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Key Facts: Iran ENT Specialty Board Exam

150

Written MCQs

Sanjesh Pezeshki

210 min

Exam Duration

Sanjesh Pezeshki

70% (105/150)

Written Pass Mark

MOHME Council

No Penalty

Negative Marking

Sanjesh Pezeshki

Cummings

Primary Reference

Board Syllabus

The Iranian Specialty Board in Otolaryngology – Head and Neck Surgery is a high-stakes national exam administered by Sanjesh Pezeshki. Candidates must answer 152 MCQs in 240 minutes and achieve at least 70% (105 correct) without negative marking to qualify for the oral/OSCE clinical board. This 100-question practice bank provides comprehensive, Cummings-referenced English-language clinical vignettes with full distractor rationales.

Sample Iran ENT Specialty Board Practice Questions

Try these sample questions to review concepts for the Iran ENT Specialty Board exam. Each question includes a detailed explanation. Start the interactive quiz above for the full 100+ question experience with AI tutoring.

1A 7-year-old boy presents with high fever, acute otalgia, retroauricular erythema, and outward and downward displacement of the auricle. Contrast-enhanced CT reveals coalescent mastoiditis and an abscess deep to the sternocleidomastoid muscle. What is this specific complication termed?
A.Bezold abscess
B.Citelli abscess
C.Luc abscess
D.Subperiosteal retroauricular abscess
Explanation: A Bezold abscess arises when mastoid pus erodes through the thin medial cortex of the mastoid tip into the incisura digastrica, tracking deep to the sternocleidomastoid muscle into the neck. Treatment requires intravenous broad-spectrum antibiotics, surgical drainage of the neck abscess, and cortical mastoidectomy.
2Which theory of acquired middle ear cholesteatoma pathogenesis proposes that negative middle ear pressure leads to invagination of the pars flaccida into the epitympanum?
A.Epithelial invasion / migration theory (Habermann)
B.Retraction pocket theory (Bezold and Wittmaack)
C.Squamous metaplasia theory (Wendt)
D.Basal cell hyperplasia theory (Lange)
Explanation: The retraction pocket theory formulated by Bezold and refined by Wittmaack posits that chronic Eustachian tube dysfunction creates sustained negative middle ear pressure, leading to retraction of the thin pars flaccida into the Prussak space, desquamation retention, and cholesteatoma formation.
3A 32-year-old pregnant woman presents with progressive bilateral hearing loss. Pure-tone audiometry demonstrates bilateral conductive hearing loss with an apparent elevation of the bone-conduction threshold peaking at 2000 Hz. What is the pathophysiological cause of this classic 'Carhart notch'?
A.True sensorineural damage of the organ of Corti at 2000 Hz
B.Acoustic shadow artifact produced by round window calcification
C.Disruption of the normal ossicular inertia and middle ear resonance contribution to bone conduction
D.Stapedial artery persistent calcification damping perilymph transmission
Explanation: The Carhart notch is an artifactual depression in the bone-conduction threshold peaking at 2000 Hz (approximately 15 dB) in patients with otosclerosis. It results from mechanical fixation of the stapes footplate, which eliminates the normal inertial ossicular vibration and alters the resonant frequency contribution to bone-conducted sound.
4A 45-year-old patient with an intracanalicular vestibular schwannoma measuring 8 mm in the internal auditory canal (IAC) is being evaluated for surgical resection. Which surgical approach offers the best exposure for complete tumor removal while preserving serviceable hearing when the tumor does not reach the lateral fundus?
A.Translabyrinthine approach
B.Transotic approach
C.Infratemporal fossa type A approach
D.Middle cranial fossa approach
Explanation: The middle cranial fossa (MCF) approach is ideal for small intracanalicular vestibular schwannomas (<1.5 cm) confined to the IAC with preserved hearing, particularly when lateral fundus visualization is required. The translabyrinthine and transotic approaches inherently sacrifice hearing.
5According to the AAO-HNS diagnostic criteria, which combination of symptoms and objective findings establishes the definitive clinical diagnosis of Meniere disease?
A.Two or more spontaneous episodes of vertigo lasting 20 minutes to 12 hours, audiometrically documented low- to mid-frequency sensorineural hearing loss, and fluctuating aural symptoms in the affected ear
B.Continuous unremitting vertigo for 72 hours accompanied by high-frequency bilateral sensorineural hearing loss and normal caloric responses
C.Positional vertigo provoked by head rotation lasting less than 60 seconds with downbeating torsional nystagmus and bilateral conductive hearing loss
D.Sudden unilateral profound sensorineural deafness within 24 hours accompanied by facial nerve paresis and severe persistent dysequilibrium
Explanation: The updated diagnostic criteria for Meniere disease require two or more definitive spontaneous vertigo episodes lasting 20 minutes to 12 hours, audiometrically documented low- to medium-frequency sensorineural hearing loss in the affected ear, and fluctuating aural symptoms (tinnitus, fullness, or hearing loss).
6During a Dix-Hallpike maneuver of the right ear, a patient exhibits a 5-second latency followed by 25 seconds of geotropic torsional nystagmus beating toward the right forehead and upward. What is the diagnosis and the most appropriate initial repositioning maneuver?
A.Horizontal canal cupulolithiasis; treated with the barbecue roll maneuver
B.Right posterior semicircular canal canalithiasis; treated with the Epley maneuver
C.Right superior semicircular canal canalithiasis; treated with the Semont liberatory maneuver for anterior canal
D.Central vestibular lesion; treated with immediate magnetic resonance imaging and vestibular suppressants
Explanation: Right posterior canal canalithiasis is characterized by latency, upbeating and torsional nystagmus (with top pole of the eyes beating toward the dependent right ear), fatigability, and duration under 1 minute during the right Dix-Hallpike test. The gold standard repositioning treatment is the Epley particle repositioning maneuver.
7A 58-year-old man presents with severe right otalgia followed by complete unilateral peripheral facial paralysis and vesicular eruptions on the concha, antihelix, and external auditory canal. What is the most appropriate initial medical therapy?
A.High-dose systemic oral corticosteroids alone for 5 days without antiviral coverage
B.Immediate surgical decompression of the labyrinthine and fallopian canal segments within 48 hours
C.Combination therapy with oral acyclovir or valacyclovir and systemic corticosteroids initiated within 72 hours
D.Intravenous broad-spectrum cephalosporin and aminoglycoside targeting Pseudomonas aeruginosa
Explanation: Ramsay Hunt syndrome (Herpes Zoster Oticus) involves reactivation of varicella zoster virus in the geniculate ganglion. Landmark trials and Cummings otolaryngology guidelines support prompt initiation of combination oral antiviral therapy (valacyclovir 1000 mg three times daily) and systemic corticosteroids within 72 hours of onset to maximize facial nerve recovery.
8A 72-year-old diabetic male presents with unrelenting nocturnal otalgia and persistent granulation tissue at the bone-cartilage junction of the external auditory canal despite topical ear drops. What is the diagnostic test of choice to monitor therapeutic response and resolution of osteomyelitis in this condition?
A.High-resolution non-contrast temporal bone CT
B.Technetium-99m methylene diphosphonate bone scintigraphy
C.Gallium-67 citrate or Indium-111 labeled leukocyte scintigraphy
D.Serial audiograms and tympanometry
Explanation: Necrotizing (malignant) external otitis is an invasive osteomyelitis of the skull base caused by Pseudomonas aeruginosa. While Technetium-99m scans stay positive for months after cure due to persistent osteoblastic activity, Gallium-67 citrate (or labeled leukocytes) binds to active inflammatory cells and returns to normal when infection resolves, making it the preferred test for monitoring resolution.
9When performing a tympanoplasty for a subtotal perforation in an ear with severe Eustachian tube dysfunction, chronic atelectasis, or previous graft failure, why is a cartilage graft preferred over temporalis muscle fascia?
A.Cartilage provides superior resistance to re-retraction, negative middle ear pressure, and recurrent perforation
B.Cartilage produces significantly superior high-frequency sound transmission compared to thin fascia
C.Cartilage completely eliminates the risk of postoperative middle ear cholesteatoma
D.Cartilage undergoes complete spontaneous osteogenesis and fuses permanently with the malleus handle
Explanation: Tragal or conchal cartilage (either as a full-thickness or thinned island plate) is markedly stiffer than temporalis fascia. It resists inward retraction and reperforation under conditions of persistent Eustachian tube dysfunction and chronic negative middle ear pressure, without clinically significant acoustic disadvantage when properly thinned.
10A 40-year-old musician complains of dizziness and oscillopsia induced by loud trumpet playing, hearing his own footsteps loudly in his right ear, and autophony. High-resolution temporal bone CT confirms dehiscence of the bone overlying the superior semicircular canal. What is the pathognomonic clinical sign of sound-induced vertigo seen in this patient?
A.Hennebert sign
B.Tullio phenomenon
C.Chvostek sign
D.Griesinger sign
Explanation: The Tullio phenomenon is sound-induced vertigo and nystagmus resulting from a third mobile window in the inner ear, classic for superior semicircular canal dehiscence (SSCD). Hennebert sign is vertigo/nystagmus induced by pressure changes in the external auditory canal.

About the Iran ENT Specialty Board Exam

The Iranian Medical Specialty Board Examination in Otorhinolaryngology – Head and Neck Surgery (آزمون دانشنامه تخصصی گوش و حلق و بینی و جراحی سر و گردن) is the definitive terminal credential required for subspecialty fellowship entry and academic university appointments across the Islamic Republic of Iran. Conducted annually by the National Center for Health Assessment (مرکز سنجش آموزش پزشکی - Sanjesh Pezeshki) under the auspices of the Secretariat of the Council for Medical and Specialized Education, this examination tests comprehensive mastery across Otology & Neurotology, Rhinology & Skull Base Surgery, Laryngology & Upper Airway, Head and Neck Surgical Oncology, Pediatric Otolaryngology, and Facial Plastic & Trauma Surgery. The core curriculum is anchored to Cummings Otolaryngology: Head and Neck Surgery. Candidates who successfully achieve 70% (105/150) on the written examination qualify to sit for the rigorous multi-station clinical OSCE and structured oral case evaluations. Please note that this resource is an independent English-language MCQ study adaptation authored by OpenExamPrep to assist clinicians and residents in mastering the core syllabus.

Exam sponsor: National Center for Health Assessment (Sanjesh Pezeshki) & Council for Medical and Specialized Education, Ministry of Health and Medical Education (MOHME). The requirements and fees below concern the certification or admission exam, separate from our free practice resources.

Assessment

The national certification process comprises two sequential stages: Stage 1 Written Examination (152 single-best-answer MCQs, 240 minutes, testing comprehensive medical and surgical otolaryngology based on Cummings Otolaryngology) and Stage 2 Clinical/Practical Examination (Objective Structured Clinical Examination [OSCE], Patient Management Problems [PMPs], surgical instrument identification, and oral vivas).

Time Limit

240 minutes

Passing Score

70% of the written total (105 of 150 points)

Exam / Certification Fees

Official annual registration fee published on the Sanjesh Pezeshki portal (sanjeshp.ir) during the registration window.

Exam sponsor website

Fees, eligibility, and exam policies can change. Confirm them with the exam sponsor before applying or paying.

Our practice resources: topics covered

We aim to reflect publicly available exam outlines and topic information in our study resources. Coverage, format, and difficulty may differ from the actual exam, and we cannot guarantee that every detail is accurate or current. Confirm exam requirements, fees, and policies with the official exam sponsor.

25%

Otology, Neurotology & Audiology

Acute and chronic otitis media, tympanomastoidectomy, cholesteatoma management, stapes surgery for otosclerosis, peripheral vestibular diagnostics and rehabilitation, Meniere disease, facial nerve decompression and repair, and vestibular schwannoma.

20%

Rhinology & Paranasal Sinus Disease

Pathophysiology and medical/surgical management of rhinosinusitis, nasal polyposis, severe epistaxis management (sphenopalatine artery ligation), functional endoscopic sinus surgery (FESS), Keros classification, frontal sinusotomy (Draf I-III), CSF leak repair, and endoscopic skull base approaches.

15%

Laryngology, Voice Disorders & Bronchoesophagology

Phonosurgical microflap techniques, vocal fold paralysis and thyroplasty types, benign vocal fold lesions (polyps, nodules, granulomas, papillomatosis), spasmodic dysphonia (botulinum toxin therapy), adult laryngotracheal stenosis, and aerodigestive endoscopy.

20%

Head & Neck Surgical Oncology

Staging and surgical management of oral cavity, oropharyngeal (HPV-related and smoking-related), laryngeal, and hypopharyngeal malignancies; cervical lymph node levels and neck dissection classifications; thyroid carcinoma (differentiated, medullary, anaplastic); salivary gland neoplasms; and local/free flap reconstruction.

10%

Pediatric Otolaryngology & Congenital Anomalies

Congenital stridor and laryngomalacia (supraglottoplasty), pediatric subglottic stenosis (cricoid split and laryngotracheal reconstruction), choanal atresia repair, branchial cleft and thyroglossal duct cyst surgery (Sistrunk), pediatric obstructive sleep apnea, and congenital hearing loss.

10%

Facial Plastic & Reconstructive Surgery & Maxillofacial Trauma

Functional and aesthetic rhinoplasty (open vs. closed approaches, structural grafting, tip dynamics), management of midface and mandibular fractures (closed vs. open reduction internal fixation), facial soft tissue reconstruction using local advancement and rotation flaps, and otoplasty.

Preparing for the Iran ENT Specialty Board Exam

What You Need to Know

  • Passing score: 70% of the written total (105 of 150 points)
  • Assessment: The national certification process comprises two sequential stages: Stage 1 Written Examination (152 single-best-answer MCQs, 240 minutes, testing comprehensive medical and surgical otolaryngology based on Cummings Otolaryngology) and Stage 2 Clinical/Practical Examination (Objective Structured Clinical Examination [OSCE], Patient Management Problems [PMPs], surgical instrument identification, and oral vivas).
  • Time limit: 240 minutes
  • Exam / certification fees: Official annual registration fee published on the Sanjesh Pezeshki portal (sanjeshp.ir) during the registration window. Official sources

Using Our Practice Resources

  • Work through all 100 available questions
  • Review every answer and explanation
  • Track weak areas and revisit them
  • Use our AI tutor for tough concepts

Iran ENT Specialty Board: Suggested Study Strategy

1Prioritize high-yield surgical anatomy in temporal bone and paranasal sinuses: commit the facial nerve landmarks (pyramidal process, Bill's bar, cog) and frontal recess boundaries to memory.
2Review TNM-8 staging for head and neck squamous cell carcinoma, with special emphasis on depth of invasion (DOI) for oral tongue cancers and extranodal extension (ENE) in cervical nodal metastasis.
3Systematically practice audiogram and tympanogram interpretation, including masking dilemmas, acoustic reflexes, otoacoustic emissions, and electrocochleography findings in Meniere disease.
4Master pediatric airway emergencies and surgical indications, particularly timing of supraglottoplasty for severe laryngomalacia, congenital vs. acquired subglottic stenosis grading (Myer-Cotton), and Sistrunk procedure nuances.
5Focus on facial trauma reduction sequences: memorize fixation priorities for Le Fort fractures, indications for orbital blowout repair, and tension-band plating principles in mandibular angle and parasymphyseal fractures.

Frequently Asked Questions

What is the structure and duration of the Iranian ENT Written Board Examination?

The written examination consists of 152 single-best-answer multiple-choice questions (four choices per item) administered over a total duration of 240 minutes (4 hours). There is no negative marking for incorrect answers.

What is the passing score required to advance to the clinical OSCE?

Candidates must achieve at least 70% in the written stage, equivalent to answering 105 points out of a written total of 150. Meeting this threshold is a mandatory prerequisite to qualify for the practical/OSCE and oral examination stations.

What is the primary reference textbook for the Iranian ENT Board Exam?

The primary official reference specified by the Secretariat of the Council for Medical and Specialized Education is Cummings Otolaryngology: Head and Neck Surgery (latest published edition adopted by the Ministry of Health), complemented by relevant subspecialty guidelines.

What does the Stage 2 Clinical / OSCE examination include?

The second stage evaluates practical clinical competencies across multiple stations, including Objective Structured Clinical Examination (OSCE) circuits, Patient Management Problems (PMP), interpretation of radiological imaging (CT, MRI) and audiograms, surgical instrument and specimen identification, and structured oral case discussions with examining board faculty.

Who is eligible to register for the Iranian Specialty Board Examination?

Senior otolaryngology residents who have completed their required four-year residency program at an accredited Iranian university of medical sciences and successfully passed their institutional promotion and pre-board (Gonavi/Ertegha) examinations are eligible to sit for the National Board Exam administered by Sanjesh Pezeshki.

Is this OpenExamPrep question bank an official Sanjesh Pezeshki test?

No. This question bank is an independent English-language educational study adaptation developed by OpenExamPrep. It is designed to assist candidates in mastering the standard Cummings Otolaryngology curriculum and testing their diagnostic and surgical decision-making skills prior to the examination.