral ear. What is a recognised approach to the auricle?
- Ear and audiology: indication for myringotomy · ApplicationA 4-year-old with acute otitis media has severe ear pain and fever, and the drum is bulging and red with no response to 48 hours of antibiotics. What is the most approp…
- Ear and audiology: facial recess approach · Multi-stepDuring cochlear implantation, the surgeon opens the posterior tympanotomy through the mastoid to reach the round window niche. Which structures bound the gap that gives…
- Ear and audiology: Citelli abscess · ApplicationA child with mastoiditis has a swelling behind the ear along the line of the posterior belly of the digastric extending up to the occipital area. What is it called?
- Ear and audiology: Luc's abscess · ApplicationA boy with acute mastoiditis develops a tender swelling in the temporal region above the root of the zygoma. Which complication is this?
- Ear and audiology: cortical mastoidectomy · ApplicationA 5-year-old has acute coalescent mastoiditis with a subperiosteal abscess not responding to intravenous antibiotics. The surgeon removes mastoid air cells and keeps th…
- Ear and audiology: Donaldson's line · ApplicationIn endolymphatic sac surgery, which surgical landmark helps the surgeon locate the sac?
- Ear and audiology: stapedotomy prosthesis · Multi-stepA 30-year-old woman with otosclerosis undergoes surgery in which a small hole is made in the stapes footplate and a piston is placed on the long process of the incus. W…
- Ear and audiology: Fisch classification · Multi-stepA radiologist describes a glomus tumour that involves the jugular bulb, the infralabyrinthine compartment and carotid canal, with intracranial extension. Which classifi…
- Ear and audiology: imaging of glomus tumour · ApplicationMRI of a pulsatile mass behind the intact drum shows flow voids in a bright tumour giving a speckled appearance. What is this described as?
- Ear and audiology: Koerner's septum · ApplicationA surgeon performing cortical mastoidectomy removes the superficial cells but cannot find the antrum, as a bony plate separates the superficial cells from the deeper on…
- Ear and audiology: bilateral vestibular schwannoma · Multi-stepA 19-year-old man with bilateral progressive sensorineural deafness and tinnitus has a family history of similar illness. MRI shows bilateral cerebellopontine angle mas…
- Ear and audiology: interaural attenuation · ApplicationIn pure tone audiometry using supra-aural earphones, what is the approximate interaural attenuation for air conduction?
- Ear and audiology: electroneuronography · Multi-stepTen days after onset of complete facial palsy from a temporal bone injury, electroneuronography shows more than 90 percent degeneration. What does this imply?
- Ear and audiology: embryology of the pinna · ApplicationThe auricle develops from the fusion of six hillocks around the first pharyngeal groove. From which arches do these hillocks arise?
- Ear and audiology: pure tone average · ApplicationFor calculating the pure tone average used to grade hearing disability, which frequencies are conventionally averaged?
- Ear and audiology: sinus tympani · ApplicationIn surgery for cholesteatoma, which middle ear recess is hardest to inspect and is a common site of residual disease?
- Ear and audiology: aberrant carotid artery · Multi-stepA 20-year-old woman has pulsatile tinnitus and a red mass seen through the inferior part of an intact drum. CT shows absence of the bony carotid canal in its usual plac…
- Ear and audiology: Trautmann's triangle · ApplicationWhich anatomical area is bounded by the labyrinth, the sigmoid sinus and the superior petrosal sinus and gives access to the posterior fossa dura?
- Ear and audiology: decibel scale · ApplicationOn the decibel scale, a rise of 20 dB corresponds to what change in sound pressure?
- Ear and audiology: tonotopic organisation · ApplicationAccording to the travelling wave theory, where on the basilar membrane is the maximum displacement for high-frequency sounds?
- Ear and audiology: Bekesy audiometry · Multi-stepOn Bekesy automatic audiometry, the continuous tone tracing drops away sharply from the interrupted tone tracing within a short time and reaches the limit of the scale.…
- Ear and audiology: perilymph gusher · Multi-stepA boy with mixed hearing loss and a family history of X-linked deafness undergoes stapes surgery. After the footplate is opened, a copious flow of clear fluid wells up.…
- Ear and audiology: pars flaccida histology · ApplicationA histology student compares the two parts of the tympanic membrane. Which feature distinguishes the pars flaccida from the pars tensa?
- Ear and audiology: facial canal dehiscence in stapes surgery · Multi-stepA surgeon planning a stapedotomy notes that the tympanic segment of the facial nerve is exposed and bulging over the oval window niche. Why is this relevant?
- Ear and audiology: presbycusis management · Multi-stepA 72-year-old man has bilateral symmetrical high-frequency sloping sensorineural loss of 45 dB at 4 kHz. He hears sounds but cannot understand speech in noisy places, a…
- Ear and audiology: stapedial reflex decay · Multi-stepA 48-year-old man with unilateral sensorineural hearing loss and normal tympanometry shows a stapedial reflex that fades to half of its initial amplitude within 10 seco…
- Ear and audiology: adult cochlear implant candidacy · ApplicationWhich adult is the best candidate for a cochlear implant?
- Ear and audiology: glycerol test in Meniere disease · Multi-stepIn suspected early Meniere disease, which finding after oral glycerol dehydration supports hydrops?
- Ear and audiology: tubal occlusion stage of AOM · ApplicationA 6-year-old with a recent cold complains of fullness and mild hearing loss in one ear without fever or severe pain. The drum is retracted with a prominent lateral proc…
- Ear and audiology: false-negative fistula test · Multi-stepA man with long-standing cholesteatoma has a negative fistula test, but profound sensorineural loss in that ear with no response to caloric testing. A CT shows erosion…
- Ear and audiology: glomus jugulare lower cranial nerve syndrome · Multi-stepA 52-year-old woman has pulsatile tinnitus, a reddish retrotympanic mass, hoarseness and difficulty swallowing with deviation of the tongue. CT shows moth-eaten erosion…
- Ear and audiology: forehead sparing facial palsy · Multi-stepA 62-year-old man with hypertension wakes with left lower facial droop, but he can wrinkle his forehead and close both eyes. Which statement is correct?
- Ear and audiology: sudden SNHL work-up · Multi-stepA 38-year-old has sudden unilateral sensorineural hearing loss of 60 dB over three adjacent frequencies, evolving over a day, with normal otoscopy. Apart from starting…
- Ear and audiology: DWI MRI after cholesteatoma surgery · Multi-stepA patient who had canal wall up mastoidectomy for cholesteatoma 18 months ago has an unremarkable-looking drum. The surgeon wants to exclude residual disease without re…
- Ear and audiology: when to mask · ApplicationDuring pure tone audiometry, the air conduction threshold in the test ear exceeds that in the opposite ear by 50 dB. Why must the non-test ear be masked?
- Ear and audiology: audiogram of mixed loss · ApplicationAn audiogram shows an air conduction threshold of 70 dB and a bone conduction threshold of 40 dB in the same ear at the same frequencies. How is this loss classified?
- Ear and audiology: Metz recruitment test · Multi-stepIn a patient with unilateral sensorineural loss of 60 dB, the stapedial reflex appears at only 50 dB above the hearing threshold at the same frequency. What does this f…
- Ear and audiology: BAHA indication · ApplicationA 25-year-old has had complete unilateral deafness since a viral illness. The opposite ear is normal, and CROS aids are unsatisfactory. Which device transmits sound fro…
- Ear and audiology: stapes surgery in only hearing ear · ApplicationA patient with bilateral otosclerosis requests stapes surgery. Which principle is generally followed when planning the operation?
- Ear and audiology: vaccination before cochlear implant · ApplicationBefore cochlear implantation in a 2-year-old child, which preventive step is recommended?
- Ear and audiology: visual reinforcement audiometry · ApplicationA cooperative 10-month-old infant is to have behavioural hearing assessment in a sound field. Which technique is appropriate at this developmental age?
- Ear and audiology: auditory steady-state response · Multi-stepA baby with a flat ABR click response is suspected to have profound loss, but frequency-specific thresholds are needed to plan amplification. Which objective test can p…
- Ear and audiology: hearing aid choice by degree of loss · ApplicationA 75-year-old with severe bilateral sensorineural loss and poor manual dexterity needs a hearing aid. Which style is generally preferred for severe loss and easy handli…
- Ear and audiology: salicylate ototoxicity · ApplicationA 60-year-old woman on high-dose aspirin for arthritis develops bilateral tinnitus and a flat mild sensorineural loss on audiometry within a week. Her drums are normal.…
- Ear and audiology: cholesterol granuloma · Multi-stepA 40-year-old man has mild conductive hearing loss and a dark blue bulging tympanic membrane, with no history of trauma. MRI of the temporal bone shows a middle ear les…
- Ear and audiology: first branchial cleft anomaly · Multi-stepA 6-year-old has a recurrent infected swelling just below the earlobe near the angle of the mandible. Pus intermittently drains into the external auditory canal. Which…
- Ear and audiology: unilateral effusion in an adult · Multi-stepA 52-year-old man has had blocked hearing in the right ear for two months with no cold or allergy. The right drum is dull with an air-fluid level and tympanometry is fl…
- Ear and audiology: temporal lobe abscess · ApplicationA man with long-standing foul-smelling ear discharge develops headache and fever, then sudden difficulty finding words with fluent but meaningless speech. Which intracr…
- Ear and audiology: eye care in facial palsy · ApplicationA 30-year-old has acute right lower motor neuron facial palsy and cannot close the right eye. Which measure best protects the eye in the first days?
- Ear and audiology: signs of coalescent mastoiditis · ApplicationA 4-year-old has fever, a tender postauricular swelling pushing the pinna forwards, and otoscopy shows drooping of the posterosuperior part of the bony canal wall. What…
- Ear and audiology: eczematous otitis externa · ApplicationA 35-year-old man with seborrhoeic dermatitis has itchy, flaky skin in both ear canals for months. There is no pain or discharge and the drums are normal. Which treatme…
- Ear and audiology: neural presbycusis · Multi-stepA 78-year-old says he hears people speaking but cannot understand them. Pure tone audiometry shows only a mild sloping high-frequency loss, but speech discrimination is…
- Ear and audiology: antiviral treatment of congenital CMV hearing loss · ApplicationA 3-week-old term infant with confirmed congenital cytomegalovirus infection has microcephaly, thrombocytopenia and failed hearing screening with a sensorineural patter…
- Ear and audiology: otoprotection against cisplatin · ApplicationA 6-year-old receiving cisplatin for a localised hepatoblastoma is at risk of high-frequency sensorineural hearing loss. Which agent is used to reduce this ototoxicity?
- Ear and audiology: facial palsy in acute otitis media · Multi-stepA 5-year-old with a red bulging tympanic membrane and fever develops right lower motor neuron facial palsy over a day. What is the most appropriate management?
- Ear and audiology: CT in cochlear otosclerosis · Multi-stepA 42-year-old woman with otosclerosis now has a mixed loss with a sensorineural component. High-resolution CT shows a band of reduced density encircling the cochlea. Wh…
- Ear and audiology: gallium scan in malignant otitis externa · Multi-stepA diabetic man with malignant otitis externa has completed three months of ciprofloxacin and the pain has settled. Which investigation best helps decide when to stop tr…
- Ear and audiology: vegetable foreign body in the ear · ApplicationA child has a dried pea lodged in the ear canal. Why should syringing with water be avoided?
- Ear and audiology: congenital syphilis and deafness · Multi-stepA 12-year-old has progressive bilateral sensorineural hearing loss, notched peg-shaped upper incisors and corneal haze from keratitis. Which diagnosis explains all thre…
- Ear and audiology: tympanic membrane in hearing aid mould allergy · ApplicationA man wearing a hearing aid for several years has itchy, red, weeping skin in the concha and canal where the earmould sits. What is the likeliest cause?
- Ear and audiology: Eustachian tube balloon dilation · ApplicationAn adult with chronic obstructive eustachian tube dysfunction fails medical therapy and grommet insertion keeps extruding. Which procedure addresses the tube itself?
- Ear and audiology: Hitselberger sign in vestibular schwannoma · Multi-stepA 48-year-old woman has progressive right sensorineural hearing loss with tinnitus and poor speech discrimination. While examining the ear, light touch on the posterosu…
- Ear and audiology: Stenger test · ApplicationA 30-year-old man pursuing a compensation claim reports total right deafness, yet follows ordinary conversation without difficulty. To expose non-organic unilateral los…
- Ear and audiology: Battle sign · ApplicationA rider is brought after a road accident with bruising over the right mastoid process that appeared two days later. Which injury does this sign indicate?
- Ear and audiology: hemotympanum · ApplicationAfter a fall on his head, a man has a dark blue bulging tympanic membrane with conductive hearing loss. The drum is intact and there is no discharge or facial weakness.…
- Ear and audiology: Melkersson-Rosenthal syndrome · ApplicationA 25-year-old has had three episodes of unilateral lower motor neuron facial weakness over two years. Between episodes she has recurrent firm swelling of the lips and a…
- Ear and audiology: facial nerve schwannoma · Multi-stepA 35-year-old man has facial weakness that progressed over eight months with no recovery, after earlier twitching. Otoscopy is normal. CT shows smooth enlargement of th…
- Ear and audiology: Lyme disease and facial palsy · ApplicationA forest worker has bilateral lower motor neuron facial palsy two weeks after an expanding circular skin rash that followed a tick bite. Which organism is responsible?
- Ear and audiology: Langerhans cell histiocytosis of the temporal bone · Multi-stepA 3-year-old has chronic ear discharge unresponsive to antibiotics and a postauricular swelling. CT shows a punched-out lytic lesion of the mastoid, and a skull radiogr…
- Ear and audiology: rhabdomyosarcoma of the ear · Multi-stepA 4-year-old has bloody ear discharge and a fleshy canal polyp that bleeds on touch. Within weeks he develops facial palsy, and CT shows mastoid destruction with a soft…
- Ear and audiology: tuberculous otitis media · ApplicationA young man on treatment for pulmonary tuberculosis develops painless thin ear discharge with a rapid fall in hearing. Pale granulations are seen in the middle ear. Whi…
- Ear and audiology: ototoxicity of iron chelation · ApplicationA 12-year-old with transfusion-dependent thalassaemia receiving long-term subcutaneous infusions to remove iron develops bilateral high-frequency sensorineural loss and…
- Ear and audiology: Paget disease of the temporal bone · ApplicationA 68-year-old man has bone pain, an increasing hat size and a raised serum alkaline phosphatase. He has progressive bilateral mixed hearing loss. What is the underlying…
- Ear and audiology: osteopetrosis · Multi-stepA 2-year-old has anaemia, hepatosplenomegaly, visual loss, facial palsy and conductive deafness. X-rays show uniformly dense bones. What is the basic defect?
- Ear and audiology: Stickler syndrome · Multi-stepA newborn with micrognathia, glossoptosis and a cleft palate later develops high myopia, retinal detachment, joint hypermobility and mild sensorineural hearing loss. Wh…
- Ear and audiology: hearing loss after meningitis · Multi-stepA 4-year-old recovers from pneumococcal meningitis. Two months later he does not respond to sound, and audiometry shows bilateral profound sensorineural loss. CT shows…
- Ear and audiology: strial presbycusis · Multi-stepAn 80-year-old has gradual symmetrical hearing loss. The audiogram is flat across all frequencies, speech discrimination is good, and his mother had a similar loss. Whi…
- Ear and audiology: Susac syndrome · Multi-stepA 35-year-old woman has headache, confusion, branch retinal artery occlusions and low-frequency sensorineural hearing loss. MRI shows central lesions in the corpus call…
- Ear and audiology: congenital aural atresia · ApplicationA child has unilateral congenital atresia of the external ear canal with a normal inner ear. To decide whether canal reconstruction is worthwhile, the surgeon scores fe…
- Ear and audiology: MRI without contrast for retrocochlear screening · ApplicationA 55-year-old with asymmetric sensorineural hearing loss and tinnitus has severe renal impairment, so gadolinium should be avoided. Which MRI sequence can still screen…
- Ear and audiology: classification of nerve injury · ApplicationAfter blunt trauma, a man has temporary facial weakness. Electrical stimulation distal to the injury elicits a normal response, and recovery is complete within a few we…
- Ear and audiology: persistent stapedial artery · Multi-stepA 30-year-old has pulsatile tinnitus and a pulsating red mass behind an intact drum, near the promontory. CT shows absence of the foramen spinosum and a tiny canal over…
- Ear and audiology: branchio-oto-renal syndrome · ApplicationA 4-year-old has bilateral preauricular pits, a small fistula opening along the anterior border of the sternocleidomastoid and mixed hearing loss. Which investigation s…
- Ear and audiology: enlarged vestibular aqueduct · ApplicationA 6-year-old has stepwise worsening of sensorineural hearing loss after minor head knocks. CT of the temporal bone shows an enlarged vestibular aqueduct with a normal c…
- Ear and audiology: autoimmune inner ear disease · ApplicationA 34-year-old woman develops bilateral sensorineural hearing loss that worsens over six weeks. Examination of the ears is normal and tympanometry is normal. Which treat…
- Ear and audiology: cerebellopontine angle meningioma · Multi-stepMRI of an adult with unilateral hearing loss shows a cerebellopontine angle mass with a broad dural base, an enhancing dural tail and adjacent bone thickening. The inte…
- Ear and audiology: functional hearing loss testing · ApplicationAn adult claims profound deafness after a minor accident. Pure-tone audiometry shows a severe loss, but the person follows ordinary conversation, and speech reception t…
- Ear and audiology: bullous myringitis · ApplicationA child with an upper respiratory infection has sudden severe earache. The drum shows haemorrhagic blisters, the pinna and canal are otherwise normal, there is no facia…
- Ear and audiology: mechanotransduction in hair cells · ApplicationSound causes the stereocilia of an inner hair cell to bend toward the tallest row. What is the immediate ionic event?
- Ear and audiology: speech audiometry in retrocochlear lesion · Multi-stepA patient with unilateral hearing loss has a speech discrimination score far lower than expected from the pure-tone loss, and it falls further when the presentation lev…
- Ear and audiology: Carhart notch mechanism · Multi-stepA 32-year-old woman has progressive bilateral hearing loss that worsened during pregnancy. Otoscopy is normal. The audiogram shows an air-bone gap, and the bone conduct…
- Ear and audiology: audiometric pattern of cisplatin ototoxicity · ApplicationA child receiving cisplatin chemotherapy develops bilateral tinnitus and difficulty hearing. Which audiometric pattern is expected?
- Ear and audiology: loop diuretic ototoxicity site · ApplicationA patient with renal failure given rapid intravenous high-dose furosemide develops tinnitus and bilateral sensorineural hearing loss that recovers over several days aft…
- Ear and audiology: first site of aminoglycoside cochlear damage · ApplicationA patient on an injectable aminoglycoside for multidrug-resistant tuberculosis develops bilateral high-pitched tinnitus. Which is the earliest site of histological dama…
- Ear and audiology: pulsatile tinnitus with normal ear · Multi-stepA 26-year-old obese woman has had a whooshing pulsatile tinnitus in the right ear for two months with daily headaches and brief visual blurring on standing. Otoscopy an…
- Ear and audiology: superior canal dehiscence work-up · Multi-stepA 40-year-old has vertigo triggered by loud sounds and straining, autophony, and a conductive hearing loss with a normal tympanic membrane. Tympanometry is normal and a…
- Ear and audiology: confirming congenital CMV · Multi-stepA two-week-old baby who failed the hearing screen has petechiae, hepatosplenomegaly and periventricular calcifications on cranial ultrasound. Which test best confirms c…
- Ear and audiology: chondrodermatitis nodularis helicis · ApplicationA 65-year-old man who sleeps on his right side has a very tender, small firm nodule with a central crust on the right helix. It wakes him at night. What is the most lik…
- Ear and audiology: otitic hydrocephalus · ApplicationA child recovering from lateral sinus thrombosis due to chronic ear disease develops headache, vomiting, papilloedema and a sixth nerve palsy. Cerebrospinal fluid press…
- Ear and audiology: cerebellar abscess in chronic ear disease · Multi-stepA man with long-standing foul attic discharge develops fever, vomiting and headache. He has gross intention tremor of the right arm, ataxia and coarse nystagmus to the…
- Ear and audiology: management of otorrhoea through a ventilation tube · ApplicationA 3-year-old with tympanostomy tubes in place develops sudden purulent otorrhoea with a cold. He is afebrile and otherwise well. What is the best initial treatment?
Head and neck tumours75
- Head and neck tumours: depth of invasion in oral cancer staging · Multi-stepA 4 cm lateral tongue carcinoma has a depth of invasion of 12 mm and no extranodal extension. In the AJCC eighth edition, how does depth of invasion affect T category?
- Head and neck tumours: commando operation · ApplicationA 55-year-old man has a floor-of-mouth carcinoma invading the mandible with ipsilateral neck nodes. The surgeon removes the primary with a segment of mandible in contin…
- Head and neck tumours: supraomohyoid neck dissection · ApplicationA cN0 oral tongue carcinoma is treated with an elective neck dissection removing nodal levels I to III with preservation of the sternocleidomastoid, jugular vein and ac…
- Head and neck tumours: pectoralis major flap · ApplicationAfter excision of a large oropharyngeal cancer in a patient unfit for free tissue transfer, the defect is reconstructed with a muscle flap from the chest based on the p…
- Head and neck tumours: radial forearm free flap · ApplicationA thin pliable flap with a long vascular pedicle is chosen for reconstruction of a partial glossectomy defect. Which flap is most suitable?
- Head and neck tumours: carcinoma of the tongue · ApplicationIn which site of the tongue does squamous cell carcinoma most commonly arise?
- Head and neck tumours: ameloblastoma · ApplicationA 30-year-old has a slowly growing painless swelling of the mandibular angle. Radiograph shows a multilocular radiolucency with a soap-bubble appearance and root resorp…
- Head and neck tumours: odontogenic keratocyst · Multi-stepA teenager with multiple jaw cysts, basal cell carcinomas and bifid ribs has a recurrence of an odontogenic keratocyst after enucleation. Which syndrome is likely?
- Head and neck tumours: sinonasal mucosal melanoma · Multi-stepA 65-year-old man has recurrent unilateral epistaxis and a dark polypoid mass in the nasal cavity. Biopsy shows melanocytic cells positive for S100 and HMB-45. What is…
- Head and neck tumours: sinonasal undifferentiated carcinoma · Multi-stepA 50-year-old has rapid growth of a nasal and ethmoid mass invading the orbit and skull base. Histology shows sheets of undifferentiated cells with high mitotic activit…
- Head and neck tumours: cetuximab · Multi-stepA 68-year-old with locally advanced head and neck squamous carcinoma is unfit for cisplatin with radiotherapy. Which monoclonal antibody against EGFR may be combined wi…
- Head and neck tumours: immunotherapy in recurrent disease · Multi-stepA patient with recurrent metastatic head and neck squamous carcinoma and a PD-L1 combined positive score of 20 is considered for first-line systemic therapy. Which agen…
- Head and neck tumours: brachytherapy · ApplicationA 2 cm well-differentiated carcinoma of the oral tongue is treated with radioactive sources implanted directly in the tumour. What is this form of radiotherapy?
- Head and neck tumours: IMRT parotid sparing · ApplicationA patient with nasopharyngeal carcinoma is treated with a technique that shapes the dose to spare the parotid glands. What is the main benefit?
- Head and neck tumours: fibula free flap · ApplicationAfter segmental mandibulectomy for a gingivobuccal carcinoma, the surgeon wants to restore the bony continuity and also allow dental implant placement. Which flap is th…
- Head and neck tumours: sentinel node biopsy · Multi-stepFor a cT1-2 N0 oral cavity carcinoma, a radiotracer is injected around the tumour and a node is removed that takes up the tracer. What is the aim?
- Head and neck tumours: chyle leak · ApplicationOn the second day after left radical neck dissection, a milky fluid with high triglyceride content collects in the drain. What is the cause?
- Head and neck tumours: cherubism · Multi-stepA 5-year-old has symmetric painless bilateral swelling of the angles of the mandible giving a full-cheek appearance, with upward-turned eyes, and a family history. Radi…
- Head and neck tumours: craniofacial fibrous dysplasia · Multi-stepA 14-year-old has progressive painless hard swelling of the maxilla with proptosis. CT shows a ground-glass expansile lesion of the bone. Which mutation is typical?
- Head and neck tumours: larynx preservation by induction chemotherapy · Multi-stepA 58-year-old man with a T3 glottic carcinoma wants to keep his larynx. After induction chemotherapy with cisplatin and fluorouracil, the primary shows a good response.…
- Head and neck tumours: medication-related osteonecrosis of the jaw · ApplicationA 65-year-old woman with osteoporosis on long-term alendronate has exposed necrotic bone in the mandible after a tooth extraction, with no history of radiotherapy. What…
- Head and neck tumours: Mendelsohn manoeuvre · ApplicationA speech therapist teaches a post-stroke patient to hold the larynx elevated for a few seconds at the middle of a swallow, to prolong cricopharyngeal opening. What is t…
- Head and neck tumours: nutritional support · ApplicationA malnourished patient with advanced hypopharyngeal cancer is about to start chemoradiotherapy and has severe dysphagia. Which is the preferred route of feeding if ente…
- Head and neck tumours: level II subdivision · Multi-stepNeck node levels II and V are each divided into A and B sublevels. What structure forms the boundary between IIA and IIB?
- Head and neck tumours: hypothyroidism after neck radiotherapy · ApplicationA patient treated years ago with radiotherapy to the neck for lymphoma develops fatigue and weight gain. Which investigation is most appropriate?
- Head and neck tumours: Lhermitte sign after radiotherapy · Multi-stepFour months after radiotherapy for nasopharyngeal carcinoma, a patient reports electric shock sensations down the spine on neck flexion. What is this and what is the co…
- Head and neck tumours: narrow band imaging · ApplicationDuring endoscopy, a surgeon uses filtered blue and green light to highlight abnormal capillary patterns in mucosal lesions. What is this technique?
- Head and neck tumours: field cancerisation · ApplicationA 58-year-old smoker treated for early oral cavity cancer returns after 2 years with a new carcinoma in the oesophagus. Which concept best explains this?
- Head and neck tumours: Lugol iodine staining · ApplicationDuring oesophagoscopy for a patient with a previous oropharyngeal cancer, Lugol iodine solution is sprayed on the mucosa. How does dysplastic or malignant squamous epit…
- Head and neck tumours: biopsy for suspected lymphoma · ApplicationA 28-year-old has a painless, rubbery 4 cm cervical lymph node with night sweats and weight loss. Fine needle aspiration is inconclusive. What is the next best step?
- Head and neck tumours: non-tuberculous mycobacterial adenitis · Multi-stepA 3-year-old has a painless, slowly enlarging unilateral submandibular node with overlying violaceous skin discoloration, no fever and no response to antibiotics. The t…
- Head and neck tumours: Kimura disease · Multi-stepA 25-year-old man has multiple painless subcutaneous masses around the parotid and periauricular regions with enlarged regional nodes. Blood tests show marked periphera…
- Head and neck tumours: vagal paraganglioma · Multi-stepA 40-year-old has a painless parapharyngeal mass at the angle of the jaw, hoarseness and an ipsilateral Horner syndrome. Angiography shows the internal and external car…
- Head and neck tumours: PET-CT after chemoradiotherapy · ApplicationA man completes chemoradiotherapy for oropharyngeal squamous carcinoma. Which investigation at about 12 weeks best assesses response and need for neck dissection?
- Head and neck tumours: benign lymphoepithelial cysts in HIV · Multi-stepA 32-year-old man with HIV has painless bilateral parotid swelling. Ultrasound shows multiple cystic lesions with cervical lymphadenopathy. FNAC shows lymphocytes and n…
- Head and neck tumours: facial palsy with a parotid mass · ApplicationA 60-year-old has a hard painless right parotid mass and new right lower motor neuron facial weakness. What does the facial weakness suggest?
- Head and neck tumours: ultrasound features of a malignant thyroid nodule · ApplicationOn ultrasound, which feature of a thyroid nodule most strongly suggests papillary carcinoma?
- Head and neck tumours: hot thyroid nodule · ApplicationA 45-year-old woman has a thyroid nodule with a suppressed TSH. Which test is next?
- Head and neck tumours: radiation-associated thyroid cancer · ApplicationA 30-year-old who received neck radiotherapy for Hodgkin lymphoma in childhood now has a thyroid nodule. Which cancer is the commonest to arise?
- Head and neck tumours: phaeochromocytoma exclusion before thyroidectomy · Multi-stepA patient has medullary thyroid carcinoma and a RET mutation consistent with MEN 2A. Before thyroidectomy, which must be done first?
- Head and neck tumours: Madelung disease · ApplicationA 50-year-old man with heavy alcohol use has symmetric, non-tender fatty swellings around the neck and upper back giving a horse-collar appearance. What is the diagnosis?
- Head and neck tumours: radiation-induced carotid stenosis · Multi-stepA 58-year-old had neck radiotherapy for laryngeal cancer ten years ago. He now has episodes of transient left arm weakness. Which late complication is most likely?
- Head and neck tumours: sialadenosis · ApplicationA 45-year-old man with chronic alcohol use has had bilateral painless soft parotid enlargement for a year. There is no fever, no dry eyes or mouth, anti-Ro and anti-La…
- Head and neck tumours: Rosai-Dorfman disease · Multi-stepA 12-year-old boy has massive painless bilateral cervical lymphadenopathy with fever and a raised ESR. Node biopsy shows sheets of S100-positive histiocytes engulfing i…
- Head and neck tumours: Riedel thyroiditis · ApplicationA 50-year-old woman has a stony hard, fixed, painless goitre that has enlarged slowly over years with breathing difficulty. She has no fever, weight loss or hoarseness.…
- Head and neck tumours: subacute thyroiditis · ApplicationA 40-year-old woman has severe anterior neck pain radiating to the ear after a viral illness, with a tender firm thyroid, raised ESR and low radioiodine uptake. What is…
- Head and neck tumours: Pemberton sign · ApplicationA 60-year-old woman with a long-standing multinodular goitre develops facial plethora, distended neck veins and dizziness when she raises both arms above her head. What…
- Head and neck tumours: canine space abscess · ApplicationA patient with an infected maxillary tooth has facial swelling lateral to the nose that obliterates the nasolabial fold and extends towards the lower eyelid. The upper…
- Head and neck tumours: hungry bone syndrome · Multi-stepA 55-year-old with long-standing severe primary hyperparathyroidism and a very high alkaline phosphatase undergoes parathyroidectomy. On day 3 she has perioral tingling…
- Head and neck tumours: lymphoma in Hashimoto thyroiditis · Multi-stepA 45-year-old woman with long-standing Hashimoto thyroiditis notices that one lobe of her goitre has enlarged rapidly over weeks, with hoarseness and dysphagia. Which c…
- Head and neck tumours: unicentric Castleman disease · Multi-stepA 28-year-old has a painless 4 cm solitary cervical node for two years, with no fever and a normal ESR. Excision shows regressed germinal centres with onion-skin mantle…
- Head and neck tumours: necrotising sialometaplasia · Multi-stepA smoker presents with a deep crater-like ulcer on the hard palate that appeared rapidly after dental local anaesthetic injection. Biopsy shows lobular necrosis of mino…
- Head and neck tumours: tragal pointer landmark · ApplicationDuring superficial parotidectomy, which landmark helps to locate the main trunk of the facial nerve at its exit from the stylomastoid foramen?
- Head and neck tumours: cervicofacial actinomycosis · ApplicationAfter a dental extraction a man develops a hard swelling at the angle of the mandible that breaks down into multiple sinuses discharging yellow granules. Which treatmen…
- Head and neck tumours: elective neck dissection for the larynx · Multi-stepA clinically node-negative laryngeal squamous carcinoma needs an elective neck dissection. Which selective neck dissection is standard?
- Head and neck tumours: recurrent pleomorphic adenoma · Multi-stepA 40-year-old has several separate firm nodules in the parotid bed eight years after enucleation of a parotid lump. Facial function is normal. What best explains the re…
- Head and neck tumours: biopsy of a parotid lump · ApplicationWhy is incisional biopsy avoided in a suspected pleomorphic adenoma of the parotid?
- Head and neck tumours: risk in leukoplakia types · ApplicationWhich clinical type of oral leukoplakia carries the greatest risk of malignant transformation?
- Head and neck tumours: oral lichen planus · Multi-stepA 50-year-old woman has bilateral lacy white striae on the buccal mucosa, with painful erosions in some areas. What is the diagnosis and its significance?
- Head and neck tumours: marginal mandibulectomy · Multi-stepA floor-of-mouth carcinoma abuts the lingual cortex of the mandible, and CT shows an intact cortex with no marrow invasion. Which mandibular procedure is adequate and p…
- Head and neck tumours: histology of nasopharyngeal carcinoma · ApplicationA 30-year-old from northeast India has nasopharyngeal carcinoma with high titres of EBV antibodies. Which histological type is most likely?
- Head and neck tumours: EBV DNA as a tumour marker · ApplicationAfter chemoradiotherapy for nasopharyngeal carcinoma, which marker is used to monitor response and detect recurrence?
- Head and neck tumours: preoperative embolisation of angiofibroma · ApplicationA 15-year-old boy with a juvenile nasopharyngeal angiofibroma is scheduled for endoscopic excision. Which preoperative measure reduces intraoperative blood loss?
- Head and neck tumours: MRI of inverted papilloma · ApplicationA 55-year-old man has unilateral nasal obstruction from a mass on the lateral nasal wall extending into the maxillary sinus. Which MRI appearance is characteristic of i…
- Head and neck tumours: Kadish staging · ApplicationAn esthesioneuroblastoma involves the nasal cavity and the ethmoid and maxillary sinuses, without extension beyond them. What is the Kadish stage?
- Head and neck tumours: T category of glottic carcinoma · ApplicationA glottic carcinoma involves both vocal folds including the anterior commissure, with normal cord mobility. What is the T category?
- Head and neck tumours: carotid blowout · Multi-stepA man irradiated for hypopharyngeal cancer develops a pharyngocutaneous fistula after salvage laryngectomy. On day 12 there is a small self-limiting bleed from the neck…
- Head and neck tumours: Burkitt lymphoma of the jaw · ApplicationA 7-year-old from sub-Saharan Africa has a rapidly enlarging jaw mass with loosening of teeth. Biopsy shows sheets of monomorphic lymphoid cells with a starry-sky patte…
- Head and neck tumours: Brown sign in glomus tympanicum · ApplicationA pulsatile reddish mass is seen behind an intact tympanic membrane. On positive pressure with a pneumatic otoscope it blanches. What is this sign called?
- Head and neck tumours: biochemical screening in paraganglioma · Multi-stepA 38-year-old has a painless pulsatile mass at the carotid bifurcation, with episodic headaches, palpitations and sweating. What should be done before any biopsy or sur…
- Head and neck tumours: carotid displacement in parapharyngeal masses · Multi-stepCT of a parapharyngeal mass shows the internal carotid artery displaced anteriorly, with the mass lying behind the styloid diaphragm. Which tumour is most likely?
- Head and neck tumours: base of tongue carcinoma · ApplicationA 60-year-old has a carcinoma of the base of the tongue and bilateral nodes at presentation. Why is bilateral nodal disease common in this site?
- Head and neck tumours: lymphoma in Sjogren syndrome · ApplicationA 55-year-old woman with long-standing Sjogren syndrome develops rapid, firm, painless enlargement of one parotid gland. Which complication is most likely?
- Head and neck tumours: occupational sinonasal carcinoma · ApplicationA 52-year-old man worked for decades in a nickel refinery. Which sinonasal malignancy is he at increased risk of?
- Head and neck tumours: adenoid cystic carcinoma genetics · ApplicationA salivary carcinoma with cribriform and tubular patterns shows a recurrent t(6;9) translocation producing a MYB-NFIB fusion. Which tumour is this?
Otology72
- Otology · ApplicationIn tuning fork testing, a negative Rinne test (bone conduction better than air conduction) with the Weber test lateralising to the same ear suggests:
- Otology · ApplicationWhat is the investigation of choice for a suspected vestibular schwannoma (acoustic neuroma)?
- Otology: acute otitis media · ApplicationA 3-year-old has fever, severe earache and a red, bulging tympanic membrane with loss of the light reflex. Which stage of acute otitis media is this, and what is the fi…
- Otology: complications of otitis media · ApplicationA 4-year-old has had a discharging ear and fever for two weeks. Now there is a tender swelling behind the ear, the pinna is pushed forward and downward, and the postero…
- Otology: auricular haematoma · ApplicationA wrestler has a tense, purple swelling of the upper pinna after a blow, and the contours of the ear are lost. What is the correct management and what is the risk if it…
- Otology: glomus tumour · Multi-stepA 50-year-old woman has pulsatile tinnitus that stops on compression of the ipsilateral carotid, and conductive hearing loss. Otoscopy shows a red, vascular mass behind…
- Otology: hearing disorders · ApplicationA 68-year-old man has noticed difficulty understanding speech in noisy places and a gradual loss of high-pitched sounds in both ears, with an audiogram showing symmetri…
- Otology: dangerous quadrant · ApplicationWhich quadrant of the tympanic membrane is called the dangerous area for incision?
- Otology: traumatic perforation · ApplicationA girl has sudden pain and hearing loss after a slap on the ear. A small dry linear perforation with clean edges is seen. What is the best management?
- Otology: aerotitis media · ApplicationA passenger has severe ear pain, fullness and hearing loss during aircraft descent. The drum is retracted with some congestion. What is the underlying mechanism?
- Otology: otitis media with effusion · ApplicationA 5-year-old has had bilateral glue ear with a 35 dB conductive loss for four months and adenoid hypertrophy with snoring. What is the best management?
- Otology: tympanosclerosis · ApplicationA man with a past history of recurrent otitis media and grommets has chalky white plaques on the drum and a mild conductive hearing loss. What is the pathology?
- Otology: objective tinnitus · Multi-stepA patient complains of a rhythmic clicking in the ear that the examiner can hear and that is synchronous with movements of the soft palate. What is the cause?
- Otology: theory of cholesteatoma · ApplicationWhich theory best explains the commonest type of acquired cholesteatoma in the attic?
- Otology: ossicle eroded in cholesteatoma · ApplicationWhich ossicular part is most commonly eroded by cholesteatoma?
- Otology: imaging of cholesteatoma · ApplicationOn high-resolution CT of the temporal bone, which finding is typical of an attic cholesteatoma?
- Otology: tympanoplasty types · Multi-stepIn Wullstein's classification, a type III tympanoplasty means the graft is placed on which structure?
- Otology: myringoplasty · ApplicationIn a dry ear with a central perforation of the pars tensa and a normal ossicular chain, what is the usual graft material and technique?
- Otology: congenital cholesteatoma · Multi-stepA 4-year-old with no previous ear discharge or surgery has a white pearly mass behind an intact tympanic membrane in the anterosuperior quadrant. What is the diagnosis?
- Otology: topical therapy in CSOM · ApplicationA patient with active mucosal chronic otitis media has a wet ear with mucopurulent discharge. What is the best initial treatment?
- Otology: acoustic reflex arc · Multi-stepWhich pair of cranial nerves forms the afferent and efferent limbs of the stapedial reflex arc?
- Otology: tinnitus management · ApplicationA 55-year-old with bothersome bilateral idiopathic tinnitus and mild high-frequency hearing loss has a normal MRI. What is the most appropriate management?
- Otology · ApplicationWhich part of the ear contains the cochlea?
- Otology · ApplicationWhat is the usual function of the tympanic membrane?
- Otology · ApplicationWhich tiny middle-ear muscle inserts on the neck of the stapes and can dampen its vibration?
- Otology · ApplicationWhat does a negative Rinne test suggest in the tested ear?
- Otology · ApplicationIn unilateral conductive hearing loss, the Weber test lateralizes where?
- Otology · ApplicationWhat is the commonest cause of acute otitis media in children?
- Otology · ApplicationWhat is the typical symptom of otitis externa?
- Otology · ApplicationWhich condition classically causes episodic vertigo, tinnitus, and fluctuating hearing loss?
- Otology · ApplicationWhich part of the inner ear is primarily responsible for balance?
- Otology · ApplicationWhat is the usual role of the Eustachian tube?
- Otology · ApplicationWhat finding is common in otitis media with effusion?
- Otology · ApplicationWhat complication can follow chronic suppurative otitis media?
- Otology · ApplicationWhat does a tympanogram help assess?
- Otology · ApplicationWhat structure converts sound vibrations into neural impulses?
- Otology · ApplicationWhat is the most common symptom of impacted ear wax?
- Otology · ApplicationWhat finding is typical of a perforated tympanic membrane?
- Otology · ApplicationWhat advice is appropriate after a simple tympanic membrane perforation?
- Otology · ApplicationWhat condition is suggested by progressive conductive hearing loss with a normal ear canal?
- Otology · ApplicationWhat structure transmits vibration from tympanic membrane to incus?
- Otology · ApplicationWhat is the main role of the stapes?
- Otology · ApplicationWhat finding commonly indicates otitis externa?
- Otology · ApplicationWhat is a common complication of chronic otitis media?
- Otology · ApplicationWhich feature is most typical of uncomplicated acute otitis externa?
- Otology · ApplicationWhat otoscopic finding most supports acute otitis media?
- Otology · ApplicationWhich complication should be suspected when a patient with recent otitis media develops postauricular swelling and protrusion of the pinna?
- Otology · ApplicationWhich hearing pattern is most typical of presbycusis?
- Otology · ApplicationWhat complication can occur if a tympanic membrane perforation becomes chronically infected?
- Otology · ApplicationWhich medication class is well known to have potential ototoxic effects at high doses or in susceptible patients?
- Otology · ApplicationWhich finding best supports acute otitis media on otoscopy?
- Otology · ApplicationWhat is the most common cause of conductive hearing loss in a child with a retracted tympanic membrane?
- Otology · ApplicationWhich tuning-fork result is expected in unilateral conductive hearing loss?
- Otology · ApplicationWhat complication should be suspected when otitis media is followed by postauricular swelling and pinna displacement?
- Otology · ApplicationWhich finding favors sensorineural rather than conductive hearing loss?
- Otology · ApplicationWhat is the usual first management for uncomplicated impacted earwax causing hearing loss?
- Otology · ApplicationWhat inner-ear disorder causes episodic vertigo with tinnitus and fluctuating hearing loss?
- Otology · ApplicationWhy is a button battery in the ear canal an emergency?
- Otology · ApplicationWhich feature favors cholesteatoma over uncomplicated otitis media?
- Otology · ApplicationWhat preventive advice reduces noise-induced hearing loss?
- Otology · ApplicationWhat does a positive Rinne test mean?
- Otology: acute otitis media · ApplicationA child has ear pain, fever, a bulging erythematous tympanic membrane, and reduced mobility on pneumatic otoscopy. What is the most likely diagnosis?
- Otology: otitis externa · ApplicationA swimmer has severe ear pain, tragal tenderness, and a swollen external auditory canal with discharge. What is the diagnosis?
- Otology: malignant otitis externa · Multi-stepAn older patient with diabetes has severe persistent otalgia, purulent otorrhea, and granulation tissue in the external canal. What complication must be considered?
- Otology: conductive hearing loss · ApplicationWhich tuning-fork result supports a right-sided conductive hearing loss?
- Otology: sensorineural hearing loss · ApplicationA patient suddenly develops unilateral hearing loss with tinnitus and a normal ear canal and tympanic membrane. What is the appropriate principle?
- Otology: cholesteatoma · ApplicationA patient has chronic foul-smelling otorrhea and a retraction pocket with keratin debris in the attic of the tympanic membrane. What is the diagnosis?
- Otology · ApplicationWhich feature distinguishes otitis externa from acute otitis media?
- Otology · ApplicationWhat complication should be suspected in malignant otitis externa?
- Otology · ApplicationWhat is the key action after sudden sensorineural hearing loss is suspected?
- Otology · ApplicationWhich finding suggests otosclerosis?
- Otology · ApplicationWhat is the purpose of tympanometry?
Larynx and airway68
- Larynx and airway: myoelastic aerodynamic theory · ApplicationWhich theory explains phonation as vocal fold closure, followed by rising subglottic pressure that blows the folds apart, then elastic recoil and the Bernoulli effect c…
- Larynx and airway: determinants of pitch · ApplicationA man's voice is lower in pitch than a woman's. What is the main reason for this difference?
- Larynx and airway: paraglottic space · Multi-stepA supraglottic carcinoma invades a space lateral to the vestibular fold and ventricle, bounded by the thyroid cartilage laterally and the conus elasticus and quadrangul…
- Larynx and airway: pre-epiglottic space · Multi-stepA tumour of the lingual surface of the epiglottis shows early extension through the epiglottic cartilage into a fat-filled space between the hyoid, thyrohyoid membrane…
- Larynx and airway: quadrangular membrane · ApplicationWhich laryngeal ligament extends from the epiglottis to the arytenoid and forms the aryepiglottic fold above and the vestibular ligament at its free lower edge?
- Larynx and airway: conus elasticus · ApplicationThe free upper edge of the conus elasticus forms which structure?
- Larynx and airway: laryngeal cleft · Multi-stepA newborn has a weak cry, choking with every feed and recurrent aspiration pneumonia. Laryngoscopy shows a defect of the posterior larynx between the arytenoids. What i…
- Larynx and airway: H-type tracheoesophageal fistula · Multi-stepA 3-month-old has recurrent coughing and choking during feeds and episodes of pneumonia. A contrast swallow is normal, but there is abdominal distension on crying. Whic…
- Larynx and airway: tracheomalacia · ApplicationAn infant has a barking cough and expiratory noise that worsens with crying and feeding. Bronchoscopy shows collapse of the posterior tracheal membrane on expiration. W…
- Larynx and airway: paradoxical vocal fold motion · ApplicationA 19-year-old athlete has episodes of inspiratory stridor and breathlessness during exercise not relieved by bronchodilators. Laryngoscopy during an episode shows adduc…
- Larynx and airway: cri du chat syndrome · ApplicationA newborn has a high-pitched cat-like cry, microcephaly, hypertelorism and low-set ears. What is the cytogenetic abnormality?
- Larynx and airway: Montgomery T-tube · Multi-stepA patient with a stable but narrowed subglottic airway after reconstruction needs a stent that also acts as a tracheostomy and allows phonation when the limb is capped.…
- Larynx and airway: fenestrated tracheostomy tube · ApplicationA tracheostomised patient who is being weaned wants to speak. Which tube allows air to pass through the larynx when the inner cannula is changed and the external openin…
- Larynx and airway: decannulation · ApplicationBefore removing a tracheostomy tube, what should the patient be able to do?
- Larynx and airway: percutaneous tracheostomy · ApplicationIn which setting is percutaneous dilatational tracheostomy most commonly performed?
- Larynx and airway: Westley croup score · ApplicationA child with croup has stridor at rest, marked retractions, cyanosis in air and a depressed level of consciousness. How is the severity classified by the Westley score?
- Larynx and airway: ventricular dysphonia · ApplicationA patient with a paralysed true vocal fold develops a rough, low-pitched voice produced by approximation of the false cords. What is this called?
- Larynx and airway: supracricoid laryngectomy · Multi-stepA 58-year-old man has a T2 supraglottic carcinoma. The surgeon removes both true and false cords and the thyroid cartilage but preserves the cricoid and at least one ar…
- Larynx and airway: vertical hemilaryngectomy · ApplicationWhich tumour is best suited to a vertical partial laryngectomy?
- Larynx and airway: arytenoid adduction · Multi-stepA patient with a unilateral vocal fold paralysis has a large posterior glottic gap and a lowered vocal process, with persistent breathiness after medialisation thyropla…
- Larynx and airway: laryngeal reinnervation · Multi-stepA 30-year-old with an irreversible unilateral recurrent laryngeal nerve injury wants a dynamic restoration of the vocal fold bulk and tone. Which nerve is commonly anas…
- Larynx and airway: adjuvant therapy for papillomatosis · Multi-stepA child with aggressive recurrent respiratory papillomatosis needs repeated surgery more than 4 times per year and has lung involvement. Which adjuvant drug has been us…
- Larynx and airway: post-tracheostomy stenosis · ApplicationA patient who had a tracheostomy 6 months ago has progressive exertional stridor. Bronchoscopy shows a ring-like narrowing at the level of the stoma. What is the usual…
- Larynx and airway: laryngeal sarcoidosis · Multi-stepA 40-year-old woman with bilateral hilar lymphadenopathy has hoarseness. Laryngoscopy shows a pale, oedematous, thickened epiglottis with a turban-like appearance. What…
- Larynx and airway: sulcus vocalis · ApplicationA 25-year-old singer has a lifelong breathy, weak voice. Stroboscopy shows a groove along the vocal fold edge with absent mucosal wave. What is the diagnosis?
- Larynx and airway: post-extubation stridor · ApplicationA patient develops stridor 30 minutes after extubation from a prolonged ventilation due to laryngeal oedema. What is the initial management?
- Larynx and airway: posterior glottic stenosis · Multi-stepAfter 3 weeks of mechanical ventilation, a patient has stridor on exertion and limited cord abduction with a fibrous band between the arytenoids. What is the diagnosis?
- Larynx and airway: laryngeal electromyography · Multi-stepA patient has a vocal fold paralysis for 2 months. Which test predicts recovery by showing polyphasic reinnervation potentials versus fibrillation potentials?
- Larynx and airway: nerve monitoring in thyroidectomy · ApplicationDuring thyroid surgery, which technique helps to identify and confirm the integrity of the recurrent laryngeal nerve?
- Larynx and airway: ligament of Berry · Multi-stepAt which place is the recurrent laryngeal nerve most vulnerable during thyroidectomy as it approaches the larynx?
- Larynx and airway: puberphonia · ApplicationA 17-year-old boy has a high-pitched voice with a normal larynx on examination. Coughing produces a normal low-pitched sound. What is the best treatment?
- Larynx and airway: vocal fold haemorrhage · ApplicationA singer develops sudden hoarseness after a forceful high note, with a red, haemorrhagic swelling of one vocal fold. What is the first-line management?
- Larynx and airway: vocal fold cyst · ApplicationA teacher has chronic hoarseness. Stroboscopy shows a smooth submucosal swelling of one vocal fold with a reduced mucosal wave that has not improved with voice therapy.…
- Larynx and airway: Galen's anastomosis · Multi-stepWhich nerve communication links the internal branch of the superior laryngeal nerve and the recurrent laryngeal nerve?
- Larynx and airway: boundaries of the laryngeal inlet · ApplicationWhich structures form the lateral boundaries of the laryngeal inlet?
- Larynx and airway: inhaled steroid and laryngeal candidiasis · ApplicationA man with asthma on high-dose inhaled beclomethasone has persistent hoarseness. Laryngoscopy shows white plaques on the cords. What is the best management?
- Larynx and airway: muscle tension dysphonia · ApplicationA teacher has a strained voice for six months. Laryngoscopy shows a normal mucosa, no lesion, and tight supraglottic squeezing on phonation. What is the first-line trea…
- Larynx and airway: radionecrosis of the larynx · Multi-stepA man treated by radiotherapy for glottic cancer a year ago now has pain, a new hoarse voice and airway distress. CT shows gas bubbles in the thyroid cartilage, and rep…
- Larynx and airway: bronchogenic carcinoma and left vocal cord palsy · Multi-stepA 62-year-old smoker has a hoarse breathy voice. The left vocal cord is fixed in the paramedian position and chest X-ray shows a hilar mass. Where is the nerve most lik…
- Larynx and airway: supraglottoplasty for severe laryngomalacia · ApplicationA 4-month-old with inspiratory stridor has apnoeic episodes and poor weight gain. Laryngoscopy shows prolapse of arytenoid mucosa and a short aryepiglottic fold. Which…
- Larynx and airway: persistent tracheocutaneous fistula · ApplicationA child with a long-term tracheostomy has been decannulated. Three months later the stoma still leaks air and secretions. What is the appropriate treatment?
- Larynx and airway: myxoedema of the vocal folds · ApplicationA middle-aged woman has a gradually deepening hoarse voice, fatigue, constipation and cold intolerance. Laryngoscopy shows diffuse oedematous vocal folds. What is the m…
- Larynx and airway: arytenoid dislocation · ApplicationAfter a difficult intubation, a patient has persistent hoarseness and a breathy voice. Laryngoscopy shows an immobile left vocal cord with a tilted arytenoid, and laryn…
- Larynx and airway: cricoarytenoid arthritis · ApplicationA 50-year-old woman with long-standing rheumatoid arthritis has hoarseness, odynophagia, a feeling of fullness in the throat and exertional stridor. Laryngoscopy shows…
- Larynx and airway: mitomycin C in airway stenosis · ApplicationAfter endoscopic dilatation of a subglottic stenosis, the surgeon applies mitomycin C topically to the scar. What is its aim?
- Larynx and airway: stomal recurrence after laryngectomy · Multi-stepA surgeon counselling a patient before total laryngectomy lists risk factors for recurrence at the tracheostoma. Which of the following is a recognised risk factor?
- Larynx and airway: Tapia syndrome · Multi-stepAfter prolonged intubation for neck surgery, a patient has hoarseness with an immobile right vocal cord and deviation of the tongue to the right on protrusion. The pala…
- Larynx and airway: needle cricothyroidotomy in a child · ApplicationA 7-year-old with complete upper airway obstruction from a foreign body cannot be intubated or ventilated, and rescue manoeuvres have failed. Which emergency airway is…
- Larynx and airway: tracheostomy tube and cuff · ApplicationA patient with a cuffed tracheostomy tube coughs on drinking and food particles appear in tracheal suction. What is the likely reason?
- Larynx and airway: acoustic jitter and shimmer · ApplicationAcoustic analysis of a hoarse voice reports increased cycle-to-cycle variation in the fundamental frequency. Which parameter is this?
- Larynx and airway: voice prosthesis leakage · ApplicationMonths after a total laryngectomy with a tracheoesophageal voice prosthesis, a patient coughs whenever he drinks, and fluid is seen leaking through the lumen of the pro…
- Larynx and airway: emergency ventilation after laryngectomy · ApplicationA man who had a total laryngectomy 3 years ago collapses at home and is unresponsive. Where should the rescuer deliver rescue breaths?
- Larynx and airway: bilateral abductor paralysis surgery · Multi-stepA woman with bilateral vocal fold paralysis in the paramedian position has biphasic stridor and a normal voice. Which trade-off must be explained before a posterior cor…
- Larynx and airway: laryngeal web with 22q11 deletion · ApplicationA neonate has a weak cry and stridor. Laryngoscopy shows an anterior glottic web, and the baby also has a ventricular septal defect, cleft palate and hypocalcaemia. Whi…
- Larynx and airway: Myer-Cotton grading · ApplicationIn a child with post-intubation subglottic stenosis, sizing with endotracheal tubes shows about 60 percent luminal obstruction. What is the Myer-Cotton grade?
- Larynx and airway: polytef granuloma · ApplicationThree years after vocal fold injection for paralysis, a patient has worsening hoarseness and a firm mass at the injection site that is not malignant on biopsy. Which ma…
- Larynx and airway: spasmodic croup · ApplicationA 3-year-old with an atopic family history wakes at night with a sudden barking cough and inspiratory stridor but has no fever or coryza. The episode settles by morning…
- Larynx and airway: localised laryngeal amyloidosis · Multi-stepA middle-aged man with hoarseness has smooth, waxy yellow submucosal thickening of both ventricular folds. Biopsy shows amorphous pink deposits that stain with Congo re…
- Larynx and airway: paediatric tracheostomy pneumothorax · ApplicationImmediately after emergency tracheostomy in a 2-year-old, oxygen saturation falls, breath sounds are absent on the right and the percussion note is hyperresonant. What…
- Larynx and airway: stay sutures in paediatric tracheostomy · ApplicationSurgeons often place stay sutures on either side of the tracheal incision in a child. What is their main purpose?
- Larynx and airway: speaking valve and cuff · Multi-stepA one-way speaking valve is placed on the tracheostomy tube of a ventilator-weaned patient. Which condition must be met before it is used?
- Larynx and airway: vascular ring · Multi-stepA 6-month-old has biphasic stridor and noisy feeding. Barium swallow shows a posterior indentation of the oesophagus with bilateral tracheal compression on the frontal…
- Larynx and airway: laryngospasm management · ApplicationOn emergence from anaesthesia a patient develops stridor that turns to silence, with paradoxical chest movement and falling saturation. What is the most appropriate imm…
- Larynx and airway: negative pressure pulmonary oedema · Multi-stepA fit young man develops pink frothy sputum and bilateral infiltrates minutes after relief of laryngospasm. Which mechanism best explains this?
- Larynx and airway: T4a glottic cancer · ApplicationCT of a glottic carcinoma shows erosion through the thyroid cartilage with extension into the soft tissues of the neck. What is the standard treatment?
- Larynx and airway: fatigable voice of myasthenia · ApplicationA 30-year-old teacher's voice becomes weak and breathy after prolonged speaking and recovers after rest. She has evening ptosis. Laryngoscopy at rest is normal. What is…
- Larynx and airway: flow-volume loop in tracheal stenosis · Multi-stepAn adult with a post-intubation tracheal stenosis has exertional stridor. A flow-volume loop is performed. Which pattern is expected?
- Larynx and airway: laser surgery airway fire · ApplicationDuring CO2 laser microlaryngeal surgery, which measure best lowers the risk of an airway fire?
Nose and paranasal sinuses66
- Nose and paranasal sinuses: skin prick test · ApplicationWhich test is the first-line method to identify the offending allergen in a patient with perennial allergic rhinitis, and what must be done before it?
- Nose and paranasal sinuses: allergen immunotherapy · ApplicationA 25-year-old with severe grass pollen rhinitis has poor control despite steroid spray and antihistamines. Which treatment can alter the natural course of the disease?
- Nose and paranasal sinuses: ethmoidal polyps · ApplicationA 40-year-old asthmatic with anosmia has multiple bilateral grape-like glistening masses in the middle meatus. What is the most likely type?
- Nose and paranasal sinuses: Woakes' ethmoiditis · Multi-stepA 25-year-old with long-standing nasal polyposis has a broad nasal bridge and widely separated eyes. Which entity is this?
- Nose and paranasal sinuses: dacryocystorhinostomy · ApplicationA 50-year-old woman has chronic watering of the eye and mucopurulent regurgitation on pressure over the lacrimal sac. Syringing shows complete obstruction at the nasola…
- Nose and paranasal sinuses: Lund-Mackay score · ApplicationWhich scoring system is used to quantify the extent of mucosal opacification of the paranasal sinuses on CT in chronic rhinosinusitis?
- Nose and paranasal sinuses: periodicity of sinus headache · ApplicationA patient's headache starts on waking in the morning, is felt over the forehead and eases through the afternoon. Which sinus is most likely involved?
- Nose and paranasal sinuses: Caldwell-Luc approach · ApplicationIn the Caldwell-Luc operation, through which route is the maxillary sinus entered?
- Nose and paranasal sinuses: agger nasi cell · Multi-stepOn coronal CT before FESS for recurrent frontal sinusitis, an air cell is seen anterior and superior to the attachment of the middle turbinate. What is this cell?
- Nose and paranasal sinuses: Haller cell · Multi-stepDuring FESS planning, CT shows an ethmoid air cell extending along the medial roof of the maxillary sinus below the orbital floor, narrowing the maxillary ostium. What…
- Nose and paranasal sinuses: Onodi cell · Multi-stepA surgeon preparing for sphenoid sinus surgery notes a posterior ethmoid cell that extends superolaterally to the sphenoid sinus in contact with the optic nerve. What i…
- Nose and paranasal sinuses: concha bullosa · ApplicationA 30-year-old man has chronic nasal obstruction and headache. CT shows an enlarged air-filled middle turbinate that narrows the middle meatus. What is this?
- Nose and paranasal sinuses: staging of angiofibroma · Multi-stepA 16-year-old boy with a nasopharyngeal angiofibroma has CT showing erosion of the skull base with only minimal intracranial extradural extension. In the Radkowski stag…
- Nose and paranasal sinuses: hardwood dust adenocarcinoma · ApplicationA 55-year-old carpenter who has worked with hardwood for decades develops unilateral nasal obstruction and bloody discharge. Which tumour is he at increased risk of?
- Nose and paranasal sinuses: rhinolith · ApplicationA 30-year-old woman has had unilateral foul-smelling blood-stained nasal discharge for years. Endoscopy shows a hard irregular grey-brown stony mass on the floor of the…
- Nose and paranasal sinuses: Draf classification · Multi-stepA patient with recurrent frontal mucocele after multiple surgeries undergoes a procedure in which the floor of both frontal sinuses and the intersinus septum are remove…
- Nose and paranasal sinuses: rhinoplasty approach · ApplicationA surgeon plans a rhinoplasty that gives wide exposure of the nasal tip cartilages through a transcolumellar incision with elevation of the skin. What is this approach…
- Nose and paranasal sinuses: bilateral septal cautery · ApplicationA patient with recurrent anterior epistaxis has bleeding points on both sides of the septum at the same level. Why should cautery not be done at the same level on both…
- Nose and paranasal sinuses: toxic shock syndrome after nasal packing · Multi-stepA woman develops fever of 39 degrees C, hypotension, a diffuse erythematous rash and vomiting 36 hours after nasal packing for epistaxis. Which organism toxin is respon…
- Nose and paranasal sinuses: primary ciliary dyskinesia · ApplicationA young man has chronic sinusitis, bronchiectasis, infertility and dextrocardia. Electron microscopy of cilia would show what defect?
- Nose and paranasal sinuses: sinus fungus ball · Multi-stepA 62-year-old immunocompetent woman has chronic unilateral maxillary sinusitis. CT shows opacification with punctate calcifications, and surgery yields a cheesy debris…
- Nose and paranasal sinuses: sinus barotrauma · ApplicationA passenger develops sudden severe pain over the forehead during aircraft descent. She had a cold the day before. What is the most likely diagnosis?
- Nose and paranasal sinuses: contents of pterygopalatine fossa · Multi-stepA surgeon expects to see the terminal part of the maxillary artery and a parasympathetic ganglion in the pterygopalatine fossa. Which ganglion is it?
- Nose and paranasal sinuses: eosinophilic granulomatosis with polyangiitis · Multi-stepA 38-year-old man with adult-onset asthma and recurrent nasal polyps develops peripheral eosinophilia of 20 percent, mononeuritis multiplex and pulmonary infiltrates. W…
- Nose and paranasal sinuses: leukotriene antagonist · ApplicationA 27-year-old with seasonal allergic rhinitis and asthma still has symptoms despite a steroid spray. Which oral drug acts by blocking cysteinyl leukotriene receptors?
- Nose and paranasal sinuses: mucociliary clearance · ApplicationIn which direction do cilia in the paranasal sinuses move mucus?
- Nose and paranasal sinuses: olfactory testing · ApplicationWhich test uses scratch-and-sniff microencapsulated odorants to measure smell identification?
- Nose and paranasal sinuses: antibiotics in acute rhinosinusitis · ApplicationA 30-year-old has nasal congestion and facial pain for 3 days after a cold, with a mild fever. What is the best approach?
- Nose and paranasal sinuses: osteoma of the frontal sinus · ApplicationA young man has an incidental dense, well-circumscribed bony mass in the frontal sinus on CT. Multiple osteomas and colonic polyps are present in his family. Which synd…
- Nose and paranasal sinuses: compensatory turbinate hypertrophy · Multi-stepA young man with a septum deviated to the left has persistent right-sided nasal blockage. Examination shows a bulky right inferior turbinate in the wider right passage.…
- Nose and paranasal sinuses: contact point headache · Multi-stepA 30-year-old has episodic pain around the medial canthus. Sinus CT shows clear sinuses, but nasal endoscopy shows a septal spur touching the lateral wall. The pain dis…
- Nose and paranasal sinuses: lepromatous leprosy of the nose · ApplicationA man with long-standing lepromatous leprosy has persistent nasal crusting and blockage. A smear from the nasal mucosa is requested. What is the reason?
- Nose and paranasal sinuses: birth injury to the septum · Multi-stepA newborn has noisy breathing and a deviated columella with a flattened left nostril. A feeding catheter passes easily through both nostrils. What is the most likely ca…
- Nose and paranasal sinuses: medial rectus injury at sinus surgery · Multi-stepAfter endoscopic ethmoidectomy, a patient has double vision. The right eye cannot move toward the nose, and the diplopia is worst on looking left. Which structure was m…
- Nose and paranasal sinuses: nasal diphtheria · ApplicationAn unimmunised 4-year-old has unilateral blood-stained foul nasal discharge. A greyish membrane is seen in the nasal cavity and the child is toxic. Which organism is re…
- Nose and paranasal sinuses: aspirin desensitisation · Multi-stepA man with asthma, nasal polyps and reactions to aspirin has had two sinus operations, and the polyps keep recurring despite intranasal steroids. Which additional optio…
- Nose and paranasal sinuses: recurrent childhood epistaxis · ApplicationA 6-year-old has repeated small anterior nosebleeds with crusting of the anterior septum and a habit of nose picking. Examination and platelet count are normal. What is…
- Nose and paranasal sinuses: dacryocystocele · Multi-stepA newborn has a bluish swelling just below the medial canthus and a small cyst visible in the nose, causing noisy breathing during feeds. What is the most likely diagno…
- Nose and paranasal sinuses: house dust mite avoidance · ApplicationA child with perennial allergic rhinitis has a strongly positive skin prick test to Dermatophagoides. Which environmental measure is most useful?
- Nose and paranasal sinuses: congenital pyriform aperture stenosis · Multi-stepA newborn has cyclical cyanosis and difficulty feeding, and a small catheter will not pass through either nostril. CT shows narrowing of the anterior bony nasal apertur…
- Nose and paranasal sinuses: timing of nasal fracture reduction · ApplicationAn adult has a displaced nasal bone fracture after a fall. Swelling is marked on day one. When is closed reduction usually best performed?
- Nose and paranasal sinuses: rhinosporidiosis treatment · ApplicationA farmer who bathed in a village pond has a red, friable, polypoidal nasal mass with white dots on the surface. What is the preferred treatment?
- Nose and paranasal sinuses: nasoorbitoethmoid fracture · ApplicationAfter being struck on the nasal root by a bat, a man has a flattened nasal bridge, a widened distance between the inner angles of the eyes, and watering of the eye. Wha…
- Nose and paranasal sinuses: superior orbital fissure syndrome · Multi-stepAfter a fracture of the lateral orbital wall in a road accident, a man has ptosis, complete ophthalmoplegia, a dilated fixed pupil and numbness of the forehead. Visual…
- Nose and paranasal sinuses: lupus vulgaris of the nose · ApplicationA young woman has a slowly enlarging reddish-brown nodule on the skin of the nasal vestibule. On pressing with a glass slide, the lesion turns an apple-jelly colour. Wh…
- Nose and paranasal sinuses: bleeding disorder in epistaxis · ApplicationA 14-year-old girl has recurrent spontaneous nosebleeds, heavy menstrual bleeding and prolonged bleeding after a tooth extraction. Platelet count and prothrombin time a…
- Nose and paranasal sinuses: clival chordoma · Multi-stepA 45-year-old has headache, diplopia from a sixth nerve palsy and nasal obstruction. CT shows a destructive midline mass of the clivus with internal calcification. Whic…
- Nose and paranasal sinuses: Young syndrome · Multi-stepA 32-year-old man with chronic sinusitis and bronchiectasis is infertile. Semen analysis shows azoospermia with normal testis size, sweat chloride is normal, ciliary be…
- Nose and paranasal sinuses: zygomaticomaxillary complex fracture · ApplicationA cricketer struck by a ball has flattening of the cheek, numbness of the cheek and upper lip, a subconjunctival haemorrhage, and tenderness at the lateral orbital rim,…
- Nose and paranasal sinuses: biologic therapy in nasal polyposis · ApplicationA 45-year-old with asthma and severe recurrent nasal polyposis relapses after two endoscopic surgeries and repeated oral steroids. Which monoclonal antibody that blocks…
- Nose and paranasal sinuses: sinonasal plasmacytoma · Multi-stepA 58-year-old has unilateral nasal obstruction and bleeding. Biopsy of a polypoid mass shows monoclonal plasma cells. Skeletal survey, marrow biopsy and serum electroph…
- Nose and paranasal sinuses: empty nose syndrome · ApplicationTwo years after aggressive bilateral inferior turbinate resection, a man has a paradoxical sense of nasal blockage despite a wide airway, with dryness, crusting and a f…
- Nose and paranasal sinuses: frontal sinus posterior table fracture · Multi-stepAfter a road accident a man has a depressed forehead. CT shows a comminuted, displaced posterior table fracture of the frontal sinus with pneumocephalus and clear nasal…
- Nose and paranasal sinuses: mucormycosis hyphae · ApplicationA diabetic with ketoacidosis has facial pain and a black necrotic area on the middle turbinate. Which microscopic appearance is expected on KOH mount or biopsy?
- Nose and paranasal sinuses: olfactory neuroblastoma grading · ApplicationA tumour arising from the olfactory epithelium of the roof of the nose is graded histologically from I to IV according to its architecture, mitoses and necrosis. Which…
- Nose and paranasal sinuses: management of anterior epistaxis · ApplicationA healthy adult has recurrent anterior nosebleeds. After pressure on the soft part of the nose for 10 minutes, a bleeding vessel is seen on the anterior septum. What is…
- Nose and paranasal sinuses: nasopulmonary reflex after posterior packing · ApplicationAn elderly man with a posterior nasal pack for severe epistaxis becomes drowsy overnight, with falling oxygen saturation and rising carbon dioxide, although the airway…
- Nose and paranasal sinuses: spread of nasal vestibule infection · ApplicationA man squeezes a furuncle in the nasal vestibule. Two days later he has fever, periorbital oedema, chemosis and ophthalmoplegia, which then becomes bilateral. By which…
- Nose and paranasal sinuses: Chandler staging of orbital infection · Multi-stepA child with ethmoid sinusitis has proptosis with the globe displaced down and laterally, painful restricted eye movements and preserved vision. CT shows a lentiform co…
- Nose and paranasal sinuses: trapdoor orbital floor fracture · Multi-stepA 9-year-old struck by a ball has vomiting, bradycardia, pain on eye movement and marked limitation of upgaze, with little bruising. CT shows a linear orbital floor fra…
- Nose and paranasal sinuses: ARIA classification · ApplicationA patient has nasal itching and sneezing on two days a week, each season lasting about six weeks, with normal sleep and daily activities. By the ARIA classification, ho…
- Nose and paranasal sinuses: aspirin-exacerbated respiratory disease mechanism · Multi-stepA 38-year-old with asthma and recurrent nasal polyps develops wheeze and profuse rhinorrhoea 40 minutes after taking ibuprofen. What is the underlying mechanism?
- Nose and paranasal sinuses: lupus pernio histology · Multi-stepA 45-year-old woman has violaceous indurated plaques on the nose and cheeks, chronic nasal crusting and bilateral hilar lymphadenopathy. What would a biopsy of the skin…
- Nose and paranasal sinuses: internal nasal valve · ApplicationA patient has nasal obstruction on inspiration with narrowing of the nasal sidewalls on deep breath. Gentle lateral traction of the cheek improves breathing. Which stru…
- Nose and paranasal sinuses: silent sinus syndrome · Multi-stepA 35-year-old notices his right eye sinking, with a deeper upper lid crease, without pain or nasal symptoms. CT shows a small opacified right maxillary sinus with the o…
- Nose and paranasal sinuses: non-allergic rhinitis with eosinophilia · ApplicationA 40-year-old has perennial sneezing and profuse watery rhinorrhoea. Skin prick tests are negative and serum total IgE is normal, but nasal smear shows many eosinophils…
Vestibular disorders55
- Vestibular disorders · ApplicationA patient has recurrent attacks of vertigo lasting hours, with fluctuating low-frequency hearing loss, tinnitus and a feeling of fullness in the ear. What is the likely…
- Vestibular disorders · ApplicationA 40-year-old has severe continuous vertigo with nausea for two days after a flu-like illness. There is horizontal nystagmus beating away from the affected ear. There i…
- Vestibular disorders: cervical VEMP · ApplicationWhich test evaluates saccular function and the inferior vestibular nerve by recording an inhibitory response from the sternocleidomastoid muscle after loud clicks?
- Vestibular disorders: perilymph fistula · Multi-stepA diver has sudden vertigo and hearing loss after a forceful Valsalva during ascent. Pressure applied in the ear canal reproduces vertigo. What is the likely diagnosis?
- Vestibular disorders: lateral medullary syndrome · Multi-stepA 62-year-old hypertensive man has sudden vertigo, hoarseness, left Horner syndrome, loss of pain and temperature on the left face and the right body. Which vessel is i…
- Vestibular disorders: videonystagmography · ApplicationA clinician wants to record spontaneous and positional nystagmus without the suppressing effect of visual fixation. Which approach is used?
- Vestibular disorders: cervical vertigo · ApplicationA 55-year-old man has brief dizziness only when he extends and rotates his neck, with neck stiffness and normal vestibular tests. Which statement is correct about this…
- Vestibular disorders: mal de debarquement · ApplicationA woman returns from a 2-week sea cruise and continues to feel that she is rocking and swaying for weeks, with symptoms easing when she is in a moving car. Examination…
- Vestibular disorders: electrocochleography in Meniere disease · Multi-stepA 44-year-old man with episodic vertigo and fluctuating hearing loss undergoes electrocochleography. Which finding supports endolymphatic hydrops?
- Vestibular disorders: Ewald's first law · Multi-stepIn the horizontal semicircular canal, which direction of endolymph flow produces the strongest stimulation of the hair cells and the greatest increase in firing rate?
- Vestibular disorders: central features in positional vertigo · Multi-stepA patient with positional vertigo on Dix-Hallpike testing shows pure downbeating nystagmus without latency that does not fatigue and persists while the head position is…
- Vestibular disorders: caloric direction of nystagmus · ApplicationIn a normal subject, cold water is irrigated into the left ear during caloric testing. In which direction does the fast component of nystagmus beat?
- Vestibular disorders: ototoxicity monitoring · Multi-stepA patient is starting cisplatin chemotherapy. Which audiometric test is most sensitive for detecting early ototoxic damage?
- Vestibular disorders: orthostatic dizziness · ApplicationA 70-year-old on antihypertensives has light-headedness on standing that settles when he sits. There is no spinning, and blood pressure falls by 30 mmHg on standing. Wh…
- Vestibular disorders: compensation after neuritis · Multi-stepA patient with vestibular neuritis is still taking prochlorperazine on day seven and remains unsteady. What is the best advice?
- Vestibular disorders: otosyphilis · Multi-stepA man with known late syphilis has fluctuating sensorineural hearing loss, tinnitus and episodic vertigo that mimic Meniere disease. Which treatment is indicated?
- Vestibular disorders: acoustic neuroma and imbalance · Multi-stepA 50-year-old has progressive unilateral hearing loss and tinnitus but only mild unsteadiness, never true vertigo. Why is vertigo uncommon in vestibular schwannoma?
- Vestibular disorders: endolymphatic hydrops imaging · Multi-stepA patient with suspected Meniere disease undergoes MRI after intratympanic gadolinium. Which finding supports the diagnosis?
- Vestibular disorders: stroke mimicking vestibular neuritis · Multi-stepA 65-year-old diabetic has acute continuous vertigo, nausea and inability to walk unaided. CT head is normal. Why is MRI diffusion imaging still advised?
- Vestibular disorders: downbeat nystagmus · Multi-stepA 35-year-old has oscillopsia and unsteadiness, and examination shows persistent downbeat nystagmus in primary gaze. Which region should be imaged?
- Vestibular disorders: subclavian steal syndrome · Multi-stepA 65-year-old smoker has episodes of vertigo and blurred vision when he exercises his left arm, which also aches. Blood pressure is 30 mmHg lower in the left arm than t…
- Vestibular disorders: ageotropic horizontal canal BPPV · Multi-stepOn the supine roll test, a patient has horizontal nystagmus beating away from the ground (ageotropic) on turning to either side, with vertigo. What does this indicate?
- Vestibular disorders: persistent postural-perceptual dizziness · Multi-stepSix months after recovery from vestibular neuritis, a woman has constant unsteadiness and non-spinning dizziness that worsens when standing, in busy supermarkets and wi…
- Vestibular disorders: superior vestibular neuritis · Multi-stepIn classic vestibular neuritis limited to the superior division of the vestibular nerve, which end organ is spared?
- Vestibular disorders: hearing-preserving schwannoma surgery · Multi-stepA 40-year-old has a 7 mm intracanalicular vestibular schwannoma with good serviceable hearing and wants surgery rather than observation. Which approach can preserve hea…
- Vestibular disorders: anterior canal BPPV · Multi-stepOn Dix-Hallpike testing a patient has brief downbeating nystagmus with a torsional component after a short latency, which fatigues on repetition. There are no other neu…
- Vestibular disorders: intratympanic gentamicin in Meniere disease · Multi-stepA 52-year-old with unilateral Meniere disease has disabling vertigo despite salt restriction, a diuretic and betahistine, and still has serviceable hearing. Intratympan…
- Vestibular disorders: Lermoyez syndrome · ApplicationA woman has repeated episodes in which tinnitus and hearing loss build up, then an attack of vertigo occurs and the hearing improves. What is this variant of Meniere di…
- Vestibular disorders: Hennebert sign · ApplicationA patient with late congenital syphilis has sensorineural hearing loss. Positive pressure applied to the ear canal with a Siegle speculum produces vertigo and nystagmus…
- Vestibular disorders: caloric test in coma · Multi-stepIce-cold water is irrigated into the right ear of an unconscious patient with an intact brainstem. What eye response is expected?
- Vestibular disorders: translabyrinthine approach · Multi-stepA 2 cm vestibular schwannoma is to be removed in a patient whose hearing on that side is already non-serviceable. The surgeon wants early identification of the facial n…
- Vestibular disorders: stereotactic radiosurgery for schwannoma · ApplicationA 76-year-old with ischaemic heart disease has a vestibular schwannoma of 2 cm that has grown on two consecutive MRI scans. He is unfit for open surgery. What is the mo…
- Vestibular disorders: brainstem response audiometry in retrocochlear lesions · Multi-stepA patient with asymmetric sensorineural loss has a brainstem evoked response audiogram. Which finding favours a retrocochlear lesion such as a vestibular schwannoma ove…
- Vestibular disorders: betahistine mechanism · ApplicationBetahistine is prescribed to reduce the frequency of attacks in Meniere disease. What is its main pharmacological action?
- Vestibular disorders: endolymph flow in vertical canals · ApplicationIn the superior and posterior semicircular canals, which direction of endolymph flow excites the hair cells?
- Vestibular disorders: AICA infarction · Multi-stepA 66-year-old has sudden vertigo with ipsilateral hearing loss, tinnitus, facial weakness and limb ataxia. Which vessel is most likely occluded?
- Vestibular disorders: ocular VEMP · ApplicationAn ocular vestibular evoked myogenic potential recorded from beneath the eyes on upward gaze is used to assess which structures?
- Vestibular disorders: video head impulse test · ApplicationCaloric testing assesses the horizontal canal at very low frequency. Which test records vestibulo-ocular reflex gain for each of the six canals during rapid, high-accel…
- Vestibular disorders: VEMP in superior canal dehiscence · Multi-stepA woman with sound-induced vertigo is suspected to have superior canal dehiscence. Which VEMP finding supports the diagnosis?
- Vestibular disorders: vestibular nerve section · Multi-stepA 48-year-old with Meniere disease has disabling vertigo despite maximum medical therapy and sac surgery. Hearing in the affected ear is still useful. Which procedure c…
- Vestibular disorders: benign paroxysmal vertigo of childhood · ApplicationA 4-year-old has repeated sudden episodes of unsteadiness lasting a few minutes, with fright, pallor and nystagmus, and recovers fully. Hearing is normal and a parent h…
- Vestibular disorders: epidermoid cyst of the cerebellopontine angle · Multi-stepMRI of an adult with a cerebellopontine angle lesion shows a lobulated mass that follows CSF signal on T1 and T2, does not enhance, insinuates around cranial nerves and…
- Vestibular disorders · ApplicationWhat is the typical trigger for benign paroxysmal positional vertigo?
- Vestibular disorders · ApplicationWhat is a common symptom of vestibular neuritis?
- Vestibular disorders · ApplicationWhat is the purpose of the Dix-Hallpike maneuver?
- Vestibular disorders · ApplicationWhat feature favors central vertigo over peripheral vertigo?
- Vestibular disorders · ApplicationWhat rehabilitation can help persistent peripheral vestibular symptoms?
- Vestibular disorders · ApplicationWhat test is used to provoke benign positional vertigo?
- Vestibular disorders · ApplicationWhat is the key symptom triad of Meniere disease?
- Vestibular disorders · ApplicationWhat is the usual trigger for benign paroxysmal positional vertigo?
- Vestibular disorders · ApplicationWhich history most strongly suggests benign paroxysmal positional vertigo?
- Vestibular disorders · ApplicationWhich symptom combination is characteristic of Ménière disease?
- Vestibular disorders · ApplicationWhich feature favors vestibular neuritis over a central cause of vertigo?
- Vestibular disorders · ApplicationWhat feature suggests central rather than peripheral vertigo?
- Vestibular disorders · ApplicationWhat does a positive head-impulse test usually suggest in acute vertigo?
Nose47
- Nose · ApplicationA young woman complains that her family notices a foul smell from her nose. She herself cannot smell it. Examination shows wide nasal cavities, atrophic turbinates and…
- Nose: congenital anomalies · ApplicationA full-term newborn is cyanosed when feeding quietly but pinks up when crying. A feeding catheter cannot be passed through either nostril. What is the diagnosis?
- Nose: Woodruff's plexus · ApplicationA hypertensive elderly man has profuse posterior epistaxis. The bleeding point is located at the posterior end of the inferior meatus. Which plexus is this?
- Nose: refractory posterior epistaxis · ApplicationA patient with posterior epistaxis continues to bleed despite a posterior pack. Which is the most effective surgical step?
- Nose: hereditary haemorrhagic telangiectasia · ApplicationA man has recurrent spontaneous nosebleeds, small red lesions on the lips and tongue, and a family history of nosebleeds. What is the inheritance pattern?
- Nose: septal haematoma · ApplicationAfter a blow to the nose, a boy has bilateral nasal obstruction and a soft, bluish, fluctuant swelling on both sides of the septum. What is the correct management?
- Nose: septal abscess · ApplicationA septal abscess is dangerous because it can lead to which outcome?
- Nose: septoplasty principle · ApplicationDuring septoplasty, why is a minimum strip of cartilage left along the dorsum and caudal edge?
- Nose: septal perforation · ApplicationA man who snorts cocaine presents with crusting and whistling on breathing. A perforation of the cartilaginous nasal septum is seen. Why does this occur?
- Nose: atrophic rhinitis · ApplicationA young woman has a roomy nasal cavity with green crusts and a foul smell that she cannot herself perceive. Which organism is classically associated?
- Nose: vasomotor rhinitis · ApplicationA patient has intractable vasomotor rhinitis with watery rhinorrhoea unresponsive to medical therapy. Which operation interrupts the parasympathetic supply?
- Nose: rhinoscleroma · ApplicationBiopsy of a hard, woody nasal mass shows foamy macrophages containing bacilli (Mikulicz cells) and Russell bodies. Which organism is responsible?
- Nose: granulomatosis with polyangiitis · ApplicationA patient has crusting nasal discharge, epistaxis, a saddle nose, haemoptysis and haematuria. Which serological marker is characteristic?
- Nose: NK/T-cell lymphoma · Multi-stepA 40-year-old has progressive destruction of the midline nose and palate with necrotic ulceration and a negative ANCA. Biopsy shows angiocentric lymphoid infiltrate. Wh…
- Nose: Samter's triad · ApplicationA patient with asthma and nasal polyps has bronchospasm after taking aspirin. Which advice is correct?
- Nose: polyps in children · ApplicationA 6-year-old has bilateral nasal polyps and recurrent chest infections with poor weight gain. Which test should be done?
- Nose: encephalocele versus glioma · Multi-stepA newborn has a bluish, soft midline nasal mass that expands on crying and when the jugular veins are compressed. What is the name of this sign?
- Nose: anterior ethmoidal artery · ApplicationThe anterior ethmoidal artery, a source of epistaxis from the roof of the nasal cavity, is a branch of which artery?
- Nose: inverted papilloma · ApplicationA 55-year-old man has unilateral nasal obstruction with a warty polypoid mass arising from the lateral nasal wall. Biopsy shows inverted papilloma. What is the best tre…
- Nose: Kallmann syndrome · ApplicationA 17-year-old boy has absent puberty and has never perceived smell. Which hormonal finding is expected?
- Nose: nasal valve · ApplicationThe narrowest part of the nasal airway, forming the main site of resistance to airflow, is which area?
- Nose: nasal dermoid · ApplicationA child has a midline pit on the nasal dorsum from which hair emerges and from which there is recurrent discharge. What should be done before surgery?
- Nose: Curacao criteria for HHT · ApplicationA 35-year-old has recurrent spontaneous epistaxis, mucocutaneous telangiectasia on the lips and fingertips, and a father with the same problem. How many of the four Cur…
- Nose: acoustic rhinometry · ApplicationA surgeon wants an objective, non-invasive measurement of the cross-sectional area and volume of the nasal cavity before and after turbinate surgery. Which test provide…
- Nose: primary ciliary dyskinesia screening · Multi-stepA 9-year-old has daily wet cough, chronic rhinosinusitis, recurrent otitis media with effusion and dextrocardia on chest film. Which screening test is most appropriate…
- Nose: localising a CSF leak · Multi-stepAfter a skull base fracture, a patient has persistent clear rhinorrhoea that is positive for beta-2 transferrin, but CT and nasal endoscopy do not show the site. Which…
- Nose: posterior balloon tamponade · Multi-stepAn elderly man has torrential epistaxis not controlled by an anterior pack. Posterior bleeding is suspected. Which immediate measure is appropriate?
- Nose: ethmoidal artery bleeding · Multi-stepA patient bleeds persistently from high in the nose above the middle turbinate after head trauma, and endoscopic sphenopalatine artery ligation has failed. Which vessel…
- Nose: olfactory training · ApplicationA 35-year-old has had reduced smell for five months after a viral upper respiratory infection, with normal nasal endoscopy and CT. What is the best evidence-based advice?
- Nose: post-traumatic anosmia mechanism · Multi-stepAfter a fall on the back of his head, a man loses his sense of smell completely and notes that food tastes bland, though he can still distinguish salty and sweet. What…
- Nose: multiple magnet ingestion · Multi-stepA 4-year-old swallowed two small magnets a day ago and is now vomiting with abdominal pain. A radiograph shows two metallic densities apart from each other. Why is this…
- Nose: nasal vestibulitis treatment · ApplicationA child has a tender, red, crusted swelling at the tip of the nose after picking, with a pustule in the vestibule. What is the appropriate treatment and advice?
- Nose: synechiae after FESS · ApplicationAfter functional endoscopic sinus surgery, a patient has recurrent frontal and maxillary symptoms. Endoscopy shows a band between the middle turbinate and lateral nasal…
- Nose: retrobulbar haematoma after sinus surgery · Multi-stepWithin hours of ethmoid surgery a patient has severe eye pain, tense proptosis, a fixed dilated pupil and falling visual acuity. What is the immediate management?
- Nose: tranexamic acid for epistaxis · ApplicationA patient on aspirin has an anterior epistaxis that persists after 15 minutes of correct firm pinching. Which topical measure may be tried before cautery or packing?
- Nose: odontogenic sinusitis · Multi-stepA 50-year-old has unilateral maxillary sinusitis with foul-smelling discharge that is resistant to antibiotics. CT shows maxillary opacity and a periapical lesion of th…
- Nose: incidental maxillary retention cyst · ApplicationA patient has a CT for headache that incidentally shows a smooth dome-shaped opacity of 2 cm on the floor of the left maxillary sinus, with no symptoms and a patent ost…
- Nose: septal button · ApplicationA 48-year-old with a large symptomatic anterior septal perforation causing crusting, whistling and bleeding has had poor results from saline douching and ointment. Whic…
- Nose: foreign body · ApplicationUnilateral foul nasal discharge in child suggests what?
- Nose: CSF leak · ApplicationClear rhinorrhea after trauma that worsens leaning forward suggests what?
- Nose: polyps · ApplicationBilateral pale nasal masses with hyposmia suggest what?
- Nose · ApplicationWhere does most anterior epistaxis occur?
- Nose · ApplicationWhat emergency complication follows nasal trauma?
- Nose · ApplicationWhat pattern suggests allergic rhinitis?
- Nose · ApplicationWhich symptom makes unilateral nasal obstruction a cancer red flag?
- Nose · ApplicationWhich symptom pattern suggests rhinitis medicamentosa?
- Nose · ApplicationWhat is the usual treatment goal for hereditary haemorrhagic telangiectasia epistaxis?
Pharynx and tonsils44
- Pharynx and tonsils: tonsil bed · ApplicationDuring tonsillectomy by dissection, the surgeon exposes the muscle forming the tonsil bed. Which muscle is it, and which nerve lies just lateral to it, at risk if the d…
- Pharynx and tonsils: Centor criteria · ApplicationA 22-year-old has a sore throat, tonsillar exudates, tender anterior cervical nodes and fever, with no cough. How many Centor criteria are present, and what does this s…
- Pharynx and tonsils: parapharyngeal abscess · ApplicationA 30-year-old has trismus, fever, swelling behind the angle of the mandible and the tonsil pushed medially, with a bulging lateral pharyngeal wall. What is the diagnosis?
- Pharynx and tonsils: compartments of the parapharyngeal space · Multi-stepA parapharyngeal abscess in the poststyloid compartment is more dangerous than one in the prestyloid compartment. Which structures lie in the poststyloid compartment?
- Pharynx and tonsils: videofluoroscopic swallow study · ApplicationA 70-year-old man has coughing with thin liquids after a stroke. Which investigation dynamically assesses the oral and pharyngeal phases of swallowing and detects silen…
- Pharynx and tonsils: Eagle syndrome · ApplicationA 50-year-old woman who underwent tonsillectomy has persistent sharp throat pain on swallowing and turning the head, and a bony hard projection is felt in the tonsillar…
- Pharynx and tonsils: Behcet disease · ApplicationA 28-year-old man from the Silk Route region has recurrent painful oral ulcers, genital ulcers and uveitis. Which disease is it?
- Pharynx and tonsils: PFAPA syndrome · Multi-stepA 3-year-old has fever lasting 4 days every 4 weeks with aphthous ulcers, pharyngitis and cervical adenitis, and is entirely well between episodes with normal growth. W…
- Pharynx and tonsils: Friedman tongue position · ApplicationA patient with obstructive sleep apnoea is examined, and the surgeon grades how much of the uvula and tonsils are visible with the tongue in a neutral position and mout…
- Pharynx and tonsils: Passavant's ridge · Multi-stepA child develops hypernasal speech and nasal regurgitation after adenoidectomy. Which structure normally helps to close the nasopharynx against the soft palate during s…
- Pharynx and tonsils: pharyngeal muscle supply · ApplicationA patient has damage to the glossopharyngeal nerve. Which pharyngeal muscle, supplied exclusively by this nerve, is affected?
- Pharynx and tonsils: coblation tonsillectomy · ApplicationWhich technique of tonsillectomy uses radiofrequency energy in a saline field to dissolve tissue at a lower temperature, resulting in less postoperative pain?
- Pharynx and tonsils: glossopharyngeal neuralgia · ApplicationA 55-year-old has severe stabbing pain in the throat and ear triggered by swallowing and yawning, lasting seconds, with normal examination. Which drug is first-line?
- Pharynx and tonsils: vallecular cyst · ApplicationAn infant has stridor, feeding difficulty and a cystic swelling in the vallecula seen on laryngoscopy, pushing the epiglottis backwards. What is the treatment?
- Pharynx and tonsils: sialorrhoea management · ApplicationA child with cerebral palsy has severe drooling with recurrent aspiration. After failure of glycopyrrolate, which procedure may be offered?
- Pharynx and tonsils: temporomandibular joint dysfunction · ApplicationA 28-year-old woman has preauricular pain, clicking and limited mouth opening that worsens with chewing, with a normal ear examination. Which diagnosis explains the ref…
- Pharynx and tonsils: lymphoma of Waldeyer's ring · ApplicationA 60-year-old has unilateral tonsillar enlargement with a smooth surface and a mass in the neck. Biopsy shows large CD20-positive B cells. What is the most likely diagn…
- Pharynx and tonsils: secondary syphilis of the mouth · Multi-stepA sexually active man has a sore throat, painless greyish-white erosions on the tongue and cheek, a non-itchy palmar rash and generalised lymphadenopathy. Which diagnos…
- Pharynx and tonsils: otalgia after tonsillectomy · ApplicationA child complains of right ear pain on day 2 after tonsillectomy. The ear canal and drum are normal. Which nerve carries the pain to the ear?
- Pharynx and tonsils: herpetic gingivostomatitis · ApplicationA 3-year-old has fever, drooling, swollen bleeding gums and clusters of small ulcers on the lips and palate. What is the most appropriate drug treatment, started early?
- Pharynx and tonsils: mandibular advancement device · ApplicationA 40-year-old thin man with mild obstructive sleep apnoea and retrognathia cannot tolerate CPAP. Which alternative is most suitable?
- Pharynx and tonsils: adenotonsillectomy in a young child with OSA · ApplicationA 2-year-old with severe obstructive sleep apnoea is scheduled for adenotonsillectomy. Why is overnight postoperative observation advised?
- Pharynx and tonsils: acute HIV infection · Multi-stepA man has fever, sore throat, a faint rash and tender lymph nodes three weeks after a high-risk exposure. A rapid HIV antibody test is negative. Which test is most usef…
- Pharynx and tonsils: chin tuck manoeuvre · ApplicationAn elderly man with oropharyngeal dysphagia aspirates thin liquids because of delayed triggering of the swallow. Which simple postural manoeuvre can reduce aspiration?
- Pharynx and tonsils: infectious mononucleosis with airway obstruction · ApplicationA teenager with infectious mononucleosis has massively enlarged kissing tonsils and stridor with difficulty swallowing. Which treatment is indicated?
- Pharynx and tonsils: Vernet syndrome · Multi-stepAfter a basal skull fracture, a man has hoarseness, nasal regurgitation of fluids, an absent gag on the left and weak left sternomastoid and trapezius. Tongue movement…
- Pharynx and tonsils: dysphagia lusoria · Multi-stepA 30-year-old woman has intermittent dysphagia more marked for solids. A barium swallow shows an oblique extrinsic indentation on the posterior wall of the oesophagus a…
- Pharynx and tonsils: fish bone impaction · ApplicationA man feels a fish bone stuck in his throat after dinner and points to one side of the neck. He has no stridor or drooling. What is the most appropriate first step?
- Pharynx and tonsils: Grisel syndrome · Multi-stepA 7-year-old develops severe neck pain and a fixed head tilt with rotation to one side after adenotonsillectomy for recurrent tonsillitis. There is no fever, and the ne…
- Pharynx and tonsils: Down syndrome and cervical instability · ApplicationA 6-year-old with Down syndrome is scheduled for adenotonsillectomy for obstructive sleep apnoea. Which positioning precaution is most important?
- Pharynx and tonsils: agranulocytic angina · ApplicationA woman on long-term carbimazole develops fever and a severe sore throat. The tonsils and pharynx show grey-black necrotic ulcers with very little surrounding redness.…
- Pharynx and tonsils: Mendelson manoeuvre · ApplicationAfter a brainstem stroke a patient has food pooling in both pyriform fossae with poor opening of the upper oesophageal sphincter. Which swallowing technique, in which t…
- Pharynx and tonsils: supraglottic swallow · ApplicationA patient with delayed glottic closure aspirates thin liquids before the swallow reflex fires. Which technique asks the patient to hold the breath, swallow, and then co…
- Pharynx and tonsils: velopharyngeal incompetence after palatal surgery · ApplicationA man develops hypernasal speech and fluid regurgitating into the nose when he swallows, three weeks after uvulopalatopharyngoplasty for snoring. What is the mechanism?
- Pharynx and tonsils: Muller manoeuvre · ApplicationDuring awake flexible nasopharyngoscopy in a snorer, the patient is asked to breathe in forcefully against a closed nose and mouth while the airway is watched. What is…
- Pharynx and tonsils: tonsillar chancre · Multi-stepA 24-year-old man has a painless, shallow ulcer with an indurated base on one tonsil and firm, painless, ipsilateral neck nodes three weeks after unprotected oral sex.…
- Pharynx and tonsils: cervical osteophyte dysphagia · ApplicationAn elderly man has slowly progressive dysphagia for solids and a sensation of a lump. A lateral cervical spine radiograph shows large flowing bony outgrowths along the…
- Pharynx and tonsils: Kawasaki disease versus streptococcal pharyngitis · Multi-stepA 3-year-old has had fever for six days despite amoxicillin. He has red cracked lips, bilateral non-purulent conjunctival injection, pharyngeal erythema and a single 2…
- Pharynx and tonsils: growth failure with adenotonsillar hypertrophy · ApplicationA 4-year-old with loud snoring, witnessed apnoeas and large kissing tonsils has fallen from the 50th to the 10th weight centile. What outcome is most likely after adeno…
- Pharynx and tonsils: obesity hypoventilation · Multi-stepA man with BMI 42 and severe obstructive sleep apnoea has morning headaches. Which finding best suggests obesity hypoventilation syndrome in addition?
- Pharynx and tonsils: central sleep apnoea · ApplicationOvernight polysomnography records repeated pauses in airflow of more than 10 seconds during which chest and abdominal belts show no respiratory effort. What type of eve…
- Pharynx and tonsils: pharyngeal flap for velopharyngeal insufficiency · ApplicationA 6-year-old who had cleft palate repair has persistent hypernasal speech with nasal air escape and a gap on speech nasendoscopy. Speech therapy has failed. Which surge…
- Pharynx and tonsils: dysphagia from medullary lesion · Multi-stepA man with sudden vertigo, hoarseness, difficulty swallowing and loss of pain and temperature sensation on the right face and left body is found to have a medullary inf…
- Pharynx and tonsils: pyriform fossa foreign body · ApplicationA man who swallowed a sharp fragment of bone has pain on swallowing localised to the throat, pooling of saliva, and on indirect laryngoscopy saliva pooled in the right…
Larynx42
- Larynx · ApplicationIn singers, vocal nodules typically occur at:
- Larynx: external branch of superior laryngeal nerve · ApplicationAfter thyroidectomy with ligation of the superior thyroid pedicle, a professional singer cannot reach high notes and the voice tires easily. Which nerve is injured?
- Larynx: internal laryngeal nerve · ApplicationA patient after neck surgery aspirates liquids because sensation of the supraglottic larynx is lost. Which nerve is affected?
- Larynx: Semon's law · Multi-stepIn a slowly progressive lesion of the recurrent laryngeal nerve, which fibres are affected first according to Semon's law?
- Larynx: cord position · ApplicationA complete lesion of the vagus nerve at the jugular foramen places the ipsilateral vocal cord in which position?
- Larynx: unilateral vocal fold palsy · ApplicationA man develops a breathy voice and aspiration of thin liquids immediately after a lobectomy and a left vocal cord is in the paramedian position with a gap on phonation.…
- Larynx: vocal polyp · ApplicationA 45-year-old smoker has a unilateral pedunculated smooth swelling on the anterior vocal cord and hoarseness. Which is the best treatment?
- Larynx: Reinke's oedema · ApplicationA 50-year-old woman who smokes heavily has a low-pitched voice, and laryngoscopy shows bilateral sac-like translucent swellings of the whole membranous vocal cords. Wha…
- Larynx: recurrent respiratory papillomatosis · ApplicationA 3-year-old has progressive hoarseness and stridor, and laryngoscopy shows multiple warty growths on the cords. Which viral types are responsible?
- Larynx: contact granuloma · ApplicationA man with chronic reflux and throat clearing has a granulomatous mass at the vocal process of the arytenoid. What is the most appropriate first treatment?
- Larynx: laryngocele · Multi-stepA glassblower has a neck swelling that enlarges when he blows against a closed mouth and is resonant to percussion. What is the diagnosis?
- Larynx: staging · ApplicationA glottic carcinoma limited to the larynx with fixation of the vocal cord is staged as which T category?
- Larynx: supraglottic carcinoma · ApplicationWhich statement about supraglottic carcinoma is correct?
- Larynx: early glottic cancer treatment · ApplicationA 58-year-old has a T1a glottic carcinoma confined to the mid-portion of one cord with normal mobility. Which treatment gives voice preservation with high cure rates?
- Larynx: voice after laryngectomy · ApplicationA patient after total laryngectomy wants to speak. Which method gives the best quality voice through a surgically created tracheo-oesophageal fistula?
- Larynx: laryngectomy complication · ApplicationWhat is the commonest early complication after total laryngectomy?
- Larynx: laryngeal trauma · ApplicationAfter a handlebar injury to the neck, a rider has hoarseness, neck swelling and surgical emphysema but is breathing comfortably. What is the priority?
- Larynx: leukoplakia · ApplicationA smoker has persistent hoarseness and a white plaque on the vocal cord seen on laryngoscopy. What is the next step?
- Larynx: spasmodic dysphonia · Multi-stepA woman has a strained, strangled voice with breaks during speech, while whispering and laughing are normal. Which treatment is most effective?
- Larynx: functional aphonia · ApplicationA young woman suddenly loses her voice after an emotional trauma but coughs normally. Laryngoscopy shows normal cords that fail to adduct on phonation but adduct on cou…
- Larynx: cardiovocal syndrome · Multi-stepA woman with severe mitral stenosis and left atrial enlargement develops hoarseness with left vocal cord paralysis. What is this called?
- Larynx: laryngopharyngeal reflux · ApplicationA patient has chronic throat clearing, globus and hoarseness without heartburn. Laryngoscopy shows posterior laryngeal erythema and interarytenoid pachydermia. What is…
- Larynx: rheumatoid involvement · Multi-stepA patient with long-standing rheumatoid arthritis has hoarseness, a sensation of fullness in the throat and reduced vocal cord mobility with normal nerve function. What…
- Larynx: stroboscopy · ApplicationWhich investigation best assesses the mucosal wave and vibratory pattern of the vocal folds in a patient with persistent dysphonia?
- Larynx: Kaposi sarcoma · ApplicationA 34-year-old man with advanced HIV infection has hoarseness and a violaceous, non-ulcerated supraglottic lesion on laryngoscopy, with similar purple plaques on the pal…
- Larynx: relapsing polychondritis · Multi-stepA 45-year-old has recurrent painful red swelling of both pinnae sparing the lobules, saddle nose deformity, scleritis and a progressively hoarse voice with inspiratory…
- Larynx: laryngeal chondrosarcoma site · Multi-stepA slowly enlarging submucosal mass is seen below the glottis on the posterior wall of the larynx with calcification on CT. Which tumour most commonly arises at this site?
- Larynx: Broyles ligament · Multi-stepA glottic carcinoma involves the anterior commissure and is found to have spread directly into the thyroid cartilage. Which structure provides this route of spread?
- Larynx: presbyphonia · ApplicationA 75-year-old retired teacher has a weak, breathy, tiring voice. Stroboscopy shows bilateral bowing of the vocal folds with a glottic gap and prominent vocal processes.…
- Larynx: infant bilateral cord palsy and Chiari malformation · Multi-stepA newborn with a lumbar myelomeningocele has progressive inspiratory stridor, a weak cry and feeding difficulty. Laryngoscopy shows bilateral vocal fold immobility. Wha…
- Larynx: stridor · ApplicationInspiratory stridor localizes most often to what level?
- Larynx · ApplicationPersistent hoarseness in smoker requires what?
- Larynx · ApplicationWhich nerve injury causes breathy voice after thyroid surgery?
- Larynx · ApplicationWhich symptom is a red flag requiring laryngeal assessment in a smoker?
- Larynx · ApplicationWhat is the immediate priority in suspected acute epiglottitis with stridor and drooling?
- Larynx · ApplicationWhich nerve injury causes inability to abduct a vocal cord after thyroid surgery?
- Larynx · ApplicationWhat is the usual cause of inspiratory stridor in a thriving young infant?
- Larynx · ApplicationWhich symptom suggests recurrent laryngeal nerve palsy?
- Larynx · ApplicationWhat is the main purpose of flexible nasendoscopy?
- Larynx: recurrent laryngeal nerve · ApplicationUnilateral recurrent laryngeal palsy most commonly causes what?
- Larynx · ApplicationWhich laryngeal lesion is associated with chronic smoking and requires biopsy?
- Larynx · ApplicationWhat is the usual cause of a barking cough and inspiratory stridor in a toddler?
Head and neck28
- Head and neck: branchial cyst · ApplicationA 22-year-old has a painless, smooth, fluctuant swelling at the anterior border of the sternocleidomastoid at the junction of its upper and middle thirds. Aspiration yi…
- Head and neck: maxillary carcinoma staging · ApplicationOhngren's line used for classification of maxillary sinus carcinoma joins which two points?
- Head and neck: olfactory neuroblastoma · Multi-stepA tumour arising from the olfactory neuroepithelium in the upper nasal cavity, with Homer Wright rosettes on histology, is called what?
- Head and neck: neck dissection · ApplicationWhich structures are preserved in a type III modified radical neck dissection?
- Head and neck: unknown primary · ApplicationFNAC of a level II neck node shows metastatic squamous carcinoma, but no primary is found on examination and CT. Which approach is most appropriate?
- Head and neck: nasopharyngeal primary · ApplicationA young adult from northeast India has an enlarged posterior triangle node with metastatic undifferentiated carcinoma. Which primary site should be examined first?
- Head and neck: osteoradionecrosis · ApplicationTo reduce the risk of osteoradionecrosis of the mandible, what is done before radiotherapy for oral cancer?
- Head and neck: risk factors · ApplicationWhich statement about alcohol and tobacco in head and neck cancer is correct?
- Head and neck: premalignant lesions · ApplicationWhich statement about oral leukoplakia and erythroplakia is correct?
- Head and neck: p16 status · ApplicationIn oropharyngeal squamous cell carcinoma, positive p16 immunostaining is used as a surrogate marker of what, and what is its significance?
- Head and neck: nodal staging · ApplicationA patient with oral cancer has a single ipsilateral lymph node of 2.5 cm without extranodal extension. What is the N category?
- Head and neck: extranodal extension · Multi-stepAfter surgery for oral cavity carcinoma, histology shows extranodal extension in the neck nodes and a close margin. What is the usual adjuvant treatment?
- Head and neck: lymphatic drainage · ApplicationCarcinoma of the tip of the tongue first drains to which nodes?
- Head and neck: Kikuchi disease · Multi-stepA 24-year-old Asian woman has fever and tender cervical lymph nodes for 3 weeks. Biopsy shows paracortical necrosis with abundant histiocytes and no neutrophils. What i…
- Head and neck: cat scratch disease · ApplicationA child has a tender enlarged preauricular node 2 weeks after a kitten scratch, with a small papule at the scratch site. Which organism is responsible?
- Head and neck: Delphian node · Multi-stepA surgeon finds an enlarged prelaryngeal lymph node during surgery for a laryngeal tumour. What is this node called and what does it indicate?
- Head and neck · ApplicationWhich salivary gland is traversed by the facial nerve?
- Head and neck · ApplicationWhat is the most common benign salivary gland tumor?
- Head and neck · ApplicationA painless neck mass in an adult should raise concern for what?
- Head and neck · ApplicationWhat investigation commonly assesses a thyroid nodule initially?
- Head and neck · ApplicationWhat clinical finding raises concern in a persistent cervical lymph node?
- Head and neck · ApplicationWhat is a common symptom of a parotid gland infection?
- Head and neck · ApplicationWhat clinical sign can raise concern for head and neck cancer?
- Head and neck · ApplicationWhich imaging method can characterize deep neck soft-tissue infection?
- Head and neck · ApplicationWhich salivary gland is traversed by facial nerve branches?
- Head and neck · ApplicationWhat is the most common benign salivary-gland tumor?
- Head and neck · ApplicationWhat should a painless persistent adult neck mass raise concern for?
- Head and neck · ApplicationWhich neck lump feature is particularly concerning for head-and-neck malignancy?
Pharynx27
- Pharynx: tonsillectomy bleeding · ApplicationWhich vessel is the commonest source of haemorrhage during tonsillectomy?
- Pharynx: infectious mononucleosis · ApplicationA teenager has fever, exudative tonsillitis, posterior cervical lymphadenopathy and splenomegaly. After amoxicillin, a generalised maculopapular rash develops. What is…
- Pharynx: diphtheria · ApplicationAn unimmunised child has a grey adherent membrane on the tonsils that bleeds on removal, with a bull neck. What is the next step?
- Pharynx: Vincent's angina · ApplicationA young adult with poor oral hygiene has a unilateral painful grey sloughing ulcer of the tonsil and foul breath. Smear shows fusiform bacilli and spirochaetes. What is…
- Pharynx: post-tonsillectomy bleeding · ApplicationA child has bleeding from the tonsillar fossa seven days after tonsillectomy. What is the most likely cause?
- Pharynx: unilateral tonsil enlargement · ApplicationA 55-year-old has painless enlargement of one tonsil for two months, with no fever. What is the most important next step?
- Pharynx: blood supply of the tonsil · ApplicationThe tonsillar blood supply is mainly derived from which artery?
- Pharynx: drug-induced sleep endoscopy · Multi-stepA 45-year-old man with moderate obstructive sleep apnoea cannot tolerate CPAP and is considered for surgery. What is the purpose of drug-induced sleep endoscopy?
- Pharynx: FEES bedside advantage · ApplicationA bedridden patient in intensive care cannot be moved to the radiology suite. Which swallow assessment can be done at the bedside using a flexible endoscope passed thro…
- Pharynx: manometry for achalasia · ApplicationA 40-year-old has progressive dysphagia to solids and liquids with regurgitation. Barium shows a dilated oesophagus with a beaked lower end. Which investigation confirm…
- Pharynx: infectious mononucleosis advice · ApplicationA 17-year-old rugby player with exudative tonsillitis, posterior cervical lymphadenopathy and a positive heterophile antibody test is diagnosed with infectious mononucl…
- Pharynx: hypoglossal nerve stimulation · Multi-stepA patient with obstructive sleep apnoea, a BMI of 28 and CPAP intolerance undergoes sleep endoscopy. Which finding contraindicates a hypoglossal nerve stimulator?
- Pharynx: coin radiograph orientation · Multi-stepA frontal chest radiograph of a toddler who swallowed a coin shows a round disc seen face-on at the level of the clavicles. In which structure is it most likely located?
- Pharynx: skull base spread of nasopharyngeal carcinoma · Multi-stepA man with nasopharyngeal carcinoma develops diplopia and facial numbness. MRI shows tumour in the cavernous sinus. Which natural skull base route is most commonly used…
- Pharynx: quinsy · ApplicationTrismus and uvular deviation in sore throat suggest what?
- Pharynx · ApplicationWhat is a common clinical feature of acute tonsillitis?
- Pharynx · ApplicationWhat is a potential complication of untreated peritonsillar infection?
- Pharynx · ApplicationWhat is a common sign of a peritonsillar abscess?
- Pharynx · ApplicationWhat is the primary concern with a retropharyngeal abscess?
- Pharynx · ApplicationWhat symptom of chronic tonsillar disease may justify specialist review?
- Pharynx · ApplicationWhat is the main concern in suspected epiglottitis?
- Pharynx · ApplicationWhat finding is typical of peritonsillar abscess?
- Pharynx · ApplicationWhich examination feature supports peritonsillar abscess?
- Pharynx · ApplicationWhat is the usual cause of infectious mononucleosis?
- Pharynx · ApplicationWhich finding is typical of retropharyngeal abscess in a child?
- Pharynx · ApplicationWhat distinguishes a parapharyngeal-space infection from simple pharyngitis?
- Pharynx · ApplicationWhich symptom makes dysphagia an urgent head-and-neck cancer red flag?
Airway26
- Airway · ApplicationA standard open tracheostomy is made at which level?
- Airway: bacterial tracheitis · Multi-stepA child with croup-like illness fails to improve and develops high fever, toxic appearance and thick purulent tracheal secretions. Which organism is the commonest cause?
- Airway: subglottic stenosis · ApplicationA premature infant who was ventilated for four weeks develops biphasic stridor after extubation. What is the commonest cause of acquired subglottic stenosis in children?
- Airway: tracheostomy anatomy · ApplicationDuring a tracheostomy, which structure lies over the second to fourth tracheal rings and must be divided or retracted?
- Airway: tracheo-innominate fistula · Multi-stepTen days after tracheostomy a patient has a small bright red bleed from the tube followed hours later by torrential bleeding. What is the likely cause and first action?
- Airway: cuff pressure · Multi-stepCuff pressure in a tracheostomy or endotracheal tube should be kept below roughly what level to avoid tracheal mucosal ischaemia?
- Airway: cricothyrotomy in children · Multi-stepWhy is surgical cricothyrotomy avoided in young children?
- Airway: bronchial foreign body · ApplicationA child with a peanut in the right bronchus has hyperinflation of the right lung and the mediastinum shifts toward the left on expiration. What is the mechanism?
- Airway: stridor localisation · ApplicationWhich statement about stridor is correct?
- Airway: subglottic haemangioma · Multi-stepA 3-month-old with a cutaneous haemangioma in the beard distribution develops progressive biphasic stridor. What is the first-line treatment?
- Airway: smoke inhalation · ApplicationA man rescued from a house fire has singed nasal hairs, carbonaceous sputum and a hoarse voice. What is the immediate priority?
- Airway: Cormack-Lehane grading · ApplicationOn direct laryngoscopy, only the epiglottis is seen with no glottic structures visible. What is the Cormack-Lehane grade?
- Airway: early tracheostomy tube displacement · Multi-stepOn the second day after a surgical tracheostomy a patient pulls out the tube and becomes distressed and hypoxic. What is the safest immediate action?
- Airway: surgical emphysema after tracheostomy · ApplicationA patient in intensive care develops crepitus over the neck and chest wall a few hours after a tracheostomy. What is a recognised cause?
- Airway: inhaled foreign body imaging · Multi-stepA 2-year-old has sudden cough and wheeze after eating nuts, with reduced air entry on the right. An inspiratory chest film is normal. What additional imaging finding is…
- Airway: heliox in upper airway obstruction · ApplicationA patient with severe upper airway obstruction from a tracheal tumour is waiting for definitive treatment. How can a helium and oxygen mixture help temporarily?
- Airway: tracheal tumour types · Multi-stepWhich statement about primary tracheal tumours in adults is correct?
- Airway: epiglottitis · ApplicationDrooling, tripod posture, and toxic appearance require what?
- Airway: croup · ApplicationWhat is a typical croup sound?
- Airway · ApplicationBarking cough and stridor in toddler suggest what?
- Airway · ApplicationDrooling and tripod posture indicate what urgency?
- Airway · ApplicationWhat is the priority in a patient with suspected upper-airway obstruction?
- Airway · ApplicationWhat is the priority in suspected upper-airway obstruction?
- Airway · ApplicationWhich history supports inhaled foreign body despite a normal chest radiograph?
- Airway · ApplicationWhat symptom after thyroid surgery suggests bilateral recurrent laryngeal nerve injury?
- Airway · ApplicationWhat is the first priority in a patient with rapidly expanding neck haematoma after surgery?
Audiology23
- Audiology · ApplicationIn a tuning fork test, Rinne is negative (bone conduction louder than air conduction) in the left ear. What does this indicate?
- Audiology: tympanometry · ApplicationA tympanogram shows a flat curve (type B) with a normal ear canal volume in a child. What is the most likely condition?
- Audiology: Weber in sensorineural loss · ApplicationA man has reduced hearing in his left ear. The Rinne test is positive in both ears and the Weber test is heard louder in the right ear. What is the most likely diagnosis?
- Audiology: false negative Rinne · Multi-stepA patient has a negative Rinne on the left, but pure tone audiometry shows a dead left ear with a normal right ear. What explains the false negative Rinne?
- Audiology: noise-induced hearing loss · ApplicationA textile mill worker with 15 years of exposure to loud machinery has an audiogram with a sharp dip at 4000 Hz in both ears and recovery at 8000 Hz. What is the diagnos…
- Audiology: tympanometry patterns · ApplicationA young man has a conductive hearing loss after head injury, an intact and normal-looking drum, and a tympanogram with very high peak compliance. What is the likely cau…
- Audiology: stapedial reflex · Multi-stepA patient with a lower motor neurone facial palsy has an absent ipsilateral stapedial reflex on impedance audiometry. What does this indicate?
- Audiology: tone decay · Multi-stepA 45-year-old has progressive unilateral sensorineural loss. The tone decay test shows marked adaptation, with the patient losing a sustained tone within seconds. Which…
- Audiology: BERA waves · ApplicationIn brainstem evoked response audiometry, wave I is generated by which structure?
- Audiology: infant screening follow-up · ApplicationA newborn fails two otoacoustic emission screens. Which is the next investigation?
- Audiology: mechanism of noise damage · ApplicationIn chronic noise exposure, which structure is damaged earliest?
- Audiology: paediatric tests · ApplicationWhich behavioural test is most suitable to assess hearing thresholds in a cooperative 3-year-old?
- Audiology: asymmetrical hearing loss · ApplicationA 50-year-old has progressive unilateral sensorineural hearing loss with tinnitus. What is the best investigation?
- Audiology: speech discrimination · ApplicationIn pure conductive hearing loss, which result is expected on speech audiometry when the speech is made loud enough?
- Audiology: auditory neuropathy · Multi-stepA child has poor speech understanding but otoacoustic emissions are present and the ABR is absent or abnormal. What is this condition?
- Audiology · ApplicationWhat instrument measures hearing thresholds across frequencies?
- Audiology · ApplicationWhat is a pure-tone audiogram used to determine?
- Audiology · ApplicationWhat result suggests sensorineural hearing loss on Rinne testing?
- Audiology · ApplicationWhat type of hearing loss can follow chronic loud-noise exposure?
- Audiology · ApplicationWhat does a Weber test lateralizing to the better ear suggest?
- Audiology · ApplicationWhat graph displays a person's hearing threshold at different sound frequencies?
- Audiology · ApplicationWhat pattern is typical of presbycusis?
- Audiology · ApplicationWhich structure receives stapes footplate vibration?
Rhinology22
- Rhinology · ApplicationA 22-year-old has recurrent sneezing, watery rhinorrhoea, nasal itching and pale boggy turbinates for six months, with no relief from antihistamines alone. Which drug c…
- Rhinology · ApplicationWhich paranasal sinus most commonly drains into the middle meatus?
- Rhinology · ApplicationWhat is a common symptom of allergic rhinitis?
- Rhinology · ApplicationWhat is the immediate first-aid measure for most anterior epistaxis?
- Rhinology · ApplicationWhich vessel network is a common site of anterior nosebleed?
- Rhinology · ApplicationA deviated nasal septum can most directly cause what?
- Rhinology · ApplicationWhat is a typical symptom of acute rhinosinusitis?
- Rhinology · ApplicationWhat organism type commonly causes uncomplicated acute rhinosinusitis?
- Rhinology · ApplicationWhat is a red-flag feature in unilateral persistent nasal obstruction?
- Rhinology · ApplicationWhat is an appropriate first step for minor anterior epistaxis?
- Rhinology · ApplicationWhat is a common contributor to recurrent nosebleeds?
- Rhinology · ApplicationWhat symptom commonly accompanies nasal polyps?
- Rhinology · ApplicationWhat is an appropriate measure for allergic rhinitis symptom control?
- Rhinology · ApplicationWhat condition may cause unilateral foul-smelling nasal discharge in a child?
- Rhinology · ApplicationWhich sinus drains into the middle meatus?
- Rhinology · ApplicationWhat first-aid step is appropriate for most anterior epistaxis?
- Rhinology · ApplicationWhat vascular network is a common source of anterior nosebleed?
- Rhinology · ApplicationWhat symptom is typical of allergic rhinitis?
- Rhinology · ApplicationWhere does most anterior epistaxis arise?
- Rhinology · ApplicationWhat is the first bedside measure for most uncomplicated anterior nosebleeds?
- Rhinology · ApplicationWhich duration and pattern best supports acute bacterial rhinosinusitis rather than a simple viral cold?
- Rhinology · ApplicationWhat symptom pattern is most characteristic of allergic rhinitis?
Salivary glands20
- Salivary glands: Frey's syndrome · ApplicationA man sweats and flushes over the cheek while eating, months after a superficial parotidectomy. Which nerve is involved in the aberrant regeneration?
- Salivary glands: malignant tumours · ApplicationWhat is the commonest malignant tumour of the parotid gland?
- Salivary glands: adenoid cystic carcinoma · ApplicationA tumour of the submandibular gland with facial pain, a slow course and late lung metastases shows a Swiss-cheese pattern. What is its characteristic behaviour?
- Salivary glands: Sjogren syndrome · ApplicationA middle-aged woman has dry eyes, dry mouth and bilateral parotid enlargement. Which autoantibodies are characteristic?
- Salivary glands: sialography · ApplicationIn which situation is sialography contraindicated?
- Salivary glands: submandibular excision · ApplicationDuring excision of the submandibular gland, which nerve is at risk at the lower border of the mandible?
- Salivary glands: acute suppurative parotitis · ApplicationA dehydrated 80-year-old man after abdominal surgery has a painful tender swelling of the parotid with pus at Stensen's duct opening. What is the commonest organism and…
- Salivary glands: IgG4-related sialadenitis · Multi-stepA 60-year-old man has bilateral firm, painless submandibular gland enlargement with raised serum IgG4 and a lymphoplasmacytic infiltrate with storiform fibrosis on biop…
- Salivary glands: sialendoscopy · ApplicationA 35-year-old has recurrent meal-related swelling of the parotid gland, and ultrasound shows a 3 mm stone in the duct with dilatation. Which minimally invasive techniqu…
- Salivary glands: facial nerve plane in the parotid · ApplicationDuring superficial parotidectomy, the surgeon identifies the retromandibular vein lying in the parotid substance. What is the relation of this vein to the facial nerve?
- Salivary glands: carcinoma ex pleomorphic adenoma · Multi-stepA 65-year-old woman who has had a slow-growing parotid lump for 30 years notices rapid enlargement, pain and facial weakness. What is the likely explanation?
- Salivary glands: first bite syndrome · Multi-stepAfter parapharyngeal space surgery, a patient has severe cramping pain in the parotid region with the first bite of each meal that eases with continued chewing. What is…
- Salivary glands: why submandibular stones predominate · ApplicationSalivary calculi occur most often in the submandibular gland. Which feature of this gland explains this?
- Salivary glands: Heerfordt syndrome · Multi-stepA 30-year-old has bilateral parotid swelling, fever, anterior uveitis and facial nerve palsy. Chest film shows bilateral hilar lymphadenopathy. What is the diagnosis?
- Salivary glands · ApplicationWhat symptom can occur with a submandibular duct stone?
- Salivary glands · ApplicationWhich presentation is most typical of a submandibular duct stone?
- Salivary glands · ApplicationWhich cranial nerve injury may occur during parotid surgery?
- Salivary glands · ApplicationWhich feature makes a parotid mass concerning for malignancy?
- Salivary glands · ApplicationWhat does purulent discharge from Stensen duct suggest?
- Salivary glands · ApplicationWhich imaging is often first line for suspected salivary stone?
Neck18
- Neck: Ludwig's angina · ApplicationA man with a decayed lower molar has a rapidly spreading brawny swelling of the floor of the mouth and submandibular region, with a raised tongue and difficulty breathi…
- Neck: Lemierre syndrome · Multi-stepAfter a throat infection, a young adult has high fever, neck pain along the sternocleidomastoid and multiple septic pulmonary emboli. Which organism is typically involv…
- Neck: thyroglossal cyst · ApplicationA 7-year-old has a painless midline neck swelling below the hyoid that moves upward on protruding the tongue. What is the definitive operation?
- Neck: cystic hygroma · ApplicationA newborn has a soft, brilliantly transilluminant, multilocular swelling in the posterior triangle of the neck. What is the treatment?
- Neck: carotid body tumour · ApplicationA 40-year-old has a painless pulsatile mass at the carotid bifurcation that can be moved side to side but not up and down. Angiography is expected to show what?
- Neck: hereditary paraganglioma · Multi-stepFamilial carotid body and glomus tumours are most commonly associated with mutations in which gene family?
- Neck: Hodgkin lymphoma · ApplicationA 25-year-old has painless rubbery cervical lymphadenopathy, fever and night sweats. Which cell is diagnostic on histology?
- Neck: second branchial fistula · Multi-stepA second branchial cleft fistula opens at the lower third of the sternocleidomastoid. Where does its internal opening lie?
- Neck: spinal accessory nerve injury · ApplicationAfter excision of a lymph node from the posterior triangle, a patient has shoulder drooping, winging of the scapula and difficulty abducting the arm above the horizonta…
- Neck: danger space and mediastinitis · Multi-stepA diabetic patient with a retropharyngeal infection develops chest pain, fever and widened mediastinum on chest radiograph. Which fascial space connects the neck to the…
- Neck: congenital muscular torticollis · ApplicationA 3-week-old infant has a firm olive-sized swelling in the lower part of the sternocleidomastoid and the head tilts to the same side with the chin to the opposite side.…
- Neck: pharyngeal arch derivatives · ApplicationWhich structure is derived from the second pharyngeal arch?
- Neck: nodes of Rouviere · ApplicationA patient with nasopharyngeal carcinoma has a retropharyngeal lymph node on MRI. Which node is the first echelon station for the nasopharynx in this region?
- Neck: Shamblin classification · Multi-stepA carotid body tumour is found at surgery to completely encircle the internal and external carotid arteries. Which Shamblin group is this and what does it imply?
- Neck: thyroglossal cyst · ApplicationMidline neck mass moving with tongue protrusion suggests what?
- Neck: carotid body · ApplicationA pulsatile lateral neck mass at carotid bifurcation suggests what?
- Neck · ApplicationLateral cyst near SCM in young adult suggests what?
- Neck · ApplicationMidline mass moving with tongue protrusion suggests what?
Laryngology14
- Laryngology · ApplicationA 55-year-old man who has smoked for decades has a low-pitched hoarse voice. Laryngoscopy shows bilateral symmetrical, translucent, sac-like swelling of the entire leng…
- Laryngology · ApplicationA woman has stridor after total thyroidectomy. Laryngoscopy shows both vocal cords fixed near the midline with a very narrow glottic chink. What is the most appropriate…
- Laryngology · ApplicationWhich nerve supplies most intrinsic muscles of the larynx?
- Laryngology · ApplicationWhat symptom is most typical of laryngitis?
- Laryngology · ApplicationWhat is a concerning symptom that warrants evaluation for laryngeal malignancy?
- Laryngology · ApplicationWhich laryngeal structure protects the airway during swallowing?
- Laryngology · ApplicationWhat symptom may indicate vocal cord dysfunction?
- Laryngology · ApplicationWhat procedure visualizes the larynx directly?
- Laryngology · ApplicationWhat symptom is typical of vocal cord paralysis?
- Laryngology · ApplicationWhat is the function of the vocal folds?
- Laryngology · ApplicationWhich intrinsic laryngeal muscle is the only abductor of the vocal folds?
- Laryngology · ApplicationWhat symptom is most typical of acute laryngitis?
- Laryngology · ApplicationWhat symptom requires evaluation for possible laryngeal malignancy?
- Laryngology · ApplicationWhich patient with hoarseness needs urgent laryngeal evaluation for possible malignancy?
Sinuses14
- Sinuses: orbital complications · ApplicationA child with acute ethmoiditis develops eyelid swelling, proptosis, chemosis and painful limitation of eye movements. Through which structure does infection reach the o…
- Sinuses: cavernous sinus thrombosis · ApplicationA man squeezes a boil near his nostril and later develops fever, proptosis, chemosis and a fixed convergent squint. Which cranial nerve is usually affected first in cav…
- Sinuses: Pott's puffy tumour · ApplicationA teenager with frontal sinusitis has a tender, doughy swelling of the forehead. What complication is this?
- Sinuses: investigation · ApplicationWhich investigation is best to evaluate the anatomy and extent of chronic rhinosinusitis before surgery?
- Sinuses: CSF leak in FESS · Multi-stepAt which site is a CSF leak most likely during endoscopic sinus surgery?
- Sinuses: drainage pathways · ApplicationWhich sinus does not drain through the ostiomeatal complex?
- Sinuses: oroantral fistula · ApplicationA man has nasal regurgitation of fluids and a sinus on the upper alveolus after extraction of the upper first molar. What is the likely diagnosis?
- Sinuses: frontal mucocele · ApplicationA 50-year-old has a painless slowly enlarging swelling in the upper inner angle of the orbit that displaces the eye downwards and outwards. What is the diagnosis?
- Sinuses: sphenoid relations · ApplicationWhich of the following structures lies lateral to the sphenoid sinus?
- Sinuses: maxillary · ApplicationCheek pain and upper tooth ache suggest inflammation of what sinus?
- Sinuses · ApplicationForehead pain worse in morning suggests what sinus?
- Sinuses · ApplicationWhich imaging shows chronic sinus anatomy best?
- Sinuses · ApplicationWhat serious complication presents as frontal swelling during frontal sinusitis?
- Sinuses · ApplicationWhich symptom is a red flag for orbital complication of sinusitis?
Vertigo13
- Vertigo · Multi-stepA man with long-standing foul-smelling attic discharge and cholesteatoma develops vertigo and nystagmus when pressure is applied to the tragus to compress the air in th…
- Vertigo · ApplicationA 55-year-old woman has brief spells of spinning vertigo lasting under a minute when she rolls over in bed. Hearing is normal, and the Dix-Hallpike manoeuvre provokes t…
- Vertigo: horizontal canal BPPV · Multi-stepA patient has positional vertigo with horizontal geotropic nystagmus on the supine roll test. Which manoeuvre treats this variant?
- Vertigo: central signs · Multi-stepWhich finding in a patient with acute vertigo suggests a central cause such as cerebellar stroke?
- Vertigo: caloric test · ApplicationCold water irrigation of the right ear in a healthy person produces nystagmus with the quick component to which side?
- Vertigo: peripheral nystagmus · ApplicationWhich of the following is a feature of nystagmus in an acute peripheral vestibular lesion?
- Vertigo · ApplicationWhat triggers BPPV most often?
- Vertigo · ApplicationContinuous vertigo without hearing loss suggests what?
- Vertigo · ApplicationWhich feature is typical of benign paroxysmal positional vertigo?
- Vertigo · ApplicationWhich bedside manoeuvre is used to provoke posterior-canal BPPV?
- Vertigo: BPPV · ApplicationA patient has brief episodes of spinning lasting seconds when rolling in bed, without hearing loss or focal neurological deficit. What is most likely?
- Vertigo: Meniere disease · ApplicationWhich symptom cluster is most typical of Meniere disease?
- Vertigo: vestibular neuritis · ApplicationA patient develops continuous severe vertigo, nausea, and gait unsteadiness for three days after a viral illness, with no hearing loss. What is most likely?
Sleep medicine10
- Sleep medicine · ApplicationWhat symptom is characteristic of obstructive sleep apnea?
- Sleep medicine · ApplicationWhat is a common risk factor for obstructive sleep apnea?
- Sleep medicine · ApplicationWhat is a common daytime effect of obstructive sleep apnea?
- Sleep medicine · ApplicationWhat therapy may be prescribed for moderate-to-severe obstructive sleep apnea?
- Sleep medicine · ApplicationWhat symptom commonly suggests obstructive sleep apnea?
- Sleep medicine · ApplicationWhich nocturnal history is most suggestive of obstructive sleep apnea?
- Sleep medicine · ApplicationWhich symptom most strongly supports obstructive sleep apnoea?
- Sleep medicine · ApplicationWhat is a likely consequence of untreated obstructive sleep apnoea in children?
- Sleep medicine: obstructive sleep apnea · ApplicationA patient has loud snoring, witnessed apneas, unrefreshing sleep, and daytime somnolence. What condition is most likely?
- Sleep medicine · ApplicationWhat examination finding commonly contributes to paediatric obstructive sleep apnoea?
Ear9
- Ear · ApplicationWhich type of chronic suppurative otitis media is considered 'unsafe'?
- Ear: cerumen · ApplicationImpacted wax commonly causes what symptom?
- Ear: otitis externa · ApplicationPain on tragus movement suggests what?
- Ear: perforation · ApplicationWhat advice is important for a small traumatic tympanic perforation?
- Ear: Meniere · ApplicationWhat auditory symptom accompanies Meniere disease?
- Ear · ApplicationWhat symptom is common in otitis externa?
- Ear · ApplicationWhat finding supports acute otitis media?
- Ear · ApplicationWhat type of loss follows ossicular fixation?
- Ear · ApplicationWhat is a red flag in sudden hearing loss?
External ear9
- External ear · ApplicationAn elderly diabetic patient has severe night-time ear pain, persistent discharge and granulation tissue at the junction of the bony and cartilaginous canal that has not…
- External ear: otomycosis · ApplicationA farmer has itching, a feeling of fullness and wet, fluffy black and grey debris like blotting paper in the ear canal after using steroid-antibiotic drops. What is the…
- External ear: malignant otitis externa · ApplicationAn elderly diabetic has severe otalgia, granulation tissue at the floor of the canal and a facial palsy after several weeks of ear discharge. What is the best treatment?
- External ear: perichondritis · ApplicationAfter an ear piercing through the upper cartilage, a woman has a red, swollen, painful pinna that spares the lobule. Which organism is most commonly responsible?
- External ear: keratosis obturans · Multi-stepA young adult with bronchiectasis has sudden severe bilateral ear pain and conductive hearing loss. The canal is widened and filled with a keratin plug. What is the dia…
- External ear: exostoses · ApplicationA surfer in cold water has multiple bilateral broad-based smooth hard swellings in the deep canal. What is the best management when they are asymptomatic?
- External ear: preauricular sinus · ApplicationA child has a recurrent discharging pit just anterior to the crus of the helix, with repeated abscesses. What is the definitive treatment?
- External ear: diffuse otitis externa · ApplicationA swimmer has an itchy, painful ear with a narrowed oedematous canal and tragal tenderness. What is the best initial treatment?
- External ear: keloid of the earlobe · ApplicationA 22-year-old woman has a firm, enlarging earlobe keloid following ear piercing. Which approach gives the lowest recurrence?
Nasopharynx9
- Nasopharynx: adenoid hypertrophy · ApplicationA 6-year-old with mouth breathing, snoring and recurrent otitis media with effusion needs assessment of adenoid size. Which is the usual simple investigation?
- Nasopharynx: adenoidectomy contraindication · ApplicationIn which child is adenoidectomy relatively contraindicated?
- Nasopharynx: NPC presentation · ApplicationWhat is the commonest presenting feature of nasopharyngeal carcinoma?
- Nasopharynx: NPC treatment · ApplicationWhat is the primary treatment of nasopharyngeal carcinoma?
- Nasopharynx: Trotter's triad · Multi-stepWhich combination constitutes Trotter's triad of nasopharyngeal carcinoma?
- Nasopharynx: EBV markers · ApplicationWhich test is used for screening and monitoring nasopharyngeal carcinoma?
- Nasopharynx: angiofibroma imaging · Multi-stepOn CT of an adolescent boy with recurrent profuse epistaxis and a nasopharyngeal mass, the posterior wall of the maxillary sinus is bowed forward. What is this sign cal…
- Nasopharynx: Thornwaldt's cyst · Multi-stepA midline cystic swelling in the roof of the nasopharynx with intermittent postnasal discharge is found in an adult. What is the likely origin?
- Nasopharynx · ApplicationUnilateral adult middle-ear effusion warrants assessment of what?
Oral cavity9
- Oral cavity: nodal levels in tongue cancer · ApplicationIn carcinoma of the oral tongue, which cervical lymph node levels are most commonly involved?
- Oral cavity: verrucous carcinoma · Multi-stepA tobacco chewer has a slow-growing, exophytic, warty white lesion of the buccal mucosa with a broad pushing base and no nodal disease. Biopsy shows well-differentiated…
- Oral cavity: macroglossia · ApplicationA newborn has a large tongue that protrudes from the mouth, with exomphalos and hypoglycaemia. Which syndrome is likely?
- Oral cavity: radiation xerostomia · ApplicationA 58-year-old man who received radiotherapy to the neck for oropharyngeal cancer complains of persistent dry mouth. Which drug stimulates residual salivary function?
- Oral cavity: lingual thyroid · ApplicationA 14-year-old girl has a midline mass at the base of the tongue and mild dysphagia. Ultrasound of the neck shows no thyroid in the usual site. What is the next step bef…
- Oral cavity: timing of palatoplasty · ApplicationA baby is born with an isolated cleft of the hard and soft palate. At what age is palatoplasty ideally done to favour normal speech development?
- Oral cavity: retromolar trigone carcinoma · ApplicationA 50-year-old tobacco chewer has a painful ulcer behind the last lower molar with trismus. What is the site, and which structure is likely invaded to cause trismus?
- Oral cavity: median rhomboid glossitis · ApplicationA diabetic man using inhaled steroids has a smooth, red, rhomboid depapillated area in the midline of the posterior dorsum of the tongue. What is the diagnosis and cause?
- Oral cavity: oral hairy leukoplakia · ApplicationA patient with HIV has a white corrugated lesion on the lateral border of the tongue that cannot be scraped off. Which virus is responsible?
Facial nerve7
- Facial nerve: anatomy · ApplicationWhich intratemporal segment of the facial nerve is the narrowest and where is the nerve most vulnerable to compression in Bell's palsy?
- Facial nerve: Ramsay Hunt syndrome · ApplicationA man has severe ear pain, vesicles in the concha and external canal, facial palsy and sensorineural hearing loss. Which structure is primarily involved by the virus?
- Facial nerve: grading · ApplicationOn the House-Brackmann scale, what does grade VI denote?
- Facial nerve: topodiagnosis · Multi-stepA patient with facial palsy has reduced tear secretion on Schirmer's test, loss of taste on the anterior tongue and an absent stapedial reflex. Where is the lesion?
- Facial nerve · ApplicationWhich examination finding favors a lower motor neuron facial palsy over a central facial weakness?
- Facial nerve · ApplicationWhy is lubrication important in severe Bell palsy?
- Facial nerve: Bell palsy · ApplicationA patient has acute unilateral facial weakness involving inability to wrinkle the forehead or close the eye. What is the most likely diagnosis?
Head and neck oncology7
- Head and neck oncology · Multi-stepA 60-year-old smoker has hoarseness for six weeks. Laryngoscopy shows a small lesion on the mobile true vocal fold and no palpable neck nodes. Which anatomical feature…
- Head and neck oncology · Multi-stepA 55-year-old non-smoker has a painless, cystic level II neck mass. FNAC shows squamous cells with cystic change. There are no other findings on clinical examination of…
- Head and neck oncology · ApplicationWhich neck mass should be considered malignant until proven otherwise in an adult?
- Head and neck oncology · ApplicationWhich test establishes the diagnosis of a suspicious cervical lymph node most directly?
- Head and neck oncology · ApplicationWhich thyroid-nodule feature requires urgent cancer evaluation?
- Head and neck oncology · ApplicationWhat is the purpose of panendoscopy in upper aerodigestive tract cancer work-up?
- Head and neck oncology · ApplicationWhich imaging is particularly useful for mapping soft-tissue extent of tongue cancer?
Hearing rehabilitation7
- Hearing rehabilitation · ApplicationA 3-year-old child with congenital profound bilateral sensorineural hearing loss gets no benefit from well-fitted hearing aids. Cochlear implantation is planned. Which…
- Hearing rehabilitation: bone conduction device · Multi-stepA 10-year-old has bilateral congenital aural atresia with normal cochlear function. Which device gives best rehabilitation before surgery?
- Hearing rehabilitation: cochlear implant · ApplicationIn cochlear implantation, where is the electrode array placed?
- Hearing rehabilitation: CROS aid · ApplicationA patient has a profound unilateral sensorineural loss with normal hearing in the other ear. Which aid picks up sound on the deaf side and transmits it to the good ear?
- Hearing rehabilitation: real ear measurement · ApplicationWhen fitting a hearing aid, which method uses a probe microphone in the ear canal to verify the actual gain delivered near the eardrum?
- Hearing rehabilitation · ApplicationWhat is the role of cochlear implantation?
- Hearing rehabilitation · ApplicationWhich patient may benefit from bone-conduction hearing device?
Paediatric ENT7
- Paediatric ENT: hearing risk factors · ApplicationWhich of the following is a recognised risk factor for congenital or early-onset hearing loss in a neonate?
- Paediatric ENT: congenital CMV · ApplicationWhat is the commonest non-genetic cause of congenital sensorineural hearing loss?
- Paediatric ENT: Pierre Robin sequence · ApplicationA newborn has a small receding mandible, a U-shaped cleft palate and noisy breathing that worsens when supine, and improves when prone. What is the primary cause of the…
- Paediatric ENT · ApplicationWhat is the commonest reason children require adenoid assessment?
- Paediatric ENT · ApplicationWhich organism is a common cause of bacterial tonsillopharyngitis in school-age children?
- Paediatric ENT · ApplicationWhich feature suggests a foreign body in the nasal cavity of a young child?
- Paediatric ENT · ApplicationWhy is a unilateral nasal button battery particularly urgent?
Complications6
- Complications: Gradenigo syndrome · ApplicationA child with a discharging ear develops deep retro-orbital pain and diplopia with failure of lateral gaze on the same side. What is the diagnosis?
- Complications: lateral sinus thrombosis · Multi-stepA child with chronic ear disease has a swinging 'picket fence' fever and tender oedema over the posterior mastoid, due to thrombosis of the emissary vein. What is this…
- Complications: intracranial complications · ApplicationWhich is the commonest intracranial complication of suppurative otitis media?
- Complications: Bezold abscess · ApplicationA patient with mastoiditis has a tender swelling deep to the sternocleidomastoid in the upper neck. Where has the pus escaped from?
- Complications: labyrinthine fistula · ApplicationA patient with attic cholesteatoma has vertigo on pressure on the tragus, with nystagmus. Which canal is most commonly involved?
- Complications: facial palsy in CSOM · ApplicationIn chronic suppurative otitis media with cholesteatoma, the facial nerve is most commonly eroded in which segment?
Hypopharynx6
- Hypopharynx: Zenker's diverticulum · ApplicationAn elderly man regurgitates undigested food hours after meals and has halitosis and gurgling in the neck. Where does the pulsion diverticulum arise?
- Hypopharynx: Plummer-Vinson syndrome · ApplicationA middle-aged woman has dysphagia, glossitis, koilonychia and microcytic anaemia. What lesion is seen on barium swallow?
- Hypopharynx: postcricoid carcinoma · ApplicationWhich hypopharyngeal carcinoma is more common in women and is associated with iron deficiency?
- Hypopharynx: pyriform sinus carcinoma · ApplicationA man with carcinoma of the pyriform sinus complains of ear pain with a normal ear examination. Which nerve mediates this referred otalgia?
- Hypopharynx: Killian-Jamieson space · Multi-stepA patient has a pulsion diverticulum arising below the cricopharyngeus on the lateral wall of the cervical oesophagus. What is the site called?
- Hypopharynx: Laimer's triangle · Multi-stepIn the upper oesophagus, which triangular area on the posterior wall below the cricopharyngeus has only longitudinal muscle fibres and is prone to perforation by instru…
Oesophagus6
- Oesophagus: button battery · ApplicationA child swallows a button battery that is lodged in the oesophagus. What is the appropriate management?
- Oesophagus: corrosive ingestion · ApplicationWhich step is contraindicated after ingestion of a corrosive alkali?
- Oesophagus: Barrett oesophagus · ApplicationA 55-year-old man with long-standing reflux has biopsy showing columnar epithelium with goblet cells in the distal oesophagus. This condition predisposes to which cancer?
- Oesophagus: Schatzki ring · ApplicationA 50-year-old has intermittent dysphagia for solids only, particularly with meat, with no weight loss. Barium swallow shows a thin ring at the lower oesophagus at the s…
- Oesophagus: eosinophilic oesophagitis · Multi-stepA 22-year-old atopic man has recurrent food bolus impaction. Endoscopy shows concentric rings and longitudinal furrows, and biopsies show more than 15 eosinophils per h…
- Oesophagus: Boerhaave perforation · Multi-stepAfter a bout of forceful vomiting, a man has severe chest pain, subcutaneous emphysema in the neck and fever. A chest radiograph shows pneumomediastinum and a left pleu…
Syndromes5
- Syndromes: Treacher Collins · Multi-stepA child has downward-slanting palpebral fissures, malar hypoplasia, a notched lower eyelid, microtia and conductive deafness. What is the inheritance pattern of this sy…
- Syndromes: Pendred syndrome · ApplicationA teenager has congenital bilateral sensorineural deafness and a diffuse goitre. Which test is used to support the diagnosis?
- Syndromes: Usher syndrome · ApplicationA boy with congenital sensorineural deafness develops night blindness and tunnel vision in adolescence. Which condition fits best?
- Syndromes: Jervell and Lange-Nielsen · ApplicationA deaf child has recurrent syncope on exertion. Which investigation should be done urgently?
- Syndromes: Alport syndrome · Multi-stepA boy has haematuria, progressive bilateral sensorineural hearing loss and anterior lenticonus. Which gene is most commonly affected?
Throat5
- Throat · ApplicationA patient has a severe sore throat, trismus, a 'hot potato' voice and deviation of the uvula to the opposite side. What is the diagnosis?
- Throat · ApplicationHow is a peritonsillar abscess (quinsy) typically treated?
- Throat: tonsillectomy · ApplicationWhich child is the most appropriate candidate for tonsillectomy according to widely used criteria?
- Throat · ApplicationHot-potato voice and trismus suggest what?
- Throat · ApplicationPosterior pharyngeal swelling with drooling suggests what?
Airway emergencies4
- Airway emergencies · ApplicationWhat is an immediate management priority for an inhaled foreign body with severe obstruction?
- Airway emergencies · ApplicationA child develops a harsh inspiratory noise because of laryngeal narrowing; which clinical sign is this?
- Airway emergencies · ApplicationWhat does inspiratory stridor most often indicate?
- Airway emergencies · ApplicationWhat is the immediate priority for a child with suspected inhaled foreign body and severe respiratory distress?
Foreign body4
- Foreign body · ApplicationWhat unilateral chest finding suggests inhaled foreign body?
- Foreign body · ApplicationSudden unilateral wheeze during eating suggests what?
- Foreign body · ApplicationWhat is important before removing a nasal foreign body in a child?
- Foreign body · ApplicationWhat should be assessed before removing a nasal foreign body in a child?
Meniere's disease4
- Meniere's disease: audiometry · ApplicationIn early Meniere's disease the audiogram typically shows which pattern?
- Meniere's disease: medical management · ApplicationWhich combination is first-line prophylaxis for a patient with frequent attacks of Meniere's disease?
- Meniere's disease: intractable vertigo · Multi-stepA patient with Meniere's disease has disabling vertigo and a non-serviceable (dead) hearing in the affected ear despite medical therapy. Which procedure is the most sui…
- Meniere's disease: Tumarkin crisis · Multi-stepA patient with Meniere's disease suddenly falls to the ground without losing consciousness during an attack. What is this called?
Nasal trauma4
- Nasal trauma · ApplicationAn 8-year-old boy falls on his nose while playing. Two days later he has bilateral nasal obstruction, and the nasal septum shows a soft, bluish, boggy swelling on both…
- Nasal trauma · ApplicationWhy should a septal hematoma be identified promptly after nasal trauma?
- Nasal trauma · ApplicationWhat complication must be excluded after nasal trauma with a boggy septal swelling?
- Nasal trauma · ApplicationWhat is the first aid position for anterior epistaxis?
Nose and sinuses4
- Nose and sinuses · ApplicationWhich feature in epistaxis requires urgent airway-focused assessment?
- Nose and sinuses · ApplicationWhat is the most appropriate first aid for uncomplicated anterior epistaxis?
- Nose and sinuses · ApplicationWhich symptom combination suggests acute bacterial rhinosinusitis rather than simple viral rhinitis?
- Nose and sinuses · ApplicationWhich feature suggests a cerebrospinal fluid leak rather than simple rhinitis?
Otosclerosis4
- Otosclerosis: site of origin · ApplicationIn otosclerosis, where does the focus most commonly begin in the otic capsule?
- Otosclerosis: pregnancy · ApplicationWhich statement about otosclerosis is correct?
- Otosclerosis: medical therapy · Multi-stepWhich drug is used to stabilise cochlear otosclerosis with progressive sensorineural loss?
- Otosclerosis: surgery complication · ApplicationWhat is the most feared complication of stapedotomy?
Vestibular4
- Vestibular: superior canal dehiscence · Multi-stepA woman has vertigo and oscillopsia triggered by loud sounds and by Valsalva manoeuvre. Which is the most likely cause?
- Vestibular: rehabilitation · ApplicationA patient recovering from vestibular neuritis continues to have imbalance. Which treatment promotes central compensation?
- Vestibular: vestibular migraine · Multi-stepA 35-year-old woman with a history of migraine has recurrent attacks of vertigo lasting from minutes to hours, sometimes with headache and photophobia, and normal heari…
- Vestibular: central signs · ApplicationVertigo with dysarthria suggests what concern?
Facial trauma3
- Facial trauma: Le Fort II · ApplicationAfter a road accident, a patient has a pyramidal mobile midface with bilateral periorbital ecchymosis and CSF rhinorrhoea. Which fracture is this?
- Facial trauma: orbital blowout fracture · ApplicationAfter being hit by a tennis ball, a man has diplopia on upgaze, infraorbital numbness and enophthalmos. What is the likely injury?
- Facial trauma: mandibular fracture · ApplicationAfter an assault, a man cannot close his teeth properly, has numbness of the lower lip and a step deformity on the lower border of the jaw. A second fracture on the opp…
Nasal obstruction3
- Nasal obstruction: allergic rhinitis · ApplicationA patient has recurrent sneezing, itchy eyes, clear rhinorrhea, and pale boggy nasal turbinates during pollen season. What is the diagnosis?
- Nasal obstruction: epistaxis · ApplicationMost anterior nosebleeds arise from which vascular area?
- Nasal obstruction: septal hematoma · Multi-stepAfter nasal trauma, a child has bilateral boggy septal swelling and worsening obstruction. What is the urgent concern?
Salivary3
Vestibular schwannoma3
- Vestibular schwannoma: origin · ApplicationVestibular schwannomas arise at which site?
- Vestibular schwannoma: cranial nerve sign · Multi-stepIn a growing cerebellopontine angle schwannoma, which cranial nerve is usually affected first after the eighth nerve?
- Vestibular schwannoma: management · ApplicationA 78-year-old has a 8 mm intracanalicular vestibular schwannoma discovered incidentally with mild hearing loss. What is the preferred approach?
Voice3
Deep neck infection2
Deep neck infections2
- Deep neck infections · ApplicationA diabetic man with an infected lower molar has woody bilateral swelling of the submandibular region, a raised tongue, trismus and drooling. What is the most important…
- Deep neck infections · ApplicationA 3-year-old has fever, refusal to eat, neck stiffness and drooling. A lateral soft-tissue neck radiograph shows widening of the prevertebral space. After starting intr…
Dysphagia2
Foreign bodies2
- Foreign bodies · ApplicationA 4-year-old has unilateral foul nasal discharge. Anterior rhinoscopy shows a smooth, shiny, round metallic disc in the nostril with surrounding mucosal necrosis. What…
- Foreign bodies · ApplicationWhat should be avoided when a button battery is suspected in the ear or nose?
Fungal sinusitis2
- Fungal sinusitis · ApplicationA man with diabetic ketoacidosis develops facial pain, a black necrotic eschar on the palate and nasal turbinates, and rapid orbital involvement. Which is the most impo…
- Fungal sinusitis · Multi-stepA young asthmatic from a hot, humid region has chronic bilateral nasal polyps. CT of the sinuses shows expansion of the sinuses with hyperdense central opacities, and a…
Hearing2
Hearing assessment2
Laryngeal disease2
- Laryngeal disease: croup · ApplicationA toddler has a barking cough, hoarse voice, and inspiratory stridor that is worse overnight. What is the likely diagnosis?
- Laryngeal disease: vocal cord palsy · ApplicationA patient develops persistent hoarseness after thyroid surgery. Which nerve injury is most likely?
Neck lumps2
Neck trauma2
Ototoxicity2
- Ototoxicity · ApplicationA patient with tuberculosis on a streptomycin-containing regimen develops unsteadiness in the dark, oscillopsia on walking and a positive Romberg test, with only mild h…
- Ototoxicity: loop diuretics · ApplicationWhich ototoxic drug typically produces hearing loss that is often reversible after stopping the drug?
Pediatric ENT2
- Pediatric ENT: foreign body · ApplicationA child has unilateral foul-smelling nasal discharge with no systemic illness. What should be suspected?
- Pediatric ENT: stridor · ApplicationAn infant has chronic inspiratory stridor that worsens when feeding or lying supine but is otherwise thriving. What is the most likely cause?
Sleep2
Thyroid2
- Thyroid: medullary carcinoma · ApplicationWhich tumour marker is characteristic of medullary carcinoma of the thyroid, and which familial syndrome is associated?
- Thyroid: anaplastic carcinoma · ApplicationA 75-year-old has a rapidly enlarging hard neck mass with hoarseness and stridor. Biopsy shows undifferentiated spindle and giant cells. What is the prognosis?
Thyroid and parathyroid2
- Thyroid and parathyroid: localisation of parathyroid adenoma · ApplicationA 50-year-old woman with primary hyperparathyroidism and a high calcium level needs preoperative localisation of the adenoma. Which isotope scan is commonly used?
- Thyroid and parathyroid: Bethesda reporting · ApplicationA thyroid nodule fine-needle aspiration is reported as Bethesda category V. What is the approximate risk of malignancy and the usual management?
Tonsillitis and peritonsillar infection2
- Tonsillitis and peritonsillar infection · Multi-stepA patient with fever, trismus and a unilateral swelling above the tonsil speaks in a thick 'hot potato' voice. What is the main reason for this change in voice?
- Tonsillitis and peritonsillar infection · ApplicationA patient with fever, trismus and unilateral bulging of the soft palate above the tonsil has a swollen, oedematous uvula. In which direction is the uvula displaced?
Voice care2
Airway foreign body1
Chronic rhinosinusitis1
Complications of otitis media1
Eustachian tube and nasopharynx1
Facial nerve disorders1
Facial pain1
Genetic hearing loss1
Head and neck cancer1
Nasal care1
Pharyngeal infections1
Salivary gland tumours1
Sensorineural hearing loss1
Sleep-disordered breathing1
Swallowing disorders1
Thyroid surgery complications1
Common questions
How many ENT questions are there?
1003 original questions across 793 topics, and the bank grows over time.
Which ENT topics are covered?
Audiology, Ear, Larynx, Vestibular disorders, Throat, Otology, Airway, Facial nerve disorders, Nasal polyps, Laryngology, Head and neck oncology, Deep neck infections, and more.
How difficult are these ENT questions?
0 are recall, 741 are application and 262 are multi-step. The tags are our own editorial judgement, not an official difficulty rating.
Are these ENT questions from past papers?
No. They are original practice items. NBEMS does not publish its paper or an official key, and we do not use recalled or leaked questions.
Can I practise ENT for free?
Yes. The free plan includes 20 practice questions a day across all subjects, and the free 20-question assessment covers every subject. A paid term removes the daily limit.
Is there a timed ENT test?
Yes. The ENT subject test is included with a paid term, with a countdown and a question palette.
How should I use these ENT questions?
Answer before you look, read the reason for every option, and write a three-line note for each mistake. A few questions you fully review are worth more than many you skim.
Have these ENT questions been reviewed by faculty?
Not yet. They are original and drafted with AI assistance, then edited by our team. Independent faculty review is planned, and each item shows its status. Confirm important facts in a standard textbook.