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

AKT-1522

A 4-year-old girl is brought to her General Practitioner by her parents because of concerns regarding her hearing. They have noticed she often doesn’t respond when spoken to and seems to have difficulty following instructions. Three months ago, she presented with pain and discharge from her right ear and was treated with a course of amoxicillin.
On examination, she is well. Both tympanic membranes are intact and have a grey appearance, with absent light reflexes.
What is the single most likely diagnosis?

AKT-1523

A 25-year-old man presents with a three-month history of weight loss, night sweats, and painful lumps in his neck that worsen with alcohol consumption. What is the most probable diagnosis?

AKT-1524

A 60-year-old man comes to the clinic 3 days after being hit on the left side of his head. He reports experiencing muffled hearing on the left side since the incident. Upon examination, there are no visible bruises, but both ears are covered by a thin, translucent layer of wax. Rinne’s test reveals that the tuning fork is more audible when placed on the mastoid bone on the left side. On Weber’s test, the sound is heard most clearly on the left side. What is the probable diagnosis?

AKT-1525

A 62-year-old Chinese man who is a smoker visits his doctor with complaints of a constantly congested nose and bloody discharge from the nose. What type of cancer is he most susceptible to?

AKT-1526

A 29-year-old man presents with decreased hearing in his left ear. Upon examination, there are no signs of acute infection, but both eardrums appear dull. Tuning-fork tests are performed, revealing that bone conduction is heard better than air conduction on the left side (the affected ear) during Rinne’s test, while Weber’s test localizes to the left ear. Rinne’s test on the right side shows air conduction better than bone conduction. What type of hearing loss is present in this patient?

AKT-1527

A 24-year-old man comes to the clinic with a slow-developing swelling in the anterior triangle of his neck, located in front of the sternocleidomastoid muscle. The swelling is movable, fluctuant, painless, has no visible punctum, and doesn’t shift with swallowing.
What is the most probable diagnosis?

AKT-1501

As a GP visiting a residential home patient, you encounter a 74-year-old female with a 4 week history of oral ulceration. The patient reports experiencing pain and bleeding due to the condition. She also mentions that her dentures have not been fitting well, leading her to stop using them. Additionally, she has lost a few kilograms in weight over the past few weeks. Based on NICE guidelines for suspected cancer, which aspects of this patient’s history would necessitate referral (within 2 weeks) for oral cancer?

AKT-1502

A 57-year-old male patient complains of intense pain deep in his right ear accompanied by dizziness and a sensation of the room spinning. Upon clinical examination, he displays a partial facial nerve paralysis on the right side and vesicular lesions on the anterior two-thirds of his tongue. What condition is the most probable diagnosis?

AKT-1503

A 23-year-old male patient complains of experiencing tinnitus in his left ear for the past two weeks. He describes the sound as a buzz but denies any other accompanying ear symptoms. Upon examination, Otoscopy, Rinne, and Weber tests are all normal. What is the recommended course of action for management?

AKT-1504

A 3-year-old boy has been unwell and crying during the night and this has continued during the day with some benefit from paracetamol and ibuprofen. He has a cold. His temperature is 38C and both tympanic membranes are inflamed but not bulging.
Select from the list the single most appropriate management option.