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

AKT-1557

A 26-year-old man presents to your emergency clinic with worsening pain in his right ear. He had previously been diagnosed with otitis externa and started on antibiotic ear drops by another physician four days ago. However, he reports that the pain has only gotten worse and he has been unable to apply the drops for the past 24 hours due to swelling of the canal. Upon examination, you notice that the right external auditory canal is completely swollen shut and you are unable to see any further. The patient’s vital signs are normal.

What is the most appropriate course of action for management?

AKT-1558

Sarah is an 80-year-old woman who visits your clinic with complaints of hearing difficulty. During the examination, you observe that she has impacted earwax in both ear canals. You suggest using olive oil ear drops, but she informs you that she has previously tried them without success.

What would be your next course of action in managing the earwax?

AKT-1559

A 15-year-old girl comes to your clinic with her father for an urgent appointment. Yesterday, while playing basketball, she injured her left ear. Initially, she didn’t feel much discomfort and continued playing. However, this morning she woke up with a swollen left ear. She reports no hearing loss or discharge from the ear. She appears to be in good health.

Upon examination, you notice a significant hematoma on her left ear. Otoscopy reveals no damage to the eardrum, and basic hearing tests are normal.

What is the most appropriate course of action?

AKT-1544

A 63-year-old woman comes to your clinic complaining of a painless, foul-smelling discharge from her left ear that has been going on for four months. She had seen another doctor a month ago who prescribed gentamicin/hydrocortisone ear drops, but they did not help alleviate her symptoms.

Upon examination, there is some wax buildup in the attic of her left ear, but otherwise, everything appears normal. Her cranial nerve examination is also unremarkable.

What would be the best course of action to take?

AKT-1529

A 5-year-old girl is brought to the GP clinic by her mother. She is on day 7 post-tonsillectomy and was recovering well until this morning when her mother noticed a small amount of blood on her pillow and fresh red blood in her mouth. Upon examination, the girl appears to be in good health, but there is a blood clot in her right tonsillar fossa with no active bleeding. Her vital signs are as follows:

Systolic blood pressure: 100 mmHg (normal range: 75-110)
Pulse: 96 bpm (normal range: 80-150)
Temperature: 36.8ºC (normal range: 35.5-37.5)
Respiratory rate: 24/min (normal range: 17-30)

What is the appropriate course of action?

AKT-1530

A 55-year-old man presents to his General Practitioner complaining that he has woken up with a ‘wonky’ smile. On examination, the right side of his mouth is drooping; there is right-sided facial weakness and he cannot lift his eyebrow on the right. He has no vesicles in his ears or on his face and is otherwise well, with no other neurological findings.
What is the most likely diagnosis?

AKT-1531

A 78-year-old woman comes to the clinic with a sudden cough that has lasted for four days and a dry throat. She feels sick but has no fever. Her lung examination is normal. Which of the following is not a reason to prescribe antibiotics immediately?

AKT-1532

A 20-year-old man comes to you complaining of bilateral sneezing, watery nasal discharge, and nasal itching. He reports experiencing these symptoms at this time of year for the past few years, but this year they are worse and are interfering with his college attendance. He has no trouble breathing, no other medical issues, and takes no regular medications. His mother suggested he try putting vaseline around his nose, and he has taken some cetirizine, but it has not been effective thus far.

What is the most appropriate initial management for this patient?

AKT-1533

A 2-year-old boy is presented by his father with bilateral earache. The child has been experiencing this for the past week despite taking regular paracetamol and neurofen.

During the examination, the child’s temperature is recorded at 39.2ºC. His pulse rate is 130 beats per minute and both ears show congested, red, and bulging tympanic membranes.

What is the best course of action for managing this condition?

AKT-1534

A 28-year-old male patient comes in with a recent onset headache that has been bothering him for the past 5 days. He reports experiencing facial pain, fevers, a dry cough, thin yellow discharge from his nose, and nasal congestion. His temperature is normal at 37.4ºC and he experiences pain when pressure is applied to his maxillary area.

Based on the probable diagnosis, what would be the best course of treatment?