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

AKT-1560

A 65-year-old man visits his GP with concerns about an unusual patch inside his cheek. He noticed a red-white patch while brushing his teeth, but he is unsure how long it has been there. He has a smoking history of 35 pack years and drinks approximately 18 units of alcohol per week. There is no family history of oral cancer. On examination, he appears to be in good health, and no cervical lymphadenopathy is detected. There is a 2cm red and white macule with a velvety texture on the buccal vestibule of the oral cavity, consistent with erythroleukoplakia. What is the most appropriate course of action?

AKT-1576

You encounter a 50-year-old woman during your afternoon clinic. She reports experiencing sudden episodes where the room spins uncontrollably, accompanied by nausea and occasional vomiting. Additionally, she feels as though her hearing is impaired on the right side and experiences a ringing sound and a feeling of fullness on that side. Based on these symptoms, you suspect that she may have Meniere’s disease. What is a true statement about this condition?

AKT-1561

You diagnose a left-sided sudden sensorineural hearing loss (SSNHL) in a normally fit and well 36-year-old woman who has come to see you in your GP clinic. She developed her symptoms over a few hours yesterday and now can not hear at all through her left ear. Her examination shows no obvious external or middle ear causes.

What is your next step?

AKT-1577

A 50-year-old woman comes to her GP complaining of recurrent vertigo that has been going on for 6 months. She reports experiencing episodes that last from a few minutes to several hours, accompanied by tinnitus and decreased hearing in her left ear. She denies any identifiable triggers that worsen her symptoms. She has no significant medical history. Her ear and cranial nerve examinations are normal.

What is the probable diagnosis?

AKT-1562

A 42-year-old man who is a smoker presents with a 6-week history of hoarseness of voice. He is otherwise well with no weight loss or sore throat, and has a normal-looking oropharynx and oral cavity.
What is the MOST APPROPRIATE management option?

AKT-1563

You are a primary care physician seeing a 2-year-old girl with her mother. The mother reports that over the past 48 hours, her daughter has had intermittent fevers (up to 37.5ºC) and has been fussy. However, she has been eating and drinking normally.

The mother has also noticed that her daughter has been tugging at her right ear.

Upon examination, the child appears comfortable, and the following vital signs are noted:
Temperature 37.2ºC
Heart rate 105 beats/min
Respiratory rate 22 breaths/min

Upon otoscopy, you observe a small perforation in the right tympanic membrane with a small amount of discharge present in the external ear canal. The left tympanic membrane appears normal.

What is the most appropriate course of action based on the information provided?

AKT-1564

A 49-year-old man presents with concerns about his hearing. He has a history of recurrent Ménière disease which has resulted in significant hearing loss. He struggles to hear his coworkers at work and his partner has noticed that he needs to turn the volume up high on the television. He has not considered hearing aids due to negative stories he has heard about them.

Upon reviewing his recent audiogram, it shows an 80 dB hearing loss at the 1,000 Hz and 2,000 Hz frequencies. The patient is interested in being referred for a cochlear implant.

What is the recommended management plan?

AKT-1565

A 6-year-old boy comes to you complaining of sudden and severe pain in his right ear after recently having an ear infection. During examination, you notice a perforated eardrum. He has a soccer game next week and is eager to play. What advice would you give him regarding this situation?

AKT-1566

A 25-year-old male comes to the GP complaining of a lump in his throat and increasing hoarseness that has been present for the past 3 weeks. He reports having a cold 4 weeks ago but denies experiencing heartburn, weight loss, nausea and vomiting, or difficulty swallowing. He is a non-smoker and drinks 12 units of alcohol per week. There is no significant medical history to note.

What is the probable diagnosis?

AKT-1567

An 80-year-old man presents to the emergency department with worsening pain and fever following a dental extraction 5 days ago. He is usually in good health. On examination, he has a tender swelling in the left submandibular region and mild trismus. His tongue is slightly displaced upwards and he is unable to protrude it. There is no respiratory distress or stridor. What is the best course of action for management?