Prometric Exam Questions for ENT (Otolaryngology) Specialists 2026: 15 Practice MCQs with Answers and Rationale for the ENT5721 Paper

The ENT specialist paper (ENT5721) tests the otolaryngology registrar across the ear, nose, throat, head and neck: the child with recurrent otitis media, the adult with sudden hearing loss, the nosebleed that will not stop, the neck lump that is cancer until proven otherwise, and the airway that must be secured now. It is usually 100 to 150 single-best-answer questions in 2.5 to 3 hours, with a pass mark of about 60%.

The fifteen questions below follow that blueprint. Allow about 70 seconds each and read every rationale.

For titles and the route, read the ENT surgeon guide. For timed papers use the ENT specialist bank, about 2,750 questions. Audiologists sit a separate paper (audiology guide).

Otology

Question 1

A 45-year-old wakes with sudden unilateral hearing loss. Otoscopy is normal, Weber lateralises to the good ear and audiometry shows a 50 dB sensorineural loss across three frequencies. The management is:

1. Reassure and review in three months
2. Treat as idiopathic sudden sensorineural hearing loss with high-dose oral corticosteroids (or intratympanic steroids) started within days, and MRI to exclude a vestibular schwannoma
3. Antibiotics for otitis media
4. Ear syringing

Answer: B. Sudden SNHL is an otological emergency; steroids within two weeks improve recovery. Asymmetric loss warrants MRI of the internal auditory meati.

Question 2

A 6-year-old has bilateral middle ear effusions for four months with a 30 dB conductive loss and speech delay. The management is:

1. Long-term antibiotics
2. Ventilation tubes (grommets), with adenoidectomy considered on repeat insertion or with nasal obstruction; hearing aids are an alternative
3. Oral decongestants for six months
4. Nothing until adolescence

Answer: B. Persistent otitis media with effusion beyond three months with hearing loss and developmental impact is treated surgically; antibiotics, decongestants and antihistamines have no lasting benefit.

Question 3

A patient has a foul-smelling discharging ear for years, an attic perforation with keratin debris, and new facial weakness. The diagnosis and management are:

1. Otitis externa; drops
2. Cholesteatoma with complication; CT temporal bone and mastoid surgery (tympanomastoidectomy), because cholesteatoma erodes bone and does not resolve medically
3. Wax; syringing
4. Serous otitis media; grommet

Answer: B. Cholesteatoma causes ossicular erosion, facial palsy, labyrinthine fistula and intracranial complications. Surgery is the only treatment.

Question 4

A 60-year-old has brief episodes of rotational vertigo lasting under a minute, provoked by turning in bed, with a positive Dix-Hallpike test showing torsional nystagmus. The treatment is:

1. Long-term betahistine
2. A canalith repositioning manoeuvre such as Epley for posterior canal BPPV
3. MRI brain urgently
4. Vestibular nerve section

Answer: B. BPPV is treated at the bedside with repositioning; vestibular suppressants delay compensation. Meniere's disease produces longer attacks with hearing loss and tinnitus.

Rhinology and the nose

Question 5

A 70-year-old on warfarin has a posterior epistaxis that continues after 20 minutes of correct pressure and anterior packing. The next step is:

1. Discharge with advice
2. Posterior packing (balloon or Foley) with admission, correction of coagulopathy as indicated, and endoscopic sphenopalatine artery ligation or embolisation if bleeding persists
3. More ice to the forehead
4. Oral antibiotics only

Answer: B. Posterior bleeds in anticoagulated elderly patients need escalation; airway and haemodynamic monitoring accompany packing.

Question 6

An adult has 12 weeks of nasal obstruction, anterior discharge and facial pressure with bilateral polyps on endoscopy. First-line management is:

1. Immediate sinus surgery
2. Intranasal corticosteroid spray and saline irrigation, a short course of oral steroids for severe polyps, with functional endoscopic sinus surgery for failure of maximal medical therapy and biologics for selected refractory cases
3. Long-term oral antibiotics
4. Antihistamines alone

Answer: B. Chronic rhinosinusitis with polyps is managed medically first; unilateral polyps need biopsy to exclude neoplasia.

Question 7

A child presents with unilateral foul-smelling nasal discharge for two weeks. The most likely cause is:

1. Allergic rhinitis
2. A nasal foreign body, requiring examination and removal with appropriate restraint or anaesthesia; a button battery is an emergency
3. Viral rhinitis
4. Nasal polyps

Answer: B. Unilateral discharge in a child is a foreign body until proven otherwise. Button batteries cause liquefactive necrosis within hours and must be removed immediately.

Paediatric airway and throat

Question 8

A 3-year-old has a high fever, drooling, muffled voice, sits leaning forward and has stridor. The correct action is:

1. Examine the throat with a tongue depressor
2. Do not examine the throat or distress the child; call anaesthesia and ENT, transfer to theatre for intubation under inhalational anaesthesia, then take cultures and start intravenous antibiotics for epiglottitis
3. Give oral antibiotics and discharge
4. Lay the child flat for an x-ray

Answer: B. Epiglottitis is rare since Hib vaccination but still occurs, including in unvaccinated migrant children. Securing the airway in theatre comes before any investigation.

Question 9

Which patient meets typical criteria for tonsillectomy for recurrent tonsillitis?

1. Two episodes in one year
2. Seven or more documented episodes in one year, five per year for two years, or three per year for three years, each disabling and preventing normal function
3. One episode of quinsy in a young adult with no prior history
4. Any child who snores occasionally

Answer: B. These thresholds reflect current guidance. Obstructive sleep apnoea with adenotonsillar hypertrophy is a separate, common indication in children.

Question 10

A 25-year-old with severe sore throat has trismus, a "hot potato" voice, uvular deviation to the left and a swollen right peritonsillar region. The management is:

1. Oral antibiotics and review in a week
2. Needle aspiration or incision and drainage of the peritonsillar abscess, intravenous antibiotics and analgesia, with interval tonsillectomy considered for recurrence
3. Immediate tonsillectomy
4. Steroids alone

Answer: B. Quinsy is drained; airway compromise or parapharyngeal extension needs urgent escalation.

Head and neck

Question 11

A 55-year-old smoker has a painless 3 cm level II neck lump for six weeks with no obvious primary. The first investigation is:

1. Open excision biopsy
2. Ultrasound-guided fine-needle aspiration cytology, with flexible nasendoscopy, cross-sectional imaging and panendoscopy with biopsies to find the primary, treating as squamous cell carcinoma until proven otherwise
3. Antibiotics for a month
4. Reassurance

Answer: B. Open biopsy of a metastatic node compromises later treatment. HPV-related oropharyngeal cancer is an increasingly common primary; tobacco and areca nut use are major regional risks.

Question 12

A 40-year-old has hoarseness for six weeks. The appropriate action is:

1. Voice rest and review in three months
2. Laryngoscopy, because hoarseness persisting beyond three to four weeks requires visualisation of the vocal cords to exclude malignancy and cord palsy
3. Antibiotics
4. Proton pump inhibitor without examination

Answer: B. Persistent hoarseness is a red flag; laryngoscopy is mandatory before empirical treatment.

Question 13

A patient has a 2 cm firm parotid lump present for two years, slowly enlarging, with a normal facial nerve. The most likely diagnosis and management are:

1. Parotitis; antibiotics
2. Pleomorphic adenoma; FNAC and imaging, then superficial parotidectomy with facial nerve preservation, because enucleation leads to recurrence and the tumour can undergo malignant change over time
3. Lymph node; observation
4. Sialolithiasis; stone removal

Answer: B. Facial weakness, rapid growth or pain suggests malignancy. Incisional biopsy of parotid tumours is avoided because of seeding.

Question 14

A 30-year-old wakes with complete unilateral facial weakness including the forehead, with no other neurological signs and a normal ear. The management is:

1. Urgent CT for stroke
2. Bell's palsy: oral prednisolone within 72 hours, eye protection with lubricants and taping, and review; antivirals are added for severe palsy by some guidelines
3. No treatment
4. Facial nerve decompression surgery immediately

Answer: B. Forehead involvement indicates a lower motor neuron lesion. Vesicles in the ear suggest Ramsay Hunt syndrome needing antivirals; incomplete recovery at three months needs imaging.

Question 15

A patient has a rapidly expanding neck haematoma four hours after thyroidectomy, with stridor. The immediate action is:

1. Call for a CT scan
2. Open the wound at the bedside, including the deep layer, to release the haematoma and relieve airway compression, then return to theatre for exploration
3. Give nebulised adrenaline and wait
4. Sedate the patient

Answer: B. Post-thyroidectomy haematoma kills by airway obstruction within minutes. Clip removers and a suture cutter sit at the bedside for this reason.

How to use these questions

• Learn the ENT emergencies as sequences: epiglottitis, post-thyroidectomy haematoma, posterior epistaxis, button battery, sudden hearing loss.
• Know the red flags: persistent hoarseness, unilateral polyps, unilateral discharge in children, painless neck lumps in smokers.
• Cover paediatrics and otology, which head-and-neck surgeons tend to skip.
• Practise under time in the ENT bank with the error-log method.

Other specialty banks are listed in specialty question banks for doctors. When you hold eligibility, join the doctor talent pool.

Frequently asked questions

How many questions are in the ENT Prometric exam?

Usually 100 to 150 in 2.5 to 3 hours. Your eligibility notice states the exact format.

What is the pass mark?

About 60% for the specialist paper, scaled at some authorities, and higher for consultant titles.

Does the paper include head and neck oncology?

Yes, at the level of recognition, investigation pathways and principles of treatment.

Can an MS ENT or FCPS holder skip the exam?

Sometimes, depending on the authority's recognition list; see the exemptions guide.

Are these real exam questions?

No. They are original practice questions written to the published blueprint. Real exam content is confidential.