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100+ Free FRCS ORL-HNS Section 1 Practice Questions
Pass your Intercollegiate Specialty Fellowship Examination in Otolaryngology — Head and Neck Surgery (Section 1) exam on the first try — instant access, no signup required.
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Computer-based examination testing clinical knowledge across otology, rhinology, head & neck oncology, paediatric ENT, and laryngology for senior UK surgical trainees.
Sample FRCS ORL-HNS Section 1 Practice Questions
Try these sample questions to test your FRCS ORL-HNS Section 1 exam readiness. Each question includes a detailed explanation. Start the interactive quiz above for the full 100+ question experience with AI tutoring.
1A 45-year-old woman presents with a 12-month history of progressive left-sided sensorineural hearing loss and mild unsteadiness. Pure tone audiometry demonstrates a high-frequency sensorineural hearing loss on the left with a speech discrimination score of 40%. An MRI of the internal auditory meatuses (IAM) with gadolinium contrast reveals a 1.2 cm intensely enhancing lesion within the left internal auditory canal extending into the cerebellopontine angle without brainstem compression. What is the most appropriate initial management strategy?
A.Immediate translabyrinthine surgical resection
B.Conservative management with MRI surveillance (watch and wait)
C.Stereotactic radiosurgery (Gamma Knife)
D.High-dose systemic corticosteroid therapy
Explanation: For small, non-serviceable hearing or stable acoustic neuromas (vestibular schwannomas) under 1.5–2.0 cm without significant brainstem compression, active surveillance with interval MRI scans is the recommended first-line approach in UK clinical practice. Many acoustic neuromas display slow growth rates or no growth over long periods. Intervention (surgery or stereotactic radiosurgery) is indicated for documented radiological growth, larger tumours causing mass effect, or intractable symptoms.
2A 32-year-old man presents with chronic left-sided foul-smelling otorrhea and progressive conductive hearing loss. Otoscopy shows a deep attic retraction pocket filled with keratinous debris and erosion of the scutum. High-resolution CT of the temporal bone confirms a soft tissue mass in the epitympanum with erosion of the incus body and scutum, but intact bony labyrinth and facial canal. What is the definitive management?
A.Topical fluoroquinolone ear drops and regular micro-suction alone
B.Mastoidectomy with complete excision of the cholesteatoma
C.Long-term oral antifungal therapy
D.Laser obliteration of the tympanic membrane retraction
Explanation: Cholesteatoma is a non-neoplastic destructive keratinizing squamous epithelial lesion of the temporal bone that carries a high risk of bone erosion and intracranial/extracranial complications. Surgical removal via mastoidectomy (canal wall up or canal wall down depending on anatomy and disease extent) is mandatory to create a safe, dry ear. Medical therapy like micro-suction and topical drops only controls secondary infection temporarily.
3A 38-year-old woman presents with bilateral progressive hearing loss, worse in the right ear. She notes that her hearing improves slightly in noisy environments (paracusis Willisii). Otoscopy reveals normal tympanic membranes with a reddish hue visible through the right tympanic membrane (Schwartze sign). Pure tone audiometry shows a conductive hearing loss with a notch in bone conduction thresholds at 2 kHz (Carhart notch). What is the primary underlying pathological process?
A.Demineralization and bone remodeling of the otic capsule causing stapes fixation
B.Keratin accumulation eroding the incudostapedial joint
C.Autoimmune destruction of the inner ear hair cells
D.Fibrosis and calcification of the tympanic membrane
Explanation: Otosclerosis is an autosomal dominant disorder with variable penetrance characterized by abnormal bone remodeling of the otic capsule. Active vascular spongiotic lesions (evidenced by Schwartze sign) progress to dense sclerotic bone, leading to fixation of the stapes footplate at the oval window. Carhart notch is a classic audiometric artifact of reduced bone conduction at 2 kHz due to loss of mechanical resonance.
4A 48-year-old man experiences recurrent episodes of severe vertigo lasting 2 to 4 hours, accompanied by nausea, left-sided low-frequency hearing loss, tinnitus, and a sensation of fullness in the left ear. Audiometry during an acute flare confirms a fluctuating low-frequency sensorineural hearing loss. Brain MRI rules out retrocochlear pathology. What is the recommended first-line medical management according to ENT UK guidelines?
A.Dietary salt restriction and betahistine or prophylactic diuretic therapy
B.Intratympanic gentamicin injections
C.Endolymphatic sac decompression surgery
D.Epley canalith repositioning maneuver
Explanation: This clinical presentation is characteristic of Meniere's disease (idiopathic endolymphatic hydrops). First-line prophylactic treatment aims to reduce endolymphatic pressure and includes lifestyle modifications (dietary salt restriction, caffeine/alcohol avoidance) combined with betahistine or thiazide diuretics. Acute vertigo attacks are managed short-term with vestibular suppressants (e.g. prochlorperazine or cinnarizine).
5A 60-year-old woman presents with brief episodes of intense rotational vertigo lasting 20 seconds, triggered by rolling over in bed and tilting her head back. She has no hearing loss or tinnitus. Dix-Hallpike testing on the right side produces geotropic torsional and upbeating nystagmus after a 5-second latency, which fatigues after 30 seconds. What is the diagnosis and appropriate treatment?
A.Right posterior canal BPPV; treat with Epley maneuver
B.Right lateral canal BPPV; treat with Semont maneuver
C.Vestibular neuritis; treat with 14 days of oral prochlorperazine
D.Meniere's disease; treat with intratympanic dexamethasone
Explanation: The Dix-Hallpike test eliciting latent, fatigable, upbeating torsional nystagmus towards the affected lower ear is pathognomonic for posterior canal Benign Paroxysmal Positional Vertigo (BPPV). The Epley maneuver (canalith repositioning procedure) moves canalith debris out of the posterior semicircular canal into the vestibule and is highly effective.
6A 25-year-old man undergoes a type 1 tympanoplasty for a large central perforation of the right tympanic membrane following previous otitis media. The surgeon selects a cartilage-perichondrium graft rather than temporalis fascia. What is the main advantage of using a cartilage graft in tympanoplasty?
A.Higher mechanical stability and lower rate of graft re-perforation in ears with Eustachian tube dysfunction
B.Superior high-frequency acoustic conduction compared to normal tympanic membrane
C.Complete elimination of postoperative middle ear effusion risk
D.Spontaneous re-vascularization without requiring a vascularized mucosal bed
Explanation: Tragal or conchal cartilage grafts provide superior structural rigidity and resistance to resorption and retraction compared to temporalis fascia. They are particularly advantageous in ears with severe Eustachian tube dysfunction, recurrent perforations, or atelectatic tympanic membranes. While cartilage causes a slight theoretical acoustic mass loading, clinical hearing outcomes are comparable to fascia.
7A 5-year-old child presents with a 3-day history of acute right ear pain, high fever (39.1 C), and a protruding right pinna with tenderness, erythema, and post-auricular fluctuation. Otoscopy shows a bulging, opaque right tympanic membrane. HRCT temporal bone reveals loss of mastoid trabeculae and subperiosteal abscess formation. What is the surgical procedure of choice?
A.Cortical (simple) mastoidectomy and grommet insertion
B.Modified radical mastoidectomy
C.Radical mastoidectomy with blind sac closure of the external canal
D.Canal wall down mastoidectomy with tympanoplasty
Explanation: Coalescent acute mastoiditis with a subperiosteal abscess in a child requires prompt surgical drainage via a cortical (simple) mastoidectomy, alongside myringotomy/grommet placement and intravenous antibiotics. Cortical mastoidectomy opens the mastoid antrum and exenterates air cells without disrupting the external auditory canal wall or middle ear ossicles.
8A 52-year-old man presents to the ENT emergency clinic with sudden-onset right-sided total hearing loss and high-pitched tinnitus that started 24 hours ago upon waking. Otoscopy is entirely normal. Tuning fork tests show Weber lateralizing to the left ear, and Rinne positive bilaterally. Audiometry confirms a 60 dB sensorineural hearing loss across all frequencies on the right. What is the immediate evidence-based treatment?
A.High-dose oral corticosteroids (e.g. prednisolone 1 mg/kg/day for 7 days)
B.Oral aciclovir and hyperbaric oxygen therapy alone
C.Immediate exploratory tympanotomy for perilymph fistula repair
D.Reassurance and repeat audiogram in 6 weeks
Explanation: Idiopathic sudden sensorineural hearing loss (SSNHL) is defined as SNHL of ≥30 dB over at least 3 contiguous frequencies occurring within 72 hours. Early administration of high-dose systemic oral corticosteroids (e.g. prednisolone 1 mg/kg/day, max 60 mg, for 7-14 days) is the mainstay of treatment recommended by NICE and ENT UK guidelines. Intratympanic steroid injection is used as salvage therapy if oral treatment fails.
9A 42-year-old man presents with complete right facial weakness developing over 12 hours. On examination, he cannot close his right eye, drop his mouth, or wrinkle his right forehead. Otoscopy shows vesicular eruptions on the right concha and external auditory canal. He also reports severe right otalgia. What is the diagnosis and House-Brackmann grade?
A.Ramsay Hunt syndrome (Herpes zoster oticus); House-Brackmann Grade V/VI
B.Bell's palsy; House-Brackmann Grade III
C.Acoustic neuroma; House-Brackmann Grade II
D.Otitis media with facial paralysis; House-Brackmann Grade IV
Explanation: Ramsay Hunt syndrome (Herpes zoster oticus) is caused by reactivation of varicella-zoster virus in the geniculate ganglion of CN VII. It presents with painful vesicular lesions in the ear/oral mucosa and ipsilateral severe lower motor neurone facial palsy (House-Brackmann Grade V/VI indicates severe/complete paralysis). Treatment requires combined oral aciclovir/valaciclovir and systemic prednisolone.
10A 55-year-old woman presents with right-sided pulsatile tinnitus synchronous with her pulse. Otoscopy reveals a vascular, reddish-blue mass behind the intact lower half of the right tympanic membrane. Pneumatic otoscopy causes blanching of the mass (positive Brown sign). High-resolution CT shows a soft tissue mass confined to the promontory of the middle ear without infralabyrinthine or jugular bulb erosion (Fisch Stage A). What is the most likely diagnosis?
A.Glomus tympanicum (tympanic paraganglioma)
B.Glomus jugulare (jugulotympanic paraganglioma)
C.Aberrant internal carotid artery
D.High jugular bulb anomaly
Explanation: A glomus tympanicum (tympanic paraganglioma) originates from paraganglion cells along Arnold's (CN X) or Jacobson's (CN IX) nerve on the middle ear promontory. Fisch Stage A tumors are strictly confined to the middle ear space without bony erosion of the jugular fossa. A positive Brown sign (blanching on positive canal pressure) is classic. Glomus jugulare tumors arise in the jugular fossa and erode bone.
About the FRCS ORL-HNS Section 1 Exam
The FRCS ORL-HNS Section 1 is a computer-based assessment of otolaryngology knowledge.
Assessment
2 papers of 120 SBA questions
Time Limit
4h 30m
Passing Score
Standard setting
Exam Fee
GBP 580 Section 1 (Pearson VUE)
FRCS ORL-HNS Section 1 Exam Content Outline
25%
Otology and Neurotology
Hearing loss, vestibular disorders, middle ear disease, and skull base pathology.
25%
Rhinology and Facial Plastics
Rhinosinusitis, nasal polyposis, FESS, skull base interaction, and facial plastics.
25%
Head and Neck Surgical Oncology
Mucosal head and neck cancers, thyroid/parathyroid, salivary gland neoplasms, and neck dissection.
10%
Paediatric Otolaryngology
Paediatric airway, otitis media, congenital neck masses, and paediatric tonsillar disease.
10%
Laryngology and Airway Management
Dysphonia, vocal cord palsy, swallowing disorders, and airway stenosis.
5%
Applied Basic Sciences and Governance
Head and neck anatomy, physiology, clinical governance, consent, and audit.
How to Pass the FRCS ORL-HNS Section 1 Exam
What You Need to Know
- Passing score: Standard setting
- Assessment: 2 papers of 120 SBA questions
- Time limit: 4h 30m
- Exam fee: GBP 580 Section 1
Keys to Passing
- Complete 500+ practice questions
- Score 80%+ consistently before scheduling
- Focus on highest-weighted sections
- Use our AI tutor for tough concepts
FRCS ORL-HNS Section 1 Study Tips from Top Performers
1Focus on UK national guidelines (e.g. NICE, ENT UK, BAHNO) for clinical pathways.
2Master high-yield anatomy including cranial nerve pathways, skull base foramina, and neck compartments.
3Practice single best answer (SBA) decision-making under timed conditions for both 120-question papers.
Frequently Asked Questions
What is the format of the FRCS ORL-HNS Section 1 examination?
FRCS (ORL-HNS) Section 1 consists of two computer-based single best answer (SBA) papers delivered via Pearson VUE test centers, total 240 questions testing core otolaryngology knowledge.
How is Section 1 marked and what is the pass standard?
Section 1 uses Angoff standard setting. Candidates must pass Section 1 before they are eligible to attempt the Section 2 clinical and viva examination.
Which topics carry the highest weight on the exam?
Otology & Neurotology, Rhinology & Facial Plastics, and Head & Neck Surgical Oncology each represent 25% of the examination content.