MRCGP AKT Category: Ear, Nose And Throat, Speech And Hearing

AKT-1721

What combination of findings would be expected in a patient with equal bilateral otosclerosis?

AKT-1722

A 28-year-old woman presents with progressive bilateral hearing loss over the last 2-3 years. No other symptoms are reported. She works as a machinist in a factory manufacturing clothing. She has a family history of hearing loss at a young age. She has an 18 month old son who has no hearing difficulties.

Examination of the ears reveals normal tympanic membranes both sides.

She has had a hearing test done privately and the audiogram shows bilateral hearing loss more marked at low frequencies.

What is the most likely underlying diagnosis?

AKT-1723

A 19-year-old female presents to you with complaints of a sore throat. She reports feeling sick for the past three days with a high fever and painful throat. She has been self-medicating with an over-the-counter flu remedy containing paracetamol. Upon examination, she has a temperature of 37.1°C, tender anterior cervical lymphadenopathy, visible tonsillar exudate, and a dry cough. What is this patient’s Centor score?

AKT-1724

A 44-year-old man presents with acute onset vertigo which started yesterday and has persisted.

The presence of which of the following features would most strongly suggest a diagnosis of labyrinthitis rather than vestibular neuronitis?

AKT-1725

A 41-year-old man presents to the surgery for the second time in the past month complaining of a severe sore throat. He has been prescribed a course of co-amoxiclav by your partner for suspected tonsillitis, but tells you this has had no impact on his symptoms. According to his records he has always had large tonsils and has been seen at the surgery for a number of episodes of tonsillitis over the past few years.

On examination his temperature is 37.7°C, pulse is 70 bpm and regular, BP is 122/82 mmHg. There is some cervical lymphadenopathy. There is a large erythematous nodule on the right hand side of the tonsillar bed.

What is the most appropriate next step?

AKT-1726

A 63-year-old man comes to the clinic with his wife for evaluation. He has been experiencing a change in his voice with constant hoarseness and a chronic dry cough for the past six weeks. He attributes this to a previous cold and chest infection and believes it will improve over time.
He is a heavy smoker, consuming 25 cigarettes per day for the past 50 years. He has a history of COPD and is currently taking a high dose Seretide inhaler. On examination, his BP is 145/85 mmHg, pulse is 75 and regular, and chest auscultation reveals scattered wheezing.
Investigations reveal:
Hb 134 g/L (135-180)
WCC 8.0 ×109/L (4.5-10)
PLT 179 ×109/L (150-450)
Na 137 mmol/L (135-145)
K 4.7 mmol/L (3.5-5.5)
Cr 122 µmol/L (70-110)
ECG shows sinus rhythm.
CXR (arranged by another GP partner) shows no mass lesion identified.
What is the most appropriate course of action?

AKT-1727

A 51-year-old woman presents with a two-week history of difficulty swallowing solid foods, particularly meat. She experiences discomfort at the lower end of the sternum and has trouble shifting it almost immediately after swallowing. The patient has a longstanding history of GORD and has intermittently taken omeprazole 20 mg/day for the past decade. She has not experienced any weight loss or vomiting. What is the best course of action for managing this patient’s symptoms?

AKT-1704

A 50-year-old male construction worker had recently noticed a decline in his hearing ability in both ears. As a child, he had experienced several ear infections, including a severe one during a bout of measles that impacted his education. There was no history of deafness in his family. During examination, his tympanic membranes appeared intact, but there were calcified scars anterior to the handle of the malleus in both ears. The Rinne test was positive in both ears, and the Weber test was central in both anterior and posterior positions. Striking the 256 cps tuning fork firmly was necessary to achieve the desired volume. What is the probable diagnosis?

AKT-1720

A 5-year-old child presents with a sore throat and polymorphous rash. He has had a fever for five to six days. He is well, drinking fluids, not vomiting, and passing urine normally.

On examination, he is alert, well hydrated with no photophobia or neck stiffness. His temperature is 38.7°C, HR 140, RR 30, and CRT<2 sec. His chest is clear. He has generalised blanching macular rash and bilateral conjunctival injection. His lips are dry and chapped, tonsils are erythematous with no exudate. His eardrums look normal and he has moderate cervical lymphadenopathy. Urine dipstick is positive for protein and leucocytes. What is the most appropriate management?

AKT-1705

A 55-year-old smoker presents with a persistent hoarse voice for the past three to four weeks. He saw a colleague two weeks ago who found nothing focal on examination and advised him to seek review if his hoarseness did not settle after a further week. He has no significant past medical history, is not on any regular medication, and has no known drug allergies. He denies any cough, haemoptysis, swallowing problems, weight loss, or any systemic unwellness. Clinical examination reveals no anaemia, clubbing, lymphadenopathy or neck masses. His chest sounds clear, and an urgent chest x-ray is reported as ‘normal’. What is the most appropriate next step in this patient’s management?