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

AKT-1601

A 32-year-old male surfer from Australia presents with recurrent ear infections. He has recently moved to the US and is generally healthy. The patient complains of difficulty in removing water from his ears after a shower and left ear discomfort. Upon examination, there appears to be an object protruding into the canal in the left ear, obstructing a clear view of the tympanic membrane. The right tympanic membrane appears normal, and there is no inflammation in either canal. What is the probable diagnosis?

AKT-1602

A 16-year-old girl comes in with a complaint of a sore throat. She reports no cough, has a temperature of 38.4ºC, and her tonsils are enlarged with white exudate. What is the fourth component of the Centor criteria?

AKT-1603

A 26-year-old man with sinusitis inquires about the safety of using Sudafed (pseudoephedrine). Is there any medication that would make Sudafed use inappropriate?

AKT-1604

Samantha is a 6-year-old who has been brought to the clinic by her mother to request a referral for an adenotonsillectomy. She has experienced 3 severe episodes of acute tonsillitis in the past year and 4 episodes the year before, resulting in her missing a total of 5 days of school. Despite this, she has been informed that she doesn’t meet the criteria for an adenotonsillectomy. What is the reason for her not meeting the referral criteria?

AKT-1605

A 50-year-old woman comes in with a complaint of experiencing dizzy spells for the past 4 days. She reports feeling nauseous and seeing the room spinning for a brief period before returning to normal. The patient specifically notes that looking down seems to trigger these episodes. Upon examination, there are no abnormalities found in the ears or cranial nerves. Her blood pressure measures at 126/82 mmHg. What diagnostic test can be conducted to confirm the diagnosis?

AKT-1606

A 16-year-old female presents with a sore throat. Upon examination, she has enlarged tonsils on both sides and tender cervical lymphadenopathy. Her medical history shows that she has had six episodes of tonsillitis in the past year and has missed several days of school due to her sore throat. With a Centor score of 3/4, you decide to prescribe penicillin V. What other treatment options should be considered?

AKT-1607

The wife of a 65-year-old man contacts you urgently for a home visit. The patient has a medical history of hypertension, hypercholesterolemia, and type 2 diabetes. According to his wife, he is experiencing severe dizziness due to labyrinthitis and is unable to leave his bed.

Upon arrival, you find the patient in bed, complaining of intense dizziness that makes him feel like the room is spinning. He has vomited multiple times and cannot stand up. He has never experienced this before.

During the assessment, the patient’s vital signs are normal. Otoscopy reveals no abnormalities. Neurological examination of the limbs shows normal power, tone, reflexes, and coordination. However, he cannot walk for a gait examination. Eye examination shows bidirectional nystagmus on lateral gaze bilaterally. A head impulse test is normal with no catch-up saccades seen. All other cranial nerves are normal.

What is the most appropriate course of action?

AKT-1596

A 70-year-old man presents to your clinic with a complaint of recurrent nosebleeds from his right nostril over the past week. The bleeding lasts for about 30 minutes but is not severe. The patient has a history of ischemic heart disease and is on regular medication of aspirin 75 mg and atorvastatin 40 mg. He denies any allergies and has no other significant medical history. On examination, there is no visible bleeding point, and all vital signs are normal. What is the most appropriate management for this patient, in addition to general epistaxis advice?

AKT-1597

A 23-year-old male presents with hearing difficulties. You conduct an assessment of his auditory system, which includes Rinne’s and Weber’s tests:

Rinne’s test: Left ear – bone conduction > air conduction; Right ear – air conduction > bone conduction
Weber’s test: Lateralizes to the left side

What is the significance of these test results?

AKT-1598

A 50-year-old woman has a slowly enlarging, unilateral, smooth, painless lump below her left ear.
What is the most likely diagnosis?