Archives: MRCGP AKT

AKT-1688

An 80-year-old man presents for follow up of his hoarse voice, which he first noticed after attending a family gathering a month ago. Initially, a viral infection was suspected and he was given symptomatic advice. However, he reports that there has been no improvement in his symptoms and his voice remains hoarse. He quit smoking over 30 years ago and only drinks occasionally. He denies any cough or recent illness. His weight is stable and he has not experienced any hemoptysis. On examination, his ears, nose, and throat appear normal, as does his chest. What is the most appropriate management plan for this patient?

AKT-1689

Which medication is most strongly linked to an increased risk of cleft palate during pregnancy?

AKT-1690

A 32-year-old woman presents with periodic spontaneous attacks of vertigo, nausea, tinnitus and reduced hearing in the left ear. She has had these attacks for the last 1-2 years. She has a feeling of aural fullness and discomfort in the left ear in advance of an attack which persists during an attack. Attacks can last up to 2-3 hours each time and occur in clusters over a few weeks. After an attack she feels worn out for a day or two and slightly unsteady.

When seen she is asymptomatic and head and neck examination is normal. No current hearing impairment is reported or apparent.

Which of the following is the most appropriate management approach?

AKT-1691

A 5-year-old girl attends surgery with a febrile illness. Her mother tells you that she has been unwell for almost 24 hours and has been complaining of right-sided ear pain. The child is usually healthy with no significant past medical history.

On examination you find a temperature of 38.5°C and the right eardrum is red and bulging. The rest of the clinical examination is unremarkable.

What is the most suitable course of action?

AKT-1692

What is a true statement about mumps infection?

AKT-1693

A 12-year-old girl is brought in for an urgent appointment with her mother. She has been experiencing a sore throat, fever, malaise, and headache for the past two days. Yesterday, she complained of pain in her right ear, which has now spread to both ears. She has difficulty eating and drinking due to discomfort.
During the examination, bilateral swelling is observed, which is obstructing the angle of the jaw on both sides. When attempting to open her mouth to examine her throat, she experiences discomfort.
The patient has no significant medical history, and her mother is unsure if she has received all of her scheduled vaccinations.
What is the incubation period for this infection?

AKT-1694

What is the correct option regarding nasal polyps?

AKT-1695

A 48-year-old man presents to the clinic for follow-up. He is worried about some discoloration of the oral mucosa that he has noticed while brushing his teeth. These have been present for three weeks and have not been associated with any bleeding.

He has a history of hypertension for which he takes medication, but is otherwise healthy. He smokes six cigarettes per day and drinks a glass of wine each evening.

On examination, there are several patches within the oral mucosa that have either increased reddening or pallor. The diagnosis of erythroplakia is made. There is no lymphadenopathy, but the examination is otherwise unremarkable.

Investigations reveal:
– Hb 140 g/L (135-180)
– WCC 8.9 ×109/L (4.5-10)
– PLT 310 ×109/L (150-450)
– Na 140 mmol/L (135-145)
– K 4.2 mmol/L (3.5-5.5)
– Cr 90 µmol/L (70-110)

What is the most appropriate next step?

AKT-1696

You see a 50-year-old man who was seen by a colleague three days ago for unilateral ear pain and yellow discharge, with reduction in hearing that side. He was given amoxicillin 500mg TDS to treat this but has come to see you today as the symptoms have not improved. He has previously had a renal transplant for which he is on medications for but he is otherwise well in himself.

Which is the most appropriate next step in management?

AKT-1697

You see a 30-year-old man who reports an acute onset of reduced hearing in his left ear. This started suddenly yesterday. He is otherwise well with no ear pain, fevers or systemic upset. Examination of ears and cranial nerves were unremarkable.

Which is the most appropriate next step in management?