A 14-year-old boy presents with intermittent epistaxis and no identifiable triggers. He has a history of adenoid surgery and anaphylaxis to peanuts. On examination, no bleeding focus is found, and his lab results show:
Hb 130 g/L Male: (135-180)
Female: (115 – 160)
Platelets 280 * 109/L (150 – 400)
WBC 6 * 109/L (4.0 – 11.0)
What would be the most appropriate suggestion for this patient?
A young patient suffers a traumatic left ear perforation. Which of the following sets of findings is the most likely to be noted on tuning fork testing?
Rinne left ear Rinne right ear Weber
Patient A Air conduction better than bone conduction Air conduction better than bone conduction Central
Patient B Bone conduction better than air conduction Air conduction better than bone conduction Lateralises to the left
Patient C Bone conduction better than air conduction Air conduction better than bone conduction Lateralises to the right
Patient D Air conduction better than bone conduction Bone conduction better than air conduction Lateralises to the right
Patient E Bone conduction better than air conduction Bone conduction better than air conduction Central
A 54-year-old woman visits your clinic with a complaint of continuous ringing in her ears. She had previously sought medical attention for her lower back pain and was prescribed naproxen and paracetamol. However, the paracetamol was later substituted with co-codamol and then with co-dydramol. Which medication is the probable cause of her recent symptom?
A 56-year-old woman with a history of hypertension visits the surgery with a complaint of hoarseness that has been present for 3 weeks. The hoarseness started after she had an upper respiratory tract infection 7 weeks ago. She is in good health and doesn’t smoke. What is the best course of action for management?
A 40-year-old man presents to the GP with episodes of dizziness that began two weeks ago. These episodes occur randomly but are worsened when he changes the position of his head. His most recent episode lasted longer than a day and was particularly uncomfortable, accompanied by nausea and vomiting. During a cranial nerve examination, the GP observes horizontal nystagmus. The patient denies experiencing any aural symptoms like tinnitus. When asked about his overall health, the patient reports having had a viral upper respiratory tract infection the previous week.
What is the diagnosis?
A 32-year-old woman presents to the General Practitioner with sudden onset of unilateral sensorineural deafness. She has no prior history of ear issues and is not currently taking any medications.
What is the most probable diagnosis?
A 6-year-old-girl presents with persistent hearing loss. Her mother reports concerns from her teachers that she doesn’t seem to pay attention in class. She reports the girl often turns up the volume of the television while at home. On examination, the right eardrum is retracted and there is loss of the light reflex. You suspect otitis media with effusion and arrange pure tone audiometry which reveals moderate hearing loss particularly at low frequencies. She presented to your colleague 10 weeks previously with similar symptoms, with similar audiometry findings.
What is the next most appropriate management in primary care according to the current NICE CKS guidance?
A 9-year-old patient had a tonsillectomy 4 days ago. His father has brought him to the clinic as earlier today he noticed a small amount of bright red bleeding from his mouth. He is otherwise recovering well and has been eating and drinking normally.
What is the best course of action for managing this patient’s bleeding?
A 7-year-old girl comes to the GP with her mother because she has been experiencing hearing difficulties in her left ear. She has a history of glue ear and has had grommets inserted in the past. During an otoscopy of the left ear, there is a significant buildup of earwax in the external auditory canal, and although the grommet is visible, the tympanic membrane is obscured. The right ear appears normal.
What would be the best course of action for management?
A 2-year-old girl is presented to the GP by her mother who has noticed a peculiar lump on her neck. The mother is uncertain about the duration of the lump. The lump is situated in the anterior triangle, just in front of the sternocleidomastoid muscle, and has a soft texture. The lump is mobile but doesn’t transilluminate.
After a biopsy, cholesterol crystals are discovered in the extracted fluid. What is the probable underlying diagnosis?