ENT Collection 4

What this deck covers

ENT Collection 4 – 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. Epistaxis
2. Nasal Foreign Body
3. Choanal Atresia
4. Periorbital & Orbital Cellulitis
5. Cleft Lip & Palate

What this collection teaches

• Epistaxis. ~90% of childhood nosebleeds arise from Kiesselbach’s plexus on the anterior septum, and nose-picking is the commonest trigger. Anterior bleeds are usually unilateral, bright red at the nostril, easily seen, and stop with pressure. A well, alert child with normal vitals and isolated anterior bleeding needs neither transfusion nor an oncology workup.
• Nasal Foreign Body. The single pattern to recognize: any toddler with UNILATERAL, purulent, foul-smelling nasal discharge has a nasal foreign body until proven otherwise. Organic objects absorb moisture, swell, and irritate the mucosa → secondary bacterial infection. Laterality is the clue — a viral URI gives bilateral clear/mucoid discharge with no odor; absence of fever argues against bacterial sinusitis.
• Choanal Atresia. Neonates are obligate nasal breathers, so bilateral choanal atresia produces the hallmark paradoxical (cyclical) cyanosis — cyanosis at rest that resolves with crying (the open mouth bypasses the blocked nose). No air movement from either nostril indicates a complete, bilateral obstruction. Unilateral atresia presents later with persistent unilateral nasal discharge, not acute neonatal cyanosis.
• Periorbital & Orbital Cellulitis. The bedside line between the two is the orbital septum. Preseptal (periorbital) disease spares the globe, extraocular muscles, and optic nerve — so normal vision and full, painless eye movements are the reassuring hallmark. Eyelid erythema, fever, and sudden onset happen in both and don’t localize.
• Cleft Lip & Palate. The primary palate (lip + premaxilla) forms when the medial nasal and maxillary processes fuse at 4–7 weeks — failure here gives cleft lip ± alveolus. The secondary palate (hard + soft palate) forms later, at 8–12 weeks, as the palatal shelves swing horizontal and fuse. This is why cleft lip and cleft palate can occur together or independently, and why early first-trimester insults matter.

Exam pearls from this collection

• Kiesselbach’s plexus (Little’s area) is a watershed on the anterior-inferior septum where five arteries converge (anterior + posterior ethmoidal from the ICA system; sphenopalatine + greater palatine from the maxillary; superior labial from the facial). Thin fragile mucosa, temperature/humidity extremes, and superficial vessels make it bleed easily.
• Correct positioning is upright and leaning forward — it prevents posterior drainage/aspiration and lets blood flow forward so you can see the source. Then suction clots (they block topical meds and hide the vessel) and inspect with a speculum + headlight (or endoscopy). Head-tilted-back, blind packing, and routine CT are all wrong first steps.

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.