Ent1. A 4-year-old with 24 hours of earache is well, no otorrhoea, temperature 37.8 °C. What is the most appropriate initial management (NICE NG91)?A. Analgesia with a delayed antibiotic strategy if remaining wellB. Immediate IV ceftriaxone in GPC. Ear syringing todayD. Urgent mastoidectomy referralCheck
Ent2. Parents demand a decongestant for confirmed OME. What is the most appropriate advice?A. Decongestants are first-line NICE treatmentB. Long-term oral steroids are mandatoryC. Daily ototoxic aminoglycoside drops for 3 monthsD. Do not routinely use decongestants, antihistamines, steroids or prolonged antibiotics (NICE NG233)Check
Ent3. A child with Down's syndrome has persistent OME and hearing concerns at 8 weeks. What is the most appropriate adjustment to usual waiting?A. Lower threshold for earlier audiology/ENT because of higher OME burden and developmental riskB. Longer than 3 months of observation than for other childrenC. No hearing tests are useful in Down's syndromeD. Routine neck X-ray instead of audiologyCheck
Ent4. Unilateral hearing vanished over 12 hours. The canal is clear. Tuning forks suggest sensorineural loss. What is the most appropriate action?A. Review wax in 6 weeksB. Long-term prochlorperazineC. Same-day ENT/audiovestibular referral for sudden sensorineural hearing lossD. Community amoxicillinCheck
Ent5. A well 14-year-old has anterior epistaxis. What first-aid advice is correct? The most appropriate action is: Tip the head right backTRUE. TrueFALSE. FalseCheck
Ent6. A 72-year-old smoker has recurrent unilateral epistaxis and a visible nasal mass. What is the most appropriate pathway?A. Lifelong silver nitrate as the only planB. Assume always Little's area in this storyC. 2WW head and neck / urgent ENT for possible malignancy (NICE NG12)D. Start a DOACCheck
Ent7. Epistaxis with vomiting blood, BP 88/50 mmHg, still pouring. What is the most appropriate action?A. Book ENT in 6 weeksB. Give only oral vitamin K and send homeC. Cauterise blindly without a view in an unstable patientD. Call 999; packing/resuscitation is not a leisurely GP procedure in shockCheck
Ent8. You see a prominent vessel on Little's area. What cautery precaution matters?A. Avoid cauterising both sides of the septum in one sitting (perforation/necrosis risk)B. Always burn both sides for symmetryC. Cautery replaces first aid even in shockD. Use phenol on the whole turbinate as first-line GP careCheck
Ent9. A 10-day viral URTI with facial pressure, no red flags. What is the most appropriate antibiotic decision (NICE)?A. Immediate 6 weeks of co-amoxiclav for all such casesB. No routine antibiotics; saline and analgesia; safety-netC. Urgent CT from GP as first-lineD. Intranasal adrenalineCheck
Ent10. FeverPAIN 5, marked pus, fever, no cough, 2 days of symptoms. What is a reasonable option?A. Immediate phenoxymethylpenicillin if treating streptococcal sore throatB. Immediate amoxicillin as first choice when EBV is possibleC. Clarithromycin for everyone including those who can take penicillinD. No analgesia neededCheck