ENT Collection 2

What this deck covers

ENT Collection 2 – 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. Peritonsillar & Retropharyngeal Abscess
2. OSA & Adenotonsillar Hypertrophy
3. Infectious Mononucleosis
4. Cervical Lymphadenopathy
5. Congenital Neck Masses

What this collection teaches

• Peritonsillar & Retropharyngeal Abscess. PTA is almost always unilateral: pus in the peritonsillar space pushes the uvula toward the opposite side and bulges the soft palate. Add the “hot-potato” voice and drooling and you have the classic picture. Simple pharyngitis is bilateral with diffuse erythema — exudates, bilateral nodes, and a strep history do not localize a PTA.
• OSA & Adenotonsillar Hypertrophy. Paradoxical rib-cage movement (the chest moving IN on inspiration) reflects high upper-airway resistance and a hard struggle against a collapsing pharynx — the most specific physical sign of true obstruction in a sleeping child. Snoring is common and nonspecific; witnessed gasping/apneas are suggestive. Daytime irritability and ADHD-like behavior come from fragmented sleep.
• Infectious Mononucleosis. Posterior cervical lymphadenopathy plus profound fatigue points to EBV — anterior cervical nodes favor group A strep. Tonsillar exudates are actually common in mono (~85%), so their absence is not expected. A scarlatiniform sandpaper rash suggests scarlet fever. Also look for generalized adenopathy, splenomegaly, and mild transaminitis.
• Cervical Lymphadenopathy. Bilateral, small (<2 cm), soft, mobile, non-tender nodes with URI symptoms in a well, afebrile child = reactive viral lymphadenopathy — by far the most common cause. No antibiotics or workup are needed; reassure that the nodes can take weeks to shrink. The benign signature is “bilateral + soft + mobile + non-tender.”
• Congenital Neck Masses. A midline mass near the hyoid that moves UP with tongue protrusion/swallowing = thyroglossal duct cyst — the commonest congenital neck mass (~70%). It is a remnant of the thyroglossal duct (foramen cecum → pretracheal thyroid), stays tethered to the hyoid/tongue base, and often first appears or enlarges after a URI.

Exam pearls from this collection

• Trismus in PTA comes from reflex spasm/irritation of the adjacent internal (medial) pterygoid muscle. It is a key sign separating abscess from peritonsillar cellulitis, where mouth opening is preserved. Severe trismus can make oral exam impossible and push you toward CT.
• The peritonsillar space sits between the tonsillar capsule and the superior pharyngeal constrictor; infection usually starts at the superior pole from inflamed Weber glands. Anatomy matters for drainage safety — the internal carotid lies only ~2.5 cm posterolateral to the tonsil.

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.