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

AKT-1547

An 77-year-old-man presents to your clinic with complaints of persistent right ear pain and discharge. He was previously diagnosed with otitis externa and prescribed antibiotic ear drops by a colleague, followed by further antibiotic drops and tramadol by an out of hours doctor. However, his symptoms have not improved and the pain has become unbearable.

The patient has a medical history of type-2 diabetes mellitus and hypertension, and takes metformin, gliclazide, ramipril, and atorvastatin regularly. He has no known drug allergies and doesn’t smoke or drink alcohol.

Upon examination, debris is observed in the right ear canal, but the tympanic membrane remains visible. There is no erythema of the pinna or mastoid swelling, and cranial nerve examination is normal.

What is the most appropriate course of action?

AKT-1548

You encounter a 45-year-old man who complains of a painful mouth. He reveals that he has been experiencing a mouth ulcer for about 3 weeks. It started as a small painless sore but has now grown in size and is causing him discomfort. Despite trying various mouthwashes, he has not found any relief. He is in good health and has no other symptoms. Although he is not overly concerned about the ulcer, he would like you to prescribe something to help it heal.

Upon examination, you notice a 4mm ulcer in his oral cavity, surrounded by a white plaque. There is no lymphadenopathy.

How would you approach the management of this patient?

AKT-1550

A 30 year old female smoker presents with painful aphthous ulcers and has been using a topical analgesic (benzydamine hydrochloride gel) for 3 weeks without relief. There is no indication of joint or bowel issues in her medical history or physical examination. She is in good health otherwise. What would be the most suitable course of action to take next?

AKT-1551

A 42-year-old woman who is typically healthy visits her GP complaining of hearing difficulties over the last 2 months. She has been an avid swimmer for the past 20 years. During the examination, Rinne’s test is positive on her left ear but negative on her right ear. Weber’s test shows sound localizing to the right side.

What is the type of hearing loss that this patient is experiencing?

AKT-1552

A 50-year-old woman comes to the clinic complaining of vertigo for the past 3 days. She reports feeling like ‘the room is spinning’ when she turns over in bed or looks upwards, lasting for about 10 seconds each time. She experiences some nausea but denies vomiting, hearing loss, or tinnitus. The patient states that she has been feeling generally well lately.

What is the examination technique used to diagnose the probable condition in this case, and what are the expected results of this examination?

AKT-1553

During a routine cranial nerve examination of a different patient, the following results were obtained:

Rinne’s test: Air conduction > bone conduction in both ears
Weber’s test: Localises to the left side

What do these test results indicate?

AKT-1554

A 20-year-old woman complains of hearing difficulties over the last six months. She initially suspected it was due to earwax, but her hearing has not improved after ear syringing. You conduct an auditory system examination, including Rinne’s and Weber’s tests:

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

What is the significance of these test results?

AKT-1555

A 24-year-old-man schedules an appointment due to a nose injury he sustained while playing soccer two days ago. He reports that his nose bled for a few minutes after the injury but has not bled since. He also mentions that his nose did not appear deformed after the incident. He has not sought medical attention before this appointment and is generally healthy with no long-term medications.

During the examination, you notice no signs of nasal bone deviation, but there is significant swelling in the surrounding soft tissue. On anterior rhinoscopy, you observe a bilateral fluctuant swelling of the nasal septum that almost blocks the nostrils.

What is the most suitable course of action?

AKT-1556

A 35-year-old man comes to the clinic complaining of vertigo that has been ongoing for 5 days. He reports having a recent viral upper respiratory tract infection. The patient is in good health overall and experiences nausea but no hearing loss or tinnitus. During the examination, the doctor observes fine horizontal nystagmus. What is the probable diagnosis?