ENT KFP-1 2025

A 45-year-old man presents with a two-day history of right ear pain, itching, and a scanty, odorless discharge. He reports recently swimming in a local pool and using cotton buds to clean his ears. On examination, the right external auditory canal (EAC) is erythematous and swollen, with tenderness upon tragal pressure. The tympanic membrane (TM) is not visible due to swelling, and there is no regional lymphadenopathy.

 

 

A 60-year-old woman with diabetes mellitus presents with a one-week history of left ear pain, purulent discharge, and hearing loss. She has been using over-the-counter ear drops without improvement. On examination, the left EAC is erythematous with granulation tissue at the bony-cartilaginous junction, and there is tenderness over the mastoid process. The TM is intact but obscured by debris. She is afebrile, and there is no cranial nerve involvement.

 

 

A 30-year-old woman presents with a three-day history of left ear pain, itching, and a scanty, odorless discharge. She reports recently swimming in a local pool and using cotton buds to clean her ears. On examination, the left external auditory canal (EAC) is erythematous and swollen, with tenderness upon tragal pressure. The tympanic membrane (TM) is not visible due to swelling, and there is no regional lymphadenopathy.

 

 

A 65-year-old man with diabetes mellitus presents with a one-week history of right ear pain, purulent discharge, and hearing loss. He has been using over-the-counter ear drops without improvement. On examination, the right EAC is erythematous with granulation tissue at the bony-cartilaginous junction, and there is tenderness over the mastoid process. The TM is intact but obscured by debris. He is afebrile, and there is no cranial nerve involvement.

 

 

A 50-year-old woman presents with ear pain, pruritus, and thick white discharge from her left ear for the past two weeks. She has no history of recent swimming but frequently uses hearing aids. She was initially treated with topical ciprofloxacin eardrops, but her symptoms persisted despite treatment. On examination, her left external auditory canal (EAC) is swollen with white, fluffy debris, and there is mild discomfort on tragal pressure. The tympanic membrane is intact but difficult to visualize due to canal swelling.

 

 

A 72-year-old man with chronic otitis externa presents with persistent ear pain, hearing loss, and foul-smelling otorrhea for the past three months. He has a history of type 2 diabetes and peripheral vascular disease. Examination reveals a granulation tissue mass at the bony-cartilaginous junction of the right external auditory canal (EAC), and the patient reports deep-seated pain over the mastoid area. There is no facial nerve weakness.

 

 

A 6-year-old girl presents with ear pain, swelling, and itching after swimming at a beach two days ago. She has no history of middle ear infections or hearing loss. Examination reveals diffuse swelling of the left external auditory canal (EAC), with tenderness on tragal pressure and a small amount of serous discharge. The tympanic membrane is partially visible and intact.

 

 

A 32-year-old man presents with right ear pain, fullness, and pruritus for the past five days. He recently returned from a surfing trip and frequently uses earplugs. He reports mild hearing loss and occasional ear ringing. On examination, the right external auditory canal (EAC) is erythematous with mild swelling, and moist debris is visible. The tympanic membrane (TM) is intact but partially obscured.

 

 

A 57-year-old woman with a history of eczema presents with chronic ear itching, mild discomfort, and occasional dryness of the external auditory canal (EAC). She denies hearing loss or discharge. She has been using over-the-counter ear drops containing hydrogen peroxide. Examination shows mild erythema and dry scaling of the EAC, with no significant swelling or debris. The tympanic membrane is normal.

 

 

A 25-year-old woman presents with a two-week history of left ear discharge. She describes the discharge as clear and watery, occasionally blood-tinged, and associated with intermittent ear fullness. She denies pain, hearing loss, or recent upper respiratory infections. She recalls a minor head injury from a fall about a month ago but did not seek medical attention at that time. On examination, the external auditory canal (EAC) is unremarkable, and the tympanic membrane (TM) appears intact with no obvious perforation. There is no tenderness over the mastoid process, and no lymphadenopathy is noted.

 

 

A 40-year-old man presents with a three-week history of right ear discharge. He describes the discharge as purulent and foul-smelling, accompanied by hearing loss and intermittent ear pain. He has a history of chronic otitis media but has not sought medical attention recently. On examination, the right external auditory canal (EAC) contains purulent debris, and the tympanic membrane (TM) is perforated with granulation tissue visible in the middle ear space. There is no tenderness over the mastoid process, and no facial nerve weakness is noted.

 

 

A 62-year-old woman with type 2 diabetes presents with a three-week history of persistent left ear discharge, progressive hearing loss, and deep-seated otalgia. She has tried over-the-counter eardrops without improvement. Examination reveals granulation tissue in the external auditory canal (EAC) and tenderness over the mastoid process. There is no facial nerve weakness, and the tympanic membrane is not clearly visible due to swelling.

 

 

A 35-year-old man presents with right ear discharge and hearing loss for the past four weeks. He denies ear pain but has noticed a persistent “blocked” sensation. He has had multiple ear infections since childhood. Examination reveals a retracted tympanic membrane (TM) with an attic perforation, and there is a foul-smelling discharge in the external auditory canal. No mastoid tenderness is noted.

 

 

A 7-year-old boy is brought to the clinic with two days of yellow ear discharge, mild fever, and preceding upper respiratory tract infection (URTI) symptoms. His mother reports that he woke up with fluid on his pillow. He has had no recent ear infections and no previous ear surgeries. On examination, the external auditory canal is clear, and the tympanic membrane has a small central perforation with purulent discharge. There is no mastoid tenderness or facial weakness.

 

 

A 3-year-old boy presents with a two-day history of right ear pain, fever (38.5°C), and irritability. He has had no previous episodes of otitis media and is otherwise healthy. On examination, the right tympanic membrane is bulging, erythematous, and immobile on pneumatic otoscopy. The left ear is normal. There is no mastoid tenderness or lymphadenopathy.

 

 

A 5-year-old girl presents with a one-day history of left ear pain and low-grade fever (37.8°C). She has had two episodes of otitis media in the past six months, both treated with antibiotics. On examination, the left tympanic membrane is mildly erythematous with normal mobility. The right ear is normal. She appears otherwise well.

 

 

A 2-year-old boy presents with a three-day history of bilateral ear pain, fever (39°C), and decreased appetite. He has had four episodes of otitis media in the past year, all treated with antibiotics. On examination, both tympanic membranes are bulging, erythematous, and immobile. There is no mastoid tenderness.

 

 

A 45-year-old male refugee from a developing country presents with a long-standing history of left ear discharge and hearing loss. He reports that the discharge has been persistent and purulent for several years but has not sought medical attention previously. On examination, there is purulent discharge in the external auditory canal, a large central perforation of the tympanic membrane (TM), and conductive hearing loss on tuning fork tests. There is no evidence of cholesteatoma or mastoid tenderness.

 

 

A 30-year-old female refugee presents with intermittent right ear discharge and hearing loss over the past six months. She also reports occasional vertigo and a feeling of fullness in the ear. On examination, there is foul-smelling purulent discharge, a retracted TM with an attic perforation, and a mass of whitish debris in the upper part of the middle ear. There is no facial nerve weakness or mastoid tenderness.

 

 

A 50-year-old man presents with decreased hearing in his right ear over the past week. He denies pain, discharge, or dizziness. He reports using cotton buds daily to clean his ears. On examination, the right external auditory canal (EAC) is completely occluded with cerumen, obscuring the tympanic membrane. The left ear is unremarkable.

 

 

A 30-year-old woman presents with ear fullness and mild hearing loss in her left ear. She has no pain, discharge, or history of ear problems. She reports regular use of earplugs due to her work environment. Otoscopic examination reveals a partial occlusion of the left EAC with cerumen, with the tympanic membrane partially visible. The right ear is normal.

 

 

A 61-year-old woman presents for a routine follow-up of her hypertension. During the consultation, she mentions experiencing discomfort in her left ear. Otoscopic examination reveals bilateral cerumen impaction. The general practitioner (GP) recommends ear syringing and arranges for the practice nurse to perform the procedure.

 

 

A 45-year-old man presents with itching and fullness in his right ear. He reports using cotton buds daily to clean his ears. Otoscopic examination reveals impacted cerumen in the right ear canal. The GP plans to perform ear syringing.

 

 

A 48-year-old man presents with recurrent right ear discharge over the past six months. He describes the discharge as foul-smelling and persistent, despite previous courses of oral antibiotics. He also reports progressive hearing loss in the affected ear but denies pain or dizziness. On examination, otoscopy reveals a retraction pocket in the posterosuperior quadrant of the tympanic membrane with accumulated squamous debris. The external auditory canal is clear.

 

 

A 60-year-old woman with a history of chronic otitis media since childhood presents with persistent left ear discharge, hearing loss, and a recent onset of vertigo. She denies any facial weakness. Examination reveals a polypoid mass in the external auditory canal with foul-smelling discharge. Otoscopy is limited due to debris, but there is a visible attic retraction pocket. A positive fistula test is noted.

 

 

A 42-year-old man presents with persistent left ear discharge and hearing loss for the past eight months. He has been treated with multiple courses of oral antibiotics, but the symptoms recur after each treatment. He denies vertigo or facial weakness. Examination reveals a foul-smelling discharge, attic retraction, and keratin debris in the posterosuperior quadrant of the tympanic membrane. The external auditory canal is clear, and there is no mastoid tenderness.

 

 

A 55-year-old man with a history of chronic otitis media presents with persistent right-sided otorrhoea, hearing loss, and new-onset facial weakness. He denies dizziness or headache. Examination reveals a foul-smelling discharge, a perforated tympanic membrane with keratin debris, and mild right-sided facial droop (House-Brackmann grade II facial nerve palsy).

 

 

A 62-year-old woman with a known cholesteatoma in her left ear presents with new-onset headache, fever, and confusion. Her family reports a worsening mental status over the past 48 hours. Examination reveals a purulent discharge from the left ear, neck stiffness, and a positive Kernig’s sign. A bedside otoscopic exam shows an attic perforation with debris.

 

 

A 35-year-old male recreational diver presents with acute onset of vertigo, nausea, and right ear fullness immediately after ascending from a dive. He reports difficulty equalizing pressure during descent but continued the dive. On examination, there is no nystagmus, the tympanic membrane appears intact, and there is no hearing loss.

 

 

A 28-year-old female diver presents with left ear pain and hearing loss that began during ascent from a dive. She describes a sensation of “fullness” in the ear and mild dizziness. On examination, the left tympanic membrane is erythematous with visible hemotympanum, and there is mild conductive hearing loss on tuning fork tests.

 

 

A 40-year-old experienced diver presents with acute onset of vertigo, tinnitus, and hearing loss in the right ear after a deep dive. He reports that the symptoms began shortly after surfacing. He denies any difficulty with ear equalization during the dive. On examination, there is horizontal nystagmus beating to the left, and Weber test lateralizes to the left ear.

 

 

A 30-year-old male diver presents with severe vertigo, nausea, and right ear fullness that began during ascent from a dive. He reports difficulty equalizing pressure during descent but continued the dive. On examination, there is no nystagmus, the tympanic membrane appears intact, and there is no hearing loss.

 

 

A 28-year-old female diver presents with left ear pain and hearing loss that began during ascent from a dive. She describes a sensation of “fullness” in the ear and mild dizziness. On examination, the left tympanic membrane is erythematous with visible hemotympanum, and there is mild conductive hearing loss on tuning fork tests.

 

 

A 40-year-old experienced diver presents with acute onset of vertigo, tinnitus, and hearing loss in the right ear after a deep dive. He reports that the symptoms began shortly after surfacing. He denies any difficulty with ear equalization during the dive. On examination, there is horizontal nystagmus beating to the left, and Weber test lateralizes to the left ear.

 

 

A 27-year-old male scuba diver presents with ear pain, muffled hearing, and a sense of fullness in his right ear immediately after surfacing from a deep dive. He denies vertigo or tinnitus. He attempted a Valsalva maneuver during descent but felt a sharp pain in his ear. Examination reveals a retracted right tympanic membrane with some blood behind it (hemotympanum). There is mild conductive hearing loss on tuning fork tests.

 

 

A 45-year-old commercial diver presents with severe vertigo, nausea, and hearing loss in his left ear that started minutes after surfacing from a deep-sea dive. He denies ear pain but describes a “roaring” sound in the affected ear. On examination, he has horizontal nystagmus beating to the right and a positive fistula test (vertigo induced by pressure in the external ear canal). Weber’s test lateralizes to the right ear.

 

 

A 45-year-old female presents with a painless, dome-shaped swelling on the inner surface of her lower lip. She reports that the lesion has been present for several weeks and occasionally changes in size. On examination, the lesion is smooth, fluctuant, and has a bluish tinge.

 

 

A 60-year-old male presents with a firm, non-tender swelling on the floor of his mouth. He reports that the swelling has been gradually increasing in size over the past two months and occasionally interferes with speech and eating. On examination, there is a smooth, raised mass approximately 2 cm in diameter, located on the right side of the floor of the mouth. The overlying mucosa appears normal.

 

 

A 50-year-old male presents with a painless, firm swelling on the left side of his hard palate. He reports that the swelling has been present for several months and has gradually increased in size. There is no history of trauma, and he denies any changes in sensation or function. On examination, the lesion is well-circumscribed, non-tender, and covered by normal mucosa.

 

 

A 35-year-old female presents with a painful, rapidly enlarging swelling in the right submandibular region. She reports fever, malaise, and difficulty swallowing over the past three days. On examination, there is a tender, firm swelling beneath the right mandible with overlying erythema and warmth. Intraorally, the ductal orifice of the right submandibular gland appears inflamed, and purulent discharge is noted upon palpation.

 

 

A 52-year-old male presents with a persistent ulcer on the lateral border of his tongue. He reports that the ulcer has been present for over six weeks and is painless. He denies any history of trauma to the area. On examination, the ulcer has irregular margins, a heterogeneous appearance, and raised, rolled edges. The lesion is firm on palpation.

 

 

A 65-year-old female presents with a sudden onset of severe vertigo that began two days ago. She describes a spinning sensation associated with nausea and vomiting. She denies hearing loss, tinnitus, or recent upper respiratory tract infections. On examination, there is a unidirectional horizontal nystagmus that is more pronounced when gazing to the right. The head impulse test is positive, and there are no focal neurological deficits.

 

 

A 50-year-old male presents with recurrent episodes of vertigo lasting several hours, accompanied by tinnitus and a sensation of fullness in the right ear. He also reports fluctuating hearing loss in the same ear. These episodes have occurred multiple times over the past three months. On examination, there is a low-frequency sensorineural hearing loss in the right ear. The remainder of the neurological examination is unremarkable.

 

 

A 70-year-old male presents with sudden-onset vertigo that began three hours ago. He describes a spinning sensation accompanied by difficulty walking, double vision, and slurred speech. He has a history of hypertension and type 2 diabetes mellitus. On examination, he exhibits left-sided limb weakness, ataxia, and dysarthria. The head impulse test is negative, and there is no hearing loss.

 

 

A 55-year-old female presents with episodic vertigo that occurs with certain head movements, such as looking up or turning quickly. Each episode lasts less than a minute and is accompanied by nausea but no hearing loss or tinnitus. She denies recent infections or head trauma. On examination, the Dix–Hallpike maneuver elicits rotational nystagmus and reproduces her symptoms.

 

 

A 52-year-old male presents with intermittent episodes of vertigo over the past six months. Each episode lasts approximately 20 minutes to several hours and is accompanied by a roaring tinnitus and a sensation of fullness in the left ear. He also reports progressive hearing loss in the same ear. There is no history of recent infections or head trauma. On examination, the Weber test lateralizes to the right ear, and the Rinne test is positive bilaterally. The Romberg test is negative, and there are no signs of nystagmus.

 

Given these findings, what are the MOST appropriate next steps in managing this patient? Select four (4) options from the list below:

 

A 34-year-old female presents with a sudden onset of severe vertigo that began three days ago. She describes a constant spinning sensation associated with nausea and vomiting. She denies hearing loss, tinnitus, or recent upper respiratory tract infections. On examination, there is a unidirectional horizontal nystagmus that is more pronounced when gazing to the left. The head impulse test is positive, and there are no focal neurological deficits.

 

Considering these findings, what are the MOST appropriate next steps in managing this patient? Select four (4) options from the list below:

 

A 45-year-old female presents with a three-month history of episodic dizziness. She describes the sensation as a spinning feeling that occurs when she turns her head quickly or looks upward. Each episode lasts for less than a minute and is accompanied by mild nausea but no vomiting. She denies any hearing loss, tinnitus, or aural fullness. There is no history of recent infections, head trauma, or new medications. On examination, her vital signs are stable, and cardiovascular and neurological examinations are unremarkable. The Dix–Hallpike maneuver on the right side elicits rotatory nystagmus and reproduces her symptoms, while the test on the left side is negative.

 

Considering these findings, what are the MOST appropriate next steps in managing this patient? Select four (4) options from the list below:

 

A 60-year-old male presents with a sudden onset of vertigo that began two days ago. He describes a constant spinning sensation associated with nausea, vomiting, and unsteadiness. He denies any hearing loss, tinnitus, or recent upper respiratory tract infections. His medical history includes hypertension, hyperlipidemia, and a transient ischemic attack (TIA) five years ago. On examination, his blood pressure is 150/90 mmHg, and he has a regular pulse rate of 80 beats per minute. Neurological examination reveals gait ataxia, dysmetria on finger-to-nose testing, and a left-beating nystagmus that does not suppress with visual fixation. The head impulse test is negative, and there are no signs of hearing loss.

 

Considering these findings, what are the MOST appropriate next steps in managing this patient? Select four (4) options from the list below:

 

A 62-year-old male presents with a sudden onset of severe vertigo that began two hours ago. He describes a rotatory spinning sensation, associated with nausea, vomiting, and unsteadiness. He denies any recent upper respiratory infection, ear pain, or hearing loss. His past medical history includes hypertension, type 2 diabetes mellitus, and hyperlipidemia. On examination, he has horizontal nystagmus, gait ataxia, and a normal head impulse test. His blood pressure is 165/95 mmHg, and his blood glucose is 7.8 mmol/L. Dix-Hallpike maneuver is negative, and there is no hearing asymmetry on tuning fork tests.

 

Given these findings, what are the MOST appropriate next steps in management? Select four (4) options from the list below:

 

 

A 38-year-old female presents with episodic vertigo that occurs when turning in bed or tilting her head backward. Each episode lasts for less than a minute and is accompanied by nausea but no hearing loss or tinnitus. She denies any head trauma or infections. On examination, the Dix-Hallpike maneuver reproduces vertigo with rotational nystagmus, which resolves within 30 seconds. Romberg test is negative, and Weber and Rinne tests are normal.

 

Given these findings, what are the MOST appropriate next steps in management? Select four (4) options from the list below:

 

A 55-year-old male presents with recurrent episodes of vertigo that last several hours. He reports associated fluctuating hearing loss, tinnitus, and a sensation of fullness in his right ear. These episodes have been occurring over the past six months, with no clear triggers. He denies any recent infections, head trauma, or new medications. His past medical history includes hypertension and type 2 diabetes mellitus. On examination, Weber’s test lateralizes to the left ear, and the Rinne test is positive bilaterally. The Dix-Hallpike maneuver is negative, and the head impulse test is normal. Romberg test shows mild instability, but finger-to-nose testing is intact.

 

 

A 67-year-old female presents with chronic dizziness and unsteadiness that worsens when walking in the dark or on uneven surfaces. She denies spinning vertigo, nausea, vomiting, or hearing loss. Her medical history includes type 2 diabetes mellitus, diabetic neuropathy, and hypertension. Examination reveals reduced sensation in both feet, a positive Romberg test, and bilateral absent ankle reflexes. The Dix-Hallpike test is negative, and head impulse test is normal.

 

 

A 48-year-old male presents with intermittent dizziness and imbalance that has been progressively worsening over the past six months. He reports no spinning sensation but describes unsteadiness while walking, especially in crowded places and on uneven surfaces. He denies hearing loss, tinnitus, nausea, or visual disturbances. His medical history includes chronic alcohol use for the past 20 years. On examination, he has a broad-based gait, dysmetria on finger-to-nose testing, and an abnormal Romberg test. The Dix-Hallpike test is negative, and the head impulse test is normal.

 

Given these findings, what are the MOST appropriate next steps in managing this patient? Select four (4) options from the list below:

 

A 32-year-old pregnant woman (20 weeks gestation) presents with intermittent dizziness that has been occurring over the past two months. She describes a lightheaded, fainting sensation rather than a spinning feeling. The dizziness occurs when she stands up quickly or after prolonged sitting. She denies nausea, vomiting, hearing loss, or tinnitus. There is no history of recent illness or infections. On examination, her blood pressure is 100/65 mmHg while seated and drops to 85/55 mmHg upon standing, with a corresponding increase in heart rate by 25 beats per minute. The Romberg test is negative, and Dix-Hallpike maneuver does not reproduce symptoms.

 

Given these findings, what are the MOST appropriate next steps in managing this patient? Select four (4) options from the list below:

 

A 50-year-old male presents with intermittent vertigo and imbalance for the past four months. He reports a gradual onset of symptoms with mild headache and occasional blurry vision. The vertigo episodes last for minutes to hours and occur randomly, without positional triggers. He denies nausea, hearing loss, or tinnitus but has noticed clumsiness and mild difficulty with coordination in his left hand. His past medical history is unremarkable. On examination, gait is mildly ataxic, Romberg test is positive, and dysmetria is present on finger-to-nose testing on the left side. The head impulse test is negative, and the Dix-Hallpike maneuver does not reproduce symptoms.

 

 

A 27-year-old female presents with brief episodes of vertigo that occur when she turns her head to the right. Each episode lasts less than 30 seconds and is associated with mild nausea but no vomiting. She denies headaches, hearing loss, tinnitus, or neurological symptoms. The symptoms began two weeks ago, and she recalls a mild viral illness before onset. On examination, the Dix-Hallpike maneuver on the right side reproduces vertigo with rotational nystagmus, which resolves within 20 seconds. The head impulse test is normal, and there are no focal neurological deficits.

 

 

A 45-year-old female presents with a sudden onset of hearing loss in her left ear that occurred yesterday morning. She describes a fullness in the ear and mild tinnitus but denies pain, vertigo, or recent infections. She has a history of allergic rhinitis but is otherwise healthy. On examination, the left ear canal is clear, and the tympanic membrane appears normal. Tuning fork tests reveal that the Weber test lateralizes to the right ear, and the Rinne test is positive bilaterally.

 

Given these findings, what are the MOST appropriate next steps in management? Select four (4) options from the list below:

 

A 60-year-old male presents with a sudden onset of hearing loss in his right ear that developed over the past 48 hours. He reports associated dizziness, right-sided tinnitus, and a sensation of ear fullness. He denies any ear pain, discharge, or recent illnesses. His medical history includes hypertension and type 2 diabetes mellitus. On examination, the right ear canal is patent, and the tympanic membrane is intact with no abnormalities. Tuning fork tests show the Weber test lateralizes to the left ear, and the Rinne test is positive bilaterally.

 

Considering these findings, what are the MOST appropriate next steps in management? Select four (4) options from the list below: