110+ Free DO-HNS (RCSI) Practice Questions

Pass your Diploma in Otolaryngology – Head and Neck Surgery (DO-HNS) (RCSI, Ireland) exam on the first try — instant access, no signup required.

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Key Facts: DO-HNS (RCSI) Exam

OSCE Circuit

Exam Format

RCSI Surgical Affairs Exams Guidelines

~€750-€900

Average Fee

Royal College of Surgeons Annual Fee Schedule

Angoff standard

Passing Score

Intercollegiate MRCS Board Standard Setting

~70%

Average Pass Rate

Intercollegiate Exam Statistical Reports

4 attempts

Retake Limit

Intercollegiate Board Exam Regulations

5 domains

Syllabus Areas

Intercollegiate Surgical Curriculum Programme (ISCP)

The DO-HNS (RCSI, Ireland) is a prestigious diploma assessing core clinical competence in Otolaryngology – Head and Neck Surgery. The exam format consists of a structured OSCE circuit assessing clinical history-taking, communication, and examination skills. The syllabus covers otology, rhinology, laryngology, oncology, and basic sciences. Passing scores are standard-set per sitting using the Angoff method. Successful candidates can progress to higher surgical training in ENT.

Sample DO-HNS (RCSI) Practice Questions

Try these sample questions to test your DO-HNS (RCSI) exam readiness. Each question includes a detailed explanation. Start the interactive quiz above for the full 110+ question experience with AI tutoring.

1A 4-year-old child presents with a 24-hour history of severe right ear pain, high fever of 39.5°C, and irritable behavior. Otoscopy reveals a bulging, intensely erythematous right tympanic membrane with loss of landmarks and visible purulent effusion behind it. What is the single best initial management step for this child, assuming no signs of systemic complications?

A.Reassurance and watchful waiting for 48 hours

B.Oral amoxicillin at 80-90 mg/kg/day split into two doses

C.Immediate referral for urgent myringotomy and grommet insertion

D.Topical ciprofloxacin-dexamethasone ear drops

Explanation: According to clinical guidelines, acute otitis media (AOM) in a child under 2 years of age, or any child with severe symptoms (fever >= 39°C, severe otalgia, or bilateral disease), warrants immediate oral antibiotic therapy. High-dose amoxicillin (80-90 mg/kg/day) is the first-line empirical agent of choice to target Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis. Watchful waiting is only appropriate for mild, unilateral AOM in older children, and topical drops are ineffective unless a perforation or tympanostomy tube is present.

2A 22-year-old university student presents with right ear pruritus, mild discomfort, and a sensation of fullness after returning from a summer beach holiday. Otoscopy shows a narrowed external auditory canal containing white, fuzzy debris with black spores that resembles wet blotting paper. What is the most appropriate first-line treatment for this patient?

A.Systemic oral fluconazole for 7 days

B.Aural toilet followed by topical clotrimazole or acetic acid drops

C.Topical ciprofloxacin ear drops for 7 days

D.Oral amoxicillin-clavulanate for 10 days

Explanation: The patient exhibits classic findings of otomycosis, a fungal infection of the external auditory canal most commonly caused by Aspergillus niger (which produces black spores) or Candida species. The cornerstone of management is thorough aural toilet (microsuctioning of fungal debris) followed by topical antifungal drops (such as clotrimazole or topical acetic acid/acidifying agents). Oral antifungals are reserved for resistant cases or immunocompromised patients, and topical or systemic antibacterial agents will not treat the fungal pathogen and may worsen the condition by altering local flora.

3A 68-year-old male with poorly controlled type 2 diabetes presents with deep, unrelenting right-sided otalgia that is worse at night, and persistent purulent otorrhea. Otoscopy reveals granulation tissue at the junction of the cartilaginous and bony parts of the external auditory canal. What is the most likely pathogen responsible for this condition?

A.Streptococcus pneumoniae

B.Pseudomonas aeruginosa

C.Staphylococcus aureus

D.Aspergillus fumigatus

Explanation: The patient's clinical presentation of severe otalgia, nocturnal pain, diabetes, and granulation tissue in the ear canal is pathognomonic for necrotizing (malignant) otitis externa (NOE). Pseudomonas aeruginosa is the causative pathogen in over 90% of cases of NOE. This invasive infection of the skull base bones requires prolonged antipseudomonal antibiotic therapy (such as ciprofloxacin or ceftazidime) and urgent workup, including a CT scan of the temporal bone and potentially nuclear imaging.

4A 32-year-old female presents with slowly progressive, bilateral hearing loss, which she notes is easier to tolerate in noisy environments (paracusis Willisii). Otoscopy shows normal, mobile tympanic membranes, though a faint pinkish blush is visible behind the left tympanic membrane. Audiometry confirms bilateral conductive hearing loss with a notch at 2000 Hz. Which surgical procedure is the treatment of choice for this patient?

A.Cortical mastoidectomy

B.Stapedotomy or stapedectomy

C.Myringotomy and grommet insertion

D.Endolymphatic sac decompression

Explanation: This patient presents with classic signs of otosclerosis, including progressive conductive hearing loss, paracusis Willisii, Schwartze sign (pinkish promontory blush indicating hypervascular active foci), and Carhart's notch (conductive drop at 2000 Hz). The primary surgical treatment of choice to restore the conductive hearing mechanism is a stapedotomy or stapedectomy, where the fixed stapes footplate is bypassed or partially replaced with a prosthesis. Mastoidectomy is used for chronic suppurative otitis media, grommets are for middle ear fluid/dysfunction, and endolymphatic sac surgery is for Meniere's disease.

5A 45-year-old man presents with recurrent episodes of rotational vertigo lasting between 1 and 3 hours, accompanied by a roaring sound in his left ear and a sensation of pressure. Audiometric testing during an symptomatic phase demonstrates a low-to-medium-frequency sensorineural hearing loss in the left ear. What is the primary pathophysiological mechanism underlying this disease?

A.Ectopic bone formation around the stapes footplate

B.Endolymphatic hydrops leading to distension of the membranous labyrinth

C.Migration of calcium carbonate crystals into the posterior semicircular canal

D.Microvascular compression of the vestibulocochlear nerve in the cerebellopontine angle

Explanation: The clinical triad of episodic vertigo (lasting minutes to hours), fluctuating low-frequency sensorineural hearing loss, and roaring tinnitus/fullness defines Meniere's disease. The underlying pathophysiology is endolymphatic hydrops, which is characterized by the overaccumulation (either due to oversecretion or impaired absorption) of endolymph leading to the swelling and eventual rupture of the membranous labyrinth (specifically Reissner's membrane), mixing potassium-rich endolymph with perilymph and causing acute vestibular and cochlear dysfunction.

6A 58-year-old woman describes brief episodes of room-spinning vertigo lasting 20-30 seconds, triggered whenever she rolls over to the right side in bed or looks up to reach a high shelf. What is the gold standard diagnostic test to confirm the most likely diagnosis?

A.Frenzel goggles examination during head shake

B.Dix-Hallpike maneuver

C.Caloric reflex test

D.Video head impulse test (vHIT)

Explanation: The description is highly characteristic of Benign Paroxysmal Positional Vertigo (BPPV) affecting the posterior semicircular canal. The Dix-Hallpike maneuver is the gold standard diagnostic test to elicit the classic geotropic rotary nystagmus (with latency and fatigability) and reproduce vertigo. Epley maneuver is the repositioning treatment, whereas caloric tests and vHIT assess general vestibular function rather than canalithiasis.

7A 48-year-old man presents with progressive left-sided hearing loss and mild unsteadiness over the last 18 months. Audiometry shows a unilateral high-frequency sensorineural hearing loss in the left ear with poor word recognition scores. What is the diagnostic imaging modality of choice to evaluate this patient?

A.High-resolution non-contrast CT scan of the temporal bones

B.Magnetic resonance imaging (MRI) of the brain and internal auditory meatus (IAM) with gadolinium contrast

C.Positron emission tomography (PET-CT) of the skull base

D.Duplex ultrasound of the carotid arteries

Explanation: Unilateral sensorineural hearing loss, asymmetrical tinnitus, and unsteadiness are red flags for a retrocochlear lesion such as a vestibular schwannoma (acoustic neuroma). T1-weighted MRI with gadolinium contrast focusing on the internal auditory meatus (IAM) and cerebellopontine angle (CPA) is the gold-standard diagnostic imaging modality, capable of detecting tumors as small as 1-2 mm. CT is useful for bony details but lacks the soft-tissue resolution to exclude small intracanalicular tumors.

8A 35-year-old male presents with sudden onset of complete right-sided facial weakness. On examination, he is unable to wrinkle his forehead, close his right eye fully, or smile on the right side. There is no otalgia, otorrhea, vesicles, or hearing loss. What is the most appropriate first-line medical therapy according to clinical consensus guidelines?

A.Immediate referral for surgical decompression of the facial nerve

B.High-dose oral corticosteroids (e.g., prednisolone 1 mg/kg/day) started within 72 hours of onset

C.Intravenous acyclovir therapy alone

D.Physical therapy and electrical nerve stimulation only

Explanation: This patient presents with Bell's palsy (acute idiopathic lower motor neuron facial nerve palsy), as evidenced by weakness affecting both the upper and lower face. High-dose oral corticosteroids (e.g., prednisolone) started within 72 hours of onset significantly increase the probability of complete recovery. Antivirals may be added for severe cases but are not recommended as monotherapy, surgical decompression is controversial and rarely indicated, and electrical stimulation is not supported by strong evidence.

9A 52-year-old female presents with severe pain in her right ear, vertigo, and a right-sided lower motor neuron facial nerve palsy. On physical examination, painful vesicular eruptions are observed on the right concha and within the external auditory canal. What is the causative organism of this clinical syndrome?

A.Herpes simplex virus type 1 (HSV-1)

B.Varicella-zoster virus (VZV)

C.Epstein-Barr virus (EBV)

D.Coxsackievirus A16

Explanation: Ramsay Hunt syndrome (herpes zoster oticus) is caused by the reactivation of latent Varicella-zoster virus (VZV) in the geniculate ganglion of the facial nerve. It characteristically presents with the triad of severe otalgia, an erythematous vesicular rash in the ear canal or auricle, and lower motor neuron facial nerve paralysis. Treatment involves combination therapy with oral acyclovir/valacyclovir and corticosteroids, which should be initiated promptly to prevent permanent facial nerve dysfunction.

10A 40-year-old woman presents to the emergency department complaining of sudden hearing loss in her left ear that occurred upon waking yesterday morning. She has associated mild vertigo and tinnitus. Audiometry confirms a 45 dB sensorineural hearing loss across three contiguous frequencies in her left ear. What is the initial treatment of choice?

A.Reassurance and repeat audiometry in 4 weeks

B.Immediate initiation of oral corticosteroids (prednisolone) at 1 mg/kg/day

C.Vasodilator therapy and hyperbaric oxygen therapy

D.Myringotomy and insertion of a grommet

Explanation: Sudden sensorineural hearing loss (SSNHL) is defined as a rapid-onset sensorineural hearing loss of 30 dB or more over at least three contiguous frequencies occurring within 72 hours. It is considered an otologic emergency, and oral corticosteroids (e.g., prednisolone 1 mg/kg/day for 10-14 days) are the first-line therapy to maximize the chances of hearing recovery. Watchful waiting risks permanent hearing impairment, vasodilators are not supported, and grommets have no role as there is no middle ear fluid.

About the DO-HNS (RCSI) Exam

The Diploma in Otolaryngology - Head and Neck Surgery (DO-HNS) is designed to test the breadth of knowledge, clinical skills, and professional attributes appropriate for a doctor in a trainee post in Otolaryngology. It is administered by the RCSI and other intercollegiate surgical colleges, serving as a critical benchmark for early-stage ENT trainees. The assessment consists of a clinical OSCE testing physical exam, clinical history, communication, and basic sciences, aligned with the core syllabus covering otology, rhinology, laryngology, and head and neck surgery.

Questions

100 scored questions

Time Limit

OSCE circuit / MCQ Paper

Passing Score

Angoff standard set

Exam Fee

~€750-€900 (Royal College of Surgeons in Ireland (RCSI))

DO-HNS (RCSI) Exam Content Outline

~25%

Otology & Neurotology

Covers chronic and acute otitis media, otomycosis, cholesteatoma, otosclerosis, sudden sensorineural hearing loss, Meniere's disease, BPPV (Dix-Hallpike/Epley), vestibular schwannoma, facial nerve palsy, and audiometry/tympanometry interpretation.

~25%

Rhinology & Sinus

Covers rhinosinusitis, epistaxis, nasal fractures, allergic rhinitis, CSF rhinorrhea, inverted papillomas, Wegener granulomatosis, and nasal polyps.

~20%

Laryngology & Airway

Covers vocal fold paralysis, laryngopharyngeal reflux, subglottic stenosis, laryngomalacia, stridor, croup, epiglottitis, and airway foreign bodies.

~20%

Head & Neck Oncology

Covers oral cavity, laryngeal, and thyroid cancers, salivary gland tumors, neck dissection levels, and staging guidelines.

~10%

Basic Sciences & Professionalism

Covers branchial arch embryology, temporal bone anatomy, cranial nerve pathways, local anesthetics pharmacology, and clinical consent/ethics.

How to Pass the DO-HNS (RCSI) Exam

What You Need to Know

Passing score: Angoff standard set
Exam length: 100 questions
Time limit: OSCE circuit / MCQ Paper
Exam fee: ~€750-€900

Keys to Passing

Complete 500+ practice questions
Score 80%+ consistently before scheduling
Focus on highest-weighted sections
Use our AI tutor for tough concepts

DO-HNS (RCSI) Study Tips from Top Performers

1Master audiogram interpretation (conductive vs. sensorineural hearing loss, tympanometry types A, B, and C) as these are tested in both clinical stations and MCQ formats.

2Understand the surgical levels of the neck (I to VI) and the lymph node drainage of oral, laryngeal, and thyroid cancers.

3Learn the management flowcharts for epistaxis (nasal cautery, packing, arterial ligation) and acute airway emergencies (needle cricothyroidotomy vs. tracheostomy).

4Familiarize yourself with facial nerve anatomy (extratemporal branches: temporal, zygomatic, buccal, marginal mandibular, cervical) and grading of facial palsy (House-Brackmann scale).

5Review branchial arch embryology (first to fourth arches) and their corresponding skeletal, muscular, and nerve derivatives.

Frequently Asked Questions

What is the DO-HNS (RCSI)?

The Diploma in Otolaryngology – Head and Neck Surgery (DO-HNS) is a specialized certification awarded by the Royal College of Surgeons in Ireland (RCSI) and partner colleges. It verifies clinical competency and core knowledge in ear, nose, and throat (ENT) medicine and surgery for trainees in their early years of surgical training.

What is the format of the DO-HNS exam?

The examination is structured as an Objective Structured Clinical Examination (OSCE) circuit containing 15-20 stations that test clinical history-taking, physical examination skills, communication skills, and clinical management. Historically, it also included a written MCQ paper covering surgical principles and basic sciences.

What is the passing score for the RCSI DO-HNS exam?

The passing score is calculated using standard-setting methods (usually the Angoff method) for each individual sitting based on the difficulty of the stations. Candidates are graded on their performance across clinical skills, communication, and basic sciences.

How much does the DO-HNS exam cost?

The exam registration fee is set annually and typically ranges between €750 and €900 depending on the college and location. The fee covers registration, exam administration, and diploma issuance.

What are the eligibility requirements for DO-HNS?

Candidates must hold a primary medical qualification (such as an MB BCh BAO) recognized by the GMC or the Irish Medical Council and have completed basic surgical foundation training, with some clinical experience in Otolaryngology/ENT.

What topics are covered on the DO-HNS exam?

The syllabus covers five key domains: (1) Otology and neurotology, (2) Rhinology and sinus pathology, (3) Laryngology and pediatric ENT, (4) Head and neck oncology and general surgery, and (5) Applied basic sciences (anatomy, embryology, and pharmacology) and ethical consent.