ENT Emergencies: Student Prep Guide for Final MB
High-yield rules, clinical cheat sheets, diagnostic red lines, and self-test questions distilled for final-year medical students taking their Final MB;BS examination.
What to Expect in the ENT Paper
Straightforward Clinical Scope
Questions are fair, direct, and firmly anchored in clinical posting encounters. Nothing falls outside routine presentations.
Higher Weight Per Question
Because total questions per specialty are limited under the updated structure, each ENT question carries a higher mark percentage.
The Four Priority Topics
The faculty identified these four core areas as the most critical from the curriculum. Candidates must master these first:
| Priority Topic | What You Must Be Able to State |
|---|---|
| Epistaxis | Anterior vs. posterior bleed, local vs. systemic causes, simultaneous steps (pressure, FBC, electrolytes & urea), and posterior packing with a Foley catheter. |
| Foreign Body in the Ear | Live insect vs. inanimate objects, the mandatory oil instillation step, otoscopy technique (right hand for right ear), and treating the inflamed canal (toilet + antibiotic/steroid pack). |
| Foreign Body in the Nose | The unilateral foul nasal discharge rule in children, anterior rhinoscopy with headlight, passing the retrieval hook beyond the object, and immediate button battery extraction. |
| Foreign Body in the Throat | Presentation (dysphagia, drooling, normal oral exam), diagnostic soft tissue lateral neck X-ray, and site-specific endoscopic removal (direct laryngoscopy vs. oesophagoscopy). |
High-Yield Golden Rules
Unilateral foul-smelling nasal discharge in a child is a foreign body until proven otherwise.
A live insect in the ear canal: instil oil (e.g. olive oil) first to immobilise it, then inspect and retrieve.
Traction on the pinna causes severe pain in otitis externa, but causes NO discomfort in otitis media.
CSF otorrhoea after trauma: keep the ear sterile and dry. NEVER instrument the ear canal.
Hypertension does NOT cause epistaxis directly, but exacerbates bleeding once initiated.
A button battery in the nasal cavity causes liquefactive necrosis and requires emergency removal.
Laryngeal stridor is INSPIRATORY. Tracheobronchial stridor is EXPIRATORY.
Cut throat injury: secure the airway via tracheostomy before attempting GA wound repair.
ENT Emergency Topic Cheat Sheet
| Emergency | Clinical Presentation | Immediate Management |
|---|---|---|
| Insect in Ear | Irritation, loud fluttering, pain, fever | Instil oil, otoscopy, retrieval; antibiotic/steroid wick if canal is inflamed. |
| Ear Trauma | TM perforation, hearing loss, bleeding | Otoscopy, Rinne & Weber tuning fork tests, audiometry (free-field if <5y, pure tone if ≥5y). |
| CSF Otorrhoea | Clear fluid leak post-RTA or head injury | Sterile pad, keep dry, zero instrumentation or syringing. |
| Epistaxis | Anterior nares drip or posterior spitting | Direct pressure, bloods (FBC, E/U), posterior Foley pack if refractory. |
| Nasal Foreign Body | Unilateral foul nasal discharge in child | Anterior rhinoscopy, child restraint, pass curved hook beyond object to extract. |
| Stridor | Noisy respiration, intermittent cyanosis | Determine anatomical level (inspiratory vs expiratory) and trigger from history. |
| Quinsy (Peritonsillar Abscess) | Hot-potato muffled voice, trismus, drooling | Admit, IV antibiotics, needle aspiration or incision and drainage. |
| Deep Neck Infection | Fever, swollen submandibular jaw, dental history | Admit, IV broad-spectrum antibiotics (anaerobes + aerobes), steroids, surgical decompression. |
| Cut Throat Injury | Open anterior neck laceration, exposed trachea | Tracheostomy for secure airway, surgical repair under GA, size 20–22 NG tube stent. |
| Swallowed Foreign Body | Dysphagia, odynophagia, drooling, normal mouth | Soft tissue lateral neck X-ray, then rigid direct oesophagoscopy extraction. |
5-Step Answering Framework for Clinical Questions
1. History
Mechanism, onset, duration, fever, foreign body composition, and past dental procedures or trauma.
2. Examination
Inspect first before touching. Use correct technique: right hand holding otoscope for right ear, left hand for left ear; pull pinna upward and backward in adults.
3. Targeted Investigations
FBC and electrolytes for haemorrhage; tuning fork tests and audiometry for hearing; soft tissue neck X-ray for radiopaque foreign bodies.
4. Immediate Treatment
Stabilize ABCs first, secure alternative airway if indicated, then perform definitive extraction or surgical decompression.
5. Follow-Up & Rehabilitation
Re-evaluate hearing thresholds post-inflammation, repeat rhinoscopy to confirm intact mucosa, and monitor wound healing.
11 High-Yield Self-Test Questions
Test your diagnostic recall against these exam questions before reviewing the full report:
Want Prof. Afolabi's Full 31-Minute Class Transcript?
Review detailed case discussions, student Q&A on hearing tests, and complete surgical protocols.