How to Prepare ENT for FMGE 2026: High-Yield Topics and Strategy

By Dr. Utsav Bhattacherjee, MBBS, MBA · 26 August 2026 · 9 min read

FMGE ENT high yield topics

• Rinne and Weber tests — interpreting the combined pattern for conductive versus sensorineural hearing loss.
• Vertigo — distinguishing peripheral from central causes.
• Epistaxis — the anatomical source and management approach.
• Ear infections — otitis media and otitis externa, and how they differ.
• Airway emergencies — foreign body aspiration and epiglottitis as time-critical presentations.
• Tonsillitis and its complications — recognising peritonsillar abscess as a distinct, more serious entity.

Rinne and Weber: reading the pattern

The counterintuitive part worth remembering: Weber lateralizes toward the bad ear in conductive loss (since blocking the air-conduction pathway relatively enhances bone-conducted sound in that ear), but away from the bad ear in sensorineural loss (since the cochlea itself is worse at perceiving sound regardless of pathway).

Vertigo: peripheral vs central

Distinguishing peripheral from central vertigo is one of the highest-value skills in this subject, since the underlying causes and urgency differ substantially. Peripheral vertigo (from the inner ear or vestibular nerve — BPPV, vestibular neuritis, Meniere’s disease) tends to be more severe in intensity, with a sudden onset, often accompanied by hearing loss or tinnitus in Meniere’s specifically, and typically without other neurological signs. Central vertigo (from a brainstem or cerebellar lesion) tends to be less intensely rotational, is more likely to be accompanied by other neurological findings (diplopia, dysarthria, limb weakness), and carries a higher index of suspicion for a serious underlying cause like stroke. A vertigo presentation with any accompanying neurological finding beyond the ear itself should shift suspicion toward a central cause and prompt more urgent evaluation.

Epistaxis: location determines management

The majority of epistaxis originates from Kiesselbach’s plexus (Little’s area), an anastomotic network on the anterior nasal septum — this anterior source is usually manageable with direct pressure and local measures. Posterior epistaxis, arising from branches of the sphenopalatine artery, is less common but more difficult to control with simple anterior pressure and carries a higher risk of significant blood loss, sometimes requiring posterior packing or more invasive intervention. Recognising which source a presentation suggests — based on bleeding severity, direction and response to initial anterior pressure — is the practical skill this topic actually tests.

Otitis media vs otitis externa

These are frequently confused because both cause ear pain, but they are anatomically and clinically distinct. Otitis media is an infection of the middle ear, common in children, often following an upper respiratory infection, presenting with pain, fever and sometimes a bulging tympanic membrane on examination. Otitis externa is an infection of the ear canal itself, classically associated with water exposure (swimmer’s ear), presenting with pain that is markedly worsened by movement of the pinna or tragus — a specific exam finding that helps distinguish it from otitis media, where tragal manipulation typically does not reproduce the pain the same way.

Airway emergencies: recognise before it is too late

Foreign body aspiration classically presents with sudden-onset coughing, choking and stridor, particularly in young children — and a unilaterally decreased breath sound or wheeze on examination can localise the obstruction to one side. Epiglottitis, though less common since Haemophilus influenzae type b vaccination became widespread, remains a genuine emergency when it occurs — presenting with rapid-onset high fever, drooling, and a preference for sitting forward (the tripod position), with attempts to visualise the airway directly carrying a real risk of triggering complete obstruction. Recognising epiglottitis from its classic presentation, and knowing that direct examination should be deferred in favour of a controlled airway setting, is a genuinely important safety concept beyond just exam recall.

Tonsillitis and peritonsillar abscess

Acute tonsillitis presents with sore throat, fever and enlarged, often exudative tonsils — usually managed with supportive care or antibiotics depending on the suspected cause. Peritonsillar abscess (quinsy) is a more serious complication, presenting with unilateral throat pain, trismus (difficulty opening the mouth), a muffled hot potato voice, and uvular deviation away from the affected side — a distinct enough clinical picture that recognising it, rather than treating it as severe tonsillitis, is the actual point of this topic. Peritonsillar abscess requires drainage in addition to antibiotics, unlike straightforward tonsillitis.

Sinusitis and allergic rhinitis

Acute sinusitis typically follows a viral upper respiratory infection, and distinguishing viral from bacterial sinusitis matters for management — bacterial sinusitis is more likely when symptoms persist beyond 10 days without improvement, or when there is a double worsening pattern (initial improvement followed by a new decline). Allergic rhinitis, by contrast, presents with a more chronic or seasonal pattern of sneezing, clear rhinorrhea and nasal itching, often alongside other atopic conditions like asthma or eczema — a history worth actively seeking, since allergic and infectious causes of nasal symptoms are managed quite differently despite some overlapping features.

Hoarseness and vocal cord pathology

Hoarseness lasting more than a few weeks, particularly in an adult with risk factors like smoking, warrants direct visualisation of the vocal cords rather than being dismissed as a simple viral laryngitis. Vocal cord nodules, classically from vocal overuse, present as bilateral, symmetric lesions typically at the junction of the anterior and middle thirds of the cord — a location and pattern that follows directly from the mechanical stress point during phonation. Recurrent laryngeal nerve palsy, which can result from thyroid surgery, malignancy or other causes of nerve compression, presents with a breathy, weak voice and reduced vocal cord mobility on the affected side — a distinction worth knowing from nodules, since the underlying cause and management differ substantially.

Foreign bodies in the ear and nose

Foreign bodies in the ear or nose are common in young children and are usually more of a removal-technique problem than a diagnostic one, but the exam does test a few specific management principles. Button batteries lodged in the nose or ear are a genuine emergency, not a routine foreign body — they can cause rapid, severe tissue damage through a chemical burn mechanism, and require urgent removal rather than the wait-and-see approach sometimes reasonable for other objects. Organic material (like a bean or seed) in the nose can swell with moisture over time, making delayed removal progressively more difficult, which is why prompt removal is generally preferred even for objects that do not seem urgent on first presentation. Live insects in the ear canal are typically managed by first instilling an agent to immobilise the insect (mineral oil or similar) before attempting extraction, since a struggling live insect can cause significant additional discomfort and canal trauma during removal attempts.

A smart study plan for FMGE ENT

• Master the Rinne and Weber interpretation table until it is automatic — it is tested constantly and rewards fast, confident recall over reasoning through it each time.
• Build a peripheral-versus-central vertigo comparison in your own notes, since distinguishing the two is more valuable than memorising every individual vertigo diagnosis in isolation.
• Treat airway emergencies as their own priority category — recognising epiglottitis and foreign body aspiration quickly is both a genuine safety skill and a reliably tested topic.
• Practise comparing conditions in pairs (otitis media vs externa, tonsillitis vs peritonsillar abscess, nodules vs recurrent laryngeal nerve palsy) rather than studying each condition in isolation, since that is the form most ENT questions actually take.

For the complete high-yield picture across every FMGE subject, see our FMGE high yield topics guide, and for how ENT fits into your overall timeline, our FMGE December 2026 preparation strategy covers the sequencing across subjects.