NExT ENT and Ophthalmology (Regional Specialties) Syllabus

Which sinus is most commonly involved in acute bacterial sinusitis in adults, and what are the common organisms?

The maxillary sinus; organisms are Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis.

What is the danger of frontal/ethmoid sinusitis spreading, and name a serious orbital complication.

Spread can cause orbital cellulitis or orbital/subperiosteal abscess (most often from ethmoid sinusitis) and cavernous sinus thrombosis.

Where is the most common site of anterior epistaxis?

Little's area (Kiesselbach's plexus) on the anteroinferior nasal septum.

Which artery supplies the posterior nasal cavity and is the usual source of posterior epistaxis?

The sphenopalatine artery (a branch of the maxillary artery).

What is a CSF rhinorrhea, and which simple bedside test helps confirm it?

Leakage of cerebrospinal fluid from the nose due to a skull-base/cribriform plate defect; the halo (double ring) sign on tissue and beta-2 transferrin assay confirm it (glucose testing is unreliable).

Differentiate ethmoidal (allergic) nasal polyps from an antrochoanal polyp.

Ethmoidal polyps are bilateral, multiple, arise from the ethmoid sinuses in adults, and are allergic. Antrochoanal (Killian's) polyp is usually unilateral, single, arises from the maxillary antrum in children/young adults, and extends to the choana.

What is the most common benign sinonasal tumor in young males presenting with recurrent epistaxis and nasal mass?

Juvenile nasopharyngeal angiofibroma (JNA); highly vascular, occurs almost exclusively in adolescent males.

What environmental exposure is classically associated with adenocarcinoma of the ethmoid sinus?

Hardwood dust exposure (woodworkers).

What is the most common indication for tonsillectomy, and what defines recurrent tonsillitis warranting surgery (Paradise criteria)?

Recurrent acute tonsillitis; Paradise criteria: 7 episodes in 1 year, or 5/year for 2 years, or 3/year for 3 years.

What is a quinsy and how is it managed?

Peritonsillar abscess: pus between the tonsil capsule and superior constrictor; presents with trismus, uvular deviation, and hot-potato voice; managed by incision and drainage plus antibiotics, with interval tonsillectomy.

What is the most common cause of nasal obstruction and mouth breathing in children, leading to adenoid facies?

Adenoid hypertrophy; chronic mouth breathing produces the long, open-mouthed adenoid facies with a high-arched palate.

In a child with biphasic stridor, what congenital cause is most common, and how does laryngomalacia differ?

Subglottic stenosis can cause biphasic stridor; laryngomalacia (the most common congenital cause of stridor overall) causes inspiratory stridor that worsens when supine/feeding and improves prone, usually resolving by 2 years.

What is the most common benign laryngeal tumor in children and its causative agent?

Recurrent respiratory papillomatosis (laryngeal papilloma), caused by HPV types 6 and 11.

Which laryngeal cancer subsite has the best prognosis and earliest symptom, and why?

Glottic (true vocal cord) carcinoma; earliest symptom is hoarseness, and prognosis is best because of sparse lymphatic drainage of the glottis (early presentation, low nodal spread).

What nerve injury causes vocal cord paralysis, and what position do the cords take in unilateral paralysis?

Recurrent laryngeal nerve injury; the affected cord lies in the paramedian position, with hoarse breathy voice that often improves as the opposite cord compensates.

What is a Plummer-Vinson syndrome and its malignant risk?

Triad of dysphagia (post-cricoid esophageal web), iron-deficiency anemia, and glossitis, mainly in middle-aged women; a premalignant condition for post-cricoid carcinoma.

What is a pharyngeal pouch (Zenker's diverticulum)?

A pulsion diverticulum herniating through Killian's dehiscence between the thyropharyngeus and cricopharyngeus muscles; presents with dysphagia, regurgitation of undigested food, and gurgling neck swelling.

How are neck masses classified by the '80% rule' / by age, and what is the rule of 7 for branchial cysts?

In adults, 80% of non-thyroid neck masses are neoplastic and 80% of these are malignant (often metastatic). A persistent lateral neck mass in an adult >40 is metastatic carcinoma until proven otherwise. Branchial cyst classically presents in the 2nd-3rd decade.

What is the most common site of a midline neck swelling that moves with swallowing and tongue protrusion?

Thyroglossal cyst; it moves upward on tongue protrusion because of its tract attachment to the foramen cecum/hyoid.

What is the recommended site for an emergency surgical airway and for an elective tracheostomy?

Emergency: cricothyroidotomy through the cricothyroid membrane. Elective tracheostomy: through the 2nd-3rd (or 3rd-4th) tracheal rings.

What are the immediate complications of tracheostomy?

Hemorrhage, apnea, pneumothorax, surgical emphysema, injury to recurrent laryngeal nerve, and tube displacement/obstruction.

What is the most common cause of preventable corneal blindness worldwide and a leading infective keratitis cause?

Trachoma (Chlamydia trachomatis serotypes A-C) is a leading cause of preventable blindness; bacterial/fungal keratitis and corneal ulcers are major causes of corneal blindness.

Differentiate viral, bacterial, and allergic conjunctivitis by discharge.

Bacterial: purulent/mucopurulent discharge; Viral: watery discharge with follicles and preauricular lymphadenopathy; Allergic: stringy/ropy mucoid discharge with itching and papillae.

What is the most common type of cataract and its hallmark symptom?

Age-related (senile) cataract; the hallmark is gradual painless progressive loss of vision, with nuclear sclerotic, cortical, or posterior subcapsular morphologies.

What is the gold-standard modern surgery for cataract?

Phacoemulsification with foldable intraocular lens (IOL) implantation through a small self-sealing incision.

What defines glaucoma, and how do primary open-angle and primary angle-closure glaucoma differ in presentation?

Glaucoma is a progressive optic neuropathy with characteristic cupping and visual field loss, usually with raised IOP. POAG is chronic, painless, with insidious peripheral field loss; PACG presents acutely with severe pain, halos, red eye, mid-dilated pupil and a hard eye.

What field defect and disc change are characteristic of glaucoma?

Arcuate scotoma (Bjerrum) and nasal step in the visual field, with increased optic disc cup-to-disc ratio (cupping) and bayonetting of vessels.

Differentiate anterior uveitis (iridocyclitis) from acute angle-closure glaucoma by pupil.

Anterior uveitis: small/constricted (miotic) irregular pupil with photophobia, ciliary flush, and cells/flare; acute angle-closure: fixed mid-dilated pupil with high IOP.

What is the formula relating the power of a lens to its focal length, and the lens-maker basis for spectacle correction of myopia and hypermetropia?

Power (Dioptres) = 1 / focal length in metres (P = 1/f). Myopia is corrected with concave (minus) lenses; hypermetropia with convex (plus) lenses; presbyopia with convex reading add.

What is the classic fundus picture and emergency status of central retinal artery occlusion?

An ophthalmic emergency with sudden painless loss of vision; fundus shows a pale retina with a cherry-red spot at the macula and attenuated arteries; treated within minutes-hours (ocular massage, lowering IOP).

What is the leading cause of irreversible blindness in the elderly in developed countries, and what national/leprosy-style program addresses avoidable blindness in India?

Age-related macular degeneration is the leading cause of irreversible blindness in the elderly; in India, the National Programme for Control of Blindness and Visual Impairment (NPCBVI) targets cataract (the leading avoidable cause) and refractive errors via the Vision 2020 'Right to Sight' initiative.