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Foreword
I remember sitting my FRCS examinations as if they were yesterday; the endless hours
of preparation while my young daughter pressed her face up against the window of
my study, the exhaustion of having to hit the books after a long day at work and the
fear that this may all need to be repeated six months later with a new-born in tow,
given the relatively high failure rate. It was something Iwanted to be sure that Ionly
had to endure once. Whilst accustomed to sitting exams throughout our training,
the stakes are never higher than for the FRCS, which comes at a time when many
candidates are already heavily committed both at work, in research and with caring
roles within the family, be that for children or other relatives. Those who fail seldom do
so because of lack of knowledge and experience, but more often because of poor
exam technique. It is therefore critical to be able to access tools to assist with this.
The authors of this textbook build on their success from previous books covering
all stages of ENT formative assessment and now complete their series with this guide
to passing the MCQ section of the FRCS. Selecting the ‘single best answer’ involves
more than just knowledge, but careful evaluation of both the question and the
possible answers in order to make a value judgement as to the best fit. This needs
practice to perfect. The text provides an excellent opportunity to do so with ques-
tions covering the full breadth of the syllabus with clear explanations supporting
the ‘most correct’ answer. This will be an invaluable resource for anyone sitting the
FRCS(ORLHNS)—I certainly wish their books had been available in my day.
Reviews of their previous books demonstrate the commitment of the authors, Peter
Kullar, Jameel Muzaar and Joseph Manjaly, to medical education and supporting
those that follow in their footsteps. They have assembled a formidable team of senior
trainees and young consultants to assist them in producing this volume, for which the
five star reviews will quickly follow. It’s a great privilege to be asked to introduce this
book, and I’d like to take the opportunity to congratulate all the authors, and to thank
them on behalf of all those preparing for their FRCS exams who will benefit.
Professor Claire Hopkins
MA (Oxon), BMBCh, FRCS(ORLHNS), DM
Professor of Rhinology
Guy’s and St Thomas’ NHS Hospitals Trust, UK
About the Authors
Peter Kullar is a Clinical Instructor in Neurotology/Lateral Skull Base Surgery at Stanford
University. He was previously an NIHR academic lecturer and a Wellcome Trust/Royal
College of Surgeons clinical research fellow at the University of Cambridge. Peter is
the author of two MasterPass series books Advanced ENT Training: AGuide to Passing
the FRCS (ORL-HNS) Examination and ENT OSCEs: AGuide to Your First ENT Job and
Passing the MRCS (ENT) OSCE (one FRCS and one MRCS).
Jameel Muzaar is Consultant in Otology and Auditor y Implantation at University
Hospitals Birmingham, Honorary Senior Research Fellow at the University of
Birmingham and National Specialty Lead for ENT for the National Institute of Health
and Care Research (NIHR) Research Delivery Network. He was previously TWJ
Foundation fellow in Otology and Auditory Implantation in Cambridge and prior
to that Honorary Royal College of Surgeons research fellow. He remains part of the
Sensor y Encoding and Neurosensory Engineering (SENSE) Lab, through which he first
met Peter Kullar. Jameel is an editor of CRC Press ENT Vivas: AGuide to Passing the
Intercollegiate FRCS (ORL-HNS) Viva Examination 9781032113401.
Joseph Manjaly is Consultant Otologist, Auditory Implant and ENT surgeon, special-
ising in ear and hearing problems for adults and children. He is currently clinical
lead for adult ENT at the Royal National ENT Hospital and University College London
Hospitals, UK. He is a member of the British Society of Otology Council and also pro-
duces educational ENT and medical content on social media as @earsurgeonjoe
Section Editors
HEAD AND NECK
Raghav Dwivedi PhD FRCS (ORL-HNS)
Consultant ENT/Head and Neck/Thyroid
Surgeon
University College London Hospitals NHS
Foundation Trust
Honorary Associate Professor, Division of
Surgery and Interventional Science
University College London
London, UK
Jonathan Fussey MBChB MD FRCS
(ORL- H N S)
Consultant Head and Neck Surgeon
University Hospitals Birmingham NHS
Foundation Trust
Birmingham, UK
Hannah Nieto BSc MBBS PhD FRCS
(ORL- H N S)
Clinician Scientist
University of Birmingham
Birmingham, UK
RHINOLOGY
Adnan Darr BSc(Hons) MSc MBChB
DOHNS PGCME FRCS (ORL-HNS)
Consultant Rhinologist and Anterior Skull
Base Surgeon
University Hospitals Coventry and
Warwickshire NHS Foundation Trust
Cove nt r y, UK
Karan Jolly MBChB FRCS (ORL-HNS)
Consultant Rhinologist and Anterior Skull
Base Surgeon
University Hospitals Birmingham NHS
Foundation Trust
Birmingham, UK
FACIAL PLASTIC SURGERY
Monica Rossi Meyer MD
Attending Facial Plastic Surgeon
Vanderbilt University Medical Center
Nashville, Tennessee, USA
MISCELLANEOUS AND
EVIDENCE-BASED MEDICINE
Baptiste Leurent PhD
Associate Professor in Medical Statistics
Department of Statistical Science
University College London
London, UK
PAEDIATRICS
Amit Parmar MBBS MSc FRCS (ORL-HNS)
Consultant Paediatric ENT Surgeon
Birmingham Children’s Hospital
Birmingham, UK
Major Contributors
HEAD AND NECK
Vikas Acharya BMBS MA MBA FRCS(ORL-
HNS) FHEA MAcadMEd MFSTEd
Specialist Registrar (ST8) in Ear, Nose and
Throat Surgery
The Royal National ENT Hospital and
University College London Hospitals
London, UK
Vikram Padaye MBBS PhD FRACS
Adult and Paediatric Ear, Nose and
Throat Surgeon
Sleep Apnoea and Sinus Specialist
University of Adelaide
Adelaide, Australia
RHINOLOGY
Vikas Acharya BMBS MA MBA FRCS
(ORL-HNS) FHEA MAcadMEd MFSTEd
Specialist Registrar (ST8) in Ear, Nose and
Throat Surgery
The Royal National ENT Hospital and
University College London Hospitals
London, UK
Zechariah Franks MD MPH
Senior Associate Consultant
Division of Rhinology, Department of
Otolaryngology, Head and Neck
Surgery
Mayo Clinic
Jacksonville, Florida, USA
FACIAL PLASTIC SURGERY
Abdul Nassimizadeh MBChB BMedSci
FRCS (ORL-HNS)
Locum Consultant Rhinologist and Facial
Plastic Surgeon
University Hospitals Birmingham NHS
Foundation Trust
Birmingham, UK
MISCELLANEOUS AND
EVIDENCE-BASED MEDICINE
Munira Ally MBBS DOHNS MRCS
ENT Specialty Registrar
Lister Hospital
Stevenage, UK
PAEDIATRICS
Munira Ally MBBS DOHNS MRCS
ENT Specialty Registrar
Lister Hospital
Stevenage, UK
Taseer F Din MBChB FCORL MMED
Assistant Professor of Clinical
Otolaryngology Head and Neck Surgery
Weill Cornell Medical College, Qatar
OTO LOGY
Cillian Forde BSc (Hons) MB BChir
(Cantab) DOHNS FRCS (ORL-HNS)
ENT Specialty Registrar
Royal National ENT Hospital and
University College London Hospitals
London, UK
Reshma Ghedia MBBS BSc(Hons) FRCS
(ORL-HNS)
Otology and Neurotology Fellow
Queen Elizabeth II Health Sciences Centre,
Halifax, Nova Scotia, Canada
Fiona McClenaghan BSc MBBS DOHNS
FRCS (ORL-HNS)
Lateral Skull Base Fellow
Guy’s and St Thomas’ and King’s College
Hospital London
London, UK
Ankit Patel MBBS BSc Dip (M.Med) FRCS
(ORL- H N S)
ENT Specialty Registrar
Royal National ENT Hospital and
University College London Hospitals
London, UK
Bhavesh Patel MBBS BSc(Hons) MEd(Surg)
DOHNS FRCS (ORL-HNS)
Consultant ENT Surgeon
London Northwest University Healthcare
NHS Trust
London, UK
Dalal Sabban MBBS DES-ORLCCF
Otology and Auditory Implant Fellow
Royal National ENT Hospital and
University College London Hospitals
London, UK
xviii Major Contributors
Priya Sethukumar BSc MBBS DOHNS FRCS
(ORL- H N S)
Otology and Auditory Implant Fellow
Royal National ENT Hospital and
University College London
Hospitals
London, UK
Benjamin Silver MBBS BSc MRCS DOHNS
ENT Specialty Registrar
Royal National ENT Hospital and University
College London Hospitals
London, UK
Elinor Warner MBBS MA(Oxon) PG cert FRCS
(ORL- H N S)
ENT Specialty Registrar Royal National
ENT Hospital& University College London
Hospitals
London, UK
Introduction
The Intercollegiate Specialty Fellowship exam, more commonly known simply as
the ‘FRCS’, represents a significant milestone on the way to obtaining a Certificate
of Completion of Training (CCT) or Certificate of Eligibility for Specialist Registration
(CESR) and becoming a consultant surgeon in the United Kingdom.
The exam is divided into two parts: Section1, often called ‘the MCQ’ or ‘the
written’ and Section2, typically referred to as ‘the viva and clinicals’. Section1 is
often seen, somewhat unfairly, as a warm-up for the more important and rigorous
Section2. However, whilst Section2 has several high-quality resources available,
candidates have, in years previous, struggled to find resources targeted at the lat-
est iteration of Section1. The scope of the exam is huge, covering the breadth of
ENT and allied specialities and therefore the importance of exam-specific revision
cannot be over-emphasised. Our intention was to create a book that made prepar-
ing for the exam a little easier and less daunting for candidates across the UK and
around the world.
In previous generations, Section1 focussed on straight factual recall, and whilst the
questions may have been hard, particularly if they explored an area of hazy knowl-
edge, there was little confusion as to what the question was asking. More recently,
the examiners’ approach has changed, focussing on higher-order judgement, and
testing real-world clinical decision making.
Questions are presented as a common stem with five possible answers, one of
which will be the most correct answer: a ‘single best answer’. The stem is carefully
designed to not contain extraneous information, so every word should help guide
candidates to the correct answer. None of the answers will be obviously wrong
or dangerous. The candidate must recognise that a ‘single best answer’ is not
the same as a ‘single correct answer’. In many of the questions, all the presented
answers could be considered correct, but the candidate must choose the best or
most appropriate answer from those available. The highest-performing questions,
those that discriminate between candidates at the pass/fail boundar y, often test
multi-logical thinking whereby multiple pieces of knowledge must be systematically
applied to solve a problem. Nevertheless, it should be remembered that if a question
looks easy, then it probably is, and the examiners are generally not trying to trick the
candidates. These changes in question setting style have accompanied an update
of core topics, which now include newer relevant topics such as immunotherapy and
hearing preservation cochlear implantation.
It is important to read the wording of the questions carefully. For example, a ques-
tion asking for the ‘best first treatment’ may have a dierent answer from one ask-
ing for the ‘best definitive treatment’. Questions exploring anatomy and physiology
are integrated into clinical scenarios, rather than being presented as direct factual
recall, and there will be far fewer ‘name the syndrome’ style questions, though of
course the underlying knowledge remains of use. Whilst the aim of this approach to
testing performance is laudable, it can be particularly stressful for candidates, when
multiple answers are presented and most sound as though they could be correct. We
would encourage candidates to not be paralysed by uncertainty. Due to these sub-
tleties, many questions prove not to be clear discriminators between candidates and
are removed from the examination. Rest assured there is extensive standard setting
that happens behind the scenes that ensures the exam is a valid assessment of the
curriculum and can distinguish between good and poorly performing candidates.