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

AKT-1624

A 25 year old male smoker presents with multiple, painful aphthous ulcers, he puts this down to stress at work. He only gets ulcers on his tongue and oral mucosa. He is otherwise well. He has never had any joint or bowel symptoms. He reports several previous episodes similar to this one, with painful oral ulceration lasting a week or two, dating back to when he was a teenager.

What signs or symptoms should prompt an immediate referral to secondary care for this 25 year old male smoker with recurrent painful oral ulcers?

AKT-1625

A 42-year-old man comes to your clinic complaining of ear pain. He had visited the emergency department 3 days ago but was only given advice. He has been experiencing ear pain for 5 days now.

During the examination, his temperature is recorded at 38.5ºC, and his right eardrum appears red and bulging. What is the appropriate course of action for this patient?

AKT-1626

You encounter a 30-year-old mother of two who is experiencing recurrent Meniere’s disease. She has been suffering from tinnitus and mild hearing loss on the right side for nearly 2 years. Every 2 months, she has an episode of vertigo accompanied by nausea and vomiting, which lasts up to 7 days and causes her significant distress. While under the care of the ENT team, she is curious about any available treatments to prevent Meniere’s disease attacks.

What would be your initial recommendation?

AKT-1611

A middle-aged woman of Chinese origin presents to you in surgery to discuss her recurrent nosebleeds. They started 3 months ago and have been occurring unprovoked with increasing frequency. She is not on any anticoagulants, has never had any previous episodes of unexplained or excessive bleeding, and has no family history of any bleeding disorders. On further questioning, the nosebleeds always seem to be from the right nostril which feels a bit blocked. She has tried 2 weeks of Naseptin (chlorhexidine dihydrochloride and neomycin sulfate nasal cream) with no change in her symptoms. She mentions that the previous GP she saw asked about weight loss which she denied at the time, however, she volunteers that she has been tightening her belt more now. Blood tests reveal normal coagulation screen, haemoglobin within the normal range and a thrombocytosis. What condition is it most important to investigate for?

AKT-1627

A 40-year-old female patient presents with vestibular neuronitis after a recent viral respiratory infection. She reports experiencing vertigo, nausea, and vomiting. What is the initial treatment recommended for her symptoms?

AKT-1612

A 6-year-old girl presents to the surgical department with complaints of a sore throat. She is running a temperature of 39.2ºC and is experiencing difficulty in eating due to the pain, although she is able to tolerate fluids. There are no other associated symptoms such as cough or rash. On examination, her heart rate is 120/min and chest auscultation is normal. Bilateral tonsils are covered in exudate, while ear examination is unremarkable. Apart from supportive care, what is the most appropriate course of action?

AKT-1613

A 6-year-old girl with Down syndrome is brought to see the General Practitioner by her mother who is concerned that she seems to be struggling to hear normal volume voices on the television and in conversation. On examination she is afebrile and there is a loss of the light reflex on both tympanic membranes.
Which of the following is the most appropriate management plan?

AKT-1614

A 65-year-old woman comes to her doctor complaining of dizziness. She experiences sudden onset dizziness and nausea when she rolls over in bed in the morning, which goes away after about 20 seconds if she keeps her head still. After these episodes, she feels unsteady and light-headed for several hours. The patient has a history of recurrent otitis media and her family has a history of otosclerosis.

What is the most crucial initial test that needs to be done?

AKT-1615

A 30-year-old football player comes in for evaluation the day after a game. He has noticeable swelling and redness in his left ear. Upon examination, it appears to be an auricular hematoma. What is the best course of action for treatment?

AKT-1616

A 45-year-old man presents with decreased hearing in his right ear. Upon examination, you observe that his right ear canal is obstructed with wax, while the left ear is unobstructed. What results would you anticipate when conducting Rinne and Weber tests?