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Ear, Nose and Throat, Speech and Hearing Flashcards

1
Q

Which of the following drugs is associated with ototoxicity?
A. Aminoglycosides
B. Beta-adrenoceptor blockers
C. Opiates
D. Cephalosporins
E. Amiodarone

A

Answer: A. Aminoglycosides
Justification: Ototoxicity is a disabling adverse effect of several widely used drug classes, including aminoglycoside antibiotics, diuretics, anti-inflammatory and antineoplastic agents.

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2
Q

70-year-old woman with left-sided facial weakness following severe ear pain, tinnitus, vertigo, and loss of taste. Otoscopy shows canal swelling and blistering.
What is the SINGLE MOST likely condition?
A. Bell’s palsy
B. Cholesteatoma
C. Lyme disease
D. Necrotising otitis externa
E. Ramsay Hunt syndrome

A

Answer: E. Ramsay Hunt syndrome
Justification: Defined as acute peripheral facial neuropathy with erythematous vesicular rash in ear canal/auricle. Less than 50% complete recovery rate compared to Bell’s palsy.

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3
Q

8-year-old boy with right-sided nosebleed for 10 minutes.
What is the SINGLE MOST appropriate immediate advice?
A. Sit him up and squeeze the proximal (bony) part of his nose
B. Lie him down and squeeze the distal (non-bony) part
C. Sit him up and squeeze the distal (non-bony) part
D. Lie him down and squeeze the proximal (bony) part
E. Insert cotton wool into right nostril

A

Answer: C. Sit him up and squeeze the distal (non-bony) part
Justification: First ensure stability, then apply pressure to the soft part of the nose for 10–15 minutes without releasing.

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4
Q

Male student with moderate allergic rhinitis, predominantly nasal obstruction.
Best treatment on repeat prescription?
A. Sodium cromoglycate nasal spray
B. Fluticasone nasal spray
C. Oral antihistamines
D. Ipratropium bromide nasal spray
E. 0.5% Ephedrine nose drops

A

Answer: B. Fluticasone nasal spray
Justification: BSACI guidelines recommend topical corticosteroids (e.g., fluticasone, mometasone) as mainstay for allergic rhinitis.

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5
Q

15-year-old girl with sore throat, tonsillar exudates, tender anterior cervical lymph nodes, fever, but no cough.
SINGLE MOST likely causative organism?
A. Group A Streptococcus
B. Group B Streptococcus
C. Group C Streptococcus
D. Non-pyogenic Streptococcus
E. Streptococcus pneumoniae

A

Answer: A. Group A Streptococcus
Justification: FeverPAIN or Centor criteria are used to assess likelihood of Group A Streptococcus in sore throat presentations.

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6
Q

Mouth ulcers scenarios:
1. 33M with HLA B51 and recurrent oral/genital ulcers and iritis
2. 58M on co-trimoxazole with high fever, painful mouth ulcers
3. 29F with recurrent, short-lasting painful mouth ulcers
Options:
- Behçet’s disease
- Stevens–Johnson syndrome
- Recurrent aphthous stomatitis

A

Answers:
1 → Behçet’s disease
2 → Stevens–Johnson syndrome
3 → Recurrent aphthous stomatitis
Justification: Behçet’s includes multisystem vasculitis; co-trimoxazole can trigger Stevens–Johnson; RAS is common, idiopathic.

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7
Q

43-year-old man’s ear shows white patches on drum after prior wax removal.
What is the SINGLE MOST appropriate management?
A. Antifungal eardrops
B. Antibacterial eardrops
C. Referral for surgery
D. No intervention
E. Nasal steroid spray

A

Answer: D. No intervention
Justification: Tympanosclerosis is benign, often post-trauma/infection, and doesn’t require treatment unless hearing loss is significant.

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8
Q

Non-surgical treatment for chronic otitis media with effusion (OME) in children with hearing loss?
A. Hearing aids
B. Probiotics
C. Antibiotics
D. Antihistamines
E. Decongestants

A

Answer: A. Hearing aids
Justification: Antibiotics, antihistamines, decongestants, steroids and other alternative treatments are not recommended. Hearing aids are advised when surgery not suitable.
Resource: NICE CG60. Otitis Media with Effusion in Under 12s (2008)

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9
Q

19-year-old with severe recurrent aphthous ulcers unresponsive to topical treatments.
What is the SINGLE MOST appropriate management option?
A. Iron supplements
B. Aciclovir
C. Cryotherapy
D. Folic acid
E. Short course of prednisolone

A

Answer: E. Short course of prednisolone
Justification: Systemic steroids are used when topical and antiseptic therapies fail. NICE and InnovAiT guidance support escalation to oral steroids.

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10
Q

55-year-old woman with unilateral tinnitus, worsening hearing. Rinne’s: AC > BC. Weber lateralises left.
SINGLE MOST likely diagnosis?
A. Otosclerosis
B. Presbycusis
C. Acoustic neuroma
D. Cholesteatoma
E. Ear wax

A

Answer: C. Acoustic neuroma
Justification: Unilateral tinnitus and progressive sensorineural hearing loss are red flags for acoustic neuroma.
Resource: RCGP Curriculum Topic Guide (ENT)

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11
Q

17-year-old with midline neck mass post-URTI, moves on swallowing and tongue protrusion.
What is the SINGLE MOST appropriate management?
A. Routine ENT referral for excision
B. Reassurance
C. Urgent ENT referral for drainage
D. Start antibiotics
E. Two-week wait referral

A

Answer: A. Routine ENT referral for excision
Justification: Classic presentation of thyroglossal cyst. Management is surgical excision to prevent recurrence/infection.

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12
Q

48-year-old man with otitis media 2 days ago, now with right-sided facial droop, cannot close eye or raise brow.
What is the SINGLE MOST likely diagnosis?
A. Facial nerve palsy
B. Meningitis
C. CVA
D. Venous sinus thrombosis
E. Brain abscess

A

Answer: A. Facial nerve palsy
Justification: LMN palsy due to inflamed facial nerve in middle ear. ENT referral for potential grommet.
Document severity using House–Brackmann scale.

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13
Q

48-year-old with 3-week hoarseness and known reflux. No neck masses.
What is the SINGLE MOST appropriate management?
A. Neck ultrasound
B. Check FBC and TFTs
C. Routine ENT referral
D. Urgent ENT referral
E. Trial benzydamine hydrochloride

A

Answer: D. Urgent ENT referral
Justification: NICE recommends urgent 2WW referral for unexplained persistent hoarseness over age 45.
Resource: Khan H et al. Laryngeal cancer. InnovAiT 2017.

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14
Q

Most evidence-based indication for tonsillectomy in children?
A. Frequent, severe sore throats
B. Tonsilloliths
C. Sleep apnoea
D. Snoring
E. Guttate psoriasis

A

Answer: A. Frequent, severe sore throats
Justification: Paradise criteria define thresholds for tonsillectomy: 7/year or 5/year x 2 years, or 3/year x 3 years.
Resource: BJGP 2019; 69(678): 33–41

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15
Q

Most effective ear drop or spray for wax removal in adults and children?
A. Cerumol
B. Docusate sodium
C. Sodium bicarbonate
D. Saline
E. No superior treatment

A

Answer: E. No superior treatment
Justification: 2018 Cochrane review showed no agent superior to others.
Resource: Cochrane Database CD012171

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16
Q

68-year-old woman with chronic hoarseness, sinister causes excluded. Suspects medication link.
Which agent is MOST likely to cause hoarseness?
A. Losartan
B. Bisoprolol
C. Alendronic acid
D. Gliclazide
E. Sertraline

A

Answer: C. Alendronic acid
Justification: Bisphosphonates and ACE inhibitors can irritate larynx and cause dysphonia.

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17
Q

4-year-old with OME and 1-month hearing loss. What is the SINGLE MOST appropriate management?
A. Amoxicillin
B. No medication
C. Beclometasone spray
D. Cetirizine
E. Ephedrine drops

A

Answer: B. No medication
Justification: Antihistamines, decongestants and steroids not effective. Short-term antibiotics show minimal benefit.
Resources: Cochrane reviews (2011, 2016)

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18
Q

36-year-old woman with bluish translucent lump inside lower lip, lip-biting habit.
What is the SINGLE MOST likely diagnosis?
A. Ranula
B. Leukoplakia
C. Squamous carcinoma
D. Mucocoele
E. Granulomatosis with polyangiitis

A

Answer: D. Mucocoele
Justification: Mucous retention cyst from salivary duct obstruction, often related to trauma or lip chewing.
Resource: DermNet NZ

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19
Q

39-year-old with right maxillary pain worse on bending. Suspected sinusitis.
Which TWO features suggest acute bacterial rhinosinusitis?
A. Nasal blockage
B. Fever > 38 °C
C. Anosmia
D. Discoloured unilateral discharge
E. Frontal pain

A

Answers: B. Fever > 38 °C, D. Discoloured unilateral discharge
Justification: 3 of 5 criteria (fever, coloured discharge, pain, elevated CRP, ‘double sickening’) needed for diagnosis.
Resources: Ann Intern Med 2001; Cochrane Review 2012

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20
Q

19-year-old man with intermittent allergic rhinitis, unresponsive to three H1-antihistamines.
Next step?
A. Intranasal antimuscarinic
B. Leukotriene receptor antagonist
C. IM corticosteroid
D. Oral H1-antihistamine
E. Intranasal corticosteroid

A

Answer: E. Intranasal corticosteroid
Justification: Recommended next-line for persistent rhinitis symptoms despite antihistamines.
Resource: BSACI 2017; Clin Exp Allergy 47(7): 856–889

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21
Q

You see a 14-year-old patient with recurrent episodes of discharge from the right ear treated with oral antibiotics. Examination reveals a deep retraction pocket with crusty keratinised debris at the superior aspect of the tympanic membrane.
What is the SINGLE MOST likely diagnosis?
A. Squamous cell carcinoma
B. Foreign body
C. Otitis externa
D. Acute suppurative otitis media
E. Cholesteatoma

A

Answer: E. Cholesteatoma
Justification: Cholesteatoma is an abnormal collection of keratinised tissue within a retraction pocket of the ear drum, typically in the superior aspect due to pars flaccida vulnerability. Requires urgent ENT referral.
Resource: Wood MF, Jaroenchasri MR. Otorrhoea – the discharging ear. InnovAiT 2024; 17(5): 230-234.

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22
Q

A 55-year-old lady presents with unilateral tinnitus in her right ear for 6 months, worse at night and accompanied by progressive right-sided hearing loss.
What is the SINGLE MOST likely diagnosis?
A. Glue ear
B. Eustachian Tube Dysfunction
C. Presbycusis
D. Ear wax
E. Acoustic neuroma

A

Answer: E. Acoustic neuroma
Justification: Unilateral tinnitus with progressive hearing loss is most suggestive of acoustic neuroma.
Resource: RCGP. Curriculum Topic Guides: ENT, Speech and Hearing. 2019.

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23
Q

A 10-year-old boy is found to have conductive deafness in the right ear.
Which statement about tuning fork tests is TRUE?
A. Weber heard in right ear; Rinne BC > AC on right
B. Weber heard in left ear; Rinne BC > AC on right
C. Weber heard in left ear; Rinne AC > BC on right
D. Weber heard in right ear; Rinne AC > BC on right

A

Answer: A.
Justification: In conductive deafness, Weber lateralises to the affected ear and Rinne is negative (BC > AC).

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24
Q

Which is the MOST evidence-based indication for tonsillectomy in children?
A. Sleep apnoea
B. Recurrent guttate psoriasis
C. Frequent episodes of tonsillitis
D. Multiple tonsilloliths
E. Snoring

A

Answer: C. Frequent episodes of tonsillitis
Justification: Paradise criteria support tonsillectomy for ≥7 episodes/year or 5/year for 2 years or 3/year for 3 years.
Resource: BJGP 2019; 69(678): 33–41.

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25
A 30-year-old man reports a neck lump for six weeks with fatigue and night sweats. Firm swelling in the left posterior triangle without erythema or punctum. What is the SINGLE MOST likely diagnosis? A. Thyroglossal cyst B. Abscess C. Infected sebaceous cyst D. Lymphoma E. Reactive lymphadenopathy
Answer: D. Lymphoma Justification: Firm, persistent lump with systemic symptoms is most consistent with lymphoma. Resource: NICE NG12. Suspected Cancer. 2015 (updated 2023).
26
A 28-year-old regular swimmer presents with right-sided otalgia and itching. Canal is inflamed with cotton-like strands and black/white dots. What is the SINGLE MOST appropriate treatment? A. Oral flucloxacillin B. Topical gentamicin 0.3% drops C. Topical clotrimazole 1% solution D. Urgent ENT referral E. Topical acetic acid 2% spray
Answer: C. Topical clotrimazole 1% solution Justification: Suggestive of fungal otitis externa (aspergillus/candida); treat with antifungal drops. Resource: Newton M, Tsirevelou P. Otorrhoea. InnovAiT 2020; 13(5): 281–288.
27
18-month-old boy with cystic swelling in the posterior triangle of the neck post-URTI. Fluctuant, transilluminates. What is the SINGLE MOST likely diagnosis? A. Cervical lymphadenopathy B. Cystic hygroma C. Chemodectoma D. Carotid artery aneurysm E. Thyroglossal cyst
Answer: B. Cystic hygroma Justification: Lymphatic malformation common in infants; soft, cystic, transilluminates. Resource: Darr A et al. Neck lumps. InnovAiT 2018; 11(6): 322–329.
28
49-year-old smoker with painful oral ulcer present for 6 weeks, indurated with irregular margins. What is the SINGLE MOST likely diagnosis? A. Aphthous ulcer B. Viral ulcer C. Traumatic ulcer D. Inflammatory ulcer E. Malignant ulcer
Answer: E. Malignant ulcer Justification: Risk factors and chronicity suggest malignancy. Refer urgently. Resource: RCGP ENT Topic Guide
29
In which TWO situations are antibiotics MOST useful for children with acute otitis media (AOM)? A. Aged <2 years with bilateral AOM B. Aged >10 years C. AOM with otorrhoea D. AOM with pharyngitis and cough E. AOM with conjunctivitis
Answer: A and C Justification: Cochrane review 2015 supports antibiotics in children <2 with bilateral AOM or AOM with otorrhoea. Resource: Venekamp et al., Cochrane Review 2015.
30
Which of the following is a cause of conductive hearing loss? A. Noise trauma B. Presbyacusis C. Cholesteatoma D. Aminoglycosides E. Meniere’s disease
Answer: C. Cholesteatoma Justification: Cholesteatoma is a middle ear mass that disrupts sound conduction. Resource: PCDS; RCGP ENT Topic Guide
31
27-year-old woman with right facial pain radiating to ear, worse on chewing, with jaw clicking. No tenderness or swelling. What is the SINGLE MOST likely diagnosis? A. Trigeminal neuralgia B. Acute sinusitis C. Temporomandibular joint disorder D. Migraine E. Giant-cell arteritis
Answer: C. Temporomandibular joint disorder Justification: Pain related to jaw use with joint clicking suggests TMJ disorder. Resource: Collins T. TMJ disorders. InnovAiT 2020; 13(8): 475–483.
32
68-year-old woman with persistent hoarseness, ENT review 3 months ago was normal. She asks if her medication may be contributing. Which SINGLE agent is MOST likely to cause hoarseness? A. Sertraline B. Losartan C. Gliclazide D. Alendronic acid E. Bisoprolol
Answer: D. Alendronic acid Justification: Bisphosphonates and ACE inhibitors are common medication causes of dysphonia. Resource: RCGP ENT Topic Guide
33
28-year-old with 7-day history of sore throat, no cough, temp 38.3 °C, exudate on tonsils, tender lymphadenopathy. What is the SINGLE MOST appropriate management? A. Delay antibiotics 24h B. Amoxicillin for 7 days C. Monitor for a week D. Phenoxymethylpenicillin for 10 days E. Doxycycline for 5 days
Answer: D. Phenoxymethylpenicillin for 10 days Justification: Scores 4 on Centor and FeverPAIN → antibiotics indicated. Resource: NICE CKS; RCGP ENT Topic Guide
34
Which ONE of the following is included in the Centor criteria? A. Presence of a cough B. Absence of tonsillar exudate C. Tender posterior cervical lymph nodes D. Tender anterior cervical lymph nodes E. Fever > 37.5 °C
Answer: D. Tender anterior cervical lymph nodes Justification: Centor criteria include: exudate, tender anterior nodes, fever, absence of cough. Resource: NICE CKS. Sore throat – acute
35
64-year-old man with tinnitus. Which drug is MOST LIKELY to cause tinnitus? A. Simvastatin B. Amlodipine C. Furosemide D. Paracetamol E. Amoxicillin
Answer: C. Furosemide Justification: Loop diuretics, aminoglycosides, NSAIDs, and aspirin are ototoxic. Resource: RCGP ENT Topic Guide
36
40-year-old with vestibular neuritis, continuous vertigo and vomiting for one day. What is the SINGLE MOST appropriate treatment to relieve vomiting rapidly? A. Oral metoclopramide B. Oral cinnarizine C. Oral prochlorperazine D. Buccal prochlorperazine E. Oral cyclizine
Answer: D. Buccal prochlorperazine Justification: NICE recommends buccal or IM prochlorperazine for rapid symptom relief. Resource: NICE CG150 (2021 update)
37
45-year-old man with sudden hearing loss and tinnitus. Weber lateralises to left. Which Rinne result suggests right-sided sensorineural loss? A. AC>BC both ears B. AC>BC right; BC>AC left C. BC>AC right; AC>BC left D. BC>AC both sides
Answer: A. Justification: Sensorineural loss → Weber lateralises to normal ear, Rinne remains positive (AC > BC).
38
72-year-old man with unilateral tinnitus and hearing loss, normal otoscopy, confirmed SNHL. What is the SINGLE MOST likely diagnosis? A. Ramsay–Hunt syndrome B. Perforated tympanic membrane C. Presbyacusis D. Acoustic neuroma E. Ear wax
Answer: D. Acoustic neuroma Justification: Unilateral SNHL with normal exam = red flag for acoustic neuroma. Resource: RCGP ENT Topic Guide
39
40-year-old woman returns from holiday with mild otalgia and canal pus. TM intact. What is the SINGLE MOST appropriate initial recommendation? A. Topical antibiotic/steroid combo B. Oral antibiotics/steroid combo C. Use cotton buds TID D. Flush with water TID E. Oral antibiotics
Answer: A. Topical antibiotic/steroid combination Justification: First-line for uncomplicated otitis externa. Avoid cotton buds and water ingress. Resource: NICE CKS. Otitis externa (2024)
40
40-year-old man with nasal stuffiness. Speculum shows pale grey, mobile, insensate lesion in both nostrils. What is the SINGLE MOST likely cause? A. Cotton wool B. Carcinoma C. Inferior turbinate D. Middle turbinate E. Nasal polyp
Answer: E. Nasal polyp Justification: Bilateral, grey, mobile, insensate mass in nose is typical of nasal polyps. Resource: RCGP ENT Topic Guide
41
A 57-year-old woman has had intermittent, sudden, disabling symptoms of dizziness, nausea and tinnitus over the past three months. She has a type 1 drivers license. In a patient with sudden and unprovoked dizziness, according to Driver and Vehicle Licensing Agency (DVLA) guidance, which is the SINGLE MOST appropriate advice to give regarding driving? A. Cease driving on days when symptomatic B. Cease driving until symptoms controlled C. No restrictions on driving D. She is banned from driving for five years E. Undertake an in-car driving assessment
Answer: B. Cease driving until symptoms controlled Justification: The DVLA guidance states that: "Must not drive on presentation and must notify DVLA. When satisfactory control of symptoms has been achieved, relicensing may be considered for restoration of the ’til 70 licence". Resource: DVLA. Assessing fitness to drive: a guide for medical professionals.
42
You see a 14-year-old patient with acute bacterial tonsillitis who is allergic to phenoxymethylpenicillin. What is the SINGLE MOST appropriate alternative antibiotic option? A. Doxycycline B. Ciprofloxacin C. Clarithromycin D. Amoxicillin E. Cefalexin
Answer: C. Clarithromycin Justification: Oral penicillin V is the antibiotic of choice for suspected GABHS tonsillitis. Clarithromycin is recommended for true penicillin allergy. Resource: De Castro F et al. Tonsillitis. InnovAiT 2023; 16(6): 278–285.
43
A 38-year-old woman is diagnosed with Reinke’s oedema. She is a smoker. Which of the following is the SINGLE MOST appropriate advice to give to this patient? A. Refer for speech therapy B. Treat any symptoms of gastro-oesophageal reflux (GORD) C. Eradicate human papilloma virus (HPV) infection D. Stop smoking E. Stop drinking alcohol
Answer: D. Stop smoking Justification: Reinke’s oedema is most commonly caused by tissue irritation due to smoking. Resources: RCGP. ENT Topic Guides 2019; Biggs T. Hoarseness. InnovAiT 2012; 5(4): 226–231.
44
A 38-year-old man has had a purulent nasal discharge for two weeks and worsening right-sided facial pain. Temp: 38.5 °C. What is the SINGLE MOST appropriate management option? A. Symptomatic treatment only B. Flucloxacillin C. Phenoxymethylpenicillin D. Delayed antibiotic prescription E. Ciprofloxacin
Answer: C. Phenoxymethylpenicillin Justification: Persistent purulent discharge and worsening pain indicates need for a 5-day course of phenoxymethylpenicillin. Resource: NICE. Rhinosinusitis antimicrobial guidance.
45
62-year-old man with hearing loss. Rinne: AC > BC left; BC > AC right Weber: loudest on right What is the SINGLE MOST likely hearing loss? A. Conductive hearing loss in the right ear B. Conductive hearing loss in the left ear C. Sensorineural hearing loss in the left ear D. Normal hearing E. Sensorineural hearing loss in the right ear
Answer: A. Conductive hearing loss in the right ear Justification: Rinne test shows BC > AC (negative) on the right and Weber lateralises to the right — indicating right-sided conductive loss.
46
70-year-old man presents with 5 weeks of oral white raised lesion. Smoker, drinks 40 units/week. What is the SINGLE MOST likely diagnosis? A. Lichen planus B. Aphthous ulcer C. Leukoplakia D. Lichen sclerosus E. Frictional trauma
Answer: C. Leukoplakia Justification: White patches that cannot be characterised otherwise and occur in smokers are most likely leukoplakia. Resource: NICE NG12; PCDS. Leukoplakia.
47
54-year-old woman with progressive right-sided hearing loss, tinnitus, earache, dizziness, and imbalance. Right-sided SNHL confirmed. What is the SINGLE MOST likely diagnosis? A. Impacted cerumen B. Presbycusis C. Trigeminal neuralgia D. Vestibular schwannoma E. Labyrinthitis
Answer: D. Vestibular schwannoma Justification: Unilateral SNHL, tinnitus, and imbalance suggest vestibular schwannoma. Resource: Michalik D. Vestibular schwannoma. InnovAiT 2023; 16(1): 34–38.
48
2-year-old boy with 2 weeks of nighttime snoring and purulent discharge from the left nostril. Family history of asthma and eczema. What is the SINGLE MOST likely cause? A. Nasal polyps B. Vasomotor rhinitis C. Seasonal allergic rhinitis D. Foreign body E. Acute sinusitis
Answer: D. Foreign body Justification: Unilateral purulent nasal discharge in young children is most commonly due to a foreign body. Resource: Scadding G et al. BSACI 2017.
49
45-year-old woman with unilateral facial drooping. Which ONE clinical feature suggests an upper motor neurone lesion? A. Flexor plantar reflexes B. Muscle wasting C. Able to wrinkle forehead D. Normal lower limb power E. Normal upper limb power
Answer: C. Able to wrinkle forehead Justification: Forehead sparing occurs in UMN lesions due to bilateral innervation. Resource: RCGP ENT Topic Guide 2019.
50
39-year-old man with maxillary facial pain worse on bending forwards. Which TWO features MOST support diagnosis of acute bacterial rhinosinusitis? A. Fever > 38 °C B. Anosmia C. Discoloured unilateral discharge D. Nasal blockage E. Frontal pain
Answer: A and C Justification: Fever >38 °C and discoloured unilateral discharge are key indicators of acute bacterial rhinosinusitis. Resources: Ann Intern Med 2001; Cochrane 2012.
51
A 47-year-old man developed sudden hearing loss in the left ear 2 days ago. Exam shows partial view due to wax. Rinne: AC > BC both ears Weber: loudest in right ear What is the SINGLE MOST appropriate management option? A. Routine referral to audiology B. Same day referral to ENT C. Nasal corticosteroid D. Earwax softener E. Oral decongestant
Answer: B. Same day referral to ENT Justification: NICE recommends urgent ENT referral for sudden hearing loss within 30 days. Resource: NICE NG98. Hearing loss in adults (2023).
52
7-year-old boy with sore throat for 4 days. Eating and drinking normally. Red throat, no exudate or lymphadenopathy, temp 37.2°C. COVID-19 negative. What is the SINGLE MOST appropriate management option? A. Amoxicillin B. Paracetamol C. Soluble aspirin D. Phenoxymethylpenicillin E. Benzydamine oral rinse
Answer: B. Paracetamol Justification: Most sore throats are viral and self-limiting. FeverPAIN/Centor score low. Resource: NICE NG84. Sore Throat (acute): antimicrobial prescribing. 2018.
53
54-year-old man with painless white patch on underside of tongue for two months. Smoker. What is the SINGLE MOST likely cause? A. Lichen planus B. Psoriasis C. Leukoplakia D. Candidiasis E. Geographical tongue
Answer: C. Leukoplakia Justification: Persistent painless white patch in a smoker is suggestive of leukoplakia. Resources: PCDS; NICE NG12.
54
Which ONE statement is TRUE about acute otitis media (AOM)? A. Systemic signs and effusion confirm diagnosis B. Diagnosed in primary care by history and otoscopy C. AOM and OME have separate pathologies D. AOM usually becomes chronic E. AOM is clearly linked to language delay
Answer: B. Diagnosed in primary care by history and otoscopy Justification: AOM is a clinical diagnosis; the line between AOM and OME is often blurred. Resource: NICE CKS. Otitis media – acute (2022).
55
46-year-old diabetic on treatment for otitis externa. Worsening pain, granulation tissue at bony-cartilaginous junction. What is the SINGLE MOST appropriate management? A. Switch to oral antibiotics B. Same-day ENT referral C. Routine ENT referral D. Two-week-wait ENT referral E. Ear irrigation
Answer: B. Same-day ENT referral Justification: Necrotising otitis externa is a life-threatening complication in diabetics. Resource: Wright O et al. Blocked ears. InnovAiT 2020; 13(5): 289–296.
56
32-year-old patient with left earache, itching, debris, visible hyphae and spores. What is the SINGLE MOST appropriate management? A. Ear syringing B. Routine referral C. Oral antibiotics D. Topical antibiotics E. Topical antifungals
Answer: E. Topical antifungals Justification: Hyphae and spores indicate fungal otitis externa. Resource: Dolan S, Ellis S. Otitis externa. InnovAiT 2023; 16(2): 73–77.
57
46-year-old Chinese man with right-sided dull, retracted tympanic membrane. No Valsalva movement. What is the SINGLE MOST appropriate management? A. Routine ENT referral B. Urgent ENT referral C. Antihistamine D. Nasal corticosteroid E. Amoxicillin
Answer: B. Urgent ENT referral Justification: Unilateral effusion and Chinese ethnicity raises concern for nasopharyngeal carcinoma. Resource: NICE NG12; RCGP ENT Topic Guide.
58
Which vaccine has reduced incidence of epiglottitis in children? A. Haemophilus influenzae type B B. DTP C. Meningococcal B D. Chickenpox E. MMR
Answer: A. Haemophilus influenzae type B Justification: HiB vaccine has led to a significant decline in childhood epiglottitis. Resource: Jaroenchasri MR et al. Supraglottitis. InnovAiT 2024.
59
Male student with moderate allergic rhinitis, nasal obstruction. Tried azelastine. What is the BEST next-line option? A. 0.5% Ephedrine nose drops B. Fluticasone nasal spray C. Sodium cromoglycate nasal spray D. Oral antihistamines E. Ipratropium bromide nasal spray
Answer: B. Fluticasone nasal spray Justification: Topical steroids like fluticasone are first-line for nasal obstruction. Resource: Scadding G et al. BSACI 2017.
60
66-year-old man with rhinitis and nasal congestion. Suspected drug cause. Which medication is MOST likely responsible? A. Omeprazole B. Tamsulosin C. Mesalazine D. Furosemide E. Co-codamol
Answer: B. Tamsulosin Justification: Alpha blockers like tamsulosin can cause vasomotor rhinitis. Resource: RCGP ENT Topic Guide 2019.
61
A 20-year-old man attends for follow-up after blood tests. He presents with recurrent painful mouth ulcers affecting eating and talking. Otherwise fit and well, all tests (FBC, ESR, haematinics, IgA, tTG) are normal. What is the SINGLE MOST likely cause of this patient's symptoms and signs? A. Crohn’s disease B. Behçet’s syndrome C. Coeliac disease D. Ulcerative colitis E. Recurrent aphthous stomatitis
Answer: E. Recurrent aphthous stomatitis Justification: History and normal investigations confirm recurrent aphthous stomatitis. Associated with stress, trauma, food triggers, smoking cessation, and hormonal changes. Resource: Field A, Field J. InnovAiT 2011; 4(1): 12–15; PCDS. Oral lesions.
62
A 48-year-old patient with recent otitis media presents with acute right-sided facial weakness over 6 hours. Unable to close right eye or raise eyebrow. No vesicles present. What is the SINGLE MOST likely diagnosis? A. Brain abscess B. Stroke C. Facial nerve palsy D. Venous sinus thrombosis E. Meningitis
Answer: C. Facial nerve palsy Justification: Facial nerve palsy from otitis media presents as LMN palsy. Document with House–Brackmann scale. ENT referral is advised. Resource: RCGP ENT Topic Guide 2019.
63
Thyroid case scenarios: 1. 40F with diffuse swelling and raised TSH 2. 60M with neck swelling and stridor 3. 59F with hard, irregular unilateral lower neck swelling What are the appropriate next steps? Options: Reassure, Bloods, Review, Ultrasound, Routine referral, Urgent referral, Emergency admission
Answers: 1 → Refer routinely 2 → Arrange emergency admission 3 → Refer urgently Justification: Emergency referral for stridor; urgent if suspicious features present; routine if likely benign. Resources: NICE NG12; RCGP ENT Topic Guide 2019.
64
According to NICE guidance, which ONE of the following is the LEAST appropriate method for managing earwax? A. Sodium bicarbonate ear drops B. Electronic ear irrigation C. Olive oil ear drops D. Manual syringing E. Microsuction
Answer: D. Manual syringing Justification: NICE advises against manual syringing due to safety risks. Pre-treatment softeners and irrigation/microsuction are preferred. Resource: NICE NG98. Hearing loss in adults (2018).
65
A 5-year-old girl presents with a 24-hour history of painful right ear and otitis media. No antibiotics prescribed. What is the SINGLE MOST likely average total duration of her illness in days? A. 10 B. 4 C. 3 D. 7 E. 2
Answer: C. 3 Justification: Most cases of otitis media resolve in about 3 days but may last up to a week. Resource: NICE NG91. Otitis media (acute): antimicrobial prescribing (2022).
66
A 70-year-old man presents with 2 months of left-sided nasal obstruction, facial pain, and blood-streaked discharge. No fever, not unwell. On amlodipine. What is the SINGLE MOST appropriate management? A. Antibiotics B. Stop amlodipine C. Urgent ENT referral D. Steroid nasal spray E. Oral antihistamine
Answer: C. Urgent ENT referral Justification: Unilateral nasal symptoms with blood require exclusion of malignancy. Resource: NICE NG12. Suspected cancer: recognition and referral (2023).
67
Which ONE of the following signs on examination would raise concern for malignant otitis externa? A. A retraction pocket in the tympanic membrane B. A facial nerve palsy C. Vesicles in the ear canal D. Ramsay Hunt syndrome E. Protrusion of the pinna
Answer: B. A facial nerve palsy Justification: Facial nerve palsy in otitis externa suggests malignant otitis externa and warrants same-day ENT review. Resource: RCGP ENT Topic Guide 2019.
68
A 45-year-old man developed tinnitus and vertigo 3 hours ago. No speech issues, facial droop, or limb weakness. What is the SINGLE MOST appropriate next step? A. Urgent ENT appointment B. GP review in 24 hours C. Prescribe oral betahistine D. Administer cyclizine injection E. Refer to the emergency department
Answer: E. Refer to the emergency department Justification: Sudden onset of tinnitus with vertigo may suggest brainstem stroke. Resource: NICE NG155. Tinnitus: assessment and management (2020).
69
A 40-year-old man has recent onset unilateral deafness. Audiogram confirms sensorineural hearing loss on the left. What is the SINGLE MOST likely diagnosis? A. Presbycusis B. Tympanosclerosis C. Acoustic neuroma D. Otitis media E. Otosclerosis
Answer: C. Acoustic neuroma Justification: Unilateral SNHL in a 40-year-old strongly suggests acoustic neuroma. Resource: RCGP ENT Topic Guide 2019.
70
A 51-year-old man has two episodes of vertigo with tinnitus lasting 3 hours each. Now notes reduced hearing in the right ear. Exam normal except reduced whisper test. What is the SINGLE MOST likely diagnosis? A. BPPV B. Brainstem TIA C. Ménière’s disease D. Recurrent vestibulopathy E. Vestibular neuronitis
Answer: C. Ménière’s disease Justification: Triad of vertigo, tinnitus, and hearing loss strongly indicates Ménière’s disease. Resource: NICE; InnovAiT ENT resources.
71
A 48-year-old woman presents with 6-week hoarseness. History of acid reflux, well-controlled on omeprazole. No lumps on neck exam. What is the SINGLE MOST appropriate management? A. Benzydamine hydrochloride spray trial B. Routine ENT referral C. FBC and TFTs D. Neck ultrasound E. Urgent ENT referral
Answer: E. Urgent ENT referral Justification: NICE recommends 2WW ENT referral for hoarseness >3 weeks in patients >45 years old. Resource: NICE NG12. Suspected cancer: recognition and referral (2023).
72
A 58-year-old man with renal transplant presents with otitis externa not responding to treatment. Still has pain, discharge, itch, hearing loss. Exam: oedematous canal. What is the SINGLE MOST appropriate management? A. Routine ENT referral B. Ear swab C. Ciprofloxacin ear drops D. Immediate ENT referral E. Oral co-amoxiclav
Answer: D. Immediate ENT referral Justification: Immunocompromised patient with unresponsive otitis externa → risk of necrotising otitis externa. Resource: NICE NG98. Hearing loss in adults (2023).
73
What is the SINGLE MOST common cause of vertigo in adults? A. BPPV B. Cerebellar infarction C. Labyrinthitis D. Vestibular neuritis E. Ménière’s disease
Answer: A. BPPV Justification: Benign paroxysmal positional vertigo is the most common vestibular disorder in adults. Resource: Bhattacharyya N et al., Otolaryngol Head Neck Surg. 2008.
74
Which ONE of the following statements is TRUE about malignant otitis externa? A. Diabetes is a risk factor B. It’s more common in psoriasis C. Pain is mild at onset D. Same pathology as cancer
Answer: A. Diabetes is a risk factor Justification: Malignant otitis externa is an aggressive infection of temporal bone; diabetes is a major risk factor. Resource: RCGP ENT Topic Guide.
75
A 25-year-old man with constant ear itch and discomfort. Exam: erythematous canal, small tympanic membrane perforation. Which single treatment should be AVOIDED? A. Hydrocortisone and gentamicin drops B. Aluminium acetate drops C. Prednisolone drops D. Clotrimazole drops E. Flumetasone + clioquinol drops
Answer: A. Hydrocortisone and gentamicin drops Justification: Aminoglycoside drops (e.g., gentamicin) are ototoxic and contraindicated in tympanic perforation. Resource: BNF; RCGP ENT Topic Guide.
76
Centor scoring in sore throat: Which ONE criterion supports group A β-haemolytic streptococcal (GABHS) infection? A. Bilateral tonsillar erythema B. Productive cough C. Tachycardia D. Tender anterior cervical lymph nodes E. Unilateral tonsillar enlargement
Answer: D. Tender anterior cervical lymph nodes Justification: Centor criteria include tonsillar exudate, tender anterior nodes, fever, and absence of cough. Resource: NICE NG84. Sore throat (acute): antimicrobial prescribing (2018).
77
A 69-year-old man has 3 months of intermittent dysphagia with regurgitation of undigested food and halitosis. No dysphagia to fluids. What is the SINGLE MOST likely diagnosis? A. Soft food bolus B. GORD C. Pharyngeal pouch D. Multiple sclerosis E. Oesophageal cancer
Answer: C. Pharyngeal pouch Justification: Characteristic features include intermittent dysphagia, regurgitation, halitosis. Resource: Owen MA et al. Dysphagia. InnovAiT 2023; 16(10): 490–497.
78
A 14-year-old girl presents with upper third pinna swelling 2 weeks post-piercing. No fluctuation or allergies. What is the SINGLE MOST appropriate antibiotic? A. Clindamycin B. Ciprofloxacin C. Flucloxacillin D. Azithromycin E. Doxycycline
Answer: B. Ciprofloxacin Justification: Covers both Pseudomonas and Staph. aureus; used for perichondritis. Resource: RCGP ENT Topic Guide 2019.
79
A 60-year-old man with suspected Ménière’s disease presents with vertigo, tinnitus, hearing loss, and aural fullness. What is the SINGLE BEST next step? A. ENT referral B. Request hearing test C. Start prochlorperazine D. Ear syringing E. Epley manoeuvre
Answer: A. ENT referral Justification: ENT referral is needed for diagnosis and long-term management. Resource: NICE; RCGP ENT Topic Guide.
80
A 45-year-old woman with 4-day URTI and bilateral maxillary sinus pain. Afebrile, well, COVID-negative. What is the SINGLE MOST appropriate treatment? A. Amoxicillin B. Cetirizine C. Doxycycline D. Paracetamol E. Pseudoephedrine
Answer: D. Paracetamol Justification: Viral sinusitis is self-limiting. NICE advises against antibiotics unless severe/systemic signs present. Resource: NICE NG79. Sinusitis (acute): antimicrobial prescribing (2017).
81
You see a 62-year-old man with left-nostril obstruction and nasal discharge. He also has some crusting and mild facial pain for 4 weeks. Which SINGLE possible diagnosis should be given the highest priority consideration in the management plan for this patient? A. Nasal infection B. Chronic rhinosinusitis C. Acute rhinosinusitis D. Migraine E. Sinonasal tumour
Answer: E. Sinonasal tumour Justification: The unilateral nature, red-flag signs (e.g. crusting, persistent symptoms), age >60 all raise concern for sinonasal tumour. Requires urgent referral. Resources: - Dickson E, Hopkins C. Chronic rhinosinusitis. InnovAiT 2020; 13(4): 199–206 - NHS. Nasopharyngeal cancer. 2021
82
A 34-year-old man has significant right-sided nasal discharge and facial pressure for 7 days. Not responding to phenoxymethylpenicillin. Febrile and unwell. Which is the SINGLE MOST appropriate antibiotic to NOW recommend? A. Amoxicillin B. Cefalexin C. Clarithromycin D. Doxycycline E. Co-amoxiclav
Answer: E. Co-amoxiclav Justification: Co-amoxiclav is recommended when there's no response to first-line treatment (e.g. phenoxymethylpenicillin) or severe symptoms. Guidance: NICE NG79. Sinusitis (acute): antimicrobial prescribing. 2017.
83
Patient presents with worsening facial discomfort and purulent nasal discharge after 12 days of URTI despite nasal steroids and rinses. No allergies. What is the SINGLE MOST appropriate treatment? A. Cefalexin B. Co-amoxiclav C. Ciprofloxacin D. Phenoxymethylpenicillin E. Doxycycline
Answer: D. Phenoxymethylpenicillin Justification: Despite viral origin in most sinusitis, prolonged/worsening symptoms justify antibiotics. Phenoxymethylpenicillin is first line. Resource: NICE NG79. Sinusitis (acute): antimicrobial prescribing. 2017.
84
A 48-year-old construction worker presents with gradual hearing loss and tinnitus. Normal otoscopy and tuning fork tests. Audiogram shows 4000 Hz dip. What is the SINGLE MOST likely cause? A. Otosclerosis B. Noise-induced hearing loss C. Cholesteatoma D. Presbyacusis E. Impacted ear wax
Answer: B. Noise-induced hearing loss Justification: Classic audiogram pattern with 4000 Hz dip in construction worker with bilateral tinnitus. Resource: NICE NG98. Hearing Loss in Adults: assessment and management. 2018.
85
Match the scenarios to the SINGLE MOST likely diagnosis: - 78M with dysphagia and earache - 75M with facial weakness, rash and earache - 45F with earache worsened by yawning and eating
Answers: - 78M → Nasopharyngeal carcinoma - 75M → Ramsay Hunt syndrome - 45F → Temporomandibular joint dysfunction Justification: Nasopharyngeal carcinoma can present with referred otalgia; Ramsay Hunt includes facial palsy and rash; TMJ pain worsens on movement. Resource: RCGP ENT Topic Guide 2019.
86
48-year-old woman presents with unilateral hearing loss and tinnitus. Suspect vestibular schwannoma. Which SINGLE test is MOST useful in diagnosis? A. Weber’s test B. Gelle test C. Head impulse test D. Romberg’s test E. Unterberger’s test
Answer: A. Weber’s test Justification: Unilateral SNHL → Weber lateralises to the unaffected ear; helpful in distinguishing from conductive causes. Resource: Michalik D. Vestibular schwannoma. InnovAiT 2023; 16(1): 34–38.
87
40-year-old man reports soreness and white patches in his mouth. Examination shows reticular striae. What is the SINGLE MOST likely diagnosis? A. Herpes simplex virus B. Candidiasis C. Aphthous ulcer D. Oral hairy leukoplakia E. Lichen planus
Answer: E. Lichen planus Justification: Classic white reticular lesions on buccal mucosa; associated with tobacco/alcohol. Resource: Iles R et al. Oral mucosal manifestations. InnovAiT 2021; 14(12): 714–723.
88
55-year-old man with long-standing allergic rhinitis now develops worsening nasal obstruction and occasional unilateral epistaxis. What is the SINGLE MOST appropriate NEXT step? A. Oral amoxicillin B. Allergy testing C. ENT referral D. Intranasal corticosteroid E. Oral leukotriene antagonist
Answer: C. ENT referral Justification: Unilateral epistaxis in >50s is a red flag for sinonasal malignancy. Resource: Scadding G et al. Allergic and non-allergic rhinitis. BSACI 2017.
89
45-year-old woman has right-sided non-pulsatile tinnitus, hearing loss, and fullness. Exam shows unilateral SNHL. What is the SINGLE MOST likely diagnosis? A. Ménière’s disease B. Chronic otitis media C. Otosclerosis D. Idiopathic intracranial hypertension E. Tympanic membrane perforation
Answer: A. Ménière’s disease Justification: Classic triad of SNHL, tinnitus, and aural fullness. Resource: Bhamra N et al. Tinnitus. InnovAiT 2021; 14(9): 546–550.
90
41-year-old woman diagnosed with bilateral acoustic neuromas on MRI. What underlying condition is most likely? A. Marfan syndrome B. SLE C. Neurofibromatosis D. Haemochromatosis E. Wilson’s disease
Answer: C. Neurofibromatosis Justification: NF2 is associated with bilateral acoustic neuromas, meningiomas, and schwannomas. Resource: RCGP ENT Topic Guide 2019.
91
42-year-old woman with sudden sharp left ear pain lasting ~30 seconds, occurring multiple times per day. Left-sided facial tenderness. Normal otoscopy. What is the SINGLE MOST appropriate management option? A. Prednisolone B. Amoxicillin C. Aciclovir D. Carbamazepine E. Naproxen
Answer: D. Carbamazepine Justification: Classic presentation of trigeminal neuralgia. Carbamazepine is first-line. Resources: - Lai K et al. The painful ear. InnovAiT 2020; 13(12): 722–730 - NICE CKS. Trigeminal neuralgia. Revised 2022.
92
36-year-old woman with a 4-week history of a painless, bluish, round lesion on the inner lower lip. She admits to habitual lip biting. What is the SINGLE MOST likely diagnosis? A. Leukoplakia B. Squamous carcinoma C. Granulomatosis with polyangiitis D. Ranula E. Mucocoele
Answer: E. Mucocoele Justification: Bluish, cystic lesion associated with trauma/biting — common salivary duct mucous retention cyst. Resource: DermNet NZ. Mucocoele of the lip.
93
8-year-old with sore throat. You plan to use a score incorporating fever, cough, nodes, exudate, and age. Which is the SINGLE MOST likely scoring system? A. Modified Centor score B. FeverPAIN score C. Streptococcal scoring system D. Centor score E. Brodsky’s classification
Answer: A. Modified Centor score Justification: Age-adjusted Centor score assesses risk of streptococcal tonsillitis. Resource: De Castro F et al. Tonsillitis. InnovAiT 2023; 16(6): 278–285.
94
Which patient should be referred to a community audiology service? A. 23M with mild tinnitus post-head injury B. 26F with suicidal ideation due to tinnitus C. 70M with longstanding tinnitus and new vertigo D. 65F with bilateral hearing loss + moderately distressing tinnitus E. 14M with post-URTI fluctuating hearing and tinnitus
Answer: D. 65F with bilateral hearing loss + moderately distressing tinnitus Justification: Community audiology referral is appropriate for bilateral tinnitus + hearing loss without red flags. Resource: NICE NG155. Tinnitus: assessment and management. 2020.
95
78F with gradual bilateral hearing loss. Audiogram shows bilateral SNHL. What is the SINGLE MOST likely diagnosis? A. Ménière’s disease B. Presbyacusis C. Meningioma D. Ear wax E. Acoustic neuroma
Answer: B. Presbyacusis Justification: Age-related bilateral SNHL is most likely presbyacusis. Resource: RCGP ENT Topic Guide 2019.
96
20-year-old with 15 minutes of light epistaxis. Stable and well. What is the SINGLE MOST effective first aid measure? A. Pinch soft part of nose, tilt head forward B. Pinch top of nose, tilt head back C. Pinch soft part, head neutral D. Pinch top, head forward E. Pinch soft part, tilt head back
Answer: A. Pinch soft part of nose, tilt head forward Justification: Standard first aid advice for epistaxis. Resources: - RCGP ENT Topic Guide 2019 - St John Ambulance Nosebleeds guidance - RCH Melbourne Clinical Guidelines
97
54M with hoarseness for 4 weeks. Smoker. Exam unremarkable. What is the SINGLE MOST appropriate next step? A. Routine CXR B. Urgent 2WW head and neck referral C. FBC D. Trial antibiotics E. Routine ENT referral
Answer: B. Urgent 2WW head and neck referral Justification: NICE recommends urgent referral for unexplained hoarseness >3 weeks in over 45s. Resource: NICE NG12. Suspected Cancer. 2015 (updated 2023).
98
3-year-old with URTI. Otoscopy shows pearly white mass behind normal tympanic membrane. What is the SINGLE MOST likely diagnosis? A. Necrotising otitis externa B. Congenital cholesteatoma C. Acute otitis media D. Foreign body E. Otitis externa
Answer: B. Congenital cholesteatoma Justification: Asymptomatic white mass behind TM in a child suggests congenital cholesteatoma. Resource: Newton M, Tsirevelou P. Otorrhoea. InnovAiT 2020; 13(5): 281–288.
99
35F with progressive bilateral deafness (worse left), worsened during pregnancies. Rinne negative both ears, Weber lateralises left. What is the SINGLE MOST likely diagnosis? A. Acoustic neuroma B. Presbyacusis C. Chronic otitis media D. Otosclerosis E. Cholesteatoma
Answer: D. Otosclerosis Justification: Progressive bilateral conductive loss, pregnancy link, Rinne negative → otosclerosis. Resource: RCGP ENT Topic Guide 2019.
100
32-year-old with recurrent vertigo, tinnitus, aural fullness. Audiogram: mild SNHL. What is the SINGLE MOST likely diagnosis? A. Vestibular neuronitis B. Vestibular migraine C. BPPV D. Glue ear E. Ménière’s disease
Answer: E. Ménière’s disease Justification: Classic triad (vertigo, tinnitus, SNHL) with aural fullness. Resource: Sheehan S et al. A guide to vertigo. InnovAiT 2022; 15(10): 573–580.
101
The parents of a 4-year-old boy report snoring, poor sleep, and observed apnoeas. What is the SINGLE MOST appropriate management option? A. Start a steroid nasal spray B. Explore the mother’s anxiety in more detail C. Refer for a sleep study or overnight pulse oximetry D. Start an oral antihistamine E. Mandibular advancement device
Answer: C. Refer for a sleep study or overnight pulse oximetry Justification: A suspicion of sleep apnoea in a child requires investigation via sleep study or overnight pulse oximetry. These tests assess severity and guide treatment. Resource: Agarwal T. Snoring and sleep apnoea. InnovAiT 2020; 13(10): 605–607.
102
A 54-year-old man has difficulty fitting dentures and has palatal swelling. Diagnosed with squamous cell carcinoma of maxillary sinus. Which is the SINGLE LEAST likely presenting feature? A. Facial swelling B. Loose teeth C. Trismus D. Nasal obstruction E. Frontal headache
Answer: E. Frontal headache Justification: Maxillary carcinoma rarely presents with frontal headache. Common signs include facial swelling, loose teeth, nasal obstruction and trismus. Resources: RCGP ENT Curriculum 2019; NICE NG12 (2023).
103
A 33-year-old woman with a 3-week left neck lump. No systemic symptoms. What is the SINGLE MOST appropriate initial investigation? A. Blood tests B. Fine needle aspiration C. MRI D. Ultrasound scan E. CT scan
Answer: D. Ultrasound scan Justification: Ultrasound is the investigation of choice for neck lumps, especially suspected lymphadenopathy. Resource: Williams L et al. Neck lumps. InnovAiT 2023; 16(8): 375–380.
104
62-year-old diabetic with persistent ear pain and discharge despite antibiotics. Granulation seen in auditory canal. What is the SINGLE MOST appropriate management? A. Further oral antibiotics B. Ear syringing C. Emergency ENT admission D. Trial topical antifungals E. Routine ENT referral
Answer: C. Emergency ENT admission Justification: Malignant otitis externa is a severe infection with potential skull base osteomyelitis. Requires urgent ENT admission and IV antibiotics. Resource: Agarwal T et al. Imaging in ENT. InnovAiT 2023; 16(3): 126–132.
105
Which organisms most commonly cause acute otitis externa? A. E. coli and S. viridans B. H. influenzae and M. catarrhalis C. Pseudomonas aeruginosa and Staphylococcus aureus D. S. epidermidis and C. diphtheriae E. S. pyogenes and S. pneumoniae
Answer: C. Pseudomonas aeruginosa and Staphylococcus aureus Justification: These are the most common causative organisms in acute otitis externa. Resource: Kaushik V et al. Cochrane Review 2010.
106
Which is the MOST common malignant salivary gland tumour? A. Lymphoma B. Acinic cell carcinoma C. Squamous cell carcinoma D. Adenoid cystic carcinoma E. Mucoepidermoid carcinoma
Answer: E. Mucoepidermoid carcinoma Justification: Accounts for ~30% of malignant parotid tumours; often occurs in 3rd–5th decade. Resource: Balai E et al. Parotid tumours. InnovAiT 2021; 14(8): 500–505.
107
55-year-old man with intermittent submandibular swelling and pain worse before meals. What is the SINGLE MOST likely diagnosis? A. Sialolithiasis B. Tumour C. Sjögren’s syndrome D. Mumps E. Sialoadenitis
Answer: A. Sialolithiasis Justification: Pain and swelling before meals suggests obstruction due to salivary stone. Resource: Harrison P et al. Sialolithiasis. InnovAiT 2022; 15(9): 515–519.
108
40-year-old secretary wakes up with complete left-sided deafness and tinnitus. Normal exam. Rinne positive both ears. What drug has evidence of benefit in this scenario? A. ACE inhibitors B. Antibiotics C. Beta blockers D. Diuretics E. Steroids
Answer: E. Steroids Justification: Sudden sensorineural hearing loss should be treated urgently with corticosteroids. Resource: NICE CKS. Sudden sensorineural hearing loss.
109
60-year-old former miner with bilateral 4kHz sensorineural hearing loss on audiogram. What is the SINGLE MOST likely diagnosis? A. Otosclerosis B. Chronic otitis media C. Noise-induced deafness D. Presbycusis E. Acoustic neuroma
Answer: C. Noise-induced deafness Justification: 4kHz notch is characteristic of occupational noise-induced hearing loss. Resource: RCGP ENT Topic Guide 2019.
110
19-year-old with persistent allergic rhinitis not relieved by H1 antihistamines. Unremarkable exam. What is the SINGLE MOST appropriate next treatment step? A. Intranasal corticosteroid B. IM corticosteroid C. Intranasal antimuscarinic D. Oral leukotriene receptor antagonist E. Switch to different H1 antihistamine
Answer: A. Intranasal corticosteroid Justification: Recommended next-line for allergic rhinitis if antihistamines alone ineffective. Resource: Scadding G et al. BSACI Guidelines 2017.
111
42-year-old man presents with right-sided facial paralysis preceded by ear pain. No rash. LMN features confirmed. What is the BEST treatment to optimise recovery? A. Aciclovir 400 mg x5 daily B. Prednisolone 10 mg daily C. Prednisolone 50 mg daily D. Prednisolone 50 mg daily + consider aciclovir E. Admit for probable stroke
Answer: D. Prednisolone 50 mg daily + consider aciclovir Justification: Corticosteroids improve recovery if started within 72 hours; antivirals may benefit if viral prodrome. Resource: NICE CKS. Bell’s Palsy. 2023.
112
20-year-old with sore throat, fever 38.5°C, and ulceration of soft palate and uvula. What is the SINGLE MOST likely viral cause? A. Coxsackie A virus B. Enterovirus 71 C. Epstein–Barr virus D. Herpes simplex virus E. Varicella-zoster virus
Answer: A. Coxsackie A virus Justification: Herpangina presents with soft palate/uvula vesicles and fever — caused by Coxsackie A16. Resource: Wellcome Images; RCGP ENT Topic Guide.
113
16-year-old boy post-tonsillectomy wants to return to school. How long should he stay off school? A. 3 days B. 4 weeks C. 48 hours D. 7 days E. 2 weeks
Answer: E. 2 weeks Justification: Two weeks off is advised post-tonsillectomy to reduce infection/bleeding risk. Resource: De Castro F et al. Tonsillitis. InnovAiT 2023; 16(6): 278–285.
114
24-year-old athlete with mild allergic rhinitis to grass pollen. Wishes to avoid corticosteroids. What is the SINGLE MOST appropriate first-line treatment? A. Intranasal oxymetazoline B. Intranasal azelastine C. Intranasal beclometasone D. Oral montelukast E. Intranasal ipratropium
Answer: B. Intranasal azelastine Justification: Topical antihistamines suitable for mild intermittent allergic rhinitis. Resources: BSACI 2017; WADA Prohibited List.
115
58-year-old with painless, slow-growing parotid swelling. What is the SINGLE MOST likely diagnosis? A. Sialadenitis B. Sialolithiasis C. Sarcoidosis D. Pleomorphic adenoma E. Sjögren’s syndrome
Answer: D. Pleomorphic adenoma Justification: Classic features — painless, firm, slow-growing solitary parotid mass. Resource: Balai E et al. Parotid tumours. InnovAiT 2021; 14(8): 500–505.
116
37-year-old with mild facial droop from yesterday. You suspect Bell’s palsy. What is the SINGLE BEST initial treatment? A. Streptokinase B. Aspirin C. Botulinum toxin D. Prednisolone E. Aciclovir
Answer: D. Prednisolone Justification: Prompt steroid use improves recovery. Antivirals only if vesicles/herpes suspected. Resource: BMJ Best Practice. Bell’s Palsy. 2024.
117
8-year-old with 10-minute right-sided nosebleed. What is the BEST immediate advice? A. Sit up and pinch bony part of nose B. Sit up and pinch soft (distal) part of nose C. Lie down and pinch bony part D. Use cotton wool E. Lie down and pinch soft part
Answer: B. Sit up and pinch soft (distal) part of nose Justification: Standard epistaxis management involves pinching soft part and leaning forward. Resource: St John Ambulance; RCGP ENT Guide.
118
When should an ear swab be taken in otitis externa? A. Every patient B. If initial treatment fails C. Only if immunocompromised D. Only for secondary care referral E. If swimming-related
Answer: B. If initial treatment fails Justification: NICE advises swab in treatment failure or recurrent/severe/chronic cases. Resource: NICE CKS. Otitis externa. 2023.
119
34-year-old with right facial swelling, dry mouth and pain after eating sour foods. What is the MOST likely diagnosis? A. Acute sinusitis B. Dental abscess C. Sialadenitis D. Lymphadenopathy E. Sialolithiasis
Answer: E. Sialolithiasis Justification: Pain/swelling on salivation suggests ductal stone. Resources: Harrison P et al. Sialolithiasis. InnovAiT 2022; BAOMS 2022 resource.
120
15-year-old girl with sore throat, fever, no cough, exudate and cervical nodes. Most likely causative organism? A. Group A Streptococcus B. Group B Streptococcus C. Group C Streptococcus D. Non-pyogenic Streptococcus E. Streptococcus pneumoniae
Answer: A. Group A Streptococcus Justification: Centor/FeverPAIN criteria suggest GABHS infection. Resource: NICE NG84. Sore throat (acute). 2018.
121
A four-year-old girl has acute otitis media (AOM). Which is the SINGLE MOST important symptom when considering an immediate antibiotic prescribing strategy? A. Otorrhoea B. Fever C. Nasal discharge D. Tender cervical lymphadenopathy E. Bilateral earache
Answer: A. Otorrhoea Justification: National guidance suggests considering antibiotics in children aged <2 years with bilateral infection or any age with otorrhoea. Resource: NICE. Otitis Media (Acute): antimicrobial prescribing. NG91. 2018.
122
A four-year-old boy has had bilateral nasal discharge for two days. Temp: 37.6°C. COVID-19 negative. Exam normal. According to current guidance, which is the SINGLE MOST appropriate INITIAL treatment? A. Antibiotic B. Steam inhalation C. No treatment D. Antihistamine E. Antihistamine–decongestant–analgesic combination
Answer: C. No treatment Justification: Likely viral. No evidence supports benefit from decongestants or antihistamines in young children with acute rhinosinusitis. Resource: NICE. Summary of antimicrobial prescribing guidance – managing common infections. 2020.
123
44-year-old woman with recurrent vertigo lasting 20 min to 12 hours. Tinnitus, blocked ears, low-mid frequency SNHL confirmed on private audiogram. What is the SINGLE MOST likely diagnosis? A. BPPV B. Labyrinthitis C. Acoustic neuroma D. Impacted cerumen E. Ménière’s disease
Answer: E. Ménière’s disease Justification: Classic triad of vertigo, tinnitus, and fluctuating SNHL. Early cases may fluctuate and present episodically. Resource: Wright O, Wright J, Chambers W. Blocked ears. InnovAiT 2020; 13(5): 289–296.
124
Match the hoarseness cause to each patient: 1. 37F, BMI 34, hoarseness worse in morning, dyspepsia 2. 68M, hoarseness and dysphagia, difficulty walking 3. 53F, hoarseness post-thyroid surgery
Answers: 1 → GORD 2 → Motor neurone disease 3 → Recurrent laryngeal nerve palsy Justification: GORD causes reflux laryngitis; MND causes bulbar signs; thyroid surgery risks RLN injury. Resource: RCGP. ENT Curriculum Topic Guide. 2019.
125
8-year-old child with green nasal discharge after URTI. Maxillary tenderness. Apyrexial. COVID-19 negative. What is the SINGLE MOST appropriate management option? A. Nasal decongestant B. Oral Antibiotics C. Oral antihistamine D. Oral decongestant E. No evidence for these treatments
Answer: E. No evidence for these treatments Justification: No benefit from decongestants, antihistamines, or nasal irrigation in children with sinusitis. Resource: NICE. Summary of antimicrobial prescribing guidance – managing common infections. 2020.
126
32-year-old with unilateral facial pain and swelling worsening before meals. Exudate near upper second molar. What is the SINGLE MOST likely diagnosis? A. Mumps B. Dental abscess C. Sialolithiasis D. Sialadenitis E. Lymphadenopathy
Answer: D. Sialadenitis Justification: Bacterial infection of salivary gland. May follow sialolithiasis. Features include pain, swelling, erythema, exudate. Resource: Harrison P, Richards C, Niziol R, Fry A. Sialolithiasis. InnovAiT 2022; 15(9): 515–519.
127
39-year-old woman with left-sided facial palsy and vesicular rash in left ear. Which virus is the SINGLE MOST likely cause of Ramsay–Hunt syndrome? A. Parvovirus B19 B. Herpes simplex C. Coxsackie D. Varicella zoster E. Rubella
Answer: D. Varicella zoster Justification: Ramsay–Hunt syndrome = facial palsy + sensorineural hearing loss + vesicular rash. Resource: RCGP ENT Topic Guide.
128
8-year-old with fever, right earache, red/dull TM, mastoid tenderness, pinna displaced outward. What is the SINGLE MOST appropriate management? A. Symptomatic management B. Immediate ENT referral C. Delayed antibiotics D. Start oral antibiotics E. Urgent ENT referral
Answer: B. Immediate ENT referral Justification: Suggestive of mastoiditis — a complication of AOM. Needs urgent admission and IV antibiotics. Resource: RCGP ENT Topic Guide.
129
23-year-old with right facial swelling, worsens with eating (esp. citrus). What is the SINGLE MOST appropriate investigation? A. Sialogram B. Thyroid ultrasound C. Blood tests incl. LDH D. Lymph node biopsy E. MRI
Answer: A. Sialogram Justification: Sialography is diagnostic for sialolithiasis — evaluates salivary ducts and obstruction. Resource: Harrison P, Richards C, Niziol R, Fry A. Sialolithiasis. InnovAiT 2022; 15(9): 515–519.
130
27-year-old man with snoring worsened in spring, nasal catarrh. Wife is disturbed by it. What is the SINGLE MOST appropriate management? A. Nasal steroid or antihistamine spray B. Relationship counselling C. Mandibular advancement device D. ENT referral for septoplasty E. Sleep clinic referral
Answer: A. Nasal steroid or antihistamine spray Justification: Likely allergic rhinitis. Medical management improves nasal patency and snoring. Resource: Agarwal T. Snoring and sleep apnoea. InnovAiT 2020; 13(10): 605–607.
131
Nine-year-old girl: temp 39.4°C, dribbling, reluctant to eat, swollen bleeding gums, ulcerated buccal mucosa. What is the SINGLE MOST likely infective cause? A. Coxsackie virus B. HSV C. Measles virus D. Parvovirus E. VZV
Answer: B. HSV Justification: Primary HSV infection may present with gingivostomatitis in children — ulcers, bleeding gums, fever. Resource: Wellcome Images; RCGP ENT Topic Guide.
132
Which drug is associated with ototoxicity? A. Aminoglycosides B. Cephalosporins C. Opiates D. Beta-blockers E. Amiodarone
Answer: A. Aminoglycosides Justification: Aminoglycosides can cause irreversible sensorineural hearing loss. Resource: BNF; NICE CKS.
133
67-year-old with gradual hearing loss, tinnitus. Weber lateralises to right. Which SINGLE Rinne’s test result supports right conductive hearing loss? A. AC>BC AC>BC B. AC>BC BC>AC C. BC>AC AC>BC D. BC>AC BC>AC
Answer: C. BC>AC (right), AC>BC (left) Justification: In conductive hearing loss, Weber lateralises to affected side and Rinne is negative (BC>AC). Resource: RCGP ENT Topic Guide.
134
7-year-old girl with 2 AOM episodes in 6 months. Audiogram: mild-moderate hearing loss. No school problems. What is the SINGLE MOST appropriate NEXT step? A. Oral decongestants B. Oral antihistamines C. Prophylactic antibiotics D. Repeat audiogram in 3 months E. ENT referral
Answer: D. Repeat audiogram in 3 months Justification: NICE advises repeat audiometry before ENT referral unless impact on life is significant. Resource: NICE CKS. Otitis media with effusion.
135
Which ONE statement about otitis externa is CORRECT? A. Lasts over 6 weeks B. 25% lifetime incidence C. More common in men D. Peak age <3 E. Commonly caused by Pseudomonas and Staph aureus
Answer: A. Lasts up to 6 weeks Justification: Acute otitis externa defined as <6 weeks. Pseudomonas and S. aureus common causes. Resource: Smith ME et al. PLoS One. 2021; 16(5): e0251395.
136
Which option is NOT advised after administering ear drops? A. Cotton wool buds B. Counting drops C. Lying with affected ear up D. Squeezing bottle gently E. Pressing tragus
Answer: A. Cotton wool buds Justification: Cotton buds risk infection, wax impaction, and perforation. Resource: RCGP ENT Topic Guide.
137
24-year-old woman with 3 months of rhinitis. Which symptom is LEAST suggestive of intermittent allergic rhinitis? A. Bilateral nasal obstruction B. Sneezing C. Anosmia D. Postnasal drip E. Clear nasal discharge
Answer: C. Anosmia Justification: Anosmia is more typical of chronic conditions like nasal polyps or chronic rhinosinusitis. Resource: Scadding G et al. BSACI 2017.
138
64-year-old with unilateral SNHL. Suspect vestibular schwannoma. What is the gold standard investigation? A. Audiogram B. Brain MRI C. Skull X-ray D. MRI of internal auditory meatus E. Head CT
Answer: D. MRI of internal auditory meatus Justification: High-resolution MRI IAM is diagnostic gold standard. Resource: Michalik D. Vestibular schwannoma. InnovAiT 2023; 16(1): 34–38.
139
4-year-old girl with AOM. Which is the SINGLE MOST important symptom when considering immediate antibiotic prescribing? A. Fever 37.6°C B. Otorrhoea C. Tender cervical lymphadenopathy D. Unilateral earache E. Nasal discharge
Answer: B. Otorrhoea Justification: Otorrhoea or AOM in under-2s with bilateral infection requires prompt antibiotics. Resource: NICE. NG91. Otitis media (acute): antimicrobial prescribing. 2018 (updated 2022).
140
Which prescriptions should be marked ‘ACBS’? A. Urinary catheter B. Sunscreen C. Drugs given by GP D. Artificial saliva E. Anti-reflux infant formula
Answer: B, D, E Justification: ACBS applies to borderline substances (e.g. artificial saliva, specialist infant formula, sunscreen for photodermatoses). Resources: BNF; NHS BSA; Gov.uk ACBS guidance.
141
A 70-year-old man complains of difficulty hearing. He can manage one-to-one conversations but struggles in group settings. Audiogram shows high-frequency loss. What is the SINGLE MOST likely diagnosis? A. Presbyacusis B. Ménière’s disease C. Otosclerosis D. Impacted wax E. Acoustic neuroma
Answer: A. Presbyacusis Justification: Progressive, bilateral sensorineural hearing loss with high-frequency loss typical in age-related presbyacusis. Resource: NICE NG98. Hearing Loss in Adults: assessment and management. 2018.
142
A 45-year-old man with severe asthma on maximal inhaled therapy presents with strained voice and hoarseness for over a month. What is the SINGLE MOST important diagnosis to exclude? A. Gastroesophageal reflux B. Vocal cord polyps C. Viral laryngitis D. Laryngeal carcinoma E. Myopathy of vocal cord muscles
Answer: D. Laryngeal carcinoma Justification: Hoarseness >3 weeks requires urgent ENT referral to exclude malignancy. Resource: NICE NG12. Suspected cancer: recognition and referral.
143
A 29-year-old woman seeks pre-conception advice. Which medication is MOST likely associated with oral cleft palate? A. Levothyroxine B. Insulin C. Salbutamol D. Topiramate E. Clenil modulite
Answer: D. Topiramate Justification: Antiepileptics like topiramate are linked with increased risk of oral clefts. Resource: Lotfallah A et al. Cleft lip and palate. InnovAiT 2023; 16(4): 165–170.
144
A 75-year-old man has progressive right-sided hearing loss and tinnitus. Weber localises to the left. Rinne positive bilaterally. What is the SINGLE MOST likely diagnosis? A. Otitis media B. Eustachian tube obstruction C. Paget’s disease D. Acoustic neuroma E. Otosclerosis
Answer: D. Acoustic neuroma Justification: Unilateral sensorineural hearing loss is classic for acoustic neuroma. Resource: RCGP ENT Curriculum Topic Guide. 2019.
145
A 63-year-old develops new onset rhinitis after starting arthritis medication. Which drug is MOST likely the cause? A. Tramadol B. Naproxen C. Paracetamol D. Codeine E. Dihydrocodeine
Answer: B. Naproxen Justification: NSAIDs like naproxen can trigger drug-induced rhinitis. Resource: Giri DS. Allergic rhinitis. InnovAiT 2024; 17(2): 84–87.
146
A 47-year-old smoker has had a 1cm ulcer on her upper gum for a month. What is the SINGLE MOST appropriate management? A. Head and neck suspected cancer pathway referral B. Routine ENT referral C. Monitor and review in two weeks D. Trial miconazole gel E. Advise to see dentist
Answer: A. Head and neck suspected cancer pathway referral Justification: Any non-healing oral lesion >3 weeks in a smoker warrants urgent referral. Resource: NICE NG12. Suspected cancer: recognition and referral. 2025.
147
A 5-year-old boy with Centor 4 and FeverPAIN 4–5 has a sore throat. No allergies. What is the SINGLE MOST appropriate treatment? A. Conservative management B. Clarithromycin C. Delayed erythromycin D. Prescribe phenoxymethylpenicillin E. Delayed phenoxymethylpenicillin
Answer: D. Prescribe phenoxymethylpenicillin Justification: High Centor/FeverPAIN scores indicate bacterial cause – phenoxymethylpenicillin first-line. Resources: NICE NG84; De Castro F et al. Tonsillitis. InnovAiT 2023.
148
A 68-year-old man with bilateral tinnitus is on multiple medications. Which is MOST likely exacerbating his tinnitus? A. Furosemide B. Ramipril C. Metformin D. Clopidogrel E. Nitrofurantoin
Answer: A. Furosemide Justification: Loop diuretics like furosemide can worsen tinnitus. Resource: Bhamra N et al. Tinnitus. InnovAiT 2021; 14(9): 546–550.
149
A 32-year-old man has several months of nasal congestion, discharge, and sinus fullness. What is the SINGLE MOST appropriate management? A. Oral antihistamines B. Intranasal corticosteroids C. Oral antibiotic trial D. Oral corticosteroids E. Topical decongestants
Answer: B. Intranasal corticosteroids Justification: First-line for chronic rhinosinusitis is regular intranasal steroids. Resource: NICE NG79. Sinusitis (acute): antimicrobial prescribing. 2017.
150
A 23-year-old has bilateral conductive hearing loss and tinnitus. What is the SINGLE MOST likely diagnosis? A. Impacted cerumen B. Acute otitis media C. Otitis externa D. Ménière’s disease E. Foreign body
Answer: A. Impacted cerumen Justification: Bilateral painless conductive loss is suggestive of wax impaction. Resource: RCGP ENT Curriculum Guide.
151
A 19-year-old with recurrent severe aphthous ulcers has tried all local treatments. What is the SINGLE MOST appropriate next step? A. Folic acid B. Aciclovir C. Cryotherapy D. Iron supplements E. Prednisolone
Answer: E. Prednisolone Justification: Systemic steroids are indicated when topical options fail in recurrent aphthous stomatitis. Resources: Arwyn-Jones J et al. InnovAiT 2019; NICE CKS. Aphthous ulcer. 2022.
152
A 45-year-old man with long-term ear infections has foul discharge, hearing loss, dizziness, and retroauricular pain. What is the SINGLE MOST likely diagnosis? A. Middle ear osteoma B. Tympanosclerosis C. Chronic otitis media D. Cholesteatoma E. Chronic otitis externa
Answer: D. Cholesteatoma Justification: Classic symptoms include foul discharge, dizziness, and bone destruction. Resource: RCGP ENT Curriculum Topic Guide. 2019.
153
A breastfeeding woman has a mildly tender thyroid and low TSH with high FT4. What is the SINGLE MOST likely diagnosis? A. Thyroid cyst B. Graves’ disease C. Toxic adenoma D. Thyroid cancer E. Thyroiditis
Answer: E. Thyroiditis Justification: Postpartum thyroiditis with transient thyrotoxicosis is common in new mothers. Resource: RCGP ENT Curriculum Topic Guide. 2019.
154
A 48-year-old woman has dysphagia, fatigue, heavy periods, pallor, and koilonychia. Endoscopy shows an oesophageal web. What is the SINGLE MOST appropriate treatment? A. Ferrous sulphate B. Hydroxocobalamin C. Omeprazole D. Folic acid E. Metoclopramide
Answer: A. Ferrous sulphate Justification: Iron deficiency in Plummer–Vinson syndrome causes dysphagia. Treating anaemia improves symptoms. Resource: RCGP ENT Curriculum Topic Guide. 2019.
155
A man has a slow-growing painless lump in his parotid gland. What is the MOST common benign tumour? A. Pleomorphic adenoma B. Oncocytoma C. Basal cell adenoma D. Canalicular adenoma E. Warthin’s tumour
Answer: A. Pleomorphic adenoma Justification: Most common benign salivary gland tumour. Resource: Williams L et al. Neck lumps. InnovAiT 2023; 16(8): 375–380.
156
A 24-year-old with sore throat and uvula deviation cannot open mouth fully. What is the SINGLE MOST likely diagnosis? A. Peritonsillar abscess B. Acute tonsillitis C. Parapharyngeal abscess D. Peritonsillar cellulitis E. Ludwig’s angina
Answer: A. Peritonsillar abscess Justification: Trismus, “hot potato voice”, uvula deviation point to quinsy. Resource: De Castro F et al. Tonsillitis. InnovAiT 2023.
157
A 25-year-old with sore throat and Centor 4 is going on holiday. No allergies. What is the BEST treatment? A. Amoxicillin 250 mg TDS B. Amoxicillin 500 mg TDS C. Cefalexin 250 mg TDS D. Penicillin V 250 mg QDS E. Penicillin V 500 mg QDS for 5–10 days
Answer: E. Penicillin V 500 mg QDS for 5–10 days Justification: Full-dose penicillin V is first-line for streptococcal tonsillitis. Resource: NICE NG84. Sore throat: antimicrobial prescribing. 2018.
158
A 22-year-old immunosuppressed woman has 10-day right nasal obstruction, anosmia, fever. What is the SINGLE MOST appropriate initial antibiotic? A. Amoxicillin B. Cefalexin C. Co-amoxiclav D. Metronidazole E. Oxytetracycline F. No antibiotic required
Answer: C. Co-amoxiclav Justification: Immunosuppressed with severe or worsening sinusitis → bacterial cause → co-amoxiclav. Resource: NICE NG79. Sinusitis (acute): antimicrobial prescribing. 2017.
159
A 45-year-old swimmer has greyish-black ear discharge and itch after holiday in Spain. No response to antibiotics. What is the SINGLE MOST likely pathogen? A. Streptococcus B. Pseudomonas C. Aspergillus D. Candida E. Staphylococcus aureus
Answer: C. Aspergillus Justification: Fluffy black discharge post-swimming suggests fungal otitis externa (otomycosis), commonly Aspergillus. Resource: RCGP ENT Curriculum Topic Guide. 2019.
160
A 67-year-old with nasopharyngeal carcinoma is discussed. Which organism is MOST associated with this cancer? A. Human herpes virus 6 B. Hepatitis B C. HIV D. Epstein–Barr virus E. Helicobacter pylori
Answer: D. Epstein–Barr virus Justification: EBV is implicated in nasopharyngeal carcinoma and certain lymphomas. Resource: RCGP ENT Curriculum Topic Guide. 2019.
161
A 70-year-old woman has developed left-sided facial weakness following severe left ear pain. She's deaf in that ear and has tinnitus with some vertigo. Otoscopy reveals swelling and blistering of the canal. What is the SINGLE MOST likely condition she has? A. Bell’s palsy B. Cholesteatoma C. Lyme disease D. Necrotising otitis externa E. Ramsay Hunt syndrome
Answer: E. Ramsay Hunt syndrome Justification: Ramsay Hunt syndrome is an acute peripheral facial neuropathy associated with vesicular rash of the ear canal or oropharynx. May occur without rash (zoster sine herpete). Recovery <50%, unlike Bell’s palsy. Resource: RCGP Learning | Ramsay Hunt syndrome overview
162
A 2-year-old child presents with a 2-day history of ear tugging. Initially febrile but now settled. Bulging, inflamed tympanic membrane with no perforation. No pain/swelling behind ear. What is the SINGLE MOST appropriate management option? A. Urgent same-day referral to exclude mastoiditis B. Refer to audiology to test for hearing loss C. Topical antibiotic drops D. Flucloxacillin for 5 days E. Provide safety netting advice and advise analgesia
Answer: E. Provide safety netting advice and advise analgesia Justification: Acute otitis media without perforation often resolves spontaneously. Amoxicillin is first-line if needed, not flucloxacillin. Safety netting is appropriate. Resource: Wood MF, Jaroenchasri MR. Otorrhoea. InnovAiT 2024; 17(5): 230–234.
163
A 45-year-old man presents with worsening hearing in the left ear and some tinnitus. Rinne is normal, Weber lateralises to right ear. What is the SINGLE MOST likely diagnosis? A. Acoustic neuroma B. Cholesteatoma C. Eustachian tube dysfunction D. Impacted wax E. Otosclerosis
Answer: A. Acoustic neuroma Justification: Sensorineural hearing loss with Weber lateralising to the better ear suggests acoustic neuroma. Resource: NICE NG98. Hearing Loss in Adults.
164
A 32-year-old woman developed sudden hearing loss in her left ear 10 days ago. Otherwise well. Rinne shows AC > BC both ears, Weber loudest on right. What is the SINGLE MOST appropriate management? A. Reassure and review in six weeks B. Nasal corticosteroid C. Immediate emergency referral to ENT D. Oral decongestant E. Routine outpatient referral to audiology
Answer: C. Immediate emergency referral to ENT Justification: Sudden sensorineural hearing loss over ≤3 days within the last 30 days requires urgent ENT referral. Resource: NICE NG98. Hearing Loss in Adults.
165
A 9-year-old has a 1.5 cm midline cystic neck mass that moves on tongue protrusion and swallowing. No systemic symptoms. What is the SINGLE MOST appropriate management option? A. Routine referral to ENT for surgical excision B. Urgent ENT referral for incision and drainage C. Urgent referral to paediatrics D. Check FBC and TFTs E. Reassure the parent
Answer: A. Routine referral to ENT for surgical excision Justification: Typical of thyroglossal cyst – midline, mobile with tongue movement. Elective surgery prevents infection. Resource: Darr A, Hakim N. Neck lumps. InnovAiT 2018; 11(6): 322–329.
166
A 27-year-old with severe sore throat and odynophagia for 2 days. No visible throat abnormality. Tachycardic but stable. What is the SINGLE MOST appropriate management option? A. Routine ENT referral B. Phenoxymethylpenicillin C. NSAIDs D. Same-day ENT assessment E. Difflam spray
Answer: D. Same-day ENT assessment Justification: Suspected supraglottitis when severe sore throat occurs with a normal oropharynx. Can progress to airway compromise. Resource: Whittaker J, Jolly K. Supraglottitis. InnovAiT 2018; 11(6): 337–340.
167
A 68-year-old ex-smoker presents with 8-week history of unilateral sore throat. No exam findings. What is the SINGLE MOST appropriate management option? A. Routine ENT referral B. Oral phenoxymethylpenicillin C. Conservative management and review D. Trial of PPI E. Urgent ENT referral
Answer: E. Urgent ENT referral Justification: Persistent unilateral sore throat in older patient is red flag for oropharyngeal cancer. Resource: Watters C et al. Oropharyngeal cancer. InnovAiT 2020; 13(11): 650–654.
168
A 4-year-old girl has loud snoring, frequent sneezing, runny nose for 5 months. Chlorphenamine ineffective. Hx of asthma and eczema. Which corticosteroid nasal spray is MOST appropriate? A. Fluticasone (Flixonase®) B. Beclometasone (Beconase®) C. None D. Flunisolide (Syntaris®) E. Budesonide (Rhinocort Aqua®)
Answer: A. Fluticasone (Flixonase®) Justification: Only Fluticasone is licensed from age 4. Beclometasone from 6; Budesonide from 12. Resource: BNFC Treatment Summaries. Nose; RCGP Learning. Allergy.
169
A 53-year-old with recurrent ear infections, foul discharge. Exam shows retraction pocket in attic near tympanic membrane. What is the SINGLE MOST appropriate management? A. Surgical excision B. Microsuction C. Oral antibiotics D. Topical antibiotic drops E. Incision and drainage
Answer: A. Surgical excision Justification: Suggestive of cholesteatoma – non-malignant but locally destructive. Needs ENT surgical review. Resource: Payne T, Wong G. Hearing loss. InnovAiT 2022; 15(4): 218–225.
170
A 4-year-old with mild hearing loss for 1 month is diagnosed with otitis media with effusion. Mother asks about treatment. What is the SINGLE MOST appropriate management? A. No medication B. Ephedrine nasal drops C. Amoxicillin D. Beclometasone spray E. Cetirizine
Answer: A. No medication Justification: Cochrane reviews show little benefit for antihistamines, decongestants or steroids in OME. Monitor hearing. Resources: Cochrane Reviews (2011, 2016) on OME management.
171
A 39-year-old man has sudden-onset tinnitus for 9 hours. No regular medications. Which SINGLE additional symptom would require immediate referral? A. Ear pain B. Headache C. Hearing loss D. Vertigo E. Vesicular rash
Answer: D. Vertigo Justification: NICE advises immediate referral for tinnitus with acute vestibular symptoms, e.g. vertigo. Resource: NICE NG155. Tinnitus: assessment and management. 2020.
172
What infection is associated with laryngeal cancer? A. Hepatitis B B. HIV C. Covid-19 D. Human papilloma virus E. Hepatitis C
Answer: D. Human papilloma virus Justification: HPV increases risk for several head and neck cancers including laryngeal carcinoma. Resource: RCGP ENT Topic Guide.
173
15-year-old boy has sore throat, fever, no cough, and purulent tonsils. FeverPAIN score = 4. No allergies. What is the SINGLE MOST appropriate treatment? A. Pen V 250 mg qds for 5 days B. Pen V 500 mg qds for 3 days C. Pen V 500 mg qds for 10 days D. Pen V 500 mg qds for 14 days E. No treatment
Answer: C. Pen V 500 mg qds for 10 days Justification: NICE recommends 500 mg QDS for 5–10 days for severe tonsillitis symptoms. Resource: NICE NG84. Sore throat (acute).
174
A 4-year-old boy has a plastic bead in right ear canal. TM is perforated. What is the SINGLE MOST appropriate management? A. Blind removal B. Ear irrigation C. Urgent ENT referral D. Oral amoxicillin E. Olive oil drops
Answer: C. Urgent ENT referral Justification: Organic/foreign bodies with TM perforation → ENT required. No irrigation or blind removal. Resource: Wright O et al. Blocked ears. InnovAiT 2020.
175
Which feature of acute rhinosinusitis warrants same-day referral? A. Bilateral blood-stained nasal discharge B. Fever > 38.5°C C. Periorbital oedema D. Severe unilateral facial pain E. Conjunctival injection
Answer: C. Periorbital oedema Justification: Suggests orbital cellulitis → emergency ENT referral. Resource: NICE CKS. Sinusitis – complications. 2022.
176
45-year-old man has episodes of vertigo, tinnitus, fluctuating right ear hearing loss, and fullness. What is the SINGLE MOST likely diagnosis? A. Ménière’s disease B. Barotrauma C. Cholesteatoma D. Aminoglycosides E. Cephalosporins
Answer: A. Ménière’s disease Justification: Classic triad: vertigo, tinnitus, SNHL with aural fullness. Resource: RCGP ENT Topic Guide 2019.
177
46-year-old woman with 6-week swollen jaw. Mildly tender bilateral parotid swelling. Calcium 2.91, CRP 23. What is the SINGLE MOST likely cause? A. Sarcoidosis B. Bulimia nervosa C. Parotid tumour D. Mumps E. Alcohol dependence
Answer: A. Sarcoidosis Justification: Associated with bilateral parotid swelling and hypercalcaemia. Resource: Darr A et al. Neck lumps. InnovAiT 2018.
178
34-year-old man with 3-month history of nasal obstruction, discharge, no fever. Likely chronic rhinosinusitis. What is the SINGLE MOST appropriate management? A. Oral decongestants B. Intranasal corticosteroids C. Intranasal decongestants D. Oral corticosteroids E. Antibiotics
Answer: B. Intranasal corticosteroids Justification: First-line treatment for chronic rhinosinusitis. Resource: Dickson E, Hopkins C. Chronic rhinosinusitis. InnovAiT 2020.
179
A 33-year-old man has recurrent ulcers, past iritis, and HLA-B51 positive. What is the SINGLE MOST likely diagnosis? A. Behçet’s disease B. Pemphigus vulgaris C. Recurrent aphthous stomatitis D. Herpes simplex E. Stevens–Johnson syndrome
Answer: A. Behçet’s disease Justification: Multisystem vasculitis associated with HLA-B51 and recurrent ulcers. Resource: NHS; InnovAiT resources.
180
A 68-year-old man has painful intermittent swelling in right submandibular region triggered by eating. What is the SINGLE MOST likely diagnosis? A. Sialolithiasis B. Dental abscess C. Sialadenosis D. Sialadenitis E. Cervical lymphadenopathy
Answer: A. Sialolithiasis Justification: Stone obstructs salivary duct → pain and swelling during meals. Resource: Darr A et al. Neck lumps. InnovAiT 2018.

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