ENT PAST PAPERS

MULTIPLE CHOICE QUESTIONS

1. What is a disadvantage of BERA?
a. Cost
b. Logistics
c. Doesn't work in low sounds
2. 70-year-old lady with progressive hearing loss in both ears?
a. Presbycusis
b. Otosclerosis
3. Indications for surgery in chronic otitis media?
a. Cholesteatoma
b. Injury to ossicular chain
4. A man who has worked in jet airplane profession for 20 years, concerned about
hearing loss and low serviceable hearing, what do you do?
a. Quit
b. Change nature of job
c. Hearing aids
5. 70-year-old, bilateral narrowing of external auditory meatus? Tinnitus, pain
occasionally and hearing loss?
a. Wax
b. Bilateral Otitis Externa
c. OME
6. Plummer Wilson syndrome, what is the best way to treat this condition?
a. Administer iron and check serum iron
b. Administer iron and check Hb levels
7. Mastoidectomy complication?
a. Facial nerve damage
b. Ossicular chain damage
8. What do you ask in consent before diathermy?
a. Prolonged pain
b. Secondary hemorrhage?
9. Most common cause of facial nerve paralysis?
a. Bell’s Palsy
b. Iatrogenic
 ENT PAST PAPERS

10. Most common cause of candidiasis in children?

a. Chronic malnourishment – Immunodeficiency is the most common cause
11. Why do you remove hyoid bone in Thyroglossal cyst?
a. To prevent recurrence
12. Caldwell Luc's is good for? 13. Swelling in the neck, swelling in the groin? What do
you do as primary investigation? 14. Rhinosinusitis with hyperemic membrane and
proptosis, what do you do as an investigation?
a. CT scan
b. X ray
13. Frequent flier, how to do prevent deafness? Don’t sleep during descent, Valsalva+
grommet 16. Most common cause of buccal mucosa cancer?
a. Betel Nut
b. Tobacco
c. Smoking
14. How do you know that it is retropharyngeal?
a. X ray
15. Mass behind Pharyngeal wall, cervical TB, what to do next?
a. ATT and C/S Zeil-nelson stain
16. Indication for tonsillectomy?- Unilateral tonsillar enlargement
a. Unilateral turbinate enlargement
b. DNS.
17. Pregnant lady, dizziness, MCC?
a. Iron deficiency anemia
18. Why septoplasty over SMR?
a. Conservation
b. Less complications
19. Quinsy, long term management?
a. Incisional drainage
b. Parenteral Antibiotics?
20. Ludwig's angina, critical indication in management?
a. Parenteral Abx?
b. Tracheostomy
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21. Recurrent epistaxis and crusting in a child? Long term management?

a. Don't pick nose
b. Cautery
c. Antihistamines
22. Nasopharyngeal Angiofibroma, what is the best investigation?
a. CT with contrast
23. Immediate complication of septal hematoma?
a. Septal abscess
24. Long term complication of auricular hematoma?
a. Auricular deformity
25. Child with recurrent epistaxis, long term treatment?
a. Cautery
b. stop nose picking
26. Incidental finding of DNS for a person applying for govt job, what would you do as
a medical officer.
a. document findings and ignore
b. check if symptoms for throat and ear,
c. Tell him to go see an ENT if symptoms appear
27. Most common cause for decreased sense of smell in our population:
a. gross DNS,
b. bilateral nasal polyps,
c. pregnancy
28. Tracheostomy in our setting, most common indication:
a. Assist in ventilatory
b. Before head and neck surgery
c. Maintenance of GA
29. Preauricular sinus most commonly presents as:
a. hole at helix
b. hole with pus
c. asymptomatic
30. Drawback of cochlear implant:
a. surgical expertise needed
31. FNACE is preferred because:
a. least painful,
b. high sensitivity and specificity
c. limits spread of disease
32. What is the most common cause of tympanic perforation in our setting?
a. Slap
b. RTA
c. Gunshot wound
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33. Coin in trachea/esophagus (don't remember exactly) of a child, what to do:

a. Rigid endoscopic removal
34. Soft meat bolus stuck after man tried to hurriedly eat food and has dysphagia now,
what is the immediate action you will take
a. Endotracheal,
b. Drink plenty of paraffin fluid
c. Coke or fizzy drinks
35. Nasopharyngeal carcinoma earliest sign:
a. unilateral conductive deafness,
b. blood in saliva
36. Most common cause/commonly presented for sensorineural hearing loss:
a. Presbycusis
37. Mass behind pharyngeal wall, cervical TB (a lot of other symptoms that I'm
missing), what to do next:
a. Aspiration and ZN stain and c/s,
b. Antituberculous therapy,
c. MRI scan
d. Urgent CT scan
38. Children most susceptible to or something like that:
a. Orbital cellulitis
39. Question about person with DNS and shows tonsillitis symptoms, what to do:
a. correct nose with septoplasty
40. Something and its most dreadful complication:
a. oral cancer
41. Radical mastoidectomy, why is it not performed as compared to other surgeries.
a. Severe permanent hearing loss
b. Attacks of vertigo
c. Eustachian tube infections
42. Most common premalignant condition in our region/setting/area
a. Erythroplakia
b. Leukoplakia
c. Plummer Vinson
d. Submucous fibrosis
43. Most common cause of giddiness (dizziness) of women in our setting
a. Persistent anemia
b. Psychogenic illness
44. Why is septoplasty preferred over SMR?
a. Least Complications
45. Patient has a food bolus stuck in the esophagus, dysphagia, treatment:
a. Cola
b. Paraffin
c. Endoscopy
d. Pass ng tube
 ENT PAST PAPERS

46. Child with severe pain, blood stained discharge from ear, immediate management:
a. Treat infection with antibiotics
b. Find source of infection
c. Control bleeding
47. Child with glue ear? Dreadful complications:
a. Maldevelopment of speech
b. Antisocial withdrawal
c. Loss of hearing
48. Child dysphagia for last two hours with dribbling of saliva with coin in esophagus
a. Remove with endoscopy
b. Observe and wait for passing
49. Man, 20 cigarettes per day, hoarse voice, tumor on vocal cords. Treatment:
a. Radiosurgery
50. Teenage boy with sore throat. Whitish slough on tonsils not resolved with broad
spectrum antibiotics for 48-72 hours, what investigation will confirm diagnosis (or
something about reliable investigation)
a. Blood CP
b. Culture and sensitivity
c. Monospot test after 8-10 days
51. Ludwig’s angina presentation
a. Anterior presentation of tongue
b. Problems with swallowing and speech
c. Pain on mouth opening and something
d. slower dental tooth infection
52. Most common presentation of nasopharyngeal carcinoma
a. Blood stained saliva
b. Buccal voice
c. conductive deafness
d. Something about tumor markers
53. Case of functional aphonia, how to manage?
a. Ask patient to cough
b. Refer to psychiatrist
54. Which investigation differentiates vasomotor rhinitis from allergic rhinitis
a. Specific IgE (something?)
b. Negative skin allergy test
c. Type A personality
d. Seasonal
55. A man with ear discharge from ear for 2 months, gets it treated by family
physician, suddenly develops vertigo and something
a. CT scan of brain and temporal bone
b. MRI
56. Common complaint reported when the ears are filled with wax
a. itching
b. hearing impairment
 ENT PAST PAPERS

c. pain
d. dizziness
e. Noises in the ear
57. A young girl reports severe otalgia in the right ear with feeling of fulness since 48
hours this followed a recent rhinitis. On examination the tympanic membrane was
red and bulging outwards. The most appropriate action would be:
a. start systemic antibiotics
b. give analgesics – systemic and local
c. start nasal drops and oral decongestants to improve eustachian function
d. admit, do myringotomy under antibiotic cover
e. order a blood cp, audiogram and start parenteral amoxycillin.
58. A 40-year-old man developed itching, copious rhinorrhea with fever, headache and
malaise since 3 days. The nasal mucosa was hyperemic on examination.
Appropriate treatment measure would be:
a. isolate the patient
b. decongestant drops, analgesics and antihistamines
c. give analgesics and steam inhalations
d. reassurance and advise for bed rest
e. antibiotics and antihistamines
59. 23-year-old woman had nasal blockade, itching and sneezing bouts for many
months. on examination both the nasal cavities were found to be filled with
greyish white grape like masses. Appropriate action would be:
a. start topical intranasal steroid preparation
b. give systemic steroids for a limited period
c. polypectomy with prolonged intranasal steroid preparation
d. external ethmoidectomy
e. nasal decongestants and antihistamines
60. A 6-year-old child was brought to the ENT OPD with painful swallowing, fever and
malaise since 3 days. On examination the tonsils were swollen, and red. crypts
were filled with debris and pus. Appropriate action would be:
a. send a swab for culture and sensitivity
b. encourage oral fluids and give warm saline gargles
c. start antibiotic and systemic analgesics
d. do a blood cp, and start penicillin group of antibiotics and analgesics
e. admit and investigate for causes of acute sore throat
61. A 3-year-old child is brought to the ENT OPD with foul smelling rhinorrhea from
the right nostril since one month. Appropriate action would be:
a. Search a foreign body in the right nasal cavity while examining nose
b. Start a broad-spectrum antibiotic
c. Do an examination under anesthesia
d. Send a specimen for culture and sensitivity
e. Order an X-ray, lateral view of the skull
 ENT PAST PAPERS

62. A 15-year-old panicked girl came to the ER with sudden severe left earache and
buzzing noises. She strongly suspects that an insect has entered her left ear while
she was sleeping. Immediate response should be:
a. Thorough examination of the ear
b. Instill some oil in the affected ear to suffocate the insect
c. Suction cleansing of the affected ear
d. Syringing of the affected ear.
e. Remove the insect with forceps under magnification
63. A 25-year-old woman complained of progressive inability to open her mouth since
2 yrs. constant burning sensations in the throat disturb her daily chores of life.
Anterior pillars showed fibrosis. Desired action would be:
a. Give topical injections of steroids
b. Give iron preparations
c. Strictly warn her to stop betel nut chewing forever
d. Give vitamin preparations
e. Suggest gargles with local analgesic effect
64. A 40-year-old obese man was brought to the Ent OPD by his wife, much disturbed
by his loud snores. she is alarmed because of the recent choking attacks during
sleep. He has been experiencing excessive daytime sleepiness has affected his job
output. Probable cause that more appropriately fits into this scenario:
a. Depression
b. Morbidity associated with obesity
c. Effect of low thyroxine levels
d. Obstructive sleep apnea
e. Excessive consumption of alcohol
65. 67-year-old diabetic was brought with left sided otalgia, continuous discharge and
facial paralysis since 10 days. The ear was found to be filled with granulations and
greenish pus. Appropriate initial action would be:
a. High doses of parenteral antibiotic against pseudomonas for prolonged period.
b. CT scan of the temporal bone to know the extent of the disease
c. Effective diabetes control
d. Stop any immunosuppressive drug that the patient may have been using
e. Surgical debridement
66. The established cause that is commonly known to promote oral (buccal) mucosa
cancer.
a. Ill-fitting denture
b. Tobacco chewing
c. Betel nut chewing
d. Alcohol
e. Chronic iron deficiency
 ENT PAST PAPERS

67. A 25-year-old male fell from a height. He was taken to a remote district hospital.
He regained consciousness after some time and showed right sided bleeding
otorrhea with facial paralysis on the same side. No other injury on the body was
identified. Most appropriate early action would be:
a. Ear packing with antibiotic soaked gauze
b. Neurosurgical opinion
c. Send the ear discharge for biochemistry
d. Send him for CT of the head
e. Do a hearing assessment
68. A 5-year-old girl came with a left sided pre-auricular painful swelling for 5 days.
This is the third episode of such nature in the past six months. The most likely
diagnosis is:
a. Pre-auricular sinus with a secondary abscess
b. An infected dermoid cyst
c. A parotid tumor
d. Chronic lymphadenitis
e. Sebaceous cyst
69. A 40-year-old man came with a grossly swollen and flattened root of the nose after
being hit on the nose while helping to control a street fight. The bleeding from the
nose has been negligible. As an ER officer, the most desired action would be:
a. Send him for medico-legal documentation
b. Get a radiograph of head in profile, admit and call the ENT surgeon for
manipulation (reduction) of the fracture nasal bone under general anesthesia
c. Do a prophylactic anterior nasal packing
d. Examine nose for a possible CSF leak
e. Start prophylactic antibiotic and analgesics
70. a 65-year-old man complained of right sided otalgia for one week. He is dysphagic
for one month. an appropriate measure in OPD would be:
a. examination of the ears
b. examination of the ears, throat, indirect laryngoscopy
c. do a flexible endoscopic examination of throat
d. examination of the right ear and oral cavity
e. examination of right ear and cervical spine
71. A 5-year-old child is brought to the ENT clinic with defective language and history
of poor performance at school. most desired action would be:
a. referral to a psychiatrist to exclude mental retardation
b. referral for speech therapy
c. evaluation of hearing status
d. referral to a pediatrician
e. look for a tongue tie and cut if frenulum is short
72. A 15-year-old boy from Baltistan reported with recurrent episodes of severe
epistaxis. A space occupying lesion was seen to fill the right nasal cavity. Correct
action would be:
a. soft tissue lateral film of nasopharynx
 ENT PAST PAPERS

b. biopsy under general anesthesia

c. give transfusion to replace the lost blood
d. CT scan with contrast enhancement
e. CT, carotid angiography and embolization
73. the most important function of larynx is
a. protection of lower airways
b. phonation
c. airway for respiration
d. fixation of the chest
e. assistance in swallowing
74. 26-year-old man was being treated for the discharging right ear by the family
physician since many months. In the past one week he has had persistent otalgia,
fever with rigors, nausea and vomiting. Proper measure would be:
a. Prescribe an antibiotic after culture and sensitivity
b. Take the advice of physician
c. CT scan of the brain and cranium
d. Blood smear to rule our malaria
e. Blood culture
75. A four-year-old boy was not attentive in school due to hearing impairment. He was
a mouth breather with long face and prominent upper incisors. Dull tympanic
membrane with air bubbles behind and Rinne negative status bilaterally were the
positive findings on examination. If proper treatment is not provided within a
specified time he may suffer from a severe handicap like:
a. Atelectasis
b. Acute otitis media
c. Maldevelopment of speech
d. Retraction pocket
e. Tympanosclerosis
76. Severe breathing discomfort was a matter of concern for the obstetrician in a
neonate. A flexible endoscopic examination revealed a generally seen anomaly like
a. Choanal atresia
b. laryngeal cyst
c. laryngomalacia
d. laryngeal web
e. Subglottic stenosis
77. A thirty-year-old woman complains of suddenly developing vertigo every time she
turns the head to right side. The complaint disappears within moments. This is the
third relapse within one year that the patient faced. Better option for treatment
for her would be:
a. vestibular suppressants for long
b. wearing soft cervical collar
c. Epley maneuver
d. Posterior canal plugging
e. head using a double pillow
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78. A 25 yrs. old man presented with bilateral nasal polyps with proptosis in the right
eye. CT scan showed involvement of right maxillary and ethmoid sinus with
extension into right orbit. A useful treatment plan would be:
a. Endoscopic sinus surgery
b. External ethmoidectomy
c. Giving a systemic antifungal with steroids
d. Intranasal polypectomy with Caldwell lucs
e. Polypectomy with topical steroids
79. A 45 yrs. old man addicted to tobacco chewing and smoking for many years
reported with dysphagia and hoarse voice since two months. Indirect laryngoscopy
revealed a growth involving left pyriform fossa and extending into the same side of
the larynx. There was no other finding on clinical examination. The desired next
action in the management of this case would be:
a. Barium swallow study
b. CT scan with contrast
c. Direct laryngoscopy and biopsy
d. Flexible endoscopic examination
e. Ultrasound of neck
80. A 65-year-old man had a painless non-healing ulcerative lesion on the ala of nose
on the left side since 2 months. appropriate measure would be:
a. Apply antibiotic ointment and reassure
b. Excise the lesion
c. Take a biopsy along the margin of the lesion.
d. Cauterize the lesion with diathermy.
e. Do a skin grafting
81. A 23-year-old female complained of nasal blockade and repeated sore throat since
the last 2 yrs. On examination an s shaped deviated nasal septum was found.
hyperemia and granulations were observed on the posterior pharyngeal wall
suitable action would be:
a. Suggest corrective nasal septal surgery.
b. Do a throat swab for culture and sensitivity
c. Give nasal decongestants and analgesics
d. Suggest warm saline gargles
e. Cauterize granulations on the posterior pharyngeal wall
82. A 45-year-old man had an indurated, painful red swelling in the submental and
submandibular regions since 3 days. recent lower molar dental extraction was also
reported. most desired action would be:
a. Do a tracheostomy
b. Admit for observation regarding airway problem. Start parenteral antibiotics
against streptococcus with analgesics
c. Do an incision and drainage
d. Start oral antibiotics against anaerobes
e. Do a CT scan to know the extent of the lesion
 ENT PAST PAPERS

83. An underprivileged baby girl of 13 month of age is suspected to be congenitally

deaf. Preferred management measures would be:
a. Do an otoacoustic emission test
b. Send to an audiologist for hearing assessment
c. Do brainstem evoked response audiometry (BERA)
d. Investigate for anti-viral antibodies.to determine the cause first
e. Test with free field distraction and suggest fitting hearing aids in both ears.
84. Select the best diagnosis
a. Otitis media with effusion
b. Chronic otitis media
c. Impacted wax
d. Otosclerosis
e. Glomus tumor
85. 16 Y/O deaf male with no past treatment for deafness BER shows no response
Treatment or how to rehabilitate?
a. Sign language
86. Swelling laterally on one side of neck Appropriate investigation? CBC (Raised
neutrophils)
87. Patient with rhinorrhea, nasal blockade more in winters Possible dx? Allergic
rhinitis
88. Facial nerve paralysis of sudden onset. Bells palsy
89. Saddle nose deformity commonly results from
a. Complication of congenital syphilis
b. Complication of nasal septal surgery
c. Leprosy involving the nose
d. Relapsing polychondritis of nose
e. Untreated fracture of nasal bone
90. A 62 yrs. old man was assaulted with a baton on the right ear while participating in
a public demonstration. He was brought to the ER with intense pain and swelling
of pinna on both medial and lateral surfaces with a bluish tinge.ER management
should focus on
a. Advise to see the ENT surgeon as soon as possible
b. Aspiration of blood with a pressure bandage
c. Assessment from medico-legal point of view
d. Broad spectrum antibiotics and analgesics
e. Other facial, skull base injuries need to be ruled out
91. A 56 yrs. old male smoker had hoarse voice since three months. On flexible
endoscopy a growth was identified in the middle of the right vocal cord with
difficulty in movement. Histopathology was a squamous cell carcinoma. There was
no other finding. The oncologist advised a primary radiotherapy as the treatment
modality. The main advantage of this mode of therapy is
a. Avoidance of surgery and hospitalization
b. Adverse effects are tolerable
c. Cost is relatively cheap
 ENT PAST PAPERS

d. Failures of treatment can be offered surgery

e. Preservation of voice in 90 percent of patients
92. A 20 years old young lady presented with an asymptomatic cystic swelling in the
middle of neck close to hyoid bone. It moved up on swelling. ENT surgeon advised
for surgical removal with body of the hyoid bone. The advice is worth following for
the reason:
a. Cysts are prone to infection
b. Cysts have the tendency to recur
c. It may complicate into a discharging sinus
d. Look cosmetically ugly
e. Rarely they may be malignant
93. A young betel nut chewers of longstanding nature visits ENT clinic with intolerance
to spicy food for some time. Early changes of submucosal fibrosis were obvious on
clinical examination. He was advised to stop the habit immediately. The dreadful
complication that can result otherwise being
a. Dry mouth
b. Oral burning sensation
c. Oral cancer
d. Recurrent oral ulceration
e. Trismus
94. Common complaint reported when the ears are filled with wax
a. Itching
b. Hearing impairment
c. Pain
d. Dizziness
e. Noises in the ear
95. A young girl reports severe otalgia in the right ear with feeling of fulness since 48
hours this followed a recent rhinitis. On examination the tympanic membrane was
red and bulging outwards. The most appropriate action would be:
a. Start systemic antibiotics
b. Give analgesics – systemic and local
c. Start nasal drops and oral decongestants to improve Eustachian function
d. Admit, do myringotomy under antibiotic cover
e. Order a blood cp, audiogram and start parenteral amoxycillin.
96. A 40-year-old man developed itching, copious rhinorrhea with fever, headache and
malaise since 3 days. The nasal mucosa was hyperemic on examination.
Appropriate treatment measure would be:
a. Isolate the patient
b. Decongestant drops, analgesics and antihistamines
c. Give analgesics and steam inhalations
d. Reassurance and advise for bed rest
e. Antibiotics and antihistamines
 ENT PAST PAPERS

97. A 23-year-old woman had nasal blockade, itching and sneezing bouts for many
months. On examination both the nasal cavities were found to be filled with
greyish white grape like masses: appropriate action would be:
a. Start topical intranasal steroid preparation
b. Give systemic steroids for a limited period
c. Polypectomy with prolonged intranasal steroid preparation
d. External ethmoidectomy
e. Nasal decongestants and antihistamines
98. A year 6 old child was brought to the ENT OPD with painful swallowing, fever and
malaise since 3 days. On examination the tonsils were swollen and red. crypts
were filled with debris and pus. Appropriate action would be:
a. Send a swab for culture and sensitivity
b. Encourage oral fluids and give warm saline gargles
c. Start antibiotic and systemic analgesics
d. Do a blood cp, and start penicillin group of antibiotics and analgesics
e. Admit and investigate for causes of acute sore throat
99. a 65-year-old man complained of right sided otalgia since one week. He is
dysphagic since one month. an appropriate measure in OPD would be:
a. Examination of the ears
b. Examination of the ears, throat, indirect laryngoscopy
c. Do a flexible endoscopic examination of throat
d. Examination of the right ear and oral cavity
e. Examination of right ear and cervical spine
100. A five-year-old child is brought to the ENT clinic with defective language and
history of poor performance at school. most desired action would be:
a. Referral to a psychiatrist to exclude mental retardation
b. Referral for speech therapy
c. Evaluation of hearing status
d. Referral to a pediatrician
e. Look for a tongue tie and cut if frenulum is short
101. A fifteen-year-old boy from Baltistan reported with recurrent episodes of severe
epistaxis. A space occupying lesion was seen to fill the right nasal cavity. correct
action would be:
a. Soft tissue lateral film of nasopharynx
b. Biopsy under general anesthesia
c. Give transfusion to replace the lost blood
d. CT scan with contrast enhancement
e. CT, carotid angiography and embolization
102. The most important function of larynx is
a. Protection of lower airways
b. Phonation
c. Airway for respiration
d. Fixation of the chest
e. Assistance in swallowing
 ENT PAST PAPERS

103. A 26-year-old man was being treated for the discharging right ear by the family
physician since many months. Since one week he suffers from persistent otalgia,
fever with rigors, nausea and vomiting. Proper measure would be:
a. Prescribe an antibiotic after culture and sensitivity
b. Take the advice of physician
c. CT scan of the brain and cranium
d. Blood smear to rule our malaria
e. Blood culture
104. The established cause that is commonly known to promote oral (buccal) mucosa
cancer.
a. Ill-fitting denture
b. Tobacco chewing
c. Betel nut chewing
d. Alcohol
e. Chronic iron deficiency
105. A 25-year-old male fell from a height. He was taken to a remote district hospital.
He regained consciousness after some time and showed right sided bleeding
otorrhea with facial paralysis on the same side. No other injury on the body was
identified. Most appropriate early action would be:
a. Ear packing with antibiotic soaked gauze
b. Neurosurgical opinion
c. Send the ear discharge for biochemistry
d. Send him for CT of the head
e. Do a hearing assessment
106. A 5-year-old girl came with a left sided pre-auricular painful swelling since 5 days.
This is the third episode of such nature in the past six months. The most likely
diagnosis is:
a. Pre-auricular sinus with a secondary abscess
b. An infected dermoid cyst
c. A parotid tumor
d. Chronic lymphadenitis
e. Sebaceous cyst
107. A 40-year-old man came with a grossly swollen and flattened root of the nose after
being hit on the nose while helping to control a street fight. The bleeding from the
nose has been negligible. As an ER officer, the most desired action would be:
a. Send him for medico-legal documentation.
b. Get a radiograph of head in profile, admit and call the ENT surgeon for.
manipulation (reduction) of the fracture nasal bone under general anesthesia.
c. Do a prophylactic anterior nasal packing.
d. Examine nose for a possible CSF leak.
e. Start prophylactic antibiotic and analgesics.
 ENT PAST PAPERS

SHORT ESSAY QUESTIONS

1. Patient with watery rhinorrhea. List possible causes and treatment of choice?

Causes are: viral rhinosinusitis, allergic rhinitis, vasomotor rhinitis &CSF rhinorrhea
Treatments are: Viral rhinosinusitis (Bed rest, avoid contact with people having common
cold, steam inhalation, antihistamines + nasal decongestants, antipyretics and
analgesics); allergic rhinitis (avoidance of allergen, antihistamines, decongestants, mast
cell destabilizers, leukotriene inhibitors, corticosteroids, hypo sensitization and surgery
for hypertrophied inferior turbinate); Vasomotor rhinitis (Antihistamines, nasal
decongestants, steroids and Vidian neurectomy) AND CSF rhinorrhea (prophylactic
antibiotic to prevent meningitis, advise patients to sit semi-prone, avoid nose-blowing +
straining AND perform *endoscopic endonasal approach to repair the leakage and seal it
with local mucosal flap + human fibrin glue).

2. Patient with history of discharge since 1 month. Possible causes and treatment?

3. Patient with a midline neck lump.

a. Investigations? Indirect laryngoscopy, direct laryngoscopy, CT scan of head and
neck, MRI
b. What will you observe during examination?
c. Questions asked in History? Onset, duration, swallowing difficulties

4. Blood pressure 190/100, profuse bleeding from nose and mouth

a. Emergency treatment:
Admit the patient, IV line administration, measure extent of blood loss, anterior
packing with ribbon gauze soaked in BIPP or polyfax, vital signs monitoring, give
blood transfusion if need be, give tranexamic acid and prophylactic antibiotics.
b. What to do if initial management fails
Posterior nasal packing with either gauze w/ silk threads or balloon catheters OR
arterial ligation/embolization as a last resort in case the above management
doesn’t work

5. a. 5 most common midline neck lumps:

Thyroid swelling(goiter), salivary gland swelling, lymph node swelling( acute
lymphadenitis, chronic granulomatous lymphadenitis, etc.), congenital(thyroglossal duct
cyst, branchial cyst, dermoid/epidermoid cyst) and skin/subcutaneous
swelling(sebaceous cyst, lipoma).
b. Investigations for assessment of the lump?
 ENT PAST PAPERS

Complete hx and exam. Fine needle aspiration cytology, ultrasound, CT/MRI, thyroid
scans, sialogram.

6. 3 most common causes for noise induced hearing loss. Treatment?

Ans. All related to occupational exposure: industry workers, transportation noise, social
gathering. Txt: Mainly preventative txt use protective devices(earplugs, earmuffs) and
silencers on noisy machines, sound insulation in workrooms. Rest and rehab for patient.
Avoidance of loud sound. Change of profession in early cases(LOL). Hearing aid in
established cases.
7. Person smokes for 20 years, hoarse voice
a. 3 possible causes
If acute(less than a few weeks): acute inflammation due to infection(laryngitis,
croup, laryngeal diphtheria), trauma(vocal abuse, foreign body, inhalation of
irritant fumes) and sudden paralysis of cords(after thyroidectomy, recurrent
laryngeal nerve trauma). If chronic: tumor of larynx, vocal cord polyp(s) and
chronic inflammation like laryngitis, TB.
b. Investigations
Hx and exam. Lab investigations like: CBC and differential leukocyte count.
Radiology x-ray, CT, MRI. Direct laryngoscopy exam if lesion or growth followed
by biopsy.
c. Treatment plan of cancer involving vocal cords
Ans. Exact txt depends upon the spread of the local tumor. For a tumor involving
the vocal cords surgery is suggested. Partial, total or extended lyngectomy.
Preceding the operation chemotherapy can be given to reduce the size of the
tumor. If small T1 or T2 lesion present then radiotherapy, laser therapy or
conservative surgery like cordectomy, hemi-laryngectomy, epiglottectomy etc.
can be advised.

8. Ear trauma
a. Name 1 injury on ear pinna due to blunt trauma and describe it? Hematoma of
the pinna. It’s a collection of blood under the perichondrium due to rupture of
perichondrial blood vessels.
b. Injuries caused by pressure waves on tympanic membrane and middle ear?
Aero-otitis
c. List common causes of Noise induced hearing loss:
Industrial settings, transportation noise, social gatherings, roadside engineering,
constant use of Walkman or loud music AND war.

9. What is a hoarse voice? Roughness of voice

a. Write causes of hoarseness due to vocal abuse?
Ans. Vocal cord abuse, foreign body impaction, inhaling irritant fumes, cut
throat, intubation, external injury.
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b. How smoking brings about a hoarse voice? How this can be treated?
Ans. Cigarette smoke is hotter than normal inhaled air and irritates the delicate
vocal cords. Tar and other chemicals can deposit on the cord and cause swelling,
inflammation. Long term smoking can cause dysplasia and eventually cancer.
Smoking can also cause acid reflux which also affects vocal cords. The only cure
for this would be to stop fucking smoking. Other treatments can be to rest your
voice, have fluids, avoid caffeine

10. Allergic Rhinitis

a. Write clinical features of the seasonal nasal allergy?
Nasal obstruction, watery rhinorrhea, paroxysms of sneezing, hyposmia,
bronchospasm and anosmia.
b. Write treatment options for the perennial nasal allergy
Ans. Avoid the allergens. First line medical therapy is nasal corticosteroids.
Antihistamines to control rhinorrhea, sneezing, itching and obstruction.
Decongestants for short term otherwise rhinitis medicamentosa happens. Anti-
inflammatory like sodium cromoglycate. Allergen desensitization.
c. How nasal allergy can be differentiated from vasomotor rhinitis?
All tests for nasal allergy would be negative in vasomotor rhinitis, i.e., nasal
smear, RAST test, nasal provocation test , eosinophil count etc..
Vasomotor rhinitis is due to an unstable autonomic nervous system

11. Cholesteatoma
a. What is a cholesteatoma?
A bag of stratified squamous, keratinized epithelium in the mastoid air cells
b. How does it cause middle ear disease?
Retraction pockets due to invaginations of tympanic membrane, metaplasia and
basal cell hyperplasia
c. Write possible impacts of cholesteatoma if it not treated correctly?
Mastoiditis, labyrinthitis, petrositis and facial nerve paralysis are extracranial
complications.
Brain abscess, meningitis, subdural and extradural abscesses are intracranial
complications.

12. Foreign Body

a. How will you remove a coin stuck up in the upper esophagus?
Ans. By rigid esophagoscopy. Performed under general anesthesia with
endotracheal intubation. Maintain proper position of patient with flexed cervical
vertebra and extended atlanto-occipital joint. Lubricated esophagoscope. Keep it
in midline. Grab the coing using crocodile forceps and withdraw it along with the
esophagoscope.
b. How will you remove a betel nut piece from the right bronchus of a child?
Ans. Mostly same procedure. Anesthesia, position, intubation. Use
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bronchoscope. In children direct introduction of bronchoscope is difficult so

perform direct laryngoscopy first. Visualize vocal cords and pass the
bronchoscope through the laryngoscope. After this remove bronchoscope and as
well as the ET tube and anesthetic gases are connected to the bronchoscope.
Examine tracheobronchial tree and remove betel nut using crocodile forceps.
c. How will you remove a fish bone from the crypt of a tonsil?
Ans. Same procedure as part a.

13. A 23-year-old man had a right sided nasal obstruction for many months
a. what are the common possible causes for the complaint?
Furuncle, unilateral vestibulitis, foreign body, neoplasm, polyp, DNS and
rhinolith.
b. how will you manage if the right nasal cavity shows a polyp?
Investigations need to be done after thorough history taking and full ENT
examination are: Water’s view X-ray of nose and paranasal sinuses, CT scan of
nose & paranasal sinuses, diagnostic nasal endoscopy, nasal allergy
investigations and histopathology to determine what type of polyp is present
Medical treatments are: antihistamines and topical steroid sprays and
endoscopic sinus surgery is preferred for ethmoidal and antrochoanal polyps.
Simple intranasal polypectomy + post-operative allergy control done for a
patient presenting for the first time with ethmoidal polyps and antrochoanal
polyps in children who have not completed dentition.
Ethmoidectomy (intranasal or trans-antral) done when there is extensive or
recurrent polyp formation, which requires a more radical approach.
Caldwell Luc’s operation done when there is recurrent antrochoanal polyp

14. On the fifth day following tonsillectomy, a seven-year-old child was brought to the
ENT OPD with fever and bleeding per oral cavity.
a. Name the complication? Reactionary hemorrhage
b. How will you manage this case? Ligate bleeder under gen. anesthesia
c. List the contraindications for tonsillectomy
Acute tonsillitis attack, uncontrolled clotting + bleeding disorders, anemia,
hypertension, diabetes mellitus, asthma, cardiac and renal diseases

15. Wax in the ear

a. What are the possible complaints that can arise due to accumulation of wax in
the ear? Fullness in the ear, conductive deafness/hearing impairment, reflex
cough, vertigo, tinnitus and ear ache.
b. How will you treat an impacted wax? Syringing with normal saline at body
temperature if soft and provided there is no infection; If hard, then 2% sodium
bicarb in glycerine should be added before syringing AND if syringing is
contraindicated, then suction cleaning should be done
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c. List the common complications of ear syringing: Perforation of the tympanic

membrane due to trauma to the eardrum, otitis externa due to trauma to EAC
and vertigo due to stimulation of labyrinth.

16. Vertigo
a. What specific inquiries you would make while taking history for the above
complaint?
HOPC: Onset, duration, frequency, perception of movement, hearing loss,
tinnitus, discharge, headache, nausea, vomiting, fever, aggravating and relieving
factors. Past medical, drug history & trauma histories
b. What examination would be relevant to the above complaint?
Rinne’s test, Weber’s test, otoscopy, PTA, Speech audiometry, tympanometry, X-
ray of mastoid, CT scan of temporal bone + brain
c. Name the vestibular causes of vertigo: Labyrinthitis, Meniere’s disease, acoustic
neuroma, vestibular neuronitis, BPPV, vestibulotoxic drugs, trauma and
perilymph fistula.

17. Retropharyngeal Abscess

a. What is a retropharyngeal abscess? Collection of pus in the space behind the
pharynx between the bucco-pharyngeal fascia covering the pharyngeal muscles
and the prevertebral fascia.
b. Define its types?
Acute  caused by suppuration in the retropharyngeal nodes and is caused by
streptococcus pneumoniae most commonly and presents with: dysphagia,
difficulty in breathing, whooping/croupy cough, squawk, stridor, nasal
obstruction and high-grade fever
Chronic  sore throat, pain in throat, dysphagia, weight loss & fever due to
tuberculous etiology AND posterior pharyngeal congestion.
c. Give treatment for chronic type?
Incision and drainage done via the neck & full dose of combined anti-tuberculous
therapy. Anti-tuberculous therapy done for
18. A 20-year-old man was hit on the right ear during a street fight.
a. Give a list of the possible morbid effects/injuries
Tympanic membrane rupture, auricular hematoma and ossicular chain
dislocation,
b. How will you treat a damage inflicted on the tympanic membrane in this case?
Prophylactic antibiotics; sterile, lubricated swab use before bath and
myringoplasty

19. A 45-year-old man, a known hypertensive was brought to the ER with severe Epistaxis
Give an outline of your management measures for this case.
Ans. Admit the patient. Take a relevant history especially drug history and any missed
medication, and do exam. Record and stabilize vitals. If bleeding is visible then do
chemical cauterization of the area with silver nitrate. If severe bleeding with no bleeding
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vessel localized then maintain an IV line, monitor blood loss and replace blood if need
be. Do anterior nasal packing with ribbon gauze soaked in bismuth iodoform paraffin
paste(BIPP) or polyfax. All of the nasal cavity is packed and most cases of ant. Epistaxis
stop. The pack is removed in 42-72hrs. If posterior epistaxis then do posterior nasal
packing usually with a balloon catheter, a double balloon catheter or a ribbon gauze.
Pack is removed after 48-72hrs. After acute phase of bleeding the cause should be
determined. In this case the blood pressure should be controlled. After removing the
nasal pack a bleeding vessel may be visible with should be cauterized. If above measures
don’t work then artery ligation or vessel embolization may be required.

20. Six hours following tonsillectomy, an 8-year-old boy began to bleed from the left
tonsillar fossa.
a. Name the type of hemorrhage
Reactionary hemorrhage
b. How will you manage this case?
Ligate bleeder under general anesthesia
.
21. A 60-year-old man complained of vertigo whenever he moves his head to the Right
side. There are no other complaints.
a. Give a possible differential diagnosis for this scenario
Ans. BPPV, Meniere disease, labyrinthitis.
b. How will you investigate and treat this case?
Ans. The diagnosis is most likely BPPV. To diagnose usually the clinical history
with a simple Dix Hallpike test is done. Testing is positive when there is rotatory
nystagmus when head is turned to the affected side. The features are
characteristic where there are brief attacks of vertigo on specific head
movements. The vertigo can resolve. In Meniere disease the vertigo is
accompanied by tinnitus and sensorineural deafness. In labyrinthitis the vertigo
is accompanied by deafness. Txt of BPPV is Epley maneuver.

22. A 30 years old female notices a rapidly growing midline neck swelling close to the
hyoid bone. It moves with swallowing.
a. Give the most probable diagnosis
Ans. Thyroglossal duct cyst
b. How will you manage this case?
Ans. The only treatment is surgical resection usually by the sistrunk procedure.
However to support preoperative diagnosis, is important to rule out infection in
the cyst. Infected cysts usually present as painful mass. Thyroid ultrasound is
employed preoperatively. FNAC is employed to rule out malignancy if suspected.
The definitive treatment is to resect the cyst.
c. What are the complications that can result if this is not treated?
Ans. Infection, airway obstruction and malignancy in rare cases.
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23. Diphtheria
a. What are the main features and complications of pharyngeal diphtheria?
Sore throat, low-grade fever, severe toxemia, presence of false membrane,
cervical lymphadenopathy gives ‘Bull neck appearance’ (think of the sketchy
video on diphtheria when listing clinical features)
Complications are: myocarditis AND paralysis of: diaphragm, soft palate & ocular
muscles
b. How will you treat this condition?
Diphtheria antitoxin (20000-120000 units IV or IM), systemic penicillin or
erythromycin in the case of penicillin sensitivity AND tracheostomy if there is
respiratory obstruction due to involvement of the larynx.

24. a. What is Bell’s palsy? Paralysis of the facial nerve due to ischemia of the nerve in the
facial canal
b. How will you treat it? Reassurance, analgesics, artificial tears, eye ointment, steroids,
physiotherapy, antivirals and surgical decompression

25. How will you manage a case of foreign body impacted in nasal cavity in a 5-year-old
child? Remove via ring probe under general anesthesia if the foreign body is inanimate,
smooth and rounded. If it’s an animate object, chloroform should be instilled and the
object should be removed by syringing AND if the object is too large, then removal via
post-aural incision must be done.
a. What the common lumps that presents along the middle of the neck...how will
you investigate goiter?
Ans. Congenital (thyroglossal duct cyst, branchial cleft cyst, dermoid epidermoid
cysts), thyroid swellings(hypo, hyper thyroid, goiter),
lymphadenopathy(infective, lymphoma), salivary gland swellings, .

26. a. What is congenital deafness?

Ans. Congenital hearing loss is defined as hearing loss present at birth due to inability to
convert mechanical sound vibration into electrical impulses that can be perceived by the
brain. It can be of sensorineural(inner ear), conductive(outer ear) or of mixed types.
b.How will you assess hearing status for a case of congenital deafness?

27. A 6-year-old boy was brought to the ENT OPD with persistent epistaxis from the left
nasal cavity. The child wipes his nose very often. A raw area was identified on the
anterior region of the nasal septum.
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a. How will you manage this case?

28. What are the common causes of epistaxis in our population, age wise?
29. A fifteen-year-old boy developed severe pain on the tip of the nose. A red, tender
swelling was identified on the right nasal vestibule.
a. Suggest the most probable diagnosis?
b. How will you manage it? List the possible complications that can result from it.

30. A young lady came to the ENT OPD with suddenly developing right sided facial palsy.
Feeling of discomfort in the same ear was also reported. The ear looked normal on
examination.
a. Suggest the possible diagnosis
b. Give your management measures
31. Name the common neck space infections? How will you treat Quinsy?
32. A 25-year-old women from Baluchistan reports with a grossly swollen right pinna since
many days. She gives history of multiple ear piercing on the same ear to wear the
traditional golden rings. This was done two weeks ago by a relative.
a. What is the most likely cause for such a happening?
b. How will you treat this condition?
c. Name the complications of this condition
33. A twenty-three-year-old man was hit on the middle of the face and neck in a road
traffic accident. He was bleeding profusely from the mouth and nose with obvious
breathing difficulty, showed multiple bruises, swollen areas and cuts in the head and
neck. As the attending doctor in ER write your steps of management for this case.
34. What are nasal polyps? Differentiate between common types.
35. A 27 years old women was reported to be deaf in both the ears since many months by
her husband
a. How will you confirm on clinical examination about the type of deafness?
b. What audiological investigations would be useful to know the possible cause of
deafness?
c. What are the possible causes of conductive deafness for this scenario?
d. What are the treatment options available for stapes fixation?
36. Write a ten line note on the common preventable causes of oro-pharyngeal cancers.
37. How the seasonal and perennial types of nasal allergies present? What is
desensitization?
38. Bomb blast case:
a. Type of injuries?
b. What kind of hearing loss?
c. How to manage a bleeding ear?
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39. Dysphagia:
a. Relevant history?
b. Investigations? X-ray barium swallow, endoscopy,
c. conditions presenting with dysphagia.
Cleft palate, tongue paralysis, submucous fibrosis, reduced salivation & oral
carcinoma buccal dysphagia
Enlarged tonsils, esophageal web with Plummer Vinson syndrome, malignancies
of oropharynx, Ludwig’s angina & paralysis of constrictor muscles  Pharyngeal
Strictures, atresia, esophagitis, trauma, foreign body, tumors of the esophagus,
goiter, extrinsic pressure by mediastinal mass & hiatus hernia  Esophageal

40. Laryngomalacia (Cannot remember questions)

41. Viral rhino sinusitis

a. Treatment? Bed rest, avoid contact with people infected with viral rhinosinusitis;
antihistamines, nasal decongestants, steam inhalation, analgesics & antipyretics.

42. Midface trauma due to RTA

a. What are skeletal injuries of the face?
b. What are the soft tissue injuries of the nose?
c. What injuries happen in temporal bone? How will you investigate and establish
diagnosis and which specialties will help fix the problem?

43. Unilateral right sided hearing loss with red, bulging membrane.
a. What is happening to the TM membrane?
Ans. There is exudation collecting in the middle ear which could be serous or
mucoid in nature. The exudate causing bulging of the tympanic membrane
because of pressure on it.
b. What is the diagnosis? Acute otitis media
c. What will you do establish diagnosis?
Check for landmarks of the tympanic membrane (cone of light), Rinne’s test,
Weber’s test, PTA and tympanometry. Myringotomy + culture & sensitivity of
discharge will determine causative organism.

44. Oral ulcers.

a. Causes and treatment of aphthous ulcer?
Causes are: psychogenic, viral, vitamin deficiency, hormonal and autoimmune
disorders
Treatment is: maintenance of good oral hygiene, topical steroid paste, topical
local anesthetic, supplementation to correct vitamin or mineral deficiencies.
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b. What will you do if you suspect malignancy?

Perform a biopsy.

45. A 10-year child presented with lump in posterior triangle of the neck (Level V) since 3
months. It was irregular in shape, firm, matted and tender to touch. He also reported
of generalized weakness, evening temperature and anorexia.
a. What is the diagnosis?
b. Investigations?
46. 20-year-old man was hit on the right ear during a street fight?
a. Give a list of the possible morbid effects/injuries
b. How will you treat a damage inflicted on the tympanic membrane in this case?
47. A 45-year-old man, a known hypertensive was brought to the ER with severe Epistaxis
Give an outline of your management measures for this case.
48. Six hours following tonsillectomy, an 8-year-old boy began to bleed from the. Left
tonsillar fossa.
a. Name the type of hemorrhage
b. How will you manage this case?

Key:
27. Antihistamine to check itching due to rhinitis. Apply antibiotic ointment on the raw
area. Cauterize the raw area with silver nitrate. Reassurance.
28. In children- trauma, persistent rhinosinusitis, vestibulitis, dry cold weather,
bleeding diathesis
In adults- trauma, hypertension, chronic rhinosinusitis, angiofibroma, other benign
and malignant Sino nasal tumors, hepatic dysfunction, bleeding diathesis
29. A. Boil (furunculosis)
B. Start antibiotic effective against staphylococcus for 5-7 days, analgesic, local antibiotic
ointment application, forbid to touch the nose, Check sugar levels. Complications,
Abscess/Cavernous sinus thrombosis
30. A. Facial palsy (Bell’s Palsy}
B. Reassurance, Start systemic steroids (Bolus dose with fast taper
off}, Physical therapy, some advocate systemic antivirals Reassurance, Nerve
conduction studies in non-responsive cases and rarely facial nerve surgical
decompression.
31. A. Submental-submandibular space infection (Ludwig’s angina},
Retropharyngeal abscess, peritonsillar abscess, parapharyngeal abscess, prevertebral
abscess etc.
B. Incision and drainage along the point between anterior tonsillar pillar and
base of uvula, parenteral antibiotics and analgesics, antibiotic mouth washes,
soft liquid diet, tonsillectomy after 6 weeks
32. A. Perichondritis of the auricle complicating hematoma and abscess
formation due to multiple piercing.
B. Incision and drainage, pressure dressing for 7 days, antibiotics against
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pseudomonas, analgesics.
C. Permanent deformity of the ear (cauliflower ear)
Question No 33
1.Attend to airway, if no relief by suction, may give a call for tracheostomy/intubation
2.Monitor vitals/I/V line/send blood for grouping/give plasma expanders
3.Anterior nasal packing
4.Examination of throat for any cut on tongue/palate/ check ears for bleeding
5.Evaluate consciousness/check limb movements to exclude spinal injury
6.Examine cuts, bruises, look for nasal, facial deformity, and eyes
7.Call ENT/neurosurgery/ophthalmology as the need be.
8.Send for Radiology of Skull and neck/CT scan if consciousness is affected or suspicion of
head injury
9.Counceing

Question No. 34
Polyp is a prolapsed edematous sinus and nasal mucosa presenting as grape-like mass/
es in the nasal cavity or cavities
Antrochoanal or infective polyp, usually unilateral, usually Y shaped or trilobed, single
associated with chronic maxillary sinusitis
Allergic polyp, usually bilateral, multiple originating from ethmoid and is associated with
nasal allergy
Bleeding or malignant polyp, a tumor like state originating from nasal septum, bleeds to
Touch

Question No.35
A. whisper/conversation/loud voice test for each ear/Rinne, Weber, Scwabach’s test
B. Puretone audiometry/speech audiometry/impedance audiometry
C. Wax/otitis media with effusion/Otosclerosis
D. Stapedotomy/stapedectomy/hearing aids/Fluoride therapy
Question No 36
Outline of contents
Cigarette/Beeri/Cigar/Huqqa---Tobacco chewing, Betel nut chewing, Naswar— Alcohol--Iron
deficiency---Chronic irritation due to ill-fitting denture known causes for Buccal/oral/
pharyngeal/laryngeal/hypopharyngeal (post cricoid) cancers --- all are preventable
Question No. 37
● Features of Seasonal nasal allergy-Paroxysmal sneezing/Nasal obstruction/Watery
rhinorrhea/Itching of eyes/palate/pharynx/Bronchospasm –Cough, breathing
discomfort. Features of Perennial nasal allergy-Frequent colds round the year/
Stuffy nose/Loss of sense of smell/Postnasal dripping/Cough/Ear symptoms
● Desensitization. Specific allergens given over a period of time in increasing dosage
till the symptoms are controlled
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OSCE
1. Interactive spot- Epistaxis due to nasal bone fracture. What kind of injuries would you suspect in
this situation? What would be the initial management of the patient in the ER?
Ans. Class 1 fracture(distal thin part of nasal bone), Class 2(fracture of frontal process of
maxilla) or class 3 fracture(ethoimal labyrinth involvement). Nasal deformity, swelling and
ecchymosis. CSF rhinorrhea if dural tear in roof of nose. Management: admit the patient,
measure and monitor vitals, draw blood for cross matching. Stop the bleeding first by trying to
localize the bleeding vessel. If vessel spotted the chemical cautery otherwise do anterior nasal
packing, if doesn’t work then doo post nasal packing. Try and reduce the fracture if pt. has
presented immediately after trauma and edema not set it. Reducing or correction of fracture
can be done utilizing walshams (nasal bone) or ashe forceps(nasal septum). If open wound
then prophylactic antibiotics with analgesia. Rhinoplasty if malunion.
2. Complete nose examination.
3. Hearing assessment.
4. Otitis media w effusion and adenoid hyperplasia. Possible dx? Management and
treatment?
Ans. Txt: treat any predisposing factor like allergies, adenoids, and infection. Steam
inhalation with Valsalva maneuver. Myringotomy and grommet insertion.
5. Subglottic fibrosis. Progression of disease if not treated. Possible treatment options?
6. Benign positional vertigo. Dx? Investigation that should be ordered Treatment.
Ans. Dix hallpike test. CT/MRI to rule out other causes(but not necessary because
clinical hx is enough). Txt is simple Epley maneuver.
7. Tonsillectomy complications (reactionary hemorrhage) Management and treatment
Ans. If not profuse severe bleeding then keep under observation and manage
conservatively as bleeding may stop spontaneously. If profuse bleeding or bleeding
that doesn’t stop then ligate the bleeding vessel under general anesthesia.
8. Instructions: Read the case scenario and be ready to answer the queries of examiner
orally
a. Case Scenario: A 7 yrs. old boy was reported to be inattentive in class by the
teacher. His hearing was impaired as judged by a bilateral Rinne negative status
and tympanic membranes showing fluid behind with bubbles and. He also
showed a pinched-in nose with prominent upper incisors.
Ans. Case is most likely of acute otitis media with effusion. The cause of otitis
media with effusion most likely b/c of blockage of Eustachian tube b/c of
adenoids. The air fluid level seen is the effusion which can be purulent or
serous. The tympanic membrane will be retracted and grey or blue or some
shit. The adenoids undergo hypertrophy due to recurrent attacks of
rhinosinusitis, allergic rhinitis which lead to infection of the adenoids or it can
be due to infection of adenoids itself. You investigate with lateral plain x ray or
nasal endoscopy. Condition has to be differentiated from other causes of nasal
obstruction like congenital choanal atresia, DNS, nasal polyp, allergy or foreign
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body. Medical txt when sx are not marked(not in this case) is nasal
decongestants and systemic antihistamine for allergy. Otherwise treated with
adenoidectomy. C/I of adenoidectomy is acute URI, bleeding/clotting disorder,
cleft palate. Complications include hemorrhage, injury to oral cavity/pharynx,
injury to Eustachian tube and palatal injury.
9. Instructions: Read the case scenario and take a relevant history from the patient.
a. Case Scenario: This 45 yrs. old man reported to the ENT OPD with dysphagia
since two months…
10. Instructions: Read the case scenario and write answers to the queries posted:
11. Case Scenario: A 56 yrs. old man, a supervisor at the textile factory reports hearing
impairment in both ears since six months. He had no other health related issue.
a. what looks to be the likely cause of complaint?
Ans. Hearing impairment
b. what is the most relevant investigation you will write and the expected findings?
Ans. Pure tone audiometry which will show no air-bone gap that will be lower
than normal especially around 4kHz range.
c. what is the best remedy that you will suggest?
Ans. Rest and avoid loud noises, use ear protection while in the factory and
wherever there is loud sound present. Change profession if possible. Hearing
aids for better hearing.
d. what will you suggest preventing further worsening in hearing?
Ans. Use ear protection like ear muffs or ear plugs, change profession if
possible.
e. Suggest some precautions to save other workers.
Ans. Use ear protection, establishing sound proof work rooms, using silencers
on machines.
12. Instructions: read the Case Scenario and write answers to the questions posted:
a. Case Scenario: A 45-year-old lady has been feeling vertigo whenever she turns
her head to the right since 2 wks.
i. What further inquiries in history you would like to make?
Ans. Is it intermittent, is it associated with nausea or vomiting or fever.
Does she have pain in the ear, does she have tinnitus. Does she report
any hearing loss. Does she have pallor, sweating, hypotension or
headache.
ii. What test will help to make a clinical diagnosis?
Ans. Dix Hallpike test.
iii. How will you treat this condition?
Ans. Epley maneuver.
13. Instructions: Read the case scenario and observe the illustration and write answers to
the queries posted.
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a. Case Scenario. A young man got indulged in a street fight and injured his nose.
The bleeding spontaneously stopped. In the ER photograph and the radiographs
showed like
i. What is the significance of radiograph when the external deformity was
obvious?
Ans. It has medicolegal significance.
ii. How will you manage this case now?
Ans. Try and reduce the nasal bone and nasal septum fractures using
walsham and ashe forceps respectively. If septal fracture cannot be
reduced then septoplasty will be required. After reduction popcast fr
10-14 days. Since no external wound prophylactic abx are not required.
iii. What should be done if the treatment is delayed beyond 2-3 weeks?
Ans. There will be malunion of bones so a rhinoplasty will be required
with lateral and medial osteomies.

14. Instructions: Read the case scenario, observe the illustration and write answers to the
questions posted:
a. Case Scenario: This man aged 26 noted a painless swelling in neck since 3
months which moves up on swallowing. There are no other complaints.
i. Give a likely diagnosis.
Ans. Thyroglossal duct cyst.
ii. What are the relevant investigations needed for this case?
Ans. Ultrasound is usually enough. Thyroid function test to rule out
hypo/hyper thyroid. FNAC to rule out malignancy. CT/MRI is usually not
required but can be employed to fill your pockets and bankrupt the
patient.
iii. What is the standard treatment for the condition?
Ans. Sistrunk procedure
iv. What is the risk if the treatment is delayed indefinitely?
Ans. It can get infected or become neoplastic due to ectopic thyroid
tissue.
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15. Scenario missing

a. What seems to be the cause of deafness in this case on clinical grounds?
i. (Ans: Adenoidal enlargement causing otitis media with effusion)
b. What investigations are useful to confirm the diagnosis?
i. (Ans: Head lateral view to assess adenoid enlargement, pure tone
audiogram, Tympanometry)
c. What treatment will benefit this child on definite basis?
i. (Ans: Adenoidectomy, myringotomy and bilateral grommet insertion)
d. What complications can occur if the treatment is delayed/not offered
i. (Ans: Atelectasis, tympanosclerosis, adhesive otitis media)
16. CSOM AA type interactive.
a. Diagnose
b. treat (Systemic antibiotics, Mastoidectomy ,Tympanoplasty)
c. complication (Mastoiditis, brain abscess in either temporal lobe or cerebellum;
subdural abscess, labyrinthitis, meningitis, facial nerve paralysis, thrombosis of
internal jugular vein, chronic adhesive otitis media, otitis externa and sigmoid
sinus thrombosis)
17. Ethmoidal polyps sec to allergic rhinitis interactive.
Ans. Polyps occur due to inflammatory changes in the nasal cavity although exact
aetiology is unknown. Allergy and vasomotor rhinitis are common culprits. Usually
arise as multiple small grape like masses usually arising from the maxillary sinus.
Mucosa becomes edematous which leads to polypoidal changes. Initially sessile but
become pedunculated. Bilateral and multiple, insensitive to touch. Symptoms: nasal
obstruction, nasal allergy sx like sneezing and watery rhinorrhea. Loss of smell.
Change in voice. Headache, proptosis and widening of nasal bridge if disease is
extensive. Investigate with x-ray(waters view), CT, diagnostic nasal endoscopy, nasal
allergy investigations wll be positive, histopathology of resected polyps. Has to be
differentiated from antrochoanal polyp, meningo/encephalocele neoplasia and
foreign body. TXT in early case can be with nasal steroids and antihistamines to revert
edematous changes. Most cases need surgery and best is endoscopic sinus surgery.
Otherwise intranasal polypectomy, ethmoidectomy can be employed.
18. Tonsillectomy interactive.
Ans. It is surgical removal of tonsils. Indicated for recurrent tonsillitis, chronic
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tonsillitis, tonsils interfering with speech/respiration/swallowing, quinsy, biopsy, after

pharyngeal diphtheria, complication of chronic tonsillitis. Contraindication, during
attack or acute RTI, uncontrolled bleeding/clotting disorder, age under 3, anaemia,
uncontrolled systemic disease like HTN, DM, renal disease. Complications:
hemorrhage(primary, reactionary and secondary), palatal injury, referred earache,
blood aspiration, tonsillar remnants.
19. Mastoidectomy counselling
Ans. Greet introduce consent. Ask patient what they know. Explain procedure that an
incision is made behind the ear following drilling through the mastoid bone to gain
access to middle ear cavity. Procedure is done to treat persistent or severe infection of
the middle ear or to remove cholesteatoma, mostly CSOM. Will be done under general
anesthesia and an overnight stay in hospital. As with any surgery there can be
complications: anesthetic complications, damage to facial nerve, damage to dural
plate(intracranial complications), damage to sinus plate, damage to ossicles(deafness),
labyrinthitis, wound infection etc.
20. What would you do to maintain airway in unconscious (OP airway),
Ans. In an emergency setting where no medical equipment is present you inspect the
airway and dislodge any foreign bodies and use the head tilt chin lift or jaw thrust
maneuver. When equipment is available then (increasing order of invasiveness) use an
oropharyngeal or nasopharyngeal airway, tracheal intubation and finally
tracheostomy.
21. Trismus (tracheostomy), Aspiration of blood in laryngeal cancer (tracheostomy with
bronchial toilet)
22. Tx of following. Otosclerosis. Presbycusis, NIHL
Ans. Otosclerosis: in early stages regular follow up and hearing aids. In advanced
stages with large air bone gap do a stapedectomy or stapedotomy. Floouride therapy.
Presbycusis: reassurance, auditory training and lip reading, hearing aids. NIHL: rest
and time away from loud noise, wear ear protection, hearing aids, change profession
if possible.
23. Types of hearing aids. What to give in laborer? Model? Teacher? Graph of presbycusis?
Ans. Air conduction hearing aids: body worn type, behind the ear type, spectacle type,
in the ear type, in the canal type completely in the canal type. Bone conduction
hearing aid. Body worn type or behind the ear type. For a model completely in the
canal type. For a teacher any type can be suggested depending on their requirements;
spectacle type, behind the ear type, in the ear type.
24. X-ray waters view with maxillary haziness. What other investigations. Tx.
Ans. Most likely acute maxillary bacterial rhinosinusitis. Investigations: CT scan of
paranasal sinuses which will show pathology in all the sinuses. Broad spectrum abx,
nasal decongestants, steam inhalation. If medical txt doesn’t resolve then do surgical
drainage of sinuses or functional endoscopic sinus surgery.
25. Tumors of parotid. 2 benign 2 malignant and tx
Ans. Benign: pleomorphic adenoma treated by removal of whole superficial lobe of
tumor(capsule plus tumor), warthin tumor txt is surgical removal. Malignant:
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mucoepidermoid tumor and adenoid cystic carcinoma, removed by total

parotidectomy.
26. DNS. Tx and complications of surgery
Ans. Spetoplasty and submucous resection. Complications: anesthesia complications,
bleeding complications, septal perforation, saddle nose deformity, adhesion
formation, persistence of deviation, septal hematoma, CSF rhinorrhea, retraction of
columella.
27. Foreign body AP X-ray. What other X-ray needed and how will you remove?
Ans. Lateral xray. Removal depends on where the foreign body is: see question 12 in
SEQs.
28. Cleft palate picture- complications in adulthood
Ans. Ear infections, abnormal or delayed speech, dental problems.
29. Slap trauma perforation. Treatment. Symptoms
Ans. Symptoms: hx of trauma, bleeding, decreased hearing, vertigo, tinnitus. O/E:
ruptured membrane with congested and irregular margins. Txt: abx to prevent
infection, plugging ear with sterile cotton swab, counseling to avoid swimming,
wetting the ear or valsalva maneuver, myringoplasty if membrane doesn’t heal in 4-6
weeks.
30. Congenital deafness. Test done in OPD (Free field distraction). What other tests.
Treatment and management. What happens if not treated (cochlear atrophy)
Ans. Other tests that be done are brainstem evoked response adiometry, otoacoustic
emission and impedence audiometry. Hearing aids(specifically BTE type) with follow
up every 3 months, cochlear implants, brainstem implants.
31. Presbycusis history with investigations and treatment. Bilateral hearing loss in an old
man.
Ans. Onset(gradual abrupt), unilateral or bilateral, associated with vertigo, tinnitus,
fever, ear discharge or earache. Any history of trauma. Ear examination with rinne and
weber test. Plain tone audiometry which will show sensorineural type pattern which a
specific decrease in hearing in the 4khz range. Txt is to reassure patient, auditory
rehabilitation, lip reading, hearing aids.
32. Chronic discharging ear with foul smelling otorrhea, scanty and there was a picture of
perforation. CSOM with treatments, exams and complications.
Ans. Dx. CSOM attico antral type. Treatment is to eradicate the choleasteatoma,
make the middle ear dry and safe, eradicate disease and do tympanoplasty. Surgery is
usually required and is mastoidectomy with a tympanoplasty. Exams done are
physical exam of the ear, plain tone audiogram, xray in Law’s view, CT scan of the
temporal bone to show extent of choleastoma expansion. Complications: are
extracranial(mastoiditis, otitis externa, facial nerve paralysis, petrositis, thrombosis of
internal jugular vein, labyrinthitis, adhesive otitis media) and intracranial(meningitis,
brain abscess, extradural abscess, subdural abscess, sigmoid sinus thrombosis, otitis
hydrocephalus).
33. Dysphagia history - food bolus, relevant exams.
Ans. Onset, duration, dysphagia for solids or liquids or both, progressive, associated sx
like respiratory symptoms, hx of tobacco, betel nut or alcohol abuse, odynophagia or
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dysphagia, continuous or intermittent, weight loss or dehydration, regurgitation or

reflux, location, oropharngeal or esophageal. Xray AP and Lateral view, CT/MRI if neck
mass, fibre optic direct laryngoscopy, barium swallow, video fluoroscopy, esophageal
endoscopy or manometry.
34. BERA diagram along with diagnosis and drawbacks of the test.
Ans.
35. Retropharyngeal abscess. What do you see in the cervical spine radiograph, causes and
treatment?
Ans. Xray will show widening of the prevertebral space and loss of curvature of
cervical spine due spasm of prevertebral muscles. Causative organism is strep
pneumo. Caused by suppuration in the retropharyngeal lympg nodes or acute
penetrating injury of [posterior pharyngeal wall or cervical esophagus. Txt is I&D
under anesthesia with broad spectrum abx IV which should be changed after culture
and sensitivity reports.
36. Insect in the ear, what do you do first and why, how do you remove and what do you
check for right after?
Ans. Calm the patient and make them cooperative otherwise it can lead to
complications like TM perforation while trying to remove the insect. Do an otoscopy
to see if it is actually an insect which is alive or dead or something else. Instill mineral
oil to kill the insect and then remove using manual instrumentation(crocodile forceps)
or suction. After removal of the insect clean and dry the ear and do otoscopy again to
see if there are any excoriations or injuries to the tympanic membrane.
37. Thyroglossal duct cyst, management with investigations
Ans. It is usually resected surgically by sistrunk procedure. If theres evidence of
infection(fever etc) then treat the infection before resection. Usually only thyroid
ultrasound is required as the investigation otherwise Thyroid function tests, CT/MRI
or FNAC can be employes.
38. Paranasal sinuses identification on CT
check pg 393 of udaipurwala
39. Bilateral nasal obstruction - interactive. Dr. Abbas Zafar asked about treatment,
compilations and history taking.
Ans. Hx taking onset, duration, progression, severity, frequency, unilateral or bilateral,
aggravating/relieving factors and associated factors. Bilateral can be b/c of congenital
choanal atresia(emergency tracheostomy, surgical or laser excision by transnasal or
transpalatal approach), septal hematoma(txt is I&D with prophylactic abx,
complications are hematoma rganisation leading to thickening of septum followed by
infection and abscess), septal abscess(txt is I&D and prophylactic abx,
complicationsnecrosis of cartilage, meningitis and cavernous sinus thrombosis),
enlarged adenoids(txt is adenoidectomy), allergic rhinitis(txt is multifactorial pg 195),
ethmoidal nasal polyps(txt is polypectomy, tumors(bpth benign and malignant).
40. Epistaxis four scenarios and definitive managements for all - 1. Recurrent in a boy with
nose picking habit. 2. RTA with moderate bleed. 3. Came back from the mountains and
glaciers, don't know site of bleed. 4. Hypertensive.
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41. Otosclerosis diagram. Definitive treatment. What about second line treatment
Ans. Stapedectomy/Stapedotomy, fluoride therapy.
42. Seasonal nasal allergy - pertinent questions in history, what is the treatment.
Ans. How long its been happening, any specific time of the year it happens,
recurrence, is it trigeered by things like dust or animal fur, is there nasal discharge,
sense of smell intact, any allergy signs in other parts of the body. Txt is antihistamines,
nasal steroids, mast cell stabilisers, allergen hyposesnsitisation, avoidance of
allergen,leukotriene inhibitors.
43. A neonate with intermittent trouble breathing, referred to pediatrics - differentials,
what will you observe when you see the baby first, what is the best method to detect
laryngeal pathology.
Ans. Congenital choanl atresia, foreign body in nose, atresia/stenosis of nares.
Observe any cyanosis, abnormal facies in the baby, signs of stridor. Fibre optic direct
laryngoscopy.
44. Dysphagia in a 70 -year old man with addictions, probably SCC of nasopharynx or
pyriform fossa - interactive. history and Investigations (Dr. Khalid Mahida preferred
them being told in an order)
Ans. Dysphagia history: onset, duration, type of dysphagia(buccal, pharyngeal,
esophageal), continuous or intermittent, for solids or liquids, any
pain/hoarseness/dyspnea, associated with regurg or reflux, any weight loss or
dehydration. Do a physical exam: throat and mouth exam, indirect laryngoscopy, ask
patient to swallow in front of you. Investigations: X-ray of pharynx/larynx AP-Lateral
view, CT/MRI of the neck, FODL, barium swallow, video fluoroscopy, esophageal
endoscopy, esophageal manometry.
45. History of sore throat and Investigations
Ans. Hx taking: dysphagia/odynophagia, when did it start, how did it start, rhinorrhea,
ear complains, ass with fever/headache/respiratory symptoms, tiredness, fatigue,
contact with ill people, bowel habits. Investigations: throat and mouth
exam(congestion, erythema, exudate), palpable lymph nodes, throat swab with rapid
antigen testing or culture.
46. Endotracheal tube with cuff, portex Tracheostomy tube with cuff, uses.
Ans. Page 351. ETT uses: surgery, protection against aspiration, to support breathing,
sedation, premature babies. Tracheostomy tube: relieve airway obstruction, bronchial
toilet, decrease dead space, assit ventilation, elective procedure in surgery.
47. Benign Paroxysmal positional vertigo. Causes and treatment.
48. Instructions: Read the case scenario and be prepared to answer the queries of examiner
Case Scenario: A 15-year-old male reported to ENT OPD with painful swallow, fever,
malaise for 3 days. Throat examination revealed a white patch on the right tonsil region
with jugulodigastric node palpable and tender on the same side.
49. Instructions: Read the case scenario and be prepared to answer the queries of examiner
Case Scenario: A 15-year-old male reported to ENT OPD with painful swallow, fever,
malaise for 3 days. Throat examination revealed a white patch on the right tonsil region
with jugulodigastric node palpable and tender on the same side.
50. Give a differential diagnosis for the given scenario
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a. (Ans: Acute tonsillitis, Diphtheria, infectious mononucleosis, Candidiasis)

51. In which condition a throat swab/microbiology is most important?
a. (Ans: Diphtheria)
52. List the tests that you will ask for in infectious mononucleosis
a. (Ans: Blood CP, LFTs, Ultrasound abdomen, Monospot test)
53. What are the possible causes of candidiasis in this case?
a. (Ans: Malnutrition, Prolonged steroid therapy, Diabetes etc.)
54. Instructions: From the list of causes select the causes of Noise induced Hearing loss and
write answers to the queries posted:
a. How will you confirm the diagnosis?
b. Write a treatment plan.
“EXPOSURE TO PRESSURE HORNS, OTOSCLEROSIS, TEXTILE MACHINERY WORKERS, UNDER
WATER DIVERS, LABOUR INVOLVED IN JET ENGINE MAINTENANCE, SHOOTING INSTRUCTORS,
MENIERES DISEASE SUFFERERS’’
55. Instructions: See the illustration, read the scenario and write answer to the queries
posted;
a. Case Scenario: This male baby, two months of age has occasional respiratory
discomfort. Flexible endoscopy showed like that:
i. Give a diagnosis and a treatment plan?

56. Laryngomalacia, counsel the parents that the condition resolves by itself by 2 to 4 years
of age and that treatment is conservative. Tracheostomy may be required for some
cases of severe respiratory obstruction. Supraglottoplasty is required in cases of severe
laryngomalacia.
57. Instructions: Observe the illustration showing nasal cavity below and write answers to
the queries posted
a. Name the two instruments shown above: (Ans: Blunt hook or Eustachian
catheter, ring probe)
b. What is being shown to be done in the illustration? (Ans: A round foreign body
being gently dragged from the inferior turbinates’ of the nasal cavity on the
floor)
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c. Where else this gadget can be employed in ENT practice? (Ans: Ear)

58. Instructions: Observe the illustration and write answers to the queries posted.
a. What is the most significant clinical finding?
b. Which side of the face is affected?
c. Write 3 common causes of the finding.

59. Instructions: From the one line given below identify the cause for dysphagia.
a. Dysphagia for solids, beefy tongue, koilonychias, microcytosis, esophageal web –
(Ans: Plummer-Vinson)
b. Alcohol consumer, progressive dysphagia, stricture in barium swallow, growth on
endoscopy
(Ans: CA)
c. A burning sensation in your chest (heartburn), sometimes spreading to your
throat, along with a sour taste in your mouth. Difficulty swallowing Dry cough.
(Ans: GERD causing Chronic Pharyngitis)
60. Throat Exam
61. Nose Exam
62. Vocal nodule
a. Cause
b. Rx.
63. Probe and uses
64. Audiograms for CHL, SNHL and mixed with causes
65. Auricular Hematoma
a. Cause
b. Rx
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c. Complication.
66. Skin patch test.
67. DNS
68. Interactive Spot - Epistaxis due to nasal bone fracture.
a. What kind of injuries?
i. Answer. Soft tissue injuries, deviated septum, bruising, cosmetic
deformity.
ii. Initial ER management:
1. Answer: Nurse on side.
2. Airway.
3. Control Epistaxis. Anterior packing or Foley's with cold
compression and plaster cast.
4. Vitals
5. IV-line fluids as well as analgesics.
6. Neurological examination plus CT scan/MRI.
7. Neurosurgeon plus ENT.
69. Otitis Media w/effusion and adenoid hyperplasia.
a. Management:
i. Answer: History: Behavior at school, somnolence, deafness and
discharge. Duration. Allergies and OM history. Environmental factors
history.
ii. Investigation: PTA TM Speech audiometry Pneumatic otoscopy
iii. Treatment: Myringotomy Tube insertion, Adenoidectomy and Antibiotics.

VIVA
1. Causes of diphtheria.
a. Organism?
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2. Elderly patient foreign body stuck in throat

a. how would u remove it-endoscopic
b. Fish bone stuck in throat possible sites to get stuck and how to remove it
3. Adenoid hyperplasia causes and treatment
4. Furunculosis treatment causes suspected population
5. Otomycosis treatment causes
6. Causes for conductive deafness
7. Causes for discharging ear
8. Causes for pain in ear
9. Vit deficiency in Plummer Vinson syndrome treatment
10. Achalasia Rhinolith Vestibulitis Subglottic fibrosis Leukoplakia and Erythroplakia
11. Indications of sys and topical nasal decongestant
12. Type of cancerous growth exophytic ulcerative infiltrative
13. Types of tonsillectomy and least painful
14. Vestibular exam
15. Meniere’s disease –
a. what is it,
b. anatomy and ionic composition of Scala media/tympani,
c. diagnostic tests
d. What do you check with Dix Hallpike test?
e. Caloric test - how do you do it, temperature of water, what do you see
16. What is nasal angiofibroma
17. Oral exam,
18. Palpate level IV lymph nodes
19. Causes of oral candidiasis Treatment of candidiasis/thrush
20. Risk factors for laryngeal cancer
21. Examine the oral cavity,
a. what things did you see?
b. Causes of oral cancers.
c. Palpate level 1 lymph nodes, what area do they drain.
22. What is the side effect of steroids in the mouth?
23. Oral cavity examination what structure do you see with IDL
24. components of hypopharynx
25. Causes of unilateral vocal cord paralysis: most common iatrogenic How to treat it:
surgical repair of nerve.
26. Ear exam Pt with conductive deafness, vertigo, tinnitus. Cause?
27. How to treat otitis media Complication of myringotomy?
28. What do you know about submucous fibrosis?
a. What are its complications?
b. Name other premalignant lesions.
29. What happens in tongue tie? Perform Rinne's and weber's and interpret?
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30. What is angiofibroma? What is little's area?

31. How would you investigate a suspected malignancy in the oral cavity?
32. Laryngeal carcinoma drains into which level of lymph nodes-level 3 and 4
33. Which structure did you examine in indirect laryngoscopy?
34. What do you examine in posterior rhinoscopy?
35. External – angiofibroma
a. How do you investigate,
b. If it spreads to the orbit complications? (proptosis),
c. nasal compilations too.
36. Nose examination Fb in nose of the child.
a. If it persists so what will form?
b. How do you treat a Rhinolith?
37. Unicellular smooth mass extending into the nasopharynx
a. What’s your diagnosis? (Antrochoanal polyp.)
b. Investigations?
c. Treatment surgery?
38. Facial nerve examination (motor, sensory n secretomotor)
39. Stapedial reflex –
a. How do you check it?
b. OME diagnosis and Rx
40. Myringotomy incision?
41. how do you insert grommet and its complications?
42. Ototoxicity
a. Signs and symptoms,
b. Drugs that cause ototoxicity,
c. Rx
43. Oral cavity examination?
44. L4 LN exam?
45. Retropharyngeal abscess
a. Rx and
b. complications
46. Nose Exam
a. Septal Hematoma
b. What do you see on rhinoscopy?
c. How do you treat it
47. Oral Cavity Exam.
48. Palpate the 4th Level of lymph nodes
a. What parts does it drain?
b. What investigative tool is used to differentiate between a metastatic lymph
node and a general lymph node?
c. FNAC After treating the primary site, what will you do with the lymph node?
(Perform Neck Dissection and Remove the metastatic nodes)
49. Tonsillectomy Complications (reactionary hemorrhage)
50. Carcinoma of nose (inverted papilloma)
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51. Otosclerosis
52. Where neck lymph nodes drain
53. Facial nerve exam
54. What is oropharynx? Examine the oropharynx only?
55. How do you treat oral cancer?
56. If there's a tumor in the neck how will you treat it.
57. Indirect laryngoscope exam.
58. Lymph node levels and drainage.
59. How will you diagnose lateral neck lumps (fnac)?
60. how will you diagnose lateral tongue tumors (excisional biopsy)?
61. All three tuning fork tests (Rinne’s, Weber’s, Schwabachs)
a. what positive and negative for each test mean.
62. Causes of sensory neural and conductive deafness.
63. Causes and treatment of presbycusis
64. Facial nerve exam.
a. What component where you examining?
b. What’s the other component?
c. What does it supply?
65. Fungal rhinosinusitis
66. Polyps.
a. Types,
b. causes –
67. Presbycusis.
a. What is it?
b. How do you test for it?
c. What will you find?
68. Oral cavity exam - palpate neck nodes
a. What do the level 1 lymph nodes drain?
b. Treatment of tonsillitis?
c. Tongue tie treatment?
69. Retro pharyngeal abscess
a. Treatment of recurrent tonsillitis
b. Early complication of tonsillectomy
c. Oral cavity examination
70. Allergic Rhinitis
a. Diagnosis
b. Treatment
71. Septal Abscess
a. Causes?
b. Treatment?
c. Complications?
72. Ear exam
a. Red Tympanic membrane causes
b. and if not, red what is the cause?
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c. Treatment complication
73. Mastoiditis treatment
74. Examine neck. (He emphasized on proper exposure)
75. Define boundaries of the neck?
76. Otitis media with effusion
a. Diagnosis,
b. Causes,
c. Investigations,
d. Treatment.
77. Nose examination
a. What areas will you see on posterior rhinoscopy
b. You see a smooth mass on post rhinoscopy what could it be
c. Angiofibroma investigations and treatment
78. Perform mouth exam (which is mouth and throat both)
a. Level of lymph nodes
b. Laryngeal cancer metastasizes to which level of lymph nodes
c. Glottic carcinoma metastasis
79. Ankyloglossia
a. definition and it’s long term effects
80. Leukoplakia and submucosal fibrosis
81. Webber’s and Rennes?
82. Do Neck examination.
a. What are the boundaries of the neck "with respect to the patient"
83. Ear examination and findings.
a. Causes of conductive deafness.
84. Neck examination.
a. Boundaries of neck.
b. Location of branchial cyst.
c. Definition of cyst. Lining of cyst.
d. Extension of the tract of branchial cyst.
e. Treatment and complications of its surgery
85. Causes of deafness
86. Complications of CSOM
a. Types of CSOM
87. Meniers and Acoustic Neuroma
88. Causes of ear discharge
89. Let fort's fracture
90. Types of Bose fractures
91. Ludwig's Angina
a. Treatment
b. Complications
92. Most common FB
a. where does it get stuck?
93. Tonsillectomy indications.
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a. Styloid process
b. Tonsillectomy contraindications
c. Complications of tonsillectomy with management
94. Different between SMR and septoplasty
95. Difference between lymphoma and malignant nodes
96. Boil ear
97. Thyroglossal duct cyst
98. Midline incisions.
99. Otomycosis.
100. Diagnosis, causes, investigations and treatment for
101. Old man dysphagia headache. D/D
102. Boil complications and treatment.
103. Angiofibroma age group and whether benign/malignant
104. Tonsil tumor is what?
105. Recurrent Epistaxis treatment and ER care.
106. Patient post op tonsillectomy. Medical management.
107. DNS
108. Rhinolith is what and treatment
109. FB nose
110. Sistrunk surgeries
111. Saddle nose deformity causes.
112. Treatments for enlargement of turbinate?
a. SMD or partial turbinectomy?
b. What is better?
c. What is dangerous?
113. Antrochoanal polyp treatment.
114. Different types of rhinoplasty and treatment.
115. Secondary bleeding treatment after tonsillectomy.
116. Hump nose causes and treatment.
117. Vestibulitis treatment
118. What is cholesteatoma.
119. Acoustic neuroma (knife)
120. Reasons of anosmia
121. Turbinate swelling treatment
122. Why dont you touch boil – Cavernous sinus thrombosis
123. Leforts and complications
124. Midline swellings
125. Thyroglossal cyst treatment (sistrunks- excise and hyoid removal)
126. Tonsillectomy indications (apnea, access to styloid removal, access to CN 9)
127. Conductive hearing loss causes Sensory neural hearing loss causes Meniere’s
disease
128. Hypertensive old patient came with epistaxis.
a. What type of epistaxis? Profuse
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b. Management of patient with environmental epistaxis? keep nose moisturized

and use polyfax ointment
129. Angiofibroma
a. Angiography when to do?
130. Tonsillectomy- secondary hemorrhage - what to do?
131. Referred otalgia reasons? Specific location?
132. Rhinolith treatment
133. Epistaxis due to hypertension treatment
134. Foreign body Cell battery in nose complication
135. Causes of deafness
136. Old guy from KPK has unilateral otitis media with effusion – cause
137. Tonsillectomy.
138. Thyroglossal duct cyst,
139. Ludwig’s angina (treatment and complications, asked about abscess in it - no
abscess)
140. Congenital malformations of Larynx
141. Nasal boil and vestibulitis (treatment and complications)
142. Most common foreign body in nose and what can it cause
143. Inflamed turbinate’s – treatment
144. Rhinolith
a. What is it
b. How is it formed,
c. Treatment.
145. Epistaxis
a. Causes
b. Treatment in case of recurrent epistaxis
c. Types of cautery,
d. Substance that is used in chemical cautery.
146. Causes of hearing loss, causes of sensorineural hearing loss,
a. tell me whatever u want about Meniere’s disease.
147. How to treat severe epistaxis in ER?
a. Alternative to posterior nasal packing?
b. How to treat recurrent epistaxis?
148. How to treat swollen turbinate’s?
149. patient with dysphagia and earache. Patient has been consuming tobacco n
smoking since long. On examination ear appears totally normal.
a. What could it be?
b. Malignancy but where?
c. Oropharynx yes but where else?
150. Tonsillectomy to reach which region? (Styloid something, he said)
151. Midline neck lumps with
a. d/d and
b. relevant hx. questions
152. Ear exam
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153. Throat exam

154. Skin prick test how it is done and what it can be used in
155. Tracheostomy tube uses and c/I
156. Chart on otosclerosis and it's management
157. Brain cerebellar abscess CT and what it's seen in
a. Complications
b. Tx
158. Interactive reactionary hemorrhage
a. Tx