Otolaryngology (ENT) Prometric exam questions with answers

1. Question 1General Otology & Otoneurologymedium

   A 74-year-old man with poorly controlled type 2 diabetes has 6 weeks of severe otalgia, worse at night, and otorrhoea despite topical drops. There is granulation tissue on the floor of the external canal at the bony-cartilaginous junction, and CT shows erosion of the adjacent skull base. What is the most appropriate treatment?

   1. AA 7-day course of topical quinolone drops with aural toilet
   2. BRadical mastoidectomy as the primary treatment
   3. CProlonged systemic antipseudomonal antibiotics with tight glucose control
   4. DOral corticosteroids to reduce canal oedema
   Show answer and explanation▾

   Answer: C. Prolonged systemic antipseudomonal antibiotics with tight glucose control

   This is necrotising (malignant) otitis externa, a skull base osteomyelitis usually caused by Pseudomonas aeruginosa in elderly diabetic or immunocompromised patients. Treatment is prolonged systemic antipseudomonal therapy, such as ciprofloxacin or an intravenous antipseudomonal beta-lactam, typically for at least 6 weeks guided by culture, with strict glycaemic control and biopsy to exclude malignancy. Topical drops alone are inadequate, and surgery is limited to debridement or biopsy.

2. Question 2General Otology & Otoneurologyeasy

   A 34-year-old woman has progressive bilateral hearing loss that worsened during pregnancy. Otoscopy is normal. Audiometry shows a conductive hearing loss with a dip in bone conduction thresholds centred at 2 kHz, and stapedial reflexes are absent. What is the most likely diagnosis?

   1. AOtosclerosis
   2. BOtitis media with effusion
   3. COssicular discontinuity
   4. DSuperior semicircular canal dehiscence
   Show answer and explanation▾

   Answer: A. Otosclerosis

   A bone conduction dip around 2 kHz (Carhart notch) with conductive loss, a normal tympanic membrane, absent stapedial reflexes and worsening in pregnancy is characteristic of otosclerosis. Otitis media with effusion shows an abnormal tympanic membrane and a flat tympanogram. Superior canal dehiscence produces an apparent conductive loss with supranormal bone conduction and preserved stapedial reflexes.

3. Question 3Audiology, Vestibular Assessment & Speech-Language Pathologyeasy

   A 62-year-old woman has brief episodes of rotatory vertigo lasting under a minute when turning over in bed. On right Dix-Hallpike testing, after a few seconds' latency, she develops upbeating torsional nystagmus with the upper pole beating towards the right ear, which fatigues within 30 seconds. What is the most appropriate treatment?

   1. AA vestibular sedative such as prochlorperazine for 2 weeks
   2. BLempert (barbecue) roll manoeuvre
   3. CSemont manoeuvre for the left ear
   4. DEpley repositioning manoeuvre for the right ear
   Show answer and explanation▾

   Answer: D. Epley repositioning manoeuvre for the right ear

   Upbeating torsional nystagmus with latency and fatigability on right Dix-Hallpike testing indicates right posterior canal BPPV, the commonest type, which is treated with the Epley canalith repositioning manoeuvre (or a Semont manoeuvre) for the affected right side. The Lempert roll manoeuvre is used for horizontal canal BPPV. Vestibular sedatives do not treat the cause and delay central compensation.

4. Question 4Rhinology, Sinonasal Disorders & Allergyhard

   A 24-year-old immunocompetent man with asthma has unilateral nasal obstruction and polyps. CT shows expansion of the left ethmoid and maxillary sinuses with heterogeneous high-attenuation contents and thinning of the lamina papyracea. MRI shows central T2 signal voids, and total IgE is markedly raised. What is the most appropriate management?

   1. AIntravenous liposomal amphotericin B and urgent radical debridement
   2. BEndoscopic sinus surgery to clear eosinophilic mucin, then corticosteroid therapy
   3. CLong-term oral itraconazole as the sole treatment
   4. DBiopsy to exclude malignancy, followed by radiotherapy
   Show answer and explanation▾

   Answer: B. Endoscopic sinus surgery to clear eosinophilic mucin, then corticosteroid therapy

   These features are typical of allergic fungal rhinosinusitis, a non-invasive hypersensitivity disease with eosinophilic mucin, hyperdense sinus contents on CT and signal voids on T2-weighted MRI. Treatment is complete endoscopic removal of the mucin and polyps with wide drainage, followed by topical and often systemic corticosteroids to reduce recurrence. Systemic antifungals with radical debridement are for invasive fungal sinusitis in immunocompromised patients, and antifungals alone do not clear the disease.

5. Question 5Skull Base, Orbit & Endoscopic Skull Base Surgerymedium

   A 15-year-old boy has unilateral nasal obstruction and recurrent heavy epistaxis. Endoscopy shows a smooth, lobulated, red mass in the posterior nasal cavity near the sphenopalatine foramen. What is the most appropriate next step?

   1. AContrast-enhanced CT and MRI, avoiding biopsy
   2. BOutpatient punch biopsy under local anaesthesia
   3. CNasal cautery and review in 6 weeks
   4. DA trial of intranasal corticosteroid spray
   Show answer and explanation▾

   Answer: A. Contrast-enhanced CT and MRI, avoiding biopsy

   The presentation strongly suggests juvenile nasopharyngeal angiofibroma, a highly vascular tumour arising near the sphenopalatine foramen in adolescent males. The diagnosis is made on contrast imaging, which shows an enhancing mass widening the pterygopalatine fossa with anterior bowing of the posterior maxillary wall (Holman-Miller sign). Biopsy is avoided because it can cause life-threatening haemorrhage, and treatment is usually endoscopic resection, often after preoperative embolisation.

6. Question 6Laryngology, Voice, Swallowing & Airwaymedium

   A 78-year-old man has progressive dysphagia, regurgitation of undigested food several hours after eating, halitosis and gurgling in the neck. He has had recurrent chest infections. Which is the most appropriate initial investigation?

   1. ARigid oesophagoscopy under general anaesthesia
   2. BHigh-resolution oesophageal manometry
   3. CContrast swallow study
   4. DLaryngeal electromyography
   Show answer and explanation▾

   Answer: C. Contrast swallow study

   The symptoms suggest a pharyngeal pouch (Zenker diverticulum) protruding through Killian dehiscence between the thyropharyngeus and cricopharyngeus. A contrast swallow is the safest first investigation and shows the pouch and its size. Early endoscopy risks perforating the pouch, and manometry is not needed for diagnosis; symptomatic pouches are commonly treated by endoscopic stapling or division of the cricopharyngeal bar.

7. Question 7Head & Neck Oncology and Reconstructionhard

   A 58-year-old woman has a biopsy-proven squamous cell carcinoma of the lateral oral tongue measuring 1.8 cm in greatest dimension, with a depth of invasion of 7 mm. There is no bone or skin involvement. Under the AJCC 8th edition, what is the clinical T category?

   1. AT1
   2. BT3
   3. CT4a
   4. DT2
   Show answer and explanation▾

   Answer: D. T2

   AJCC 8th edition incorporates depth of invasion for oral cavity cancer: T1 is 2 cm or less with depth of 5 mm or less, while T2 is 2 cm or less with depth over 5 mm and up to 10 mm, or more than 2 cm and up to 4 cm with depth of 10 mm or less. A 1.8 cm tumour with 7 mm depth is therefore T2. T3 requires a tumour over 4 cm or depth over 10 mm, and T4a requires invasion of adjacent structures such as cortical bone or skin.

8. Question 8Head & Neck Oncology and Reconstructionmedium

   A 45-year-old man of southern Chinese origin has 2 months of a blocked feeling in the right ear. Otoscopy shows a dull, retracted tympanic membrane with an air-fluid level, and tympanometry is flat on the right only. He has had no recent upper respiratory infection. What is the most appropriate next step?

   1. AInsert a ventilation tube and discharge
   2. BEndoscopic examination of the nasopharynx
   3. CA course of oral antibiotics and nasal decongestant
   4. DReassure and repeat tympanometry in 3 months
   Show answer and explanation▾

   Answer: B. Endoscopic examination of the nasopharynx

   New unilateral otitis media with effusion in an adult requires examination of the nasopharynx to exclude a tumour obstructing the Eustachian tube, particularly nasopharyngeal carcinoma in high-risk populations, with biopsy and EBV testing if a lesion is seen. Inserting a grommet without assessing the nasopharynx risks missing the cancer. Antibiotics and decongestants are ineffective for effusion and also delay diagnosis.

9. Question 9Thyroid, Parathyroid & Salivary Glandsmedium

   A 42-year-old woman has a slowly enlarging, painless, mobile 2.5 cm mass in the tail of the right parotid. Facial nerve function is normal. Ultrasound-guided core biopsy confirms a pleomorphic adenoma confined to the superficial lobe. What is the most appropriate treatment?

   1. AEnucleation of the tumour through a small incision
   2. BRadiotherapy to the parotid bed
   3. CObservation with annual ultrasound
   4. DSuperficial or partial parotidectomy with facial nerve preservation
   Show answer and explanation▾

   Answer: D. Superficial or partial parotidectomy with facial nerve preservation

   Pleomorphic adenomas have an incomplete pseudocapsule with finger-like extensions, so enucleation leaves tumour behind and causes multinodular recurrence that is difficult to treat. Standard treatment is superficial or partial parotidectomy (or extracapsular dissection with a cuff of normal tissue for selected small superficial tumours) with identification and preservation of the facial nerve. Observation allows continued growth with a small lifetime risk of malignant transformation, and radiotherapy is not primary treatment for a benign tumour.

10. Question 10Thyroid, Parathyroid & Salivary Glandshard

    A 38-year-old man has a 2 cm thyroid nodule. Fine-needle aspiration cytology suggests medullary thyroid carcinoma and serum calcitonin is markedly raised. Before thyroidectomy, which investigation is essential?

    1. APlasma free or urinary fractionated metanephrines
    2. BSerum thyroglobulin
    3. CRadioactive iodine uptake scan
    4. DThyroid peroxidase antibodies
    Show answer and explanation▾

    Answer: A. Plasma free or urinary fractionated metanephrines

    All patients with medullary thyroid carcinoma should have germline RET testing and be screened for phaeochromocytoma before surgery, because MEN2 may be present and an undiagnosed phaeochromocytoma can cause a fatal hypertensive crisis during anaesthesia; if found, it is removed first. Serum calcium, calcitonin and CEA are also checked. Thyroglobulin and radioiodine are irrelevant because medullary carcinoma arises from parafollicular C cells, which do not concentrate iodine.

11. Question 11Pediatric Otolaryngologyeasy

    A 6-week-old infant has had intermittent high-pitched inspiratory stridor since 2 weeks of age, worse when feeding, crying and lying supine. She is feeding well and gaining weight, with no cyanosis or apnoea. Flexible laryngoscopy shows an omega-shaped epiglottis, short aryepiglottic folds and inspiratory prolapse of the arytenoid mucosa. What is the most appropriate management?

    1. ASupraglottoplasty
    2. BTracheostomy
    3. CReassurance and observation with regular review
    4. DLong-term nasal CPAP
    Show answer and explanation▾

    Answer: C. Reassurance and observation with regular review

    This is laryngomalacia, the commonest cause of stridor in infants, and mild cases without feeding difficulty, poor weight gain, apnoea or cyanosis usually resolve by 12 to 24 months, so reassurance and monitoring of growth are appropriate. Supraglottoplasty is reserved for severe disease with failure to thrive, apnoea or cor pulmonale. Tracheostomy and CPAP are rarely needed.

12. Question 12ENT Emergencies, Trauma & Critical Airwaymedium

    A 3-year-old boy swallowed a 20 mm button battery 1 hour ago. He is drooling but has a patent airway. A chest radiograph shows a round radiopaque object with a double-ring (halo) contour at the level of the upper oesophagus. What is the most appropriate management?

    1. ARepeat the radiograph in 24 hours to see if it passes
    2. BEmergency endoscopic removal, giving honey while awaiting theatre
    3. CAdmission and a laxative to hasten passage
    4. DElective endoscopy on the next available list
    Show answer and explanation▾

    Answer: B. Emergency endoscopic removal, giving honey while awaiting theatre

    An oesophageal button battery is a surgical emergency because hydroxide generated at the negative pole causes liquefactive necrosis within 2 hours, with risks of perforation, tracheo-oesophageal fistula and aorto-oesophageal fistula. Emergency endoscopic removal is required; in children over 1 year seen within 12 hours of ingestion, honey given while awaiting removal (or sucralfate in hospital) can reduce injury. Observation or delayed endoscopy is never appropriate for an oesophageal battery.

13. Question 13Sleep-Disordered Breathing & Snoring Surgeryhard

    A 52-year-old man with moderate-to-severe obstructive sleep apnoea who cannot tolerate CPAP is being assessed for hypoglossal nerve stimulation. His BMI and apnoea-hypopnoea index are within approved criteria. Which finding on drug-induced sleep endoscopy would exclude him from implantation?

    1. AComplete concentric collapse at the velum
    2. BAnteroposterior collapse at the velum
    3. CPartial collapse at the tongue base
    4. DPartial anteroposterior epiglottic collapse
    Show answer and explanation▾

    Answer: A. Complete concentric collapse at the velum

    Complete concentric collapse at the velopharynx predicts poor response to hypoglossal nerve stimulation and is an exclusion criterion, because tongue protrusion does not open a circumferentially collapsing palate. Anteroposterior velar collapse responds well because anterior tongue movement pulls the soft palate forward. Partial tongue base collapse is a favourable pattern, and the other selection criteria are the AHI range, BMI limit and CPAP failure or intolerance.

14. Question 14Applied Basic Sciences, Imaging, Pharmacology & Perioperative Caremedium

    A 30-year-old woman with cystic fibrosis needs intravenous aminoglycoside therapy. Her mother and maternal uncle both developed profound hearing loss after short courses of gentamicin. Which genetic finding most likely explains this family history?

    1. AAutosomal recessive GJB2 (connexin 26) mutation
    2. BAutosomal dominant COCH mutation
    3. CX-linked POU3F4 mutation
    4. DMaternally inherited mitochondrial MT-RNR1 m.1555A>G variant
    Show answer and explanation▾

    Answer: D. Maternally inherited mitochondrial MT-RNR1 m.1555A>G variant

    The m.1555A>G variant in the mitochondrial 12S ribosomal RNA gene (MT-RNR1) makes the mitochondrial ribosome resemble its bacterial counterpart, so aminoglycosides bind it and cause profound cochlear damage even at therapeutic levels. Mitochondrial DNA is inherited from the mother, explaining involvement of the mother and her brother, and testing before aminoglycoside exposure allows an alternative antibiotic to be chosen. GJB2 mutations cause congenital non-syndromic hearing loss unrelated to aminoglycosides.

15. Question 15Professionalism, Ethics, Communication & Patient Safetyeasy

    You are consenting a 28-year-old man for elective tonsillectomy for recurrent tonsillitis. Which approach best meets the modern legal and ethical standard for informed consent?

    1. ADisclose only complications occurring in more than 1 in 100 patients
    2. BDisclose the risks that most surgeons would routinely mention
    3. CDisclose material risks a reasonable patient would consider significant, including haemorrhage
    4. DAvoid discussing serious but rare risks to prevent unnecessary anxiety
    Show answer and explanation▾

    Answer: C. Disclose material risks a reasonable patient would consider significant, including haemorrhage

    Current consent standards are patient-centred: clinicians must disclose material risks that a reasonable person in the patient's position, or this particular patient, would consider significant, together with reasonable alternatives including non-surgical management. Post-tonsillectomy haemorrhage is a well-recognised and potentially serious risk that must be discussed. Fixed percentage thresholds or what other surgeons usually disclose are no longer sufficient, and withholding serious rare risks is justified only in exceptional circumstances.

Last reviewed September 2026. Questions are original and written to the published exam blueprint; they are not taken from any real paper.