A complete, clinically reviewed 120-question paper with detailed option analysis, “what if?” extensions and visible evidence passports.
Start the 135-minute timed mockOriginal educational questions with answer-by-answer reasoning and visible evidence and review passports.
A 49-year-old of Chinese family origin develops unilateral conductive hearing loss and a persistent middle-ear effusion without an upper-respiratory infection. What is the most appropriate referral?
An adult reports disproportionate difficulty understanding speech in noise. Pure-tone thresholds are mildly impaired, otoacoustic emissions are present, but auditory brainstem responses are absent and acoustic reflexes are abnormal. What diagnosis best explains this pattern?
An adult has bilateral severe-to-profound sensorineural deafness and derives inadequate benefit from appropriately fitted acoustic hearing aids after structured assessment. Which principle best guides the next step?
A patient has posterior-canal BPPV confirmed by a typical torsional up-beating Dix–Hallpike response. Symptoms persist after one correctly performed Epley manoeuvre. What is the best next action?
A 7-year-old has unilateral otitis media with effusion and confirmed hearing loss. School reports difficulty localising sound, but language development is normal. What is the most appropriate management principle?
A 58-year-old has a persistent unilateral middle-ear effusion after an upper-respiratory infection has resolved. There is no acute otalgia. What is the most appropriate next step?
An adult with worsening conductive hearing loss has a firm external-canal mass that prevents visualisation of the tympanic membrane and prevents an impression for amplification. What is the best next step?
A 72-year-old has symmetrical aidable hearing loss in both ears and difficulty understanding speech in noise. Which rehabilitation recommendation is most appropriate?
A fit patient has a persistent lateral-tongue leukoplakia. Incisional biopsy shows severe epithelial dysplasia without invasion. What is the most defensible management?
A euthyroid patient has a solitary thyroid nodule graded U4. Fine-needle aspiration is Thy3f, suggesting a follicular neoplasm. There are no distant metastases. What is the most appropriate diagnostic treatment?
A patient has a thyroid nodule without a family history of medullary thyroid cancer and without ultrasound features suggesting it. Which statement about calcitonin testing is most accurate?
A patient has newly diagnosed T4 hypopharyngeal squamous-cell carcinoma with bulky N2 nodal disease and no distant symptoms. Which systemic staging approach is most appropriate?
A patient newly diagnosed with differentiated thyroid cancer is told, 'Do not worry—this is the good cancer.' What is the best consultant response?
A parotid malignancy surrounds but does not clinically or radiologically invade a normally functioning facial nerve. What principle should guide nerve management at resection?
A U5 thyroid nodule has yielded Thy1 cytology twice despite ultrasound-guided fine-needle aspiration. There is no evidence of anaplastic disease or distant metastasis. What is the best next management principle?
An adult has a suspicious level II cervical node and a possible tonsillar primary. Which initial tissue strategy is most appropriate?
A 35-year-old has spontaneous recurrent bilateral epistaxis, mucocutaneous telangiectasias and a first-degree relative with the same problem. What is the best next management principle?
An adult has severe bilateral chronic rhinosinusitis with nasal polyps despite adherence to topical therapy and previous appropriate endoscopic sinus surgery. Asthma remains difficult to control. What is the best next principle?
CT shows complete unilateral maxillary-sinus opacification with internal calcific foci and medial-wall bowing. The patient is immunocompetent and has chronic unilateral symptoms. What is the best next step?
A teenager with frontal sinusitis develops fever, severe headache and a tender fluctuant forehead swelling. CT shows frontal-bone erosion and a subperiosteal collection. What is the immediate management principle?
A patient has unilateral foul nasal discharge after upper-molar implant surgery. CT shows unilateral maxillary opacification centred on a dental implant protruding into the sinus. What is the best management?
A patient has crusting, bleeding and whistling from a 2 cm anterior septal perforation after previous surgery. Autoimmune and drug-related causes have been excluded. Symptoms persist despite humidification and emollients. What is the best next principle?
A 5-year-old with Down syndrome has bilateral OME-related hearing loss affecting classroom communication. Which management principle is best?
A 2-year-old has drooling and refuses food. Radiography shows a 20 mm button battery lodged in the upper oesophagus. What is the correct management?
A child is being considered for tonsillectomy because of recurrent sore throats. Which factor is most important before recommending surgery?
A 6-year-old has clockwork episodes of fever, aphthous ulcers, pharyngitis and cervical adenitis. Growth is normal and the child is completely well between attacks. Which statement about tonsillectomy is most accurate?
A 4-year-old with severe obstructive sleep apnoea is scheduled for adenotonsillectomy. Sleep study shows marked desaturation and the child has obesity. What is the key perioperative principle?
A 6-year-old with persistent bilateral OME-related hearing loss is proceeding to grommet insertion. The child also has chronic nasal obstruction and enlarged adenoids. What additional procedure should be discussed?
A tracheostomised patient suddenly becomes hypoxic with high airway pressures. Suction catheter will not pass through the tube. What is the immediate airway action?
A professional voice user has a small T1a glottic squamous-cell carcinoma confined to one vocal fold with normal mobility. What is the best decision principle?
A teacher has effortful variable dysphonia. Laryngoscopy shows supraglottic hyperfunction but normal vocal-fold mobility and no mucosal lesion. Stroboscopy shows preserved vibration. What is the best initial treatment?
A smoker has a persistent unilateral irregular white vocal-fold lesion with reduced mucosal wave on stroboscopy. Voice is worsening. What is the most appropriate next step?
A patient with a total laryngectomy collapses with respiratory distress. Staff apply a face mask but oxygen saturation continues to fall. What is the critical correction?
A stable patient has displaced frontal, midface and mandibular fractures with loss of facial height and dental malocclusion. What principle best guides definitive reconstruction?
Immediately after parotidectomy for a benign tumour, the patient has complete ipsilateral facial paralysis. The operative note says the nerve was anatomically intact, but stimulation was lost near the end of dissection. What is the best next principle?
A child presents within two hours of a deep contaminated dog bite crossing the cheek and lip. There is no tissue loss and perfusion is good. What is the best management principle?
A patient seeking functional septorhinoplasty says that even a small chance of visible asymmetry would be unacceptable because of their occupation. What should the surgeon do?
A meta-analysis of small studies suggests a large benefit from a new haemostatic device, but the funnel plot is markedly asymmetric and larger trials show little effect. What is the most defensible interpretation?
A patient signed consent for parotidectomy six weeks ago. On the morning of surgery they appear uncertain and ask about facial-nerve risk. What should happen?
After endoscopic sinus surgery, imaging confirms an orbital injury requiring further treatment. The complication was not recognised intraoperatively. What is the surgeon's immediate professional obligation?
An adult with longstanding foul otorrhoea develops severe otalgia and a new lower-motor-neurone facial palsy. Otoscopy shows attic keratin debris. What is the most appropriate next step?
After a week-long cruise, a patient has persistent rocking and swaying that improves while riding in a car and returns when stationary. Examination and vestibular testing are normal. What is the most likely diagnosis?
A patient has dozens of stereotyped attacks of spinning lasting under one minute, sometimes provoked by head position, with normal examination between episodes. MRI shows a vascular loop contacting the eighth nerve. What is the most appropriate diagnostic principle?
A patient has disabling unilateral Ménière attacks despite dietary measures and maintenance treatment. Hearing remains serviceable. Which escalation principle is most appropriate?
A patient develops oscillopsia while walking and marked imbalance in darkness after prolonged aminoglycoside exposure. Head-impulse testing is abnormal bilaterally. What is the most useful rehabilitation strategy?
Immediately after forceful Valsalva during diving, a patient develops unilateral hearing loss, tinnitus and pressure-provoked vertigo. What is the safest initial management principle?
A patient with von Hippel–Lindau disease develops unilateral tinnitus, progressive sensorineural hearing loss and episodic vertigo. CT shows destructive retrolabyrinthine temporal-bone change and MRI shows a strongly enhancing lesion. What is the most likely diagnosis?
A patient describes irregular objective clicking in one ear. Otoscopy intermittently shows rhythmic tympanic-membrane movement, hearing is normal and vascular imaging is unremarkable. What is the most likely mechanism?
A patient has complete unilateral lower-motor-neurone facial weakness, hyperacusis, loss of taste from the anterior tongue and reduced lacrimation. Where is the lesion most likely?
After head trauma, a patient has haemotympanum, immediate complete facial paralysis and profound sensorineural hearing loss. CT shows a fracture crossing the otic capsule. Which statement is most accurate?
A 73-year-old has a 7-mm intracanalicular vestibular schwannoma, mild stable asymmetry, no disabling imbalance and significant comorbidity. What is the most defensible initial plan?
A child is being prepared for cochlear implantation. Which preventive measure is particularly important because implantation increases susceptibility to pneumococcal meningitis?
After canal-wall-up surgery for extensive cholesteatoma, otoscopy is reassuring but the epitympanum is not fully visible. What follow-up principle best detects residual disease?
A patient develops severe otalgia, vesicles in the concha, complete ipsilateral facial weakness and vertigo. What treatment principle is most appropriate?
A child with fluctuating progressive sensorineural hearing loss deteriorates after minor head trauma. CT shows bilateral enlarged vestibular aqueducts. What associated condition should be considered?
After a temporal-bone injury, a patient has persistent 35-dB conductive hearing loss, normal bone thresholds and an intact healed tympanic membrane. Tympanometry is hypercompliant. What is the most likely explanation?
An adult has a lateral cystic neck mass. Cytology is scant, but thyroglobulin concentration in the needle washout is very high and ultrasound shows punctate echogenic foci in a thyroid nodule. What is the most likely diagnosis?
A profoundly malnourished patient with obstructing hypopharyngeal cancer has eaten almost nothing for ten days. What is the safest nutritional principle?
After resection of a lateral tongue squamous carcinoma, the final deep margin contains invasive tumour. What is the preferred principle when anatomically feasible?
A fit patient has resectable T3 laryngeal cancer with a functional larynx and no cartilage destruction. Which statement best reflects management?
An oral squamous carcinoma abuts the mandible. CT shows superficial cortical erosion but no medullary invasion, and the patient has a functioning dentate mandible. What resection principle is most appropriate?
A patient has biopsy-proven nasopharyngeal carcinoma and bilateral cervical nodes. Which imaging combination best supports initial staging?
An older patient with previous scalp cutaneous squamous carcinomas develops a firm parotid-tail mass and upper-neck node. What diagnosis should be assumed until disproved?
An older patient with Hashimoto thyroiditis develops a rapidly enlarging painless thyroid mass, compressive symptoms and cervical nodes. What is the best diagnostic strategy?
A patient with a rapidly enlarging fixed thyroid mass has stridor and imaging suggests unresectable anaplastic carcinoma. What is the immediate management principle?
MRI shows a prestyloid parapharyngeal mass displacing the internal carotid artery posteriorly and widening the stylomandibular tunnel. What origin is most likely?
A patient with recurrent temple cutaneous carcinoma develops progressive facial numbness and facial weakness. MRI shows enhancement tracking toward the skull base. What is the key interpretation?
After chemoradiotherapy and salvage neck surgery, a patient has a small self-limiting oral bleed. CT previously showed tumour encasing an exposed carotid. What is the safest interpretation?
A patient previously irradiated for oropharyngeal cancer has exposed mandibular bone, pain and a pathological fracture without recurrent tumour. What management principle is most appropriate?
Six hours after free-flap reconstruction, the skin paddle becomes congested, dark and rapidly refills after blanching. What is the best response?
Three months after definitive chemoradiotherapy for node-positive oropharyngeal cancer, a patient has a residual but smaller neck mass. What is the best assessment strategy?
A patient develops progressive pain, oedema and cartilage exposure after laryngeal radiotherapy. Imaging is equivocal for recurrence versus chondroradionecrosis. What is the best principle?
A patient has crusting, epistaxis, septal perforation, pulmonary nodules and glomerulonephritis. Biopsy shows necrotising granulomatous inflammation. What is the most appropriate treatment principle?
A child with sinusitis has proptosis, painful restricted eye movements and declining visual acuity. CT shows a medial subperiosteal orbital abscess. What is the best next step?
A patient has unilateral watery rhinorrhoea that increases on bending forward after skull-base surgery. Which laboratory test is most specific for confirming CSF?
After craniofacial trauma, a patient has severe visual loss and a relative afferent pupillary defect but no orbital compartment syndrome and no compressive bone fragment on CT. What is the most defensible management principle?
A patient with recurrent bilateral epistaxis has mucocutaneous telangiectasia and a first-degree relative with similar symptoms. What is the most appropriate broader management principle?
An adult has lifelong wet cough, chronic pansinusitis, bronchiectasis, otitis media and situs inversus. Which test combination best establishes the suspected diagnosis?
A patient has progressive septal and palatal destruction. Cocaine use is disclosed, and serology shows atypical high-titre ANCA against multiple neutrophil antigens without renal disease. What is the best interpretation?
A patient requests complete inferior-turbinate removal for nasal obstruction despite normal-sized turbinates and a narrow internal valve. What is the best surgical principle?
A patient presents with sudden severe retro-orbital headache, ophthalmoplegia and rapidly deteriorating vision. CT sinuses is unremarkable. What is the most important next action?
A patient has unilateral nasal obstruction and a cerebriform mass arising from the lateral nasal wall. Biopsy shows inverted papilloma. What management principle is most appropriate?
A highly vascular skull-base tumour encases lower cranial nerves. Angiography confirms a paraganglioma. What is the safest principle before intervention?
A child has recurrent left-sided suppurative thyroiditis and deep-neck abscesses. Endoscopy reveals an internal opening at the apex of the left piriform fossa. What is the most likely diagnosis?
A toxic child has fever, stridor and thick secretions. Nebulised adrenaline produces little improvement, and radiography suggests irregular tracheal narrowing. What is the safest management?
A child has fever, torticollis, drooling and a bulging posterior pharyngeal wall. CT shows a rim-enhancing retropharyngeal collection with airway narrowing. What is the best next step?
An infant has inspiratory stridor but is now failing to thrive, has pectus recession and repeated cyanotic episodes during feeds. What is the most appropriate management?
A child has persistent unilateral nasal discharge and obstruction since infancy. Endoscopy suggests unilateral choanal atresia. What is the most useful confirmatory investigation for operative planning?
An infant has coughing and cyanosis with feeds, recurrent chest infections and persistent interarytenoid penetration despite reflux treatment. What investigation confirms a suspected laryngeal cleft?
A previously well toddler develops sudden coughing while eating nuts, followed by persistent unilateral wheeze despite a normal chest radiograph. What is the best next action?
A child presents seven days after tonsillectomy with repeated swallowing, pallor and fresh blood in the mouth. What is the safest immediate management?
A child has a painless midline neck mass that moves upward on tongue protrusion. Ultrasound shows a cystic lesion and no normal thyroid in its usual position. What must occur before excision?
A child with persistent bilateral OME-related hearing loss is awaiting a surgical decision and is struggling at school. What intervention should be offered now?
An obese child has severe OSA and large tonsils. What is the most accurate counselling before adenotonsillectomy?
A newborn repeatedly fails screening in both ears. What is the most important next principle?
A child with a long-term tracheostomy is clinically improved. Which principle should guide decannulation?
A patient has task-specific strained, intermittent voice breaks that improve when singing and worsen during connected speech. Laryngoscopy shows no mass. What is the most likely diagnosis?
After thyroidectomy, a professional singer has loss of high pitch and vocal fatigue, but both vocal folds abduct and adduct normally. What injury is most likely?
An older patient has regurgitation of undigested food, halitosis, dysphagia and recurrent aspiration. A contrast swallow shows a posterior pharyngoesophageal pouch. What is the best treatment principle?
A patient has cervical dysphagia and a prominent cricopharyngeal bar on swallow study, but also has weight loss and progressive symptoms. What is the safest next step?
A patient with pulmonary sarcoidosis develops progressive inspiratory stridor. Endoscopy shows smooth pale supraglottic swelling centred on the epiglottis and arytenoids, with mobile vocal folds. What is the best management principle?
A patient remains unable to decannulate after prolonged intubation. Both vocal folds appear immobile, but laryngeal electromyography shows preserved motor units. What diagnosis should be suspected?
A patient has recurrent pneumonia and silent aspiration after chemoradiotherapy. Which investigation best characterises the physiology and tests compensatory strategies in real time?
A smoker has a very low-pitched voice and bilateral translucent polypoid swelling along the membranous vocal folds. What is the best management principle?
A patient has slowly progressive dysphonia and multifocal smooth submucosal laryngeal deposits. Biopsy shows Congo-red-positive material with apple-green birefringence. What is the next principle?
After facial trauma, a patient develops rapidly falling vision, a tense proptotic orbit, relative afferent pupillary defect and raised intraocular pressure. What is the immediate action?
A sharp temple laceration causes immediate inability to elevate the ipsilateral brow. The injury is seen within hours. What is the best principle?
A patient has persistent obstruction after septoplasty. Symptoms improve with a modified Cottle manoeuvre, and inspiration causes lateral-wall collapse. What is the best interpretation?
During revision rhinoplasty, the soft-tissue envelope becomes pale and capillary refill is poor after extensive tip dissection. What is the safest response?
After high-energy trauma, the entire midface is mobile relative to the cranial base, with bilateral zygomaticofrontal and nasofrontal disruption. Which fracture pattern is present?
A patient develops a large symptomatic keloid after ear piercing and requests simple excision. What counselling is most accurate?
During parotid surgery, facial-nerve stimulation is absent after neuromuscular blockade. What is the best interpretation?
A patient with bilateral carotid-body tumours is being considered for staged surgery. Why is simultaneous bilateral excision hazardous beyond cranial-nerve injury?
A patient with unilateral conductive hearing loss struggles to localise sounds. Which binaural cue is most disrupted for low-frequency sounds?
During thyroidectomy, stimulation of the vagus produces no laryngeal response before dissection begins, but direct stimulation of the recurrent laryngeal nerve produces a response. What is the most likely issue?
A new neck-mass test performs well in a tertiary cancer clinic but poorly in primary care. What best explains the discrepancy?
A trial claims a new voice-restoration device is non-inferior, but the prespecified margin would allow a clinically important loss of intelligibility. What is the main concern?
Immediately before grommet insertion, the consent form and theatre list disagree about which ear is planned. What is the correct response?
A deaf patient who uses British Sign Language is considering major cancer surgery. Their family offers to interpret. What is the best consent approach?
A wrong implant is opened but identified before insertion. No patient harm occurs. What is the most appropriate response?