You see a 50-year-old woman who has come to see you after the nurse was unable to remove all the earwax from her left ear. She came to see you for advice on what to do next.
According to NICE, which is the most appropriate next step in management?
A 42-year-old man presents with tinnitus. No subjective hearing loss or other symptoms are reported. He is systemically well. He has had tinnitus for several years but over time the tinnitus has had an increasing psychological effect on his well-being. He has previously been seen recently for the first time with regards his tinnitus and was given tinnitus support (information provision and discussion of management options) and was also referred for audiological assessment which is pending.
He is not suicidal but has become increasingly distressed by the tinnitus which is persistent and intrusive. He struggles to sleep and has become increasingly depressed. It has got to the point over the last week where due to his tinnitus he can’t cope to go to work and is spending days at home feeling unable to do anything productive. He has no past history of any mental health problems and just wants to feel better and for his tinnitus to be less intrusive.
Which of the following is the most appropriate management strategy?
A 26-year-old female presents with nasal symptoms.
She has no significant past medical history. She reports frequent sneezing, a permanent feeling of nasal blockage, and intermittent bilateral non-purulent rhinorrhoea which have been a problem on and off for the last few years. There is no systemic unwellness. She has not identified any specific pattern to her symptoms which she describes are ‘fairly persistent’.
On further questioning there doesn’t appear to be a seasonal pattern to her symptoms, she doesn’t own or have contact with any pets, and she works in an office where there doesn’t seem to be any form of occupational trigger. She has no respiratory symptoms and examination of her chest including peak flow measurement is normal.
She has recently been using oral cetirizine regularly and also sodium cromoglycate eye drops both of which she has purchased over the counter. Despite daily use of both for the last four to six weeks her symptoms are no better and remain persistent. Examination reveals no anatomical abnormalities or red flag features.
You discuss further investigation to look into possible allergen identification and also further treatment options.
Which of the following is the next most appropriate pharmacological step in trying to manage her symptoms?
What are the indications for tonsillectomy?
A 65-year-old gentleman comes to the clinic complaining of unilateral hearing loss accompanied by otalgia and otorrhoea in the affected ear. He reports feeling otherwise healthy. Upon examination, the ear canal is red and inflamed, but patent, and there is discharge present, indicating an infection. The external ear and mastoid appear normal, and there are no abnormalities detected in the throat or neck. The patient is worried as he is immunocompromised due to treatment for multiple sclerosis.
What is the best course of action for managing this patient’s condition?
A 49-year-old woman presents with recurrent episodes of vertigo. She reports experiencing true vertigo for about 10-20 seconds at a time, which has been happening on and off for the past few days. She became frightened while driving yesterday when she turned her head and became very dizzy, causing her to stop the car. She has since stopped driving altogether, but the vertigo continues to occur throughout the day in other situations, particularly when she turns her head. She denies any hearing loss or tinnitus. On examination, her cranial nerves are normal and there are no cerebellar signs. Dix-Hallpike testing is positive when she is manoeuvred to the right side, producing rotatory vertigo and nystagmus. What is the most appropriate management strategy?
A 45-year-old man presents with complaints of dizziness that have developed over the past two weeks. He experiences episodes of vertigo when he turns his head, particularly when he turns over in bed. He denies any recent illness or injury. The vertigo lasts for several seconds at a time and he reports no hearing loss, ear pain, fullness, or ringing. On examination, there are no abnormalities in cranial nerve function, cerebellar signs, or Romberg’s test. Dix-Hallpike testing is positive for rotatory vertigo and nystagmus.
What is the most appropriate pharmacological approach for this patient?
A mother brings her 6-year-old daughter to see the GP because of a painful ulcer on her lower lip. It has been present for 5-6 days. On examination, it is erythematous with indurated papules about 4mm in diameter. The GP takes a look and diagnoses an aphthous ulcer.
Within what timescale would most minor aphous ulcers (2-10mm) take to heal?
A 22-year-old male with a past history of depression is brought by his roommate to the emergency room with an overdose of an unknown substance.
His roommate found him unconscious in their apartment this morning and immediately called for an ambulance. There was an empty bottle of unlabelled pills on the kitchen counter which the patient admitted to taking.
The patient is currently unresponsive and has shallow breathing. He is hooked up to a ventilator and his vital signs are being closely monitored. There is evidence of recent vomiting and he has a high fever.
The patient has a history of suicidal ideation and his roommate is not sure where he obtained the pills from. Which of the following has he taken in overdose?
A 48-year-old man comes to the clinic with an enlarged and discoloured filiform papillae on his tongue. The upper surface of his tongue appears black in colour, with the tip and sides being spared. Although he has no symptoms, he is worried about the appearance. The patient has no significant medical history, takes no medication, and is in good health. There are no oral cavity or tongue-related focal lesions. What is the best initial management strategy?