AKT-1491
A 50-year-old man complains of dizziness and loss of hearing on the right side during his visit to the GP. Which test is most likely to suggest the presence of an acoustic neuroma?
Archives: MRCGP AKT
AKT-1492
A 47-year-old woman visits her GP complaining of constant right-sided hearing difficulty, tinnitus, and vertigo that have been present for the past two months and have worsened recently. Upon examination, there is no wax in either auditory canal, and the tympanic membranes appear normal.
What would be the most suitable course of action for management?
AKT-1493
A 50-year-old chef presents for a follow-up appointment after experiencing a left-sided Bell’s palsy three months ago. The patient was treated with prednisolone and has seen some improvement in their facial weakness, but still experiences some weakness in their left facial muscles (power 4/5). The patient is interested in knowing if there are any additional tests or referrals that could be beneficial.
What is the most suitable next step?
AKT-1494
A 2-year-old girl is brought to the clinic by her mother. She has a history of recurrent otitis media and has been touching her right ear frequently for the past 3 days. She was restless and had a fever overnight, and now has a red, boggy swelling behind her right ear that is more prominent than on the left. During the examination, the child appears unhappy, with a temperature of 39.2ºC, a heart rate of 170 beats/minute, and a respiratory rate of 28 breaths/minute. Due to her distress, it is difficult to examine her ears, but the left ear canal and tympanic membrane appear normal, while the right ear canal and tympanic membrane appear red. What is the most probable diagnosis?
AKT-1495
A 35-year-old sales representative comes in for a routine check-up and reports a 2-week history of a droopy left eyelid with forehead weakness. Upon examination, the symptoms are confirmed and there are no abnormalities found in the eyes or ears.
What is a crucial aspect of the treatment plan?
AKT-1496
You see a 40-year-old male patient with right sided facial paralysis. It started about 3 days ago and has slowly become worse. He is unable to raise his right forehead, close his right eye or move the right-hand side of his mouth. He has also noticed that his taste has been altered on the right-hand side of his tongue.
He is not particularly worried about it as it happened 12 months ago and you diagnosed Bell’s palsy. He would like some more treatment as he feels it helped his recovery last time. He is normally fit and well and has no allergies.
You arrange to see the patient in your afternoon clinic to examine him.
Regarding Bell’s palsy, which statement below is correct?
AKT-1497
A 50-year-old woman comes to the clinic complaining of persistent tinnitus in her left ear for the past 5 months. She has also observed a gradual decline in her hearing ability in the same ear. Upon examination, both ears appear normal. Rinne’s test shows air conduction greater than bone conduction in the left ear, and Weber’s test lateralises to the right ear. What is the probable diagnosis?
AKT-1498
A 65-year-old man presents to your clinic with a chief complaint of progressive difficulty in swallowing over the past 3 months. Upon further inquiry, he reports a weight loss of approximately 2 kilograms, which he attributes to decreased food intake. He denies any pain with swallowing or regurgitation of food. During the consultation, you observe a change in his voice quality. What is the probable diagnosis?
AKT-1499
A 30 year old man comes to the clinic complaining of anorexia, feverishness, and vertigo that have been going on for four days. He reports having difficulty balancing and staying upright when walking, as well as experiencing mild vertigo episodes lasting 10-20 minutes at a time. His hearing is unaffected. During the examination, some cervical lymphadenopathy is observed, but otherwise, there are no notable findings. What is the probable diagnosis?
AKT-1481
A 43-year-old man presents to you with complaints of tinnitus and hearing loss for the past few weeks. He has a history of chronic obstructive pulmonary disease and is currently on medications including salbutamol inhaler, azithromycin, beclomethasone-formoterol (Fostair) inhaler, tiotropium inhaler, and glycopyrronium bromide.
Upon examination, you note a positive Rinne test bilaterally with reduced hearing on both sides, worse on the left. The Weber test lateralizes to the right, and otoscopy is normal. You suspect a sensorineural hearing loss and urgently refer the patient to an ENT specialist.
Which medication from his current regimen may be contributing to his symptoms and should be discontinued?