1. A 22-year-old woman has a sore throat, blocked nose and dry cough for 2 days. She is afebrile, has no tonsillar exudate and no cervical lymphadenopathy. She is otherwise well.
Which ONE of the following is the most appropriate management?
A. Supply phenoxymethylpenicillin immediately.
B. Refer urgently for suspected quinsy.
C. Provide self-care advice and safety-netting because features suggest viral upper respiratory tract infection.
D. Supply oral fluconazole.
E. Recommend stopping oral fluids until swallowing improves.
2. A 5-year-old child has ear pain and fever. The parent reports swelling, redness and tenderness behind the ear, and the ear appears pushed forwards.
Which ONE of the following is the most appropriate action?
A. Manage with analgesia alone and review in 7 days.
B. Treat as uncomplicated otitis externa.
C. Supply earwax-softening drops.
D. Recommend an oral antihistamine.
E. Arrange urgent medical assessment for possible mastoiditis.
3. A 28-year-old swimmer has ear pain, itch and discharge. The ear canal is swollen and tender when the tragus is pressed. Hearing is slightly reduced, but there is no fever, mastoid tenderness or systemic illness.
Which ONE of the following is the most likely diagnosis and management approach?
A. Acute otitis externa; consider appropriate topical treatment and advise keeping the ear dry.
B. Acute otitis media; supply oral antibiotics immediately.
C. Mastoiditis; manage with self-care only.
D. Ménière’s disease; start prochlorperazine long term.
E. Allergic rhinitis; start intranasal corticosteroid.
4. A 74-year-old man has gradual hearing loss and a blocked sensation in one ear. Otoscopy by the GP practice confirms impacted wax. He has no ear pain, discharge, perforation history or ear surgery.
Which ONE of the following is the most appropriate advice?
A. Use cotton buds daily to remove the wax.
B. Start oral antibiotics.
C. Use nasal decongestant spray.
D. Consider wax-softening drops and arrange appropriate earwax removal if needed.
E. Treat with antifungal ear drops.
5. A 61-year-old woman wakes with sudden hearing loss in her left ear. There is no wax, pain, discharge or recent trauma. She also has new tinnitus.
Which ONE of the following is the most appropriate action?
A. Reassure and review in 3 months.
B. Arrange urgent same-day or emergency assessment for sudden sensorineural hearing loss.
C. Supply earwax-softening drops.
D. Treat as allergic rhinitis.
E. Recommend oral antihistamine only.
6. A 66-year-old man receiving gentamicin for Gram-negative sepsis reports new tinnitus, dizziness and difficulty hearing.
Which ONE of the following is the most appropriate pharmacist action?
A. Reassure because tinnitus is expected and harmless.
B. Recommend ear syringing.
C. Increase gentamicin dose.
D. Treat as uncomplicated earwax.
E. Escalate urgently because aminoglycoside-associated ototoxicity should be considered.
7. A 34-year-old woman has sneezing, nasal itching, watery rhinorrhoea and congestion every summer. Symptoms affect sleep and work. She has no fever, facial pain or purulent discharge.
Which ONE of the following is the most appropriate treatment option?
A. Intranasal corticosteroid with advice on regular use and correct technique.
B. Oral antibiotics for 7 days.
C. Earwax-softening drops.
D. Oral fluconazole.
E. Emergency ENT referral for all seasonal rhinitis.
8. A 42-year-old man has used xylometazoline nasal spray several times daily for 4 weeks. His congestion improves briefly after each dose but quickly returns worse than before.
Which ONE of the following is the most appropriate advice?
A. Continue regular use because decongestants are safe long term.
B. Increase the dose to reduce rebound symptoms.
C. Add a second topical nasal decongestant.
D. Suspect rebound congestion and advise stopping or reducing decongestant use with suitable alternative management.
E. Treat with oral antibiotics.
9. A 36-year-old woman has nasal congestion, facial pressure and discoloured nasal discharge for 5 days after a cold. She is systemically well and has no orbital swelling, severe unilateral pain or high fever.
Which ONE of the following is the most appropriate management?
A. Immediate co-amoxiclav.
B. Self-care advice and safety-netting because acute sinusitis is often self-limiting early on.
C. Emergency hospital admission.
D. Oral corticosteroids for 6 weeks.
E. Treat as dental abscess.
10. A 14-year-old has sinus symptoms with swelling around the eye, severe headache, vomiting and reduced eye movement.
Which ONE of the following is the most appropriate action?
A. Supply a saline nasal spray only.
B. Recommend routine GP review in 2 weeks.
C. Arrange urgent medical assessment for possible orbital or intracranial complication.
D. Treat as uncomplicated allergic rhinitis.
E. Advise continuing school as normal.
11. A 20-year-old man has a severe sore throat, fever, muffled “hot potato” voice, trismus and deviation of the uvula. He is struggling to swallow saliva.
Which ONE of the following is the most appropriate action?
A. Provide self-care advice for viral sore throat.
B. Supply lozenges and review in 1 week.
C. Treat as uncomplicated oral thrush.
D. Arrange urgent assessment for suspected peritonsillar abscess.
E. Recommend intranasal corticosteroid.
12. A 19-year-old woman has sore throat for 1 day. She has cough, no fever, no tonsillar exudate and no tender anterior cervical lymph nodes. She is drinking normally.
Which ONE of the following is the most appropriate management?
A. Provide self-care advice and explain antibiotics are unlikely to help.
B. Supply immediate antibiotics because all sore throats are bacterial.
C. Refer urgently for suspected cancer.
D. Start oral aciclovir.
E. Supply metronidazole.
13. A 4-year-old child is drooling, has severe sore throat, stridor and is sitting forward. The parent says the child looks very unwell.
Which ONE of the following is the most appropriate action?
A. Examine the throat with a tongue depressor in the pharmacy.
B. Supply oral antibiotics and review tomorrow.
C. Treat as uncomplicated tonsillitis.
D. Recommend cold drinks and rest.
E. Arrange emergency assessment for possible epiglottitis or airway compromise.
14. A 70-year-old man using high-dose inhaled corticosteroids develops white plaques in the mouth that can be scraped off, leaving a sore red surface.
Which ONE of the following is the most likely diagnosis and management consideration?
A. Aphthous ulcer; avoid inhaler counselling.
B. Oral lichen planus; start antibiotics.
C. Oral candidiasis; review inhaler technique and advise mouth rinsing after corticosteroid use.
D. Peritonsillar abscess; manage with lozenges only.
E. Leukoplakia; reassure without review.
15. A 25-year-old woman has recurrent small painful mouth ulcers that heal within 10 days. She is otherwise well, has no weight loss, no genital ulcers and no ulcer lasting longer than 3 weeks.
Which ONE of the following is the most appropriate initial management?
A. Urgent cancer referral.
B. Symptomatic management for recurrent aphthous ulcers and safety-netting for persistent or unusual lesions.
C. Oral antibiotics for all episodes.
D. Immediate hospital admission.
E. Stop brushing teeth.
16. A 59-year-old man has a painless ulcer on the side of his tongue that has persisted for 5 weeks. He smokes and drinks alcohol regularly.
Which ONE of the following is the most appropriate action?
A. Treat with chlorhexidine mouthwash only.
B. Reassure because painless ulcers are usually benign.
C. Supply topical corticosteroid and review in 6 months.
D. Refer urgently for assessment of possible oral cancer.
E. Treat as uncomplicated oral thrush.
17. A 63-year-old man has persistent unexplained hoarseness for 6 weeks. He is a long-term smoker and has no symptoms of an acute respiratory infection.
Which ONE of the following is the most appropriate advice?
A. Refer urgently for assessment of possible laryngeal cancer.
B. Reassure because hoarseness is expected in smokers.
C. Treat with cough linctus only.
D. Recommend voice rest and review in 1 year.
E. Supply oral fluconazole.
18. A 48-year-old woman reports progressive difficulty swallowing solids, weight loss and a sensation of food sticking. She has no history of reflux.
Which ONE of the following is the most appropriate action?
A. Recommend antacid and review in 4 weeks.
B. Treat as tonsillitis.
C. Supply lozenges.
D. Start oral antihistamine.
E. Arrange urgent assessment because dysphagia and weight loss are red flags.
19. A 33-year-old man has dental pain with facial swelling, fever and difficulty opening his mouth. He has been unable to see a dentist.
Which ONE of the following is the most appropriate advice?
A. Treat with mouthwash only and wait for spontaneous resolution.
B. Supply antifungal treatment.
C. Arrange urgent dental or medical assessment because spreading dental infection may be serious.
D. Recommend loperamide.
E. Advise using leftover antibiotics without review.
20. A 66-year-old man has a spontaneous nosebleed. He is sitting upright, anxious and swallowing blood. He takes aspirin but is haemodynamically stable.
Which ONE of the following is the most appropriate first-aid advice?
A. Lie flat and tilt the head backwards.
B. Sit forward and pinch the soft part of the nose continuously for 10–15 minutes.
C. Blow the nose forcefully every minute.
D. Insert cotton buds deeply into the nostril.
E. Stop aspirin permanently without medical advice.
21. A 78-year-old woman taking warfarin has recurrent nosebleeds. Today’s bleed has continued despite 20 minutes of firm pressure. She feels light-headed.
Which ONE of the following is the most appropriate action?
A. Reassure and advise routine INR check in 6 months.
B. Recommend nasal decongestant only.
C. Advise lying flat and sleeping.
D. Stop warfarin permanently.
E. Arrange urgent medical assessment because bleeding is persistent and she is anticoagulated.
22. A 3-year-old child has ear pain, fever and reduced sleep. Otoscopy by a clinician shows a bulging red tympanic membrane. The child is otherwise well and has no mastoid tenderness, immunosuppression or systemic deterioration.
Which ONE of the following is the most appropriate management principle?
A. Immediate antibiotics are mandatory in all children with acute otitis media.
B. Ear drops alone are first-line for middle ear infection.
C. Pain relief, observation or delayed antibiotic strategy may be appropriate depending on age, severity and risk factors.
D. Intranasal corticosteroids treat acute otitis media.
E. The child must avoid fluids.
23. A 4-year-old has persistent hearing difficulty and delayed speech after several episodes of otitis media. The parent reports the child often asks for the television volume to be high.
Which ONE of the following should be considered?
A. Assessment for otitis media with effusion and hearing impact.
B. Long-term oral antibiotics without review.
C. Earwax-softening drops as the only management.
D. Reassurance until adulthood.
E. Treat as allergic rhinitis only.
24. A 52-year-old man has recurrent episodes of vertigo lasting several hours, associated with tinnitus, a feeling of fullness in one ear and fluctuating hearing loss.
Which ONE of the following condition should be considered?
A. Acute bacterial tonsillitis.
B. Otitis externa.
C. Peritonsillar abscess.
D. Ménière’s disease.
E. Nasal polyps.
25. A 44-year-old woman has brief episodes of spinning vertigo triggered by turning over in bed or looking up. Episodes last less than a minute. She has no hearing loss, tinnitus, headache, weakness or speech disturbance.
Which ONE of the following is the most likely diagnosis?
A. Ménière’s disease.
B. Benign paroxysmal positional vertigo.
C. Acute otitis media.
D. Vestibular schwannoma.
E. Stroke in all cases.
Ear, Nose and Oropharynx Questions
Answers and Rationale
1. C
Cough, blocked nose, short duration and absence of fever or exudate suggest viral upper respiratory tract infection. Antibiotics are unlikely to help, so self-care advice and safety-netting are appropriate.
2. E
Post-auricular swelling, tenderness and the ear being pushed forward suggest mastoiditis, a serious complication of acute otitis media. This requires urgent medical assessment.
3. A
Tragal tenderness, ear canal swelling, itch and discharge are typical of otitis externa. Management commonly involves topical ear treatment and keeping the ear dry, with referral if severe or complicated.
4. D
Confirmed uncomplicated earwax can be managed with wax-softening drops and appropriate removal if needed. Cotton buds can worsen impaction or injure the canal.
5. B
Sudden unilateral hearing loss with tinnitus and no conductive cause such as wax is concerning for sudden sensorineural hearing loss. This requires urgent assessment because prompt treatment may affect outcome.
6. E
Gentamicin can cause ototoxicity. New tinnitus, dizziness or hearing difficulty during treatment should be escalated urgently so therapy and drug levels can be reviewed.
7. A
Seasonal sneezing, nasal itching, watery rhinorrhoea and congestion suggest allergic rhinitis. Intranasal corticosteroids are effective for persistent or troublesome nasal symptoms when used correctly.
8. D
Topical nasal decongestants used beyond a few days can cause rebound congestion. Stopping or reducing use and switching to appropriate alternatives should be discussed.
9. B
Acute sinusitis symptoms within 10 days are often self-limiting if there are no severe or complicated features. Self-care and safety-netting are usually appropriate initially.
10. C
Periorbital swelling, severe headache, vomiting and reduced eye movement may indicate orbital or intracranial complications of sinusitis. Urgent medical assessment is required.
11. D
Severe sore throat with muffled voice, trismus, uvula deviation and difficulty swallowing saliva suggests peritonsillar abscess. This requires urgent assessment and possible drainage.
12. A
Low-risk sore throat features with cough and no fever, exudate or tender nodes suggest viral infection. Antibiotics are unlikely to provide meaningful benefit.
13. E
Drooling, stridor, severe sore throat and a toxic appearance suggest possible epiglottitis or airway compromise. This is an emergency, and throat examination should not delay urgent help.
14. C
Scrapable white plaques after high-dose inhaled corticosteroid use suggest oral candidiasis. Mouth rinsing and inhaler technique review reduce recurrence risk.
15. B
Small painful recurrent ulcers that heal within 1–2 weeks are typical of aphthous ulcers. Symptomatic treatment is reasonable, but persistent, unusual or systemic features need assessment.
16. D
An oral ulcer lasting more than 3 weeks, especially in someone who smokes and drinks alcohol, is a red flag for oral cancer. Urgent assessment is required.
17. A
Persistent unexplained hoarseness in an older smoker is a red flag for laryngeal cancer. Urgent referral is appropriate rather than repeated symptomatic treatment.
18. E
Progressive dysphagia and weight loss are red flags for upper gastrointestinal or head and neck malignancy. Urgent assessment is needed.
19. C
Dental infection with facial swelling, fever and trismus may indicate spreading infection. Urgent dental or medical assessment is required because antibiotics alone may not provide source control.
20. B
First aid for epistaxis is to sit forward and pinch the soft part of the nose continuously for 10–15 minutes. Tilting the head back can lead to swallowing blood.
21. E
Persistent epistaxis despite pressure, light-headedness and warfarin use require urgent assessment. Anticoagulation and haemodynamic status may need review.
22. C
Many children with acute otitis media improve without immediate antibiotics. Pain relief is important, and observation or delayed antibiotics may be suitable depending on age, severity and risk factors.
23. A
Persistent hearing difficulty and speech delay after otitis media suggest otitis media with effusion. Hearing impact and developmental consequences should be assessed.
24. D
Recurrent vertigo lasting hours with tinnitus, aural fullness and fluctuating hearing loss is typical of Ménière’s disease. Specialist assessment may be needed.
25. B
Brief positional vertigo triggered by turning in bed or looking up, without hearing symptoms or neurological signs, is typical of benign paroxysmal positional vertigo.
Here are 25 multiple-choice questions designed to mimic the GPHC exam itself. At the bottom of the page you will find answers and rationale for each question.