Basic Sciences
Core concepts
Integrate anatomy, physiology, microbiology, and pharmacology relevant to ENT. Know the temporal bone anatomy (middle ear cleft, ossicular chain, facial nerve course, labyrinth) and facial nerve segments (intracranial, meatal, labyrinthine, tympanic, mastoid, extratemporal). Understand hearing physiology (air vs bone conduction, cochlear tonotopy, otoacoustic emissions) and vestibular physiology (semicircular canals detect angular acceleration; otoliths detect linear acceleration/gravity). Know microbiology of common ENT infections (Streptococcus pneumoniae, Haemophilus influenzae, Moraxella catarrhalis in otitis media; Staphylococcus aureus in sinusitis complications) and pharmacology of corticosteroids, antibiotics, and antihistamines.
Traps
Do not confuse the labyrinthine (short, no branches) and tympanic facial nerve segments - the labyrinthine segment is the narrowest and most vulnerable. Remember the chorda tympani (taste anterior tongue, submandibular gland) and stapedius (damps loud sound) branches. Know that the eustachian tube equalises pressure and is shorter/horizontal in children - predisposing to otitis media.
Rule of thumb
For facial nerve palsy, localise by associated features: loss of taste/lacrimation suggests proximal (above geniculate ganglion) lesion; isolated motor loss suggests distal. Anatomy predicts deficit.
Ethics and Professionalism
Core concepts
Apply the four principles - autonomy, beneficence, non-maleficence, justice - to ENT scenarios. Know informed consent: capacity, adequate information (risks, benefits, alternatives, consequences of refusal), voluntariness, and documentation. Understand confidentiality and its limits (public interest, statutory reporting, safeguarding). Recognise professional boundaries, conflict of interest, and duty of candour after adverse events. Know resource allocation and triage ethics, and the importance of multidisciplinary team decision-making. Understand capacity assessment (understand, retain, weigh, communicate) and best interests for patients lacking capacity.
Traps
Consent is not a signature - it is a process. A patient with capacity may refuse life-saving treatment (e.g., tracheostomy) - respect autonomy after ensuring understanding. Do not breach confidentiality without justification. Beware questions where the "efficient" option conflicts with the ethical one.
Rule of thumb
When facing an ethical dilemma, ask: Is the patient competent? Have I informed them adequately? What would a reasonable body of peers do? Document the discussion and reasoning.