Master ENT
for FMGE

What the FMGE Tests in ENT

The FMGE ENT section tests the ability to diagnose and manage common otorhinolaryngological conditions presenting in primary and emergency care. Candidates must demonstrate knowledge of acute and chronic otitis media, sinusitis, tonsillitis, epistaxis, and foreign body airway obstruction. They must recognise red flags for complications such as mastoiditis, peritonsillar abscess, and intracranial extension of sinusitis. Questions focus on first-line antibiotics (e.g., amoxicillin for acute otitis media), surgical indications (e.g., myringotomy for glue ear failing grommets), and interpretation of audiometry and tuning fork tests (Rinne and Weber). Nasal fracture reduction timing, epistaxis control steps (anterior packing with BIPP), and emergency management of laryngeal obstruction (cricothyroidotomy) are frequently tested. Knowledge of vestibular disorders (BPPV, Meniere's disease) and their diagnostic criteria (Epley manoeuvre, diuretic trial) is expected.

High-Yield Concepts

• Acute Otitis Media (AOM) Diagnosis and Treatment: Diagnose by acute onset of ear pain, fever, and bulging tympanic membrane with reduced mobility on pneumatic otoscopy. First-line antibiotic is amoxicillin 80-90 mg/kg/day for 5-7 days; use amoxicillin-clavulanate if recent antibiotic use or treatment failure. Myringotomy is indicated for severe pain, mastoiditis, or when the patient is immunocompromised.
• Chronic Suppurative Otitis Media (CSOM) – Safe vs Unsafe: Safe (tubotympanic) disease involves central perforation with mucoid discharge; treat with aural toilet and topical antibiotics (ciprofloxacin drops). Unsafe (atticoantral) disease has marginal perforation, cholesteatoma, and foul discharge; requires CT temporal bone and surgical excision (mastoidectomy) to prevent intracranial complications.
• Epistaxis – First-Line Management: For anterior epistaxis (Little's area), first compress the alae nasi for 10-15 minutes with the patient leaning forward. If bleeding continues, apply topical vasoconstrictor (lidocaine with adrenaline) and silver nitrate cautery. For posterior epistaxis, insert a Foley catheter balloon or BIPP pack; consider endoscopic sphenopalatine artery ligation if packing fails.
• Peritonsillar Abscess (Quinsy) – Diagnosis and Drainage: Suspect in a patient with severe unilateral sore throat, trismus, hot potato voice, and uvula deviation away from the abscess. Drain by needle aspiration or incision and drainage at the most fluctuant point (usually superior pole of the tonsil). Give IV antibiotics (benzylpenicillin + metronidazole) and steroids (dexamethasone 8 mg) to reduce oedema.
• Foreign Body Airway Obstruction – Choking Protocol: For complete obstruction in adults, perform abdominal thrusts (Heimlich manoeuvre) until object expelled or patient becomes unconscious. In infants, use back blows and chest thrusts. If obstruction persists, perform laryngoscopy and Magill forceps removal; if not possible, proceed to cricothyroidotomy (needle or surgical) using a 14G cannula and high-flow oxygen.
• Benign Paroxysmal Positional Vertigo (BPPV) – Diagnosis and Treatment: Diagnose by history of brief (<1 minute) vertigo triggered by head movement and positive Dix-Hallpike test (nystagmus with latency and fatiguability). Treat with Epley manoeuvre (canalith repositioning) for posterior canal BPPV; success rate >80%. Avoid vestibular suppressants as they impair central compensation.
• Meniere's Disease – Diagnostic Criteria and Management: Definite diagnosis requires at least two spontaneous episodes of vertigo lasting 20 minutes to 12 hours, with audiometrically documented sensorineural hearing loss (low-frequency) and aural fullness or tinnitus. First-line treatment is dietary salt restriction (<2g/day) and a diuretic (bendroflumethiazide 2.5 mg daily). For acute attacks, use prochlorperazine 10 mg IM or betahistine 16 mg TDS.
• Tuning Fork Tests – Rinne and Weber Interpretation: Rinne test: air conduction (AC) > bone conduction (BC) is normal (Rinne positive); BC > AC indicates conductive hearing loss (Rinne negative). Weber test: lateralises to the better ear in sensorineural loss, to the worse ear in conductive loss. Use a 512 Hz fork; false negatives occur with severe sensorineural loss (false Rinne negative).

Common Traps in ENT Questions

• Using a 128 Hz tuning fork gives false Rinne negative results due to vibration perception; always use 512 Hz.
• In acute otitis media, prescribing topical antibiotic drops is ineffective unless there is tympanic membrane perforation and discharge.
• For epistaxis, do not tilt the head back as this causes blood to flow into the pharynx and may induce vomiting or airway compromise.
• In peritonsillar abscess, avoid bilateral tonsillectomy in the acute phase due to risk of bleeding and airway oedema; perform unilateral drainage first.
• Do not use antihistamines or benzodiazepines for BPPV as they delay central compensation and do not treat the underlying canalithiasis.
• In foreign body aspiration, blind finger sweeps are contraindicated as they may push the object deeper into the airway.

How to Revise ENT for the FMGE

Prioritise high-volume topics: acute and chronic otitis media, epistaxis management, tonsillitis complications, and vertigo differentials. Questions are often scenario-based, requiring you to choose the next best step (e.g., 'What is the first-line antibiotic?') or identify the complication (e.g., 'Which complication is suggested by fever, mastoid tenderness, and sagging of the posterior meatal wall?'). Practice interpreting audiograms and tuning fork results quickly. Memorise the Glasgow Benefit Inventory for grommet outcomes and the House-Brackmann scale for facial nerve palsy. For vertigo, be ready to distinguish BPPV from Meniere's and vestibular neuritis using nystagmus characteristics and Dix-Hallpike. Review the NICE guidelines for sore throat (Centor criteria) and the SIGN guidelines for epistaxis. Spend extra time on surgical emergencies: airway obstruction, peritonsillar abscess, and acute mastoiditis.

Practise it: MedLumen has 50 ENT questions for the FMGE, each with a full explanation and references.