Iran ENT Specialty Board cheat sheet

Rinne test: air conduction > bone conduction = positive (normal or sensorineural loss); bone > air = negative (conductive loss). Weber lateralizes to the affected ear in conductive loss, to the better ear in sensorineural loss.

Tympanometry types: Type A = normal middle ear pressure (peak at 0 daPa); Type B = flat (effusion, perforation, or mass); Type C = negative pressure (Eustachian tube dysfunction).

Acoustic neuroma (vestibular schwannoma): MRI with gadolinium is the gold standard; audiometry shows asymmetrical sensorineural hearing loss, often with disproportionately poor speech discrimination.

Benign paroxysmal positional vertigo (BPPV): Dix-Hallpike test for posterior canal; Epley maneuver for treatment. Horizontal canal BPPV: supine roll test, barbecue rotation maneuver.

Meniere disease: episodic vertigo, fluctuating sensorineural hearing loss, tinnitus, aural fullness; low-salt diet, diuretics, intratympanic steroids or gentamicin for refractory cases.

Cholesteatoma: keratinizing squamous epithelium in the middle ear; conductive hearing loss, foul-smelling otorrhea, retraction pocket; treatment is surgical (tympanomastoidectomy).

Otosclerosis: progressive conductive hearing loss, normal tympanic membrane, absent stapedial reflex; CT shows otospongiosis; treatment stapedotomy or hearing aid.

Sudden sensorineural hearing loss: ≥30 dB loss over 3 contiguous frequencies within 72 hours; treat with high-dose corticosteroids (oral or intratympanic) urgently.

Ostiomeatal complex: final common pathway for anterior ethmoid, maxillary, and frontal sinus drainage; obstruction leads to rhinosinusitis.

Acute bacterial rhinosinusitis: symptoms >10 days or worsening after 5 days; first-line antibiotics amoxicillin-clavulanate; avoid decongestants >3 days (rhinitis medicamentosa).

Endoscopic sinus surgery: middle meatal antrostomy, anterior ethmoidectomy, sphenoidotomy, frontal recess dissection; image guidance for revision or complex anatomy.

Allergic fungal rhinosinusitis: nasal polyps, allergic mucin with eosinophils and Charcot-Leyden crystals, fungal hyphae on silver stain; treatment surgery plus steroids, not antifungals.

Cerebrospinal fluid leak: beta-2 transferrin confirmatory; endoscopic repair with mucosal graft or fascia; avoid nose blowing and straining postoperatively.

Epistaxis: anterior from Kiesselbach plexus; posterior from sphenopalatine artery; initial treatment pressure, topical vasoconstrictor, cautery; posterior packing or arterial ligation/embolization for refractory.

Nasal polyps: bilateral, eosinophilic, associated with asthma and aspirin sensitivity (Samter triad); treat with intranasal corticosteroids, short course oral steroids, surgery for obstruction.

Orbital complications of sinusitis: preseptal cellulitis vs orbital cellulitis (proptosis, ophthalmoplegia, vision loss); orbital cellulitis requires IV antibiotics and urgent surgical drainage if abscess.

Vocal fold nodules: bilateral, symmetric, at junction of anterior and middle thirds; caused by voice abuse; treatment voice therapy, surgery rarely.

Vocal fold polyps: unilateral, often hemorrhagic, due to acute trauma; treatment excision with voice rest.

Recurrent laryngeal nerve palsy: unilateral causes hoarseness and breathiness; bilateral causes stridor; left RLN longer, vulnerable to thoracic lesions.

Laryngeal electromyography: distinguishes neuropathy from mechanical fixation; fibrillations and positive sharp waves indicate denervation.

Spasmodic dysphonia: adductor type (strained, strangled voice) treated with botulinum toxin injection into thyroarytenoid muscles; abductor type (breathy) less common.

Paradoxical vocal fold motion: episodic dyspnea with inspiratory stridor, normal spirometry between episodes; treatment speech therapy and reassurance.

Laryngopharyngeal reflux: symptoms include hoarseness, globus, throat clearing; 24-hour pH monitoring is gold standard; treat with lifestyle changes and proton pump inhibitors.

Airway stenosis: posterior glottic stenosis from prolonged intubation; treatment endoscopic dilation, laser, or open reconstruction; tracheostomy may be needed.

Squamous cell carcinoma of head and neck: most common histology; risk factors tobacco, alcohol, HPV (oropharyngeal). Staging by TNM; treatment surgery, radiation, chemotherapy.

Neck dissection levels: I submental/submandibular; II upper jugular; III middle jugular; IV lower jugular; V posterior triangle; VI anterior compartment; VII superior mediastinum.

Oral cavity cancer: floor of mouth and lateral tongue most common; treatment wide local excision with margins ≥5 mm; elective neck dissection for depth >4 mm.

Laryngeal cancer: glottic cancer presents early with hoarseness; supraglottic cancer presents late with nodal metastasis; treatment conservation surgery or chemoradiation.

Thyroid nodules: fine-needle aspiration biopsy first; Bethesda categories; papillary carcinoma most common, lymphatic spread; medullary carcinoma associated with MEN2, calcitonin marker.

Salivary gland tumors: parotid most common; pleomorphic adenoma benign; mucoepidermoid carcinoma most common malignant; facial nerve preservation unless invaded.

Nasopharyngeal carcinoma: associated with Epstein-Barr virus; presents with neck mass, nasal obstruction, epistaxis; treatment primary chemoradiation, surgery for salvage.

Head and neck melanoma: mucosal melanoma aggressive; surgical resection with margins; sentinel lymph node biopsy for staging.

Acute otitis media: bulging tympanic membrane, otalgia, fever; first-line antibiotic amoxicillin; watchful waiting for selected cases ≥2 years with mild symptoms.

Otitis media with effusion: middle ear fluid without signs of acute infection; persistent >3 months with hearing loss warrants tympanostomy tubes.

Tonsillectomy indications: recurrent throat infections (7 in 1 year, 5 per year for 2 years, 3 per year for 3 years), obstructive sleep apnea, peritonsillar abscess.

Adenoid hypertrophy: nasal obstruction, mouth breathing, snoring, otitis media; treatment adenoidectomy.

Croup (laryngotracheobronchitis): barking cough, inspiratory stridor, hoarseness; treatment nebulized epinephrine and corticosteroids; most common ages 6 months–3 years.

Epiglottitis: acute onset fever, drooling, dysphagia, tripod position; do not examine throat; secure airway in operating room; Haemophilus influenzae type b vaccine prevents.

Foreign body aspiration: sudden choking, unilateral wheeze; rigid bronchoscopy for removal; avoid blind finger sweep.

Congenital neck masses: thyroglossal duct cyst (midline, moves with tongue protrusion), branchial cleft cyst (lateral), cystic hygroma (posterior triangle); treatment surgical excision.

Rhinoplasty: open approach for complex tip work; closed approach for dorsal augmentation; complications include saddle nose, nasal valve collapse, persistent deviation.

Facial nerve branches: temporal (frontalis), zygomatic (orbicularis oculi), buccal (upper lip), marginal mandibular (depressor anguli oris), cervical (platysma). Marginal mandibular injury causes asymmetric smile.

Skin flaps: advancement, rotation, transposition, interpolation; local flaps for facial defects; free flaps for large composite defects (radial forearm, fibula).

Cleft lip repair: Millard rotation-advancement technique at 3 months; cleft palate repair at 9–12 months (von Langenbeck or Furlow).

Otoplasty: prominent ear correction; Mustarde sutures for conchal bowl, conchal setback for conchal hypertrophy; complications hematoma, infection, asymmetry.

Blepharoplasty: upper lid for visual field obstruction; lower lid for bags; avoid excessive skin excision causing lagophthalmos.

Facial fractures: Le Fort I (low maxillary), II (pyramidal), III (craniofacial dysjunction); mandibular fractures most common at angle; treatment open reduction internal fixation.

Scar revision: Z-plasty lengthens scar and changes orientation; W-plasty breaks up linear scar; steroid injection for hypertrophic scars.

Anterior skull base: cribriform plate, fovea ethmoidalis; endoscopic endonasal approach for CSF leak, esthesioneuroblastoma, meningioma.

Lateral skull base: jugular foramen (cranial nerves IX, X, XI), internal carotid artery; approaches include translabyrinthine, retrosigmoid, middle fossa.

Vestibular schwannoma: treat with observation, stereotactic radiosurgery, or microsurgery; hearing preservation best with small tumors and retrosigmoid approach.

Glomus jugulare: paraganglioma of jugular foramen; pulsatile tinnitus, lower cranial nerve palsies; treatment embolization followed by surgery or radiation.

Cerebrospinal fluid leak: endoscopic repair with fat or fascia; lumbar drain for high-flow leaks; avoid positive pressure ventilation.

Pituitary adenoma: transsphenoidal approach; complications diabetes insipidus, CSF leak, hypopituitarism; endoscopic endonasal preferred.

Chordoma: midline clival tumor; treatment maximal resection followed by proton beam radiation; chondrosarcoma lateral and better prognosis.

Orbital apex syndrome: cranial nerves II, III, IV, V1, VI; causes include tumor, infection, inflammation; urgent imaging and treatment.

Allergic rhinitis: IgE-mediated; symptoms sneezing, rhinorrhea, nasal congestion, itchy eyes; skin prick test or specific IgE for diagnosis.

First-line treatment allergic rhinitis: intranasal corticosteroids, oral or intranasal antihistamines, allergen avoidance; immunotherapy for refractory cases.

Anaphylaxis: epinephrine intramuscular 0.3–0.5 mg (1:1000) in adults, 0.01 mg/kg in children; repeat every 5–15 minutes; adjuncts antihistamines and steroids.

Samter triad: asthma, aspirin sensitivity, nasal polyps; avoid aspirin and NSAIDs; treatment leukotriene receptor antagonists, surgery.

Common variable immunodeficiency: recurrent sinopulmonary infections, low IgG; treat with intravenous immunoglobulin.

Hereditary angioedema: C1 inhibitor deficiency; recurrent angioedema without urticaria; treat with C1 inhibitor concentrate, icatibant, or fresh frozen plasma.

Skin testing: histamine positive control, saline negative control; wheal ≥3 mm greater than negative control is positive; antihistamines must be stopped before testing.

Occupational rhinitis: symptoms related to workplace; diagnosis by history, skin testing, specific IgE; treatment avoidance, medications.

Pure tone audiometry: air conduction thresholds (250–8000 Hz), bone conduction (250–4000 Hz); sensorineural loss = air and bone equally reduced; conductive loss = air-bone gap >10 dB.

Speech audiometry: speech reception threshold (SRT) should match pure tone average; speech discrimination score helps differentiate cochlear vs retrocochlear.

Otoacoustic emissions: present in normal cochlea, absent in sensorineural loss >30 dB; useful for newborn screening and functional hearing loss.

Auditory brainstem response: waves I–V; wave V latency prolonged in retrocochlear lesions; used for newborn hearing screening and estimating hearing thresholds.

Vestibular testing: caloric test assesses horizontal semicircular canal; electronystagmography; video head impulse test assesses vestibulo-ocular reflex.

Dix-Hallpike maneuver: patient seated, head turned 45° to side, rapidly lie supine with head extended 20°; positive if vertigo and nystagmus after latency.

Vestibular migraine: recurrent vertigo with migrainous features; treatment lifestyle, migraine prophylaxis (beta-blockers, amitriptyline).

Presbycusis: age-related sensorineural hearing loss, high frequencies first; treatment hearing aids, communication strategies.

Anatomy of middle ear: ossicles (malleus, incus, stapes), Eustachian tube, tympanic membrane; stapes footplate in oval window; round window for pressure release.

Cochlea: organ of Corti with hair cells; inner hair cells transmit signal, outer hair cells amplify; tonotopic organization (base high frequency, apex low frequency).

Facial nerve: seven segments; geniculate ganglion, tympanic segment, mastoid segment; susceptibility to Bell's palsy (idiopathic).

Paranasal sinus development: maxillary and ethmoid present at birth; frontal and sphenoid develop later; frontal sinus absent in 5% of adults.

Thyroid gland: develops from foramen cecum, descends along thyroglossal duct; parathyroid glands from third and fourth pharyngeal pouches.

Pharmacology: aminoglycosides ototoxic (vestibulo-cochlear), loop diuretics ototoxic, aspirin reversible hearing loss; avoid in renal impairment.

Pathology: squamous cell carcinoma most common head and neck malignancy; HPV-related oropharyngeal cancer has better prognosis; basal cell carcinoma most common skin cancer.

Physiology of smell: olfactory nerve (CN I) through cribriform plate; anosmia in head trauma, viral infection, sinonasal disease.