ENT

Otorhinolaryngology (ENT) is one of the highest-yield-per-page subjects in NEET PG and INI-CET. It is a "small subject" by syllabus volume but a "big subject" by return on investment: a focused 3–4 day reading pass can comfortably secure most of the 10–15 ENT marks that appear in a typical NEET PG paper, and ENT consistently throws image-based, instrument-based, and clinical-vignette questions that reward the well-prepared candidate disproportionately. This mother page is your single-source orientation to how ENT is examined, what to read first, the traps that drain marks, and a final-week revision script.

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How ENT Is Tested

Weightage and paper footprint

• NEET PG: Roughly 10–15 questions (≈5–8% of the clinical subject load). ENT, Ophthalmology, Anaesthesia, Radiology and Orthopaedics together form the "short clinical subjects" cluster; ENT is the most consistently scoring of these because the high-yield zone is narrow and stable year on year.
• INI-CET (AIIMS/PGI pattern): ENT is disproportionately loved. Expect 6–12 questions, frequently image-based (otoscopy, audiogram tracings, X-ray soft tissue neck, CT temporal bone, indirect laryngoscopy mirror views) and instrument/specimen identification ("identify this instrument and its use").
• FMGE/NExT relevance: Same core, slightly more emphasis on first-contact management (epistaxis, foreign body, acute airway).

Recurring question styles

1. Direct one-liners / values: "Most common benign tumour of nose?", "Carhart's notch frequency?", "Riedel's flap is used for?"
2. Audiogram interpretation: Read the air–bone gap, type of curve, and match to disease (otosclerosis, Meniere's, NIHL, presbycusis, ototoxicity).
3. Image identification: Otoscopic photos (attic perforation, AOM bulging drum, glomus, cholesteatoma), instruments (Eustachian catheter, Jobson-Horne probe, tuning fork, Boyle-Davis mouth gag, tracheostomy tube types), CT temporal bone, plain X-rays (lateral neck, Caldwell, Water's, soft tissue neck).
4. Clinical vignettes: A child with foreign body, a diver with vertigo, an elderly smoker with neck node — match to diagnosis and next best step.
5. Single best management step: "Most appropriate initial management of…" — examiners love airway, epistaxis, and acute otitis media management ladders.
6. Association/eponym matching: Eponyms are heavily milked (Gradenigo, Ramsay Hunt, Samter, Lermoyez, Hennebert, Tullio).
7. "Recently introduced" concepts: New audiology/imaging modalities, BPPV repositioning manoeuvres, and updated head-neck staging.

The examiner's mindset

ENT MCQs test bedside reasoning, not encyclopaedic depth. Master tuning fork tests, audiogram patterns, the perforation-site logic of CSOM, the epistaxis and airway ladders, and the "most common" lists — that single layer answers the overwhelming majority of questions.

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Section 1 — Ear (Otology)

The single highest-yielding group. If you read nothing else in ENT, read otology end to end.

Anatomy and physiology must-knows

• Tympanic membrane: Pars tensa (with cone of light antero-inferiorly), pars flaccida (Shrapnell's membrane, attic). Pars flaccida / attic perforations = unsafe (atticoantral) disease with cholesteatoma risk. Central pars tensa perforations = safe (tubotympanic).
• Ossicles: Malleus, incus, stapes (smallest bone). Stapes footplate sits in the oval window — the seat of otosclerosis.
• Cochlea: Tonotopic — base = high frequency, apex = low frequency. This explains why noise-induced and presbycusis hit high frequencies first.
• Facial nerve runs through the middle ear (tympanic segment, often dehiscent) — explains facial palsy in otitis media, cholesteatoma, and as an operative complication.

Tuning fork tests (guaranteed recurring marks)

Test	Normal	Conductive loss	Sensorineural loss
Rinne	AC > BC (positive)	BC > AC (negative)	AC > BC (positive, both reduced)
Weber	Central	Lateralises to diseased ear	Lateralises to better ear
Absolute Bone Conduction (ABC)	Equal to examiner	Equal/normal	Reduced

• Standard fork = 512 Hz. A false-negative Rinne (dead ear) is a classic trap — severe SNHL in one ear gives a "negative" Rinne because sound crosses to the opposite cochlea by bone conduction.

Audiology high-yield

• Otosclerosis: Young adult woman, progressive bilateral conductive loss, paracusis Willisii (hears better in noise), Schwartze sign (flamingo-pink promontory), and the classic Carhart's notch (dip in bone conduction at 2000 Hz). Treatment: stapedectomy with prosthesis (or hearing aid). Autosomal dominant with incomplete penetrance; fluoride may retard cochlear otosclerosis.
• Meniere's disease: Endolymphatic hydrops → episodic vertigo + fluctuating low-frequency SNHL + tinnitus + aural fullness. Low-frequency rising audiogram early. Lermoyez (hearing improves with vertigo), Tullio (sound-induced vertigo), Hennebert sign (pressure-induced vertigo). Management: low-salt diet, diuretics, betahistine; intratympanic gentamicin/steroid; surgery for refractory.
• Presbycusis: Age-related, bilateral, high-frequency SNHL; commonest type = sensory (organ of Corti).
• Noise-induced hearing loss (NIHL): Bilateral SNHL with a notch at 4000 Hz (4 kHz) — purely preventable; serial audiometry is screening.
• Ototoxicity: Aminoglycosides, cisplatin, loop diuretics (reversible), aspirin (reversible tinnitus). High-frequency SNHL first.

Otitis media spectrum

• ASOM (acute suppurative OM): Commonest in children; commonest organism Streptococcus pneumoniae (then H. influenzae). Stages: tubal occlusion → presuppuration → suppuration (bulging drum) → resolution → complication. Myringotomy site = postero-inferior quadrant.
• OME / glue ear / serous OM: Painless conductive loss in a child; commonest cause of childhood hearing loss; flat (Type B) tympanogram; treat with grommet/ventilation tube if persistent >3 months. In an adult with unilateral OME, exclude nasopharyngeal carcinoma.
• CSOM:
  • Tubotympanic (safe): Central perforation, profuse mucoid odourless discharge, no cholesteatoma. Conductive loss.
  • Atticoantral (unsafe): Attic/marginal perforation, scanty foul discharge, cholesteatoma (keratinising squamous epithelium — "skin in the wrong place"), bone erosion → complications. Needs mastoidectomy.

Complications and eponyms

• Gradenigo syndrome: Petrous apicitis → triad of otorrhoea + VI nerve palsy (diplopia) + retro-orbital/trigeminal pain.
• Ramsay Hunt syndrome: Herpes zoster oticus — facial palsy + vesicles in ear/concha + SNHL/vertigo; geniculate ganglion.
• Bezold abscess: Pus tracks through mastoid tip into sternocleidomastoid.
• Citelli abscess, Luc's abscess, subperiosteal abscess — mastoiditis spread routes.
• Lateral sinus thrombosis: Griesinger sign (mastoid emissary vein tenderness), picket-fence fever, Tobey-Ayer test.

Vertigo and balance (high-yield, often confused)

• BPPV: Commonest peripheral vertigo; posterior semicircular canal; brief positional vertigo. Dix-Hallpike = diagnosis; Epley manoeuvre = treatment (canalith repositioning). No hearing loss.
• Vestibular neuritis: Acute single prolonged vertigo, no hearing loss.
• Labyrinthitis: Vertigo + hearing loss.
• Acoustic neuroma (vestibular schwannoma): Arises from superior vestibular nerve, Schwann cells; unilateral progressive SNHL + tinnitus, absent corneal reflex (early CN V), at cerebellopontine angle. Bilateral = NF2. Investigation of choice: Gadolinium MRI.

Otology traps

• Weber lateralising to the worse ear means conductive, to the better ear means sensorineural — students reverse this under stress.
• Attic perforation is the dangerous one — do not call any perforation "safe."
• Unilateral glue ear/serous OM in an adult → think nasopharyngeal carcinoma until excluded.
• Cholesteatoma is not a tumour — it is keratinising squamous epithelium.

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Section 2 — Nose & PNS (Rhinology)

A reliable 3–4 marks. Allergic rhinitis, polyps, epistaxis, sinusitis, and nasopharyngeal/sinonasal tumours dominate.

Anatomy must-knows

• Little's area (Kiesselbach's plexus) = antero-inferior septum; confluence of anterior ethmoidal, sphenopalatine, greater palatine, superior labial arteries; commonest site of anterior epistaxis (especially children).
• Woodruff's plexus = posterior epistaxis (elderly, hypertensive); behind the inferior turbinate.
• Osteomeatal complex (middle meatus): Drains maxillary, anterior ethmoid, frontal sinuses — key to FESS.
• Sphenoethmoidal recess drains the sphenoid; posterior ethmoids drain into the superior meatus.
• Nasolacrimal duct opens into the inferior meatus.

Epistaxis ladder (a favourite "next step")

1. First aid: sit up, lean forward, pinch the cartilaginous nose (Trotter's method), ice.
2. Anterior nasal packing (or chemical/electrocautery of a visible Little's area bleed).
3. Posterior packing / balloon for posterior bleeds.
4. Endoscopic sphenopalatine artery ligation/cauterisation (modern preferred surgical step) or arterial ligation/embolisation.

• Juvenile nasopharyngeal angiofibroma (JNA): Adolescent male, recurrent profuse unilateral epistaxis + nasal obstruction; extremely vascular; biopsy contraindicated; diagnosis by contrast CT/MRI ("antral sign / Holman-Miller sign" — anterior bowing of posterior maxillary wall); preoperative embolisation then excision.

Allergic rhinitis and polyps

• Allergic rhinitis: Type I IgE hypersensitivity; sneezing, watery rhinorrhoea, itching; pale boggy turbinates; intranasal steroids are first-line; ARIA classification (intermittent/persistent, mild/moderate-severe).
• Ethmoidal polyps: Bilateral, multiple, allergic, bluish grape-like, from middle meatus.
• Antrochoanal polyp (Killian's polyp): Unilateral, single, from maxillary antrum in a child/young adult, prolapses into the choana/nasopharynx; treat by removal of the entire polyp including antral origin (Caldwell-Luc/endoscopic).
• Samter's triad (aspirin-exacerbated respiratory disease): Asthma + nasal polyps + aspirin sensitivity.

Sinusitis and its complications

• Maxillary sinus most commonly involved (poor dependent drainage, ostium high on medial wall).
• Acute bacterial rhinosinusitis: pneumococcus, H. influenzae, Moraxella.
• Imaging: CT PNS (coronal) is the investigation of choice; Water's view (occipitomental) for maxillary, Caldwell for frontal/ethmoid.
• Complications: Orbital cellulitis/abscess (Chandler classification), cavernous sinus thrombosis, Pott's puffy tumour (frontal osteomyelitis), intracranial abscess.
• Fungal sinusitis: Mucormycosis in uncontrolled diabetics/immunocompromised — black necrotic turbinate/eschar, rapidly invasive; needs urgent liposomal amphotericin B + aggressive surgical debridement + correction of acidosis. (Sharply revised post-COVID owing to the CAM/"black fungus" surge.)

Sinonasal tumours

• Commonest benign sinonasal tumour: inverted papilloma (Ringertz/transitional cell papilloma) — unilateral, locally aggressive, ~10% harbour SCC, lateral wall origin.
• Commonest malignancy of maxillary sinus: squamous cell carcinoma (Ohngren's line prognosticates supra- vs infrastructure tumours).
• Olfactory neuroblastoma (esthesioneuroblastoma) from olfactory epithelium.

Rhinology traps

• Unilateral nasal mass/polyp/epistaxis in any age is a red flag — never assume benign.
• JNA → never biopsy (torrential bleed).
• CSF rhinorrhoea: confirm with beta-2 transferrin (and the "ring/halo/tram-track sign" is suggestive only).
• Don't confuse antrochoanal (single, unilateral, antral, child) with ethmoidal (multiple, bilateral, allergic).

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Section 3 — Throat & Larynx (Laryngology & Oropharynx)

The airway and voice group: tonsils, adenoids, the larynx, vocal cord lesions, and the all-important acute airway/tracheostomy material.

Tonsils and adenoids

• Waldeyer's ring: Adenoids (nasopharyngeal tonsil), tubal tonsils, palatine tonsils, lingual tonsil.
• Tonsillectomy indications: Recurrent acute tonsillitis (Paradise criteria — ≥7 in 1 year, ≥5/yr for 2 years, ≥3/yr for 3 years), peritonsillar abscess, OSA, suspected malignancy/asymmetry.
• Peritonsillar abscess (Quinsy): Trismus, "hot potato" muffled voice, uvular deviation to the opposite side, drooling; incision and drainage + antibiotics.
• Adenoid hypertrophy: Child with mouth-breathing, adenoid facies, nasal twang, recurrent OME and otitis; lateral soft-tissue nasopharynx X-ray; adenoidectomy.
• Retropharyngeal abscess: Infants (suppuration of retropharyngeal nodes of Henle); lateral neck X-ray shows widened prevertebral soft tissue.
• Ludwig's angina: Bilateral submandibular space cellulitis (commonly dental origin), woody floor of mouth, airway threat.

Larynx essentials

• Recurrent laryngeal nerve supplies all intrinsic muscles except cricothyroid (external laryngeal branch of superior laryngeal). The posterior cricoarytenoid is the ONLY abductor ("safety muscle of larynx").
• Cord positions: Median, paramedian, cadaveric (intermediate), gentle/full abduction.
• Unilateral RLN palsy: Cord in paramedian position; hoarseness, often compensated.
• Bilateral abductor palsy: Both cords paramedian → airway obstruction (stridor) with a reasonable voice — emergency.
• Vocal nodules ("singer's/screamer's nodules"): Junction of anterior 1/3 and posterior 2/3; voice abuse; voice rest/therapy first.
• Reinke's edema: Smokers, low-pitched gruff voice; entire cord edema in Reinke's space.
• Laryngeal carcinoma: Smokers; glottic carcinoma presents earliest (hoarseness) and has the best prognosis (poor lymphatics); supraglottic spreads early to nodes. HPV-related oropharyngeal SCC has better prognosis.
• Laryngomalacia: Commonest congenital laryngeal anomaly and commonest cause of stridor in infants; inspiratory stridor worsening when supine; omega-shaped epiglottis; usually self-limiting.

Acute airway & stridor (very high-yield management)

• Acute epiglottitis: H. influenzae type b; child, toxic, drooling, tripod posture, "thumb sign" on lateral neck X-ray; do NOT examine throat/do not lie supine; secure airway first.
• Croup (laryngotracheobronchitis): Parainfluenza; barking/seal-bark cough, "steeple sign"; nebulised adrenaline + steroids.
• Foreign body airway: Right main bronchus more common (more vertical); peanut classic; bronchoscopy.

Tracheostomy (instrument & step favourite)

• Standard incision between 2nd and 3rd tracheal rings (some texts 2nd–4th); avoid 1st ring (subglottic stenosis).
• Cricothyroidotomy = emergency surgical airway through the cricothyroid membrane (NOT for children <12).
• Complications: immediate (haemorrhage, apnoea, pneumothorax), intermediate (tube blockage, displacement, surgical emphysema), late (tracheal stenosis, tracheo-oesophageal fistula).
• Know tube types: Fuller's, Jackson's, Portex cuffed/uncuffed, fenestrated, Montgomery T-tube.

Throat/larynx traps

• Posterior cricoarytenoid = sole abductor — the most repeated single fact.
• In quinsy, the uvula deviates away from the abscess.
• Bilateral abductor palsy = good voice but stridor (airway emergency); bilateral adductor palsy = aphonia but airway safe — students invert these.
• In epiglottitis, do not depress the tongue/examine — can precipitate complete obstruction.

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Section 4 — Head & Neck

Salivary glands, neck masses, the thyroid–neck overlap, deep neck spaces, and head-and-neck oncology. Strong overlap with General Surgery.

Neck masses — the diagnostic logic

Mass	Key feature
Thyroglossal cyst	Midline, moves with tongue protrusion & swallowing; tract to foramen caecum; Sistrunk operation
Branchial cyst	Upper lateral neck, anterior to SCM upper third; "cholesterol crystals" on aspiration; 2nd arch
Cystic hygroma	Posterior triangle infant, brilliantly transilluminant
Carotid body tumour (chemodectoma)	Pulsatile, mobile side-to-side not up-down, splaying of carotid bifurcation ("lyre sign")
Ludwig's angina	Submandibular space infection
Cold abscess	Tubercular cervical lymphadenitis (commonest cause of neck node mass in India)

Salivary glands

• Parotid: Commonest tumour overall and commonest benign = pleomorphic adenoma (benign mixed tumour); Warthin's tumour (adenolymphoma) — bilateral, elderly males, smokers, "hot" on technetium scan.
• Commonest malignant salivary tumour: mucoepidermoid carcinoma (parotid); adenoid cystic carcinoma shows perineural spread (submandibular/minor glands).
• Facial nerve runs through the parotid (superficial vs deep lobe) — facial palsy with a parotid mass suggests malignancy.
• Frey's syndrome (gustatory sweating) — post-parotidectomy auriculotemporal nerve misdirection.
• Commonest site of salivary calculi = submandibular (Wharton's) duct (mucinous, longer upward duct).

Head & neck cancer essentials

• Overwhelmingly squamous cell carcinoma; risk factors tobacco/areca/alcohol/HPV.
• Nasopharyngeal carcinoma: EBV-associated; Chinese/Northeast-India predisposition; presents with neck node, unilateral serous OM, epistaxis; radiosensitive — radiotherapy is mainstay.
• Oral cavity/tongue: Verrucous carcinoma (Ackerman), submucous fibrosis (areca nut, premalignant).
• Larynx/hypopharynx: Hypopharyngeal (pyriform fossa) cancer — poor prognosis, late presentation.
• A metastatic cervical node with unknown primary → panendoscopy + image; consider nasopharynx, tonsil, tongue base.

Head & neck traps

• "Moves with tongue protrusion" = thyroglossal; "moves only with swallowing" = thyroid; fixed lateral node = consider metastasis/TB.
• Pleomorphic adenoma can undergo malignant transformation if long-standing — never just enucleate (do superficial parotidectomy).
• Facial weakness + parotid lump = malignancy.

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Cross-Subject Integration (where ENT overlaps)

• Anatomy: Facial nerve course (temporal bone, parotid), Waldeyer's ring, neck triangles, branchial apparatus derivatives, sinus drainage pathways.
• Microbiology: Hib (epiglottitis), pneumococcus (ASOM), Pseudomonas (malignant otitis externa in diabetics), EBV (NPC), HPV (oropharyngeal SCC), mucor/aspergillus (fungal sinusitis).
• Pharmacology: Ototoxic drugs (aminoglycosides, cisplatin, loop diuretics, aspirin), antihistamines/intranasal steroids, betahistine.
• Medicine/Endocrine: Diabetic predisposition to mucormycosis and malignant otitis externa; thyroid–neck mass overlap; granulomatosis with polyangiitis (saddle nose, septal perforation, ELK).
• Paediatrics: Stridor (laryngomalacia, croup, epiglottitis, foreign body), OME and hearing/speech development, adenoids.
• Radiology: CT temporal bone (cholesteatoma, otosclerosis), CT/MRI PNS, lateral neck X-ray signs (thumb, steeple, prevertebral widening).
• Pathology: Cholesteatoma histology, pleomorphic adenoma, inverted papilloma, SCC.
• Forensic/PSM: Noise-induced hearing loss as an occupational disease (4 kHz notch, prevention).

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Recent-Update Themes for Current Exams

• Post-COVID mucormycosis (CAM): Heavily examined — rhino-orbito-cerebral mucormycosis in diabetic/steroid-exposed patients, urgent liposomal amphotericin B + debridement. Expect at least one question.
• Endoscopic sinus & skull-base surgery (FESS): Osteomeatal complex–centred surgery now standard; SPA ligation as preferred surgical step for refractory posterior epistaxis.
• Cochlear implants & newborn hearing screening: Universal newborn hearing screening (OAE/BERA), early implantation windows; congenital SNHL workup.
• HPV-associated oropharyngeal SCC: Recognised as a distinct, better-prognosis entity in updated staging (separate p16+ pathway).
• Updated AJCC/TNM head-neck staging and depth-of-invasion concept for oral cancer.
• Vestibular testing advances: Video head impulse test (vHIT), VEMP (cervical/ocular) for otolith/saccule function — newer audiology favourites.
• Biologics in CRSwNP: Anti-IL-5/IL-4 (e.g., dupilumab) for chronic rhinosinusitis with nasal polyps in resistant disease.

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Study Roadmap

Phase 1 — Build the spine (Days 1–4)

1. Day 1 — Ear part 1: Anatomy, tuning forks, audiometry/tympanometry patterns, otosclerosis, Meniere's, presbycusis, NIHL, ototoxicity.
2. Day 2 — Ear part 2: Otitis media spectrum (ASOM/OME/CSOM safe vs unsafe), cholesteatoma, complications/eponyms, vertigo (BPPV/Epley), acoustic neuroma.
3. Day 3 — Nose & PNS + Throat/Larynx: Epistaxis ladder, polyps, JNA, sinusitis/mucormycosis; tonsils/adenoids, RLN/cord palsies, stridor, tracheostomy.
4. Day 4 — Head & Neck: Neck masses, salivary tumours, H&N cancers, NPC; plus an instrument/image rapid pass.

Phase 2 — Reinforce (ongoing)

• Do previous-year ENT MCQs (NEET PG + INI-CET + AIIMS recalls) topic-wise immediately after each phase-1 topic.
• Maintain a one-page error log of every fact you got wrong.
• Drill an image atlas: otoscopy photos, X-ray signs, instruments — INI-CET especially.

Last-Week Revision Strategy

• Read only your one-pager + tables + mnemonics, not the textbook.
• Recite the four "spine" frameworks aloud: tuning-fork table, safe vs unsafe CSOM, epistaxis ladder, stridor/airway ladder.
• Re-run the "most common" lists and eponyms the night before.
• Flash through the instrument/X-ray-sign images one final time.
• Do not start new topics in the final 48 hours — consolidate.

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High-Yield Tables

"Most common" list

Question	Answer
Commonest cause of conductive deafness in young adult	Otosclerosis
Commonest cause of childhood hearing loss	Otitis media with effusion (glue ear)
Commonest organism in ASOM	Streptococcus pneumoniae
Commonest benign tumour of nose	Inverted papilloma
Commonest malignancy of maxillary sinus	Squamous cell carcinoma
Commonest salivary gland tumour	Pleomorphic adenoma (parotid)
Commonest malignant salivary tumour	Mucoepidermoid carcinoma
Commonest site of salivary calculus	Submandibular (Wharton's) duct
Commonest cause of stridor in infants	Laryngomalacia
Commonest site of anterior epistaxis	Little's area (Kiesselbach's plexus)
Sole abductor of vocal cords	Posterior cricoarytenoid

Audiogram quick-match

Pattern	Disease
Carhart's notch at 2 kHz, conductive	Otosclerosis
Low-frequency fluctuating SNHL	Early Meniere's
Notch at 4 kHz	Noise-induced hearing loss
Bilateral high-frequency SNHL, elderly	Presbycusis
Unilateral progressive SNHL + tinnitus	Acoustic neuroma

X-ray / imaging signs

Sign	Condition
Thumb sign (lateral neck)	Acute epiglottitis
Steeple sign (AP neck)	Croup
Widened prevertebral soft tissue	Retropharyngeal abscess
Holman-Miller / antral sign	Juvenile nasopharyngeal angiofibroma
Lyre sign (carotid splaying)	Carotid body tumour

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Mnemonics

• Otosclerosis clues — "S, C, P, S": Schwartze sign, Carhart's notch, Paracusis Willisii, Stapedectomy.
• Meniere's tetrad — "VTAF": Vertigo, Tinnitus, Aural fullness, Fluctuating hearing loss.
• Gradenigo triad — "Eye, Ear, Ache": VI nerve palsy (eye), otorrhoea (ear), retro-orbital pain (ache).
• Samter's triad — "ANA": Asthma, Nasal polyps, Aspirin sensitivity.
• Little's area arteries — "LEGS": Labial (superior), Ethmoidal (anterior), Greater palatine, Sphenopalatine.
• Safe vs unsafe perforation — "Central is safe, Attic attacks": central pars tensa = safe; attic/marginal = unsafe (cholesteatoma).
• Intrinsic laryngeal muscles — all RLN except cricothyroid: "Cricothyroid is the Cranky exception (external SLN)."

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Rapid-Fire One-Liners

1. Smallest bone in the body — stapes; its footplate fixation = otosclerosis.
2. Standard tuning fork frequency for clinical tests — 512 Hz.
3. Weber lateralises to the diseased ear in conductive, better ear in sensorineural loss.
4. Myringotomy is done in the postero-inferior quadrant of the tympanic membrane.
5. Dix-Hallpike diagnoses BPPV; Epley manoeuvre treats it (posterior canal).
6. Investigation of choice for acoustic neuroma — gadolinium-enhanced MRI; bilateral = NF2.
7. Never biopsy a juvenile nasopharyngeal angiofibroma — risk of torrential bleed.
8. Antrochoanal polyp (Killian's) is single, unilateral, from the maxillary antrum, in young patients.
9. Unilateral serous otitis media in an adult — rule out nasopharyngeal carcinoma.
10. In acute epiglottitis (Hib, thumb sign) — do not examine the throat; secure the airway.
11. Bilateral abductor (RLN) palsy → cords paramedian → stridor with preserved voice (airway emergency).
12. Thyroglossal cyst moves with tongue protrusion; treated by Sistrunk's operation.
13. Rhino-orbito-cerebral mucormycosis in a diabetic — liposomal amphotericin B + surgical debridement.
14. Glottic carcinoma presents earliest (hoarseness) and has the best prognosis owing to sparse lymphatics.