Otolaryngology (ENT) Prometric exam questions

The Otolaryngology (ENT) exam in every GCC country

From each regulator's own exam pages; anything a regulator does not publish says so. Assessment mode also depends on your licence title, so confirm your route on your eligibility notice.

12 worked Otolaryngology (ENT) practice questions

Original exam-style questions from the bank, spread across the blueprint domains. They are not real or recalled exam questions. Try each one, then open the answer for the rationale and reference. None of them appear in the free mock exam, so reading them will not spoil it.

1. Question 1 · General Otology & Otoneurology

   A 26-year-old recent migrant with weight loss and a chronic cough has 3 months of painless, profuse ear discharge unresponsive to repeated topical and oral antibiotics. Otomicroscopy shows multiple tympanic membrane perforations with pale granulation tissue, and there is a sensorineural component to the hearing loss with early facial weakness. What is the most likely diagnosis?

   1. ATuberculous otitis media
   2. BNecrotising otitis externa
   3. CCholesteatoma with facial nerve erosion
   4. DLangerhans cell histiocytosis of the temporal bone
   Show answer and explanation

   Correct answer: A. Tuberculous otitis media

   Painless profuse otorrhoea refractory to antibiotics, multiple perforations, pale abundant granulation, disproportionate sensorineural loss and early facial palsy in a patient with systemic features of tuberculosis constitute the classic picture of tuberculous otitis media, confirmed by acid-fast staining, culture or nucleic acid amplification and tissue biopsy. Necrotising otitis externa is intensely painful and centred on canal skin in the diabetic or immunocompromised. Cholesteatoma gives scanty offensive discharge with a single attic or marginal defect, and Langerhans cell histiocytosis typically presents with a destructive lytic mass and postauricular swelling in a young child.

   Reference: Scott-Brown's Otorhinolaryngology, Head and Neck Surgery, 8th edition (2018), specific and granulomatous infections of the ear

2. Question 2 · Head & Neck Oncology and Reconstruction

   Eight hours after a radial forearm free flap reconstruction of a tongue defect, the flap is dusky blue and swollen, capillary refill is brisk at under one second, and pinprick produces immediate dark bleeding. What is the most appropriate action?

   1. AImmediate return to theatre for exploration of the pedicle
   2. BObserve for a further 12 hours with hourly flap checks
   3. CStart a therapeutic heparin infusion and continue observation
   4. DWarm the patient, elevate the head of the bed and review in the morning
   Show answer and explanation

   Correct answer: A. Immediate return to theatre for exploration of the pedicle

   A blue, swollen flap with rapid capillary refill and brisk dark bleeding on pinprick is classic venous congestion, usually caused by venous anastomotic thrombosis, pedicle kinking or compression by a haematoma, and salvage rates fall steeply with every hour of delay, so immediate re-exploration is the standard of care. Anticoagulation alone cannot relieve a mechanical obstruction, and observation or positional measures waste the narrow salvage window; arterial insufficiency by contrast produces a pale, cool flap with sluggish refill and no bleeding on pinprick.

   Reference: Cummings Otolaryngology - Head and Neck Surgery, 7th edition, 2021 (free tissue transfer monitoring and salvage)

3. Question 3 · Pediatric Otolaryngology

   An 8-year-old has fluctuating, stepwise progressive bilateral sensorineural hearing loss that worsens after minor head knocks in sport. CT of the temporal bones shows a vestibular aqueduct with a midpoint diameter of 2 mm bilaterally and incomplete partition type II. Which additional finding would most support the diagnosis of Pendred syndrome?

   1. AHeterochromia iridis and a white forelock
   2. BPreauricular pits with branchial fistulae and renal dysplasia
   3. CProgressive night blindness with reduced electroretinogram amplitudes
   4. DAn abnormal perchlorate discharge test or euthyroid goitre developing around puberty
   Show answer and explanation

   Correct answer: D. An abnormal perchlorate discharge test or euthyroid goitre developing around puberty

   Pendred syndrome results from biallelic SLC26A4 mutations and combines enlarged vestibular aqueduct or incomplete partition type II with a partial iodine organification defect, giving a positive perchlorate discharge test and a euthyroid or hypothyroid goitre that typically appears in late childhood or adolescence. Heterochromia and a white forelock indicate Waardenburg syndrome, retinitis pigmentosa indicates Usher syndrome, and preauricular pits with branchial fistulae and renal anomalies indicate branchio-oto-renal syndrome. Children with enlarged vestibular aqueduct should be counselled to avoid head trauma and contact sports.

   Reference: Scott-Brown's Otorhinolaryngology, Head and Neck Surgery, 8th edition (2018), Paediatric hearing loss; Cummings Otolaryngology, 7th edition (2021)

4. Question 4 · Audiology, Vestibular Assessment & Speech-Language Pathology

   A 46-year-old woman has an anacusic (dead) right ear following translabyrinthine removal of a vestibular schwannoma. Hearing in the left ear is normal. On tuning fork testing the Weber lateralises to the left, but on the right the fork is reported as louder on the mastoid than at the meatus. What is the correct interpretation and next step?

   1. AA false-negative (false conductive) Rinne from cross-hearing by the left cochlea; repeat with masking noise in the left ear
   2. BA genuine right conductive loss has developed; arrange a CT of the temporal bone
   3. CThe Weber result is erroneous; repeat using a 256 Hz fork
   4. DA right ossicular discontinuity is present; proceed to exploratory tympanotomy
   Show answer and explanation

   Correct answer: A. A false-negative (false conductive) Rinne from cross-hearing by the left cochlea; repeat with masking noise in the left ear

   Bone conduction has almost no interaural attenuation, so a fork placed on the mastoid of a dead ear is heard by the opposite normal cochlea, producing a falsely negative Rinne; the Weber lateralising away from the dead ear confirms the ear is anacusic rather than conductive. Masking the non-test ear (Barany noise box or narrow-band noise) abolishes the response and exposes the artefact. Imaging or tympanotomy for a non-existent conductive lesion is inappropriate, and changing the fork frequency does not remove cross-hearing.

   Reference: Cummings Otolaryngology - Head and Neck Surgery, 7th edition (2021), chapter on audiologic assessment

5. Question 5 · Skull Base, Orbit & Endoscopic Skull Base Surgery

   A patient undergoes resection of an anterior cranial base malignancy leaving a large dural defect with high-flow CSF egress. The septum, including both nasoseptal flap pedicles, was resected with the tumour. Which is the most appropriate vascularised reconstruction?

   1. AFree middle turbinate mucosal graft alone
   2. BPedicled extracranial pericranial flap transposed through a small anterior craniotomy/glabellar corridor
   3. CAbdominal fat obliteration of the nasal cavity alone
   4. DSplit-thickness skin graft over the dural defect
   Show answer and explanation

   Correct answer: B. Pedicled extracranial pericranial flap transposed through a small anterior craniotomy/glabellar corridor

   When the nasoseptal flap is unavailable, the pedicled pericranial flap (supplied by the supratrochlear and supraorbital vessels) provides a large, robust vascularised sheet ideally suited to anterior cranial base defects and can be delivered endonasally through a glabellar or nasionectomy corridor. Free mucosal grafts, fat alone and skin grafts are avascular or unsupported reconstructions with unacceptably high failure rates for high-flow anterior fossa defects.

   Reference: Zanation A et al, Am J Rhinol Allergy 2009; ICAR: Endoscopic Skull Base Surgery (2019)

6. Question 6 · Applied Basic Sciences, Imaging, Pharmacology & Perioperative Care

   A 63-year-old man with non-valvular atrial fibrillation (CHA2DS2-VASc 3) takes apixaban 5 mg twice daily. His creatinine clearance is 82 mL/min. He is listed for elective septoplasty with inferior turbinate reduction, a procedure of high bleeding risk. What is the most appropriate perioperative plan?

   1. AContinue apixaban throughout the perioperative period without interruption
   2. BStop apixaban 48 hours before surgery with no heparin bridging
   3. CStop apixaban 5 days before surgery and bridge with therapeutic low-molecular-weight heparin
   4. DConvert to warfarin 2 weeks preoperatively and aim for an INR below 1.5 on the day
   Show answer and explanation

   Correct answer: B. Stop apixaban 48 hours before surgery with no heparin bridging

   For a direct oral anticoagulant in a patient with normal or near-normal renal function, a high-bleeding-risk procedure requires interruption for approximately 48 hours (about two days, or roughly 4-5 half-lives) with no bridging, since DOACs have a rapid onset and offset that makes heparin bridging unnecessary and demonstrably harmful. Continuing apixaban through a high-bleeding-risk nasal procedure risks significant haemorrhage. Five days of interruption and therapeutic bridging is a warfarin-era strategy that the PAUSE study showed increases bleeding without reducing thromboembolism, and switching to warfarin adds risk with no benefit.

   Reference: Douketis et al., PAUSE study, JAMA Internal Medicine (2019); ACC 2017 Expert Consensus Decision Pathway on Periprocedural Management of Anticoagulation

7. Question 7 · Sleep-Disordered Breathing & Snoring Surgery

   A surgeon plans an expansion sphincter pharyngoplasty for a patient whose drug-induced sleep endoscopy shows predominantly lateral oropharyngeal wall collapse. Which statement correctly describes the technical basis of this operation?

   1. AThe palatopharyngeus muscle is transected and transposed supero-laterally into the soft palate to splint and widen the lateral pharyngeal wall
   2. BThe uvula and the whole posterior tonsillar pillar are excised and the raw edges closed in the midline to shorten the palate
   3. CRadiofrequency energy is delivered submucosally to the soft palate to stiffen it by scar contracture
   4. DThe hyoid bone is suspended anteriorly to the thyroid cartilage to open the retrolingual airway
   Show answer and explanation

   Correct answer: A. The palatopharyngeus muscle is transected and transposed supero-laterally into the soft palate to splint and widen the lateral pharyngeal wall

   Expansion sphincter pharyngoplasty, described by Pang and Woodson, involves tonsillectomy, transection of the palatopharyngeus muscle and its supero-lateral rotation and suture into the soft palate, thereby tensioning and lateralising the pharyngeal wall - the correct target when collapse is lateral rather than anteroposterior. Simple resection of the uvula and midline closure describes classical uvulopalatopharyngoplasty, which mainly addresses the retropalatal anteroposterior dimension. Radiofrequency palatal stiffening is an office-based procedure for snoring, and hyoid suspension is a retrolingual, not a lateral wall, procedure.

   Reference: Pang KP, Woodson BT. Expansion sphincter pharyngoplasty: a new technique for the treatment of obstructive sleep apnea. Otolaryngol Head Neck Surg 2007;137:110-4

8. Question 8 · Rhinology, Sinonasal Disorders & Allergy

   Thirty minutes after endoscopic ethmoidectomy the patient has a tense proptotic eye, a rock-hard globe, a fixed dilated pupil and rising intraocular pressure. What is the immediate priority?

   1. ALateral canthotomy with inferior cantholysis to decompress the orbit
   2. BUrgent CT orbits before any intervention
   3. CIntravenous mannitol and observation overnight
   4. DRepacking the nose to tamponade the bleeding
   Show answer and explanation

   Correct answer: A. Lateral canthotomy with inferior cantholysis to decompress the orbit

   This is a retrobulbar haematoma, a sight-threatening emergency in which retinal perfusion is lost within roughly 60-90 minutes, so immediate orbital decompression by lateral canthotomy and inferior cantholysis takes precedence, with ophthalmology involvement and subsequent control of the bleeding vessel (often a retracted anterior ethmoidal artery). Waiting for imaging or relying on medical therapy alone wastes critical time, and packing the nose raises orbital pressure further rather than relieving it.

   Reference: International Consensus Statement on Allergy and Rhinology: Rhinosinusitis (ICAR-RS) 2021; Cummings Otolaryngology, 7th edition (2021)

9. Question 9 · Laryngology, Voice, Swallowing & Airway

   During a right hemithyroidectomy the surgeon cannot identify a recurrent laryngeal nerve in the tracheo-oesophageal groove, but finds a nerve entering the larynx directly from laterally after arising from the vagus at the level of the thyroid gland. Which anatomical anomaly is most strongly associated with this finding?

   1. AA right-sided aortic arch with mirror-image branching
   2. BAn aberrant right subclavian artery arising from the descending aorta
   3. CA persistent left superior vena cava
   4. DA patent ductus arteriosus
   Show answer and explanation

   Correct answer: B. An aberrant right subclavian artery arising from the descending aorta

   A non-recurrent laryngeal nerve occurs in roughly 0.5-1% of right sides and results from an aberrant right subclavian artery (arteria lusoria) arising from the descending aorta, so the fourth arch derivative that normally loops the nerve is absent. A right-sided arch is associated with the far rarer left non-recurrent nerve rather than the classical right-sided one. Persistent left superior vena cava and patent ductus arteriosus do not alter the recurrent nerve's course; indeed a patent or ligated ductus keeps the left nerve recurrent.

   Reference: Cummings Otolaryngology - Head and Neck Surgery, 7th edition (2021), thyroid surgery and laryngeal neuroanatomy chapters

10. Question 10 · ENT Emergencies, Trauma & Critical Airway

    A cyclist strikes a rope stretched across a path at neck level. He arrives with severe subcutaneous emphysema of the neck and chest, a loss of the normal laryngeal contour, hoarseness and worsening respiratory distress. Laryngotracheal separation is suspected. What is the safest way to secure his airway?

    1. ARapid sequence induction and orotracheal intubation over a bougie
    2. BNeedle cricothyroidotomy followed by jet ventilation
    3. CSupraglottic airway insertion with spontaneous ventilation until CT is completed
    4. DAwake tracheostomy under local anaesthesia, placed low in the neck distal to the injury
    Show answer and explanation

    Correct answer: D. Awake tracheostomy under local anaesthesia, placed low in the neck distal to the injury

    In suspected laryngotracheal separation, blind passage of a tube can push the distal trachea away from the larynx and create a completely lost airway, so an awake tracheostomy under local anaesthesia placed low and distal to the injury (ideally with the patient sitting and breathing spontaneously) is the safest option. Rapid sequence induction removes spontaneous ventilation in a potentially unintubatable airway, cricothyroidotomy enters at or above the level of injury and jet ventilation aggravates surgical emphysema and pneumomediastinum, and a supraglottic airway cannot ventilate past a disrupted airway.

    Reference: Cummings Otolaryngology - Head and Neck Surgery, 7th ed. (2021), Laryngeal and tracheal trauma; Scott-Brown's Otorhinolaryngology, 8th ed. (2018)

11. Question 11 · Thyroid, Parathyroid & Salivary Glands

    A 38-year-old woman has a biopsy-proven unifocal 1.5 cm papillary thyroid carcinoma confined to the right lobe. There is no extrathyroidal extension, no sonographically abnormal lymph node, no history of head and neck irradiation and no family history of thyroid cancer. Which surgical plan is most consistent with current guidance?

    1. ATotal thyroidectomy with prophylactic bilateral central neck dissection in all cases
    2. BTotal thyroidectomy followed by routine radioiodine ablation
    3. CThyroid lobectomy and isthmusectomy
    4. DTotal thyroidectomy with ipsilateral modified radical neck dissection
    Show answer and explanation

    Correct answer: C. Thyroid lobectomy and isthmusectomy

    For a unifocal, intrathyroidal papillary carcinoma between 1 and 4 cm without extrathyroidal extension or nodal disease, lobectomy alone is an accepted initial operation with oncological outcomes equivalent to total thyroidectomy and lower rates of hypoparathyroidism and bilateral nerve injury. Prophylactic central neck dissection is not routinely indicated in clinically node-negative low-risk disease, and routine radioiodine is not recommended for low-risk tumours. An elective lateral neck dissection is never appropriate in the absence of proven lateral nodal metastases.

    Reference: American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer (Haugen et al., Thyroid 2016)

12. Question 12 · Skull Base, Orbit & Endoscopic Skull Base Surgery

    Four years after radical chemoradiotherapy for nasopharyngeal carcinoma, a patient has foul-smelling nasal discharge, exposed necrotic clivus on endoscopy and two episodes of self-limiting brisk epistaxis. Imaging shows no recurrent tumour. What is the most important immediate step?

    1. AUrgent CT angiography or catheter angiography to exclude an internal carotid artery pseudoaneurysm
    2. BAnterior nasal packing with routine outpatient review in 6 weeks
    3. CTopical antibiotics and saline irrigation alone
    4. DHyperbaric oxygen therapy as the sole intervention
    Show answer and explanation

    Correct answer: A. Urgent CT angiography or catheter angiography to exclude an internal carotid artery pseudoaneurysm

    Sentinel epistaxis in a patient with post-irradiation skull base osteoradionecrosis is a warning sign of impending carotid blowout, and urgent vascular imaging with a view to endovascular stenting or occlusion is life-saving. Packing, irrigation or hyperbaric oxygen do not address the vascular risk, and delaying investigation may result in fatal haemorrhage; endoscopic debridement and vascularised flap coverage follow once the carotid has been assessed.

    Reference: Chen HJ et al, Head & Neck (skull base osteoradionecrosis and carotid blowout series); NCCN Guidelines, Head and Neck Cancers (2024)

Otolaryngology (ENT) reference books and guidelines

Every question in this bank names the textbook or guideline its answer rests on. These are the sources our Otolaryngology (ENT) questions cite most often - the reading list to revise from alongside the bank.

Where your regulator publishes a reading list, use the editions it names. Exam questions are not taken from any one book.