Archives: MRCGP AKT

AKT-1698

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?

AKT-1671

A 14-year-old female presents with acute tonsillitis.

She has been feeling unwell for the past five days with a high fever and a sore throat. Upon examination, you notice marked tonsillar exudate bilaterally and tender cervical lymphadenopathy. Given her condition, you believe that antibiotic treatment is necessary. However, her medical notes indicate a previous penicillin allergy. What would be an appropriate antibiotic to prescribe in this situation?

AKT-1672

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?

AKT-1673

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?

AKT-1674

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?

AKT-1675

A 20-year-old Asian female presents with gingival hypertrophy. What is the most likely cause of her condition?

AKT-1676

A 27-year-old man presents with persistent foul-smelling left ear discharge. This is the 3rd time he has been seen over the last few months with this problem and each time he has been treated with topical treatment for otitis externa. The discharge has never settled and he now feels that his hearing is reduced in the left ear.

On examination, he is afebrile and systemically well. There is no otalgia. There is discharge in the left ear canal obstructing visualisation of the left eardrum. Aside from the discharge there is nothing else focal to be seen. The right ear is normal. The external ears and mastoids are normal. There is no facial nerve palsy or neurological symptoms.

What is the most appropriate management approach?

AKT-1677

A 25-year-old patient presents to you with concerns about burning and irritation of their tongue, as well as rapid changes in its color. Upon examination, you observe multiple irregular but smooth red plaques on the dorsum of their tongue. The patient is anxious about these changes and seeks your advice.

What is the most probable diagnosis in this case?

AKT-1678

A 50-year-old man comes to the clinic for a follow-up of tests for hearing loss, which were arranged by another physician in the same practice. He works as a construction worker and attributes his hearing difficulties to years of exposure to loud machinery. He has no significant medical history.

Upon further questioning, he reports that his hearing loss and tinnitus only affect his left ear, while his right ear seems normal. The problem has been gradually worsening over the past six months. The hearing test confirms no hearing loss affecting the right ear.

What is the most appropriate next step?

AKT-1679

A 55-year-old smoker of 20 cigarettes a day, presents with a three month history of persistent hoarseness. On direct questioning he admits to left-sided earache.

On examination he is hoarse and has mild stridor. Examination of his ears is normal. Endoscopy of his upper airway shows an irregular mass in the larynx.

What is the most likely diagnosis?