ENT Collection 1

What this deck covers

ENT Collection 1 – 50 questions across 5 ENT topics, each with the correct answer and an explanation of why the other options are wrong. This collection is written for candidates preparing for the MRCPCH and Saudi and Gulf licensing examinations such as the Arab Board, DHA and OMSB, and it works as a single long drilling set rather than as a short case deck.

The topics in this collection

1. Otitis Externa
2. Otitis Media with Effusion
3. Acute Otitis Media
4. Cholesteatoma
5. Ear Foreign Body & Trauma

What this collection teaches

• Otitis Externa. Cerumen protects the canal with an acidic pH (~6.1–6.5) and a hydrophobic barrier. Prolonged moisture (swimming, humidity) macerates the skin and pushes canal pH above 7, creating the alkaline, water-logged environment that lets Pseudomonas aeruginosa and S. aureus invade. OE is fundamentally a disease of the canal skin, not the middle ear.
• Otitis Media with Effusion. OME (glue ear) is often silent — it shows up as mild conductive hearing loss picked up through behavior: daydreaming, inattention, turning up the TV, asking for repetition, with no pain or fever. Otoscopy shows a retracted, dull amber TM, sometimes with an air-fluid level. That subtlety is exactly why it is underdiagnosed.
• Acute Otitis Media. AOM requires acute onset + signs of middle-ear effusion (bulging TM and/or reduced mobility on pneumatic otoscopy) + signs of middle-ear inflammation (erythema, otalgia/ear-pulling, fever). A bulging TM is the single most predictive finding. OME has effusion without acute inflammation; otitis externa involves the ear canal, not the middle ear.
• Cholesteatoma. Painless, chronic, foul-smelling otorrhea is the hallmark that separates cholesteatoma from AOM (where pain dominates). Add granulation tissue and a posterosuperior/pars flaccida perforation — the weakest part of the TM and the classic origin of acquired cholesteatoma — plus conductive loss from ossicular erosion. Any child with chronic painless ear drainage is cholesteatoma until proven otherwise.
• Ear Foreign Body & Trauma. For a small, non-organic object with an INTACT tympanic membrane in a cooperative child, warm-water/saline irrigation is simplest and effective — direct the stream along the posterosuperior canal wall so water flows behind the object and floats it out. Always confirm TM integrity first. Never irrigate organic matter (beans/seeds swell) or a button battery, and avoid high-pressure jets.

Exam pearls from this collection

• Tragal/auricular tenderness is the hallmark of acute OE (>95% of cases) — the tightly bound canal skin overlies a sensitive periosteum. Mastoid tenderness suggests mastoiditis; a dull/immobile TM suggests otitis media. Practical clue: a child who cries when you merely touch the outer ear almost always has otitis externa.
• In uncomplicated OE the disease is confined to the canal, so the TM stays normal and mobile (mild erythema aside). Bulging or reduced mobility points to otitis media instead. Always try to visualize the TM to exclude concurrent OM or perforation — if the canal is too swollen to see it, assume a possible perforation until proven otherwise.

All 50 questions in this collection, with the full explanation of every option, are part of Pediatric Case Review membership. See what is included, or start with the free Pediatric Exam Review Sets.

More from this system: all ENT case decks · the free Pediatric Exam Review Sets · pediatric reference values.