ENT Collection 5

What this deck covers

ENT Collection 5 – 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. Congenital & Acquired Hearing Loss
2. Newborn Hearing Screening
3. Hearing, Speech & Language
4. Cleft Lip & Palate
5. ENT Manifestations of Syndromes

What this collection teaches

• Congenital & Acquired Hearing Loss. A failed newborn screen — especially after a confirmatory repeat — needs prompt referral to a pediatric audiologist, not reassurance or more screening. The startle reflex is unreliable (infants react to vibration/visual/loud cues even with significant SNHL). Follow the 1-3-6 rule: screen by 1 month, diagnose by 3 months, intervene by 6 months. Imaging is reserved for confirmed SNHL.
• Newborn Hearing Screening. Parental concern that a baby does not respond to voice is one of the most reliable early signs of hearing loss and always warrants formal audiology — even if the newborn screen passed or is unknown. Newborns DO localize sound by 2–3 weeks, so failing to respond to a familiar voice is abnormal, not developmental. Reinforce the EHDI 1-3-6 benchmarks.
• Hearing, Speech & Language. Screening at 24 hours often false-positives from retained vernix/fluid/debris, so a two-stage approach is used: rescreen a failed OAE, ideally with automated ABR, which tests the whole pathway (cochlea → nerve → brainstem) and catches auditory neuropathy that OAE misses. Follow the 1-3-6 rule (screen by 1 month, diagnose by 3, intervene by 6). Do not just reassure or discharge.
• 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.
• ENT Manifestations of Syndromes. Down syndrome children get chronic OME in up to ~80% — midface hypoplasia makes the Eustachian tube shorter, narrower, and more horizontal; hypotonia weakens the tensor veli palatini that opens it; and immune differences add infections. The result is conductive hearing loss that impairs speech. Keep a low threshold for grommets and screen hearing every 6–12 months.

Exam pearls from this collection

• Congenital CMV is the leading NON-genetic cause of pediatric SNHL (~20–30% of congenital hearing loss). Crucially, CMV loss can be delayed-onset and progressive — a child may pass the newborn screen and lose hearing over the next few years. So every congenital-CMV infant (even asymptomatic) needs serial audiology (every 3–6 months in year 1, then 6–12 monthly to ~age 6). Valganciclovir in the first month may reduce progression in symptomatic infants.
• The conductive loss in AOM is reversible — middle-ear effusion damps the TM and ossicular chain, cutting sound transmission (Type B/flat tympanogram = immobile TM). Hearing normalizes within days-weeks as the effusion reabsorbs. Permanent SNHL from AOM is rare (only with complications like labyrinthitis or suppurative meningitis); ossicular discontinuity/perforation are uncommon in routine AOM.

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.