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Question 1
Incorrect
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A 35-year-old male visits his GP with a complaint of persistent nasal discharge on his right side and facial pressure that worsens when he bends forward. He frequently breathes through his mouth because his nose is obstructed. He has a history of asthma and has been smoking for 6 pack-years.
What is the best course of action for management?Your Answer: Nasal irrigation with saline solution
Correct Answer: Referral to ENT
Explanation:Unilateral symptoms should raise concern for patients with chronic rhinosinusitis. The typical presentation includes facial pain, frontal pressure worsened by bending forward, clear nasal discharge (if due to allergies), and difficulty breathing through the nose. Post-nasal drip may also cause a chronic cough. However, if the symptoms are only on one side, it is considered a red flag and warrants a referral to an ENT specialist. The standard management for chronic sinusitis involves avoiding allergens, using intranasal corticosteroids, and irrigating the nasal passages with saline solution. Loratadine may be helpful if the cause is related to allergies.
Understanding Chronic Rhinosinusitis
Chronic rhinosinusitis is a common condition that affects approximately 10% of the population. It is characterized by inflammation of the nasal passages and paranasal sinuses that lasts for 12 weeks or more. There are several factors that can predispose individuals to this condition, including atopy, nasal obstruction, recent infections, swimming/diving, and smoking.
Symptoms of chronic rhinosinusitis include facial pain, nasal discharge, nasal obstruction, and post-nasal drip. Treatment options include avoiding allergens, using intranasal corticosteroids, and nasal irrigation with saline solution. However, it is important to be aware of red flag symptoms such as unilateral symptoms, persistent symptoms despite treatment, and epistaxis, which may require further evaluation and management.
In summary, chronic rhinosinusitis is a common inflammatory disorder that can cause significant discomfort and impact quality of life. Understanding the predisposing factors and symptoms, as well as appropriate management strategies, can help individuals effectively manage this condition.
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This question is part of the following fields:
- Ear, Nose And Throat, Speech And Hearing
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Question 2
Incorrect
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A 53-year-old man presents with a 3-days-history of left-sided facial droop. He denies any associated facial pain, eye symptoms or neurological symptoms. There is no history of trauma.
Upon examination, there is a unilateral facial weakness involving the entire left side of his face. He is unable to fully close his left eye. The remainder of the neurological examination is unremarkable. There are no rashes on his ears, face or mouth. His neck is soft with no palpable swellings or lymphadenopathy.
What is the most appropriate course of action for managing this patient?Your Answer: Urgent referral to secondary care
Correct Answer: Commence on a course of prednisolone and give eye care advice
Explanation:For a patient presenting with Bell’s palsy and eye symptoms, it is important to commence on a course of prednisolone and provide eye care advice. Lubricating eye drops should be used frequently during the day, eye ointment used at night, and the affected eye should be taped closed at night using microporous tape. Aciclovir may be considered if Ramsay Hunt syndrome is suspected. Referral to an ophthalmologist is advised if the patient reports eye symptoms. Urgent referral to an appropriate specialist is necessary if the patient has worsening neurologic findings, features suggestive of an upper motor neurone cause, features suggestive of cancer, systemic or severe local infection, or trauma. However, none of these features are present in this patient.
Bell’s palsy is a sudden, one-sided facial nerve paralysis of unknown cause. It typically affects individuals between the ages of 20 and 40, and is more common in pregnant women. The condition is characterized by a lower motor neuron facial nerve palsy that affects the forehead, while sparing the upper face. Patients may also experience post-auricular pain, altered taste, dry eyes, and hyperacusis.
The management of Bell’s palsy has been a topic of debate, with various treatment options proposed in the past. However, there is now consensus that all patients should receive oral prednisolone within 72 hours of onset. The addition of antiviral medications is still a matter of discussion, with some experts recommending it for severe cases. Eye care is also crucial to prevent exposure keratopathy, and patients may need to use artificial tears and eye lubricants. If they are unable to close their eye at bedtime, they should tape it closed using microporous tape.
Follow-up is essential for patients who show no improvement after three weeks, as they may require urgent referral to ENT. Those with more long-standing weakness may benefit from a referral to plastic surgery. The prognosis for Bell’s palsy is generally good, with most patients making a full recovery within three to four months. However, untreated cases can result in permanent moderate to severe weakness in around 15% of patients.
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This question is part of the following fields:
- Ear, Nose And Throat, Speech And Hearing
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Question 3
Incorrect
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A 20-year-old woman presents with a painful throat. She has been experiencing a sore throat and painful swallowing for the past few days, but her symptoms have worsened over the last 24 hours. She now has neck pain and difficulty opening her mouth fully.
Upon examination, her temperature is 38.9 °C and her throat shows a displaced uvula, an enlarged right tonsil, and swelling around the right tonsil.
What is the best initial management strategy for this patient?Your Answer: Prescribe oral antibiotics
Correct Answer: Arrange hospital admission
Explanation:Peritonsillar Abscess: A Serious Complication of Sore Throat
When evaluating a patient with a sore throat, it is crucial for clinicians to be aware of any potential serious causes or complications. One such condition is a peritonsillar abscess, which requires hospital admission and immediate treatment.
A peritonsillar abscess can lead to airway obstruction, deeper spread of infection, and abscess rupture. Therefore, it is important to check for clinical features such as difficulty swallowing, fever, and severe throat pain.
The initial management for a peritonsillar abscess is to arrange hospital admission. Once admitted, the patient can receive inpatient treatment in a safe environment with immediate care and monitoring. Treatment typically involves aspiration or drainage of the abscess, along with antibiotic use and pain relief.
In summary, a peritonsillar abscess is a serious complication of sore throat that requires prompt recognition and management. Hospital admission is necessary to ensure the patient’s safety and prevent further complications.
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This question is part of the following fields:
- Ear, Nose And Throat, Speech And Hearing
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Question 4
Correct
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You are reviewing a patient who presented to a colleague about eight weeks ago. He is a 65-year-old male with mild to moderate symptoms of nasal congestion and persistent feeling of a blocked nose. He reports ongoing problems of a similar nature. He informs you that as well as the above he gets intermittent clear nasal discharge which can alternate between nostrils and he has had periods of nasal and ocular 'itch'.
At his last appointment he was prescribed a daily non-sedating antihistamine which he has been using regularly. He was also given advice on nasal douching. Despite these measures he is still suffering from persistent nasal symptoms. He has heard that steroid medication can be used to treat his symptoms and asks for a prescription.
Which of the following is the most appropriate next pharmacological option to add in to his treatment in trying to manage his symptoms?Your Answer: Intranasal corticosteroid spray (for example, fluticasone propionate 100 mcgs each nostril once daily)
Explanation:Treatment Guidelines for Allergic and Non-Allergic Rhinitis
Guidelines for the treatment of allergic and non-allergic rhinitis recommend the use of oral non-sedating antihistamines, topical nasal corticosteroids or antihistamines, and anti-inflammatory eye drops either in isolation or in combination. For mild symptoms, oral and/or topical antihistamines are recommended, with regular use being more effective than as-required use. Sedating antihistamines should be avoided due to their negative effects on academic and work performance.
In moderate to severe symptoms, intranasal corticosteroids are the treatment of choice if antihistamine treatment has been ineffective. Different preparations have different degrees of systemic absorption, with mometasone and fluticasone having negligible systemic absorption. Intranasal corticosteroids have an onset of action of six to eight hours after the first dose, but regular use for at least two weeks may be needed to see the maximal effects.
If treatment with the above doesn’t improve things, it is important to review technique and compliance and increase the dosage where appropriate. Short courses of oral corticosteroids may be used to gain control in severe nasal blockage or if the patient has a very important upcoming event. They should be used in conjunction with intranasal corticosteroids, and a burst of prednisolone at a dose of 0.5 mg/kg/day for 5-10 days can be used.
In addition to the above, watery rhinorrhoea may respond to topical ipratropium, and catarrh in those with co-existent asthma may be helped by a leukotriene receptor antagonist. These guidelines provide a comprehensive approach to the treatment of allergic and non-allergic rhinitis, with a range of options available depending on the severity of symptoms.
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This question is part of the following fields:
- Ear, Nose And Throat, Speech And Hearing
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Question 5
Incorrect
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A 25 year old male smoker presents with multiple, painful aphthous ulcers, he puts this down to stress at work. He only gets ulcers on his tongue and oral mucosa. He is otherwise well. He has never had any joint or bowel symptoms. He reports several previous episodes similar to this one, with painful oral ulceration lasting a week or two, dating back to when he was a teenager.
What signs or symptoms should prompt an immediate referral to secondary care for this 25 year old male smoker with recurrent painful oral ulcers?Your Answer: Unexplained ulceration persisting for 2 weeks
Correct Answer: Unexplained red and white patches of the oral mucosa that are painful, swollen, or bleeding
Explanation:To identify potential oral ulceration red flags, one should look out for unexplained ulcers or masses in the oral mucosa that persist for more than three weeks, as well as red and white patches that are painful, swollen, or bleeding. If symptoms or signs related to the oral cavity persist for more than six weeks and a definitive diagnosis of a benign lesion cannot be made, this is also a red flag. While being a smoker is a risk factor for aphthous ulcers, first onset over the age of 30 is atypical and may warrant consideration of an alternative cause, such as trauma to the mouth. However, it is not necessarily an indication for referral. It is important to note that not all ulcers respond to corticosteroids, but if an ulcer has persisted for more than three weeks, an urgent referral is necessary as prolonged ulceration could be indicative of malignancy.
Aphthous mouth ulcers are painful sores that are circular or oval in shape and are found only in the mouth. They are not associated with any systemic disease and often occur repeatedly, usually starting in childhood. These ulcers can be caused by damage to the mouth, such as biting the cheek or brushing too hard, or may be due to a genetic predisposition. Other factors that can trigger these ulcers include stress, certain foods, stopping smoking, and hormonal changes related to the menstrual cycle.
Aphthous ulcers are characterized by their round or oval shape, a clearly defined margin, a yellowish-grey slough on the floor, and a red periphery. They usually appear on non-keratinized mucosal surfaces, such as the inside of the lips, cheeks, floor of the mouth, or undersurface of the tongue. In most cases, investigations are not necessary, but they may be considered if an underlying systemic disease is suspected.
Treatment for aphthous ulcers involves avoiding any factors that may trigger them and providing symptomatic relief for pain, discomfort, and swelling. This may include using a low potency topical corticosteroid, an antimicrobial mouthwash, or a topical analgesic. Most ulcers will heal within two weeks without leaving any scars. However, if a mouth ulcer persists for more than three weeks, it is important to seek urgent referral to a specialist.
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This question is part of the following fields:
- Ear, Nose And Throat, Speech And Hearing
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Question 6
Incorrect
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A 25-year-old female complains of painful chewing and clicking in her jaw accompanied by a squeezing headache. She denies any joint pains and appears to be in good health. During the examination, she was able to open her mouth normally but experienced pain when opening wider. Mild pain was observed upon palpation of the area, and her temperature was 36.4ºC. What is the best course of action?
Your Answer:
Correct Answer: Mild analgesia, heat packs, avoid exacerbating foods
Explanation:Patients with suspected temporomandibular joint dysfunction should be encouraged to practice early self-management techniques to control their symptoms and limit functional impairment. These techniques include using simple analgesics like paracetamol or ibuprofen, applying heat packs to the affected area, and avoiding hard or crunchy foods that can exacerbate the pain. With proper self-management, patients can expect to recover within 2-3 months.
If temporal arteritis is suspected, investigations such as ESR and temporal biopsy may be necessary. This condition presents with a throbbing headache, an obvious temporal artery, and claudication when chewing, and requires immediate treatment with corticosteroids to prevent vision loss.
While referral to a dentist may be necessary if self-management techniques are ineffective, an x-ray of the mandible is not required for diagnosis. Strong analgesia and opioids should be avoided, as simple analgesia is just as effective and carries fewer risks. X-rays are also unnecessary, as TMJ dysfunction is a clinical diagnosis that doesn’t require imaging to manage.
Understanding Temporomandibular Joint Dysfunction
Temporomandibular joint dysfunction (TMJ) is a condition that affects the jaw joint and the muscles that control its movement. It is characterized by pain in the TMJ area, which may radiate to the head, neck, or ear. Patients may also experience restricted jaw motion, making it painful to chew or speak. Additionally, they may notice clicking or other noises when moving their jaw.
To manage TMJ, healthcare professionals may recommend soft foods to reduce the strain on the jaw. Simple analgesia, such as paracetamol and NSAIDs, can also help alleviate pain. Short courses of benzodiazepines may be prescribed to help relax the muscles and reduce anxiety. It is also important to seek a review by a dentist to rule out any dental issues that may be contributing to the condition.
In summary, TMJ is a painful condition that affects the jaw joint and muscles. It can be managed through a combination of lifestyle changes, medication, and dental care. By understanding the symptoms and seeking appropriate treatment, patients can improve their quality of life and reduce the impact of TMJ on their daily activities.
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This question is part of the following fields:
- Ear, Nose And Throat, Speech And Hearing
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Question 7
Incorrect
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A 26-year-old man with sinusitis inquires about the safety of using Sudafed (pseudoephedrine). Is there any medication that would make Sudafed use inappropriate?
Your Answer:
Correct Answer: Monoamine oxidase inhibitor
Explanation:The combination of a monoamine oxidase inhibitor and pseudoephedrine may lead to a dangerous increase in blood pressure known as a hypertensive crisis.
Acute sinusitis is a condition where the mucous membranes of the paranasal sinuses become inflamed. This inflammation is usually caused by infectious agents such as Streptococcus pneumoniae, Haemophilus influenza, and rhinoviruses. Certain factors can predispose individuals to this condition, including nasal obstruction, recent local infections, swimming/diving, and smoking. Symptoms of acute sinusitis include facial pain, nasal discharge, and nasal obstruction. Treatment options include analgesia, intranasal decongestants or nasal saline, and intranasal corticosteroids. Oral antibiotics may be necessary for severe presentations, but they are not typically required. In some cases, an initial viral sinusitis can worsen due to secondary bacterial infection, which is known as double-sickening.
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This question is part of the following fields:
- Ear, Nose And Throat, Speech And Hearing
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Question 8
Incorrect
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A 63-year-old man comes to the clinic with his wife for evaluation. He has been experiencing a change in his voice with constant hoarseness and a chronic dry cough for the past six weeks. He attributes this to a previous cold and chest infection and believes it will improve over time.
He is a heavy smoker, consuming 25 cigarettes per day for the past 50 years. He has a history of COPD and is currently taking a high dose Seretide inhaler. On examination, his BP is 145/85 mmHg, pulse is 75 and regular, and chest auscultation reveals scattered wheezing.
Investigations reveal:
Hb 134 g/L (135-180)
WCC 8.0 ×109/L (4.5-10)
PLT 179 ×109/L (150-450)
Na 137 mmol/L (135-145)
K 4.7 mmol/L (3.5-5.5)
Cr 122 µmol/L (70-110)
ECG shows sinus rhythm.
CXR (arranged by another GP partner) shows no mass lesion identified.
What is the most appropriate course of action?Your Answer:
Correct Answer: Urgent ENT referral
Explanation:Urgent Investigation for Hoarseness
Under NICE guidance, patients who present with hoarseness for more than three weeks require urgent investigation for possible cancer. In this case, a chest x-ray did not show an underlying cancer, but an ENT referral for laryngoscopy is warranted.
While inadequate oral hygiene after inhaler use leading to candida infection is a possibility, the absence of oral candida makes it unlikely. Speech therapy is an option to maximize vocal effectiveness, and it is effective for hoarseness related to organic pathology such as nodules or polyps, and non-organic laryngeal dysfunction (for example, muscle tension dysphonia).
Stopping the use of Seretide is inappropriate because it is likely to worsen symptoms of COPD and is unlikely to elucidate the underlying cause of the hoarseness. It is important to investigate the cause of hoarseness to ensure prompt and appropriate treatment.
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This question is part of the following fields:
- Ear, Nose And Throat, Speech And Hearing
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Question 9
Incorrect
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A 40-year-old man presents to the GP with episodes of dizziness that began two weeks ago. These episodes occur randomly but are worsened when he changes the position of his head. His most recent episode lasted longer than a day and was particularly uncomfortable, accompanied by nausea and vomiting. During a cranial nerve examination, the GP observes horizontal nystagmus. The patient denies experiencing any aural symptoms like tinnitus. When asked about his overall health, the patient reports having had a viral upper respiratory tract infection the previous week.
What is the diagnosis?Your Answer:
Correct Answer: Vestibular neuronitis
Explanation:Horizontal nystagmus is a common symptom of vestibular neuronitis, which is caused by inflammation of the vestibular nerve. This condition typically presents with vertigo, nausea, vomiting, and balance problems, but doesn’t cause hearing loss as the cochlear nerve is not affected. The presence of horizontal nystagmus helps to rule out a central cause of vertigo, such as a stroke.
Acoustic neuroma, on the other hand, is characterized by a tumor that compresses the eighth cranial nerve, leading to symptoms such as vertigo, hearing loss, tinnitus, and an absent corneal reflex. Meniere’s disease is another condition that causes sudden episodes of vertigo, hearing loss, and tinnitus, but also involves a sensation of fullness in the ears due to an abnormal amount of endolymph in the inner ear. However, the absence of tinnitus in the patient in the vignette makes these diagnoses less likely.
A posterior circulation stroke can also cause nystagmus, vertigo, and nausea, but these symptoms typically come on suddenly and are accompanied by ataxia, unilateral limb weakness, and an altered mental state. In addition, a central cause of vertigo would result in vertical nystagmus rather than horizontal nystagmus.
Viral labyrinthitis is similar to vestibular neuronitis, but is more likely to cause hearing loss and tinnitus. In vestibular neuronitis, only the vestibular nerve is affected, while hearing is spared.
Understanding Vestibular Neuronitis
Vestibular neuronitis is a type of vertigo that typically occurs after a viral infection. It is characterized by recurrent episodes of vertigo that can last for hours or days, accompanied by nausea and vomiting. Horizontal nystagmus is also a common symptom, but there is no hearing loss or tinnitus.
It is important to differentiate vestibular neuronitis from other conditions such as viral labyrinthitis and posterior circulation stroke. The HiNTs exam can be used to distinguish between these conditions.
Treatment for vestibular neuronitis typically involves medication to alleviate symptoms, such as buccal or intramuscular prochlorperazine for severe cases, or a short course of oral medication for less severe cases. Vestibular rehabilitation exercises are also recommended for patients who experience chronic symptoms.
Understanding the symptoms and treatment options for vestibular neuronitis can help individuals manage this condition and improve their quality of life.
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This question is part of the following fields:
- Ear, Nose And Throat, Speech And Hearing
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Question 10
Incorrect
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A 49-year-old man presents with concerns about his hearing. He has a history of recurrent Ménière disease which has resulted in significant hearing loss. He struggles to hear his coworkers at work and his partner has noticed that he needs to turn the volume up high on the television. He has not considered hearing aids due to negative stories he has heard about them.
Upon reviewing his recent audiogram, it shows an 80 dB hearing loss at the 1,000 Hz and 2,000 Hz frequencies. The patient is interested in being referred for a cochlear implant.
What is the recommended management plan?Your Answer:
Correct Answer: Refer her for hearing aids
Explanation:Individuals with severe to profound hearing loss, such as this woman, may benefit from a cochlear implant. It is not necessary for her to wait until her hearing worsens before seeking treatment. Ménière disease-related hearing loss, which is linked to inner ear issues and balance symptoms, can also be improved with a cochlear implant. While cochlear implants are available through the NHS, patients are typically required to have attempted hearing aids before being considered for the procedure.
A cochlear implant is an electronic device that can be given to individuals with severe-to-profound hearing loss. The suitability for a cochlear implant is determined by audiological assessment and/or difficulty developing basic auditory skills in children, and a trial of appropriate hearing aids for at least 3 months in adults. The causes of severe-to-profound hearing loss can be genetic, congenital, idiopathic, infectious, viral-induced sudden hearing loss, ototoxicity, otosclerosis, Ménière disease, or trauma. Prior to an assessment for the cochlear implant, patients should have exhausted all medical therapies aimed at targeting any underlying pathological process contributing to the loss of hearing.
Surgical implantation may be complicated by infection, facial paralysis due to nerve injury intra-operatively, cerebrospinal fluid (CSF) leakage, and meningitis. Patients are discharged for the postoperative physical recovery of the implantation site and generally return to outpatient clinic 3-5 weeks post-op for device stimulation. Contraindications to consideration for cochlear implant include lesions of cranial nerve VIII or in the brain stem causing deafness, chronic infective otitis media, mastoid cavity or tympanic membrane perforation, and cochlear aplasia.
The device has both internal and external components. Externally, the microphone recognises the environmental sound and sends it to the sound processor. This, in turn, transforms the impulses received into a digital signal that which is then transferred to the transmitter coil. The transmitter coil conveys the signal to the internal components. Internally, a receiver, which magnetically connected to, and sits directly above the transmitter coil, and receives the impulses from the external apparatus which are then processed by a set of electrodes. The electrodes do the work that would be performed by the inner ear hair cells in a ‘normal’ ear. The brain can then process these signals to comprehend sound.
Rechargeable batteries can be used to power the apparatus and life span depends upon usage and the individual device. Hearing link describes cochlear implants as ‘…the world’s most successful medical prostheses in that less than 0.2% of recipients reject it or do not use it and the failure rate needing reimplantation is around 0.5%.’ It is important for patients to demonstrate an understanding of what to expect from cochlear implantation, including comprehension of the likely limitations of the device. Patients should also demonstrate an interest in using the
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This question is part of the following fields:
- Ear, Nose And Throat, Speech And Hearing
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Question 11
Incorrect
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A 44-year-old left-handed man who has played drums for years complains of hearing loss. He rests the drumsticks in his left hand and his upper arm on that side tends to cover the ear.
What is the most likely finding on audiogram?Your Answer:
Correct Answer: A right-sided high frequency sensorineural hearing loss
Explanation:Understanding Different Types of Hearing Loss: A Case Study on Rifle Shooting
Rifle shooting can lead to hearing loss, particularly high-frequency sensorineural hearing loss. In this case study, a man who is left-handed and shoots with the gun resting against his left shoulder is more likely to experience hearing loss in his right ear due to the masking effect. Ageing can also cause sensorineural hearing loss, which typically starts in the high-frequency range.
However, a right-sided conductive hearing loss is not caused by noise exposure. Conductive hearing loss occurs when there is a problem conducting sound through the outer ear, tympanic membrane, or middle ear. Causes of this include wax, serous otitis media, suppurative otitis media, perforated eardrum, and otosclerosis.
A bilateral mixed hearing loss at all frequencies is also not caused by noise exposure. Mixed hearing loss is caused when conductive damage in the outer or middle ear is combined with sensorineural damage in the inner ear or auditory nerve.
Similarly, a left-sided low-frequency sensorineural hearing loss is not an early feature of noise-induced deafness. Low-frequency hearing loss may be related to conductive hearing loss, but as a sensorineural hearing loss progresses, the initial high-frequency loss spreads through lower frequencies. Low-frequency hearing loss eventually occurs in Menière’s disease.
In summary, understanding the different types of hearing loss is crucial in identifying the causes and potential treatments. In the case of rifle shooting, high-frequency sensorineural hearing loss is a common occurrence, but other types of hearing loss may have different causes and require different interventions.
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This question is part of the following fields:
- Ear, Nose And Throat, Speech And Hearing
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Question 12
Incorrect
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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?Your Answer:
Correct Answer: Clarithromycin
Explanation:Antibiotic Treatment for Sore Throat
Penicillin V remains the preferred antibiotic for treating sore throat due to its effectiveness, affordability, safety, and narrow spectrum. This helps prevent the development of antibiotic resistance. However, individuals who are allergic to penicillin should take either erythromycin or clarithromycin for five days. The clinical knowledge summaries website provides evidence-based recommendations for antibiotic selection, drawing from guidance from SIGN, Royal College of Paediatrics and Child Health, and Public Health England.
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This question is part of the following fields:
- Ear, Nose And Throat, Speech And Hearing
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Question 13
Incorrect
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A 25-year-old man comes to his General Practitioner complaining of a painful discharging right ear and a mild unilateral right-sided hearing loss that has been going on for 3 days. During examination, the doctor observes an intact tympanic membrane and copious purulent liquid discharge. The patient has a normal heart rate of 70 bpm and is not running a fever.
What is the most suitable course of action for this patient?Your Answer:
Correct Answer: Prescribe topical antibiotics
Explanation:Management Options for Otitis Externa
Otitis externa is a common condition characterized by pain, itching, and discharge in the ear canal. Here are some management options for this condition:
Prescribe Topical Antibiotics: Topical antibiotics are the first-line treatment for otitis externa. Neomycin or clioquinol are recommended, and they may be combined with a topical corticosteroid if there is inflammation and eczema. Aminoglycosides should be used cautiously as second line if there is perforation of the eardrum.
Prescribe Oral Antibiotics: Oral antibiotics may be necessary if the patient is systemically unwell or there is preauricular lymphadenitis or cellulitis. Flucloxacillin or erythromycin is the drug of choice.
Refer to Ear, Nose and Throat (ENT) for Ear Wick Insertion: If there is extensive swelling of the auditory canal, an ear wick may be used. This is impregnated with antibiotic-steroid combination and is inserted into the auditory canal. However, if the tympanic membrane is visible, topical antibiotics would be the first-line treatment.
Prescribe Analgesia Only: Paracetamol or ibuprofen is usually sufficient for analgesia in cases of otitis externa. However, analgesia should be used in combination with antibiotics to aid in curing and preventing the worsening of symptoms.
Do Not Prescribe Topical Antifungals: Topical antifungals are not indicated in simple cases of otitis externa. They may be necessary if there is a secondary fungal infection, but this is not described in this case.
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This question is part of the following fields:
- Ear, Nose And Throat, Speech And Hearing
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Question 14
Incorrect
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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?
Your Answer:
Correct Answer: Provide advice on good oral hygiene
Explanation:Black hairy tongue is a harmless condition that causes enlargement and discoloration of the filiform papillae of the tongue, resulting in a hairy appearance. Also known as lingua villosa nigra, this condition can be caused by certain medications, poor oral hygiene, tobacco and alcohol use, colored drinks, dehydration, and hyposalivation. The use of chlorhexidine or peroxidase-containing mouthwashes can also aggravate the condition. However, hairy tongue is typically self-limiting and can be managed by advising good oral hygiene practices such as regular brushing, gentle tongue scraping, and avoiding smoking and excessive alcohol consumption.
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This question is part of the following fields:
- Ear, Nose And Throat, Speech And Hearing
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Question 15
Incorrect
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A 42-year-old man presents with a 'neck lump' that he has noticed over the past two months. On examination, you palpate a diffuse midline swelling which moves with swallowing but not with tongue protrusion. There are no other neck lumps or focal nodules, and the patient's voice is normal with no hoarseness. There is no cervical lymphadenopathy or stridor. The patient has no significant past medical history or family history.
He reports feeling slightly more fatigued and has gained some weight over the past few months but otherwise feels well. He notes that the swelling in his neck has not changed in size since he first noticed it.
Thyroid function tests reveal hypothyroidism. What is the most appropriate management plan?Your Answer:
Correct Answer: Repeat the thyroid function test in four to six weeks
Explanation:Thyroid Swelling: Recognizing and Referring Suspected Cancer
Note that it is important to clarify descriptions and findings during a patient’s history and examination. For instance, a patient may describe a lump when it is actually a diffuse swelling. According to NICE guidelines, an unexplained thyroid lump warrants a suspected cancer pathway referral within two weeks. However, other factors to consider during the assessment include a solitary nodule increasing in size, a history of neck irradiation, family history of an endocrine tumor, unexplained hoarseness or voice changes, cervical lymphadenopathy, very young or elderly patients. Patients with symptoms of tracheal compression should be admitted immediately to the hospital.
In cases where a thyroid swelling doesn’t meet any of the urgent or immediate referral criteria, a thyroid function blood test should be conducted. If the test reveals hypothyroidism, it may explain the patient’s weight gain and tiredness. Patients with abnormal thyroid function and a goitre are unlikely to have thyroid cancer and can be managed in primary care. Those with a goitre and normal thyroid function tests can be referred non-urgently to a thyroid surgeon.
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This question is part of the following fields:
- Ear, Nose And Throat, Speech And Hearing
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Question 16
Incorrect
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Ramsey Hunt syndrome
Your Answer:
Correct Answer: Refer under 2-week wait to ENT for suspected cancer
Explanation:If an adult presents with unilateral middle ear effusion, it could be a sign of nasopharyngeal cancer. In such cases, the appropriate action would be to refer the patient for an urgent 2-week wait ENT appointment to investigate the possibility of cancer. This is especially important if the patient is of East Asian origin and the effusion is not related to an upper respiratory tract infection. Other options, such as arranging a CT scan of the paranasal sinuses, do not address the urgent need to rule out cancer and should not be done in primary care. Further investigations, such as nasal endoscopy or MRI, may be arranged by the specialist to confirm or rule out the possibility of nasopharyngeal cancer.
Understanding Nasopharyngeal Carcinoma
Nasopharyngeal carcinoma is a type of squamous cell carcinoma that affects the nasopharynx. It is a rare form of cancer that is more common in individuals from Southern China and is associated with Epstein Barr virus infection. The presenting features of nasopharyngeal carcinoma include cervical lymphadenopathy, otalgia, unilateral serous otitis media, nasal obstruction, discharge, and/or epistaxis, and cranial nerve palsies such as III-VI.
To diagnose nasopharyngeal carcinoma, a combined CT and MRI scan is typically used. The first line of treatment for this type of cancer is radiotherapy. It is important to catch nasopharyngeal carcinoma early to increase the chances of successful treatment.
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This question is part of the following fields:
- Ear, Nose And Throat, Speech And Hearing
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Question 17
Incorrect
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A 2-year-old girl is brought to the clinic by her parents who are worried about her constant tugging on her left ear and increased fussiness over the past 24 hours.
During the examination, the child's temperature is found to be 38.5ºC, and the left tympanic membrane appears red. There is no discharge in the ear canal, the right ear is normal, and there are no signs of mastoiditis. The child has no significant medical history and is not taking any medications.
What is the most appropriate course of action for managing this patient?Your Answer:
Correct Answer: Regular analgesia, call back in 3 days time if the symptoms are not resolving
Explanation:Parents should be informed that antibiotics are not always necessary for treating acute otitis media in children. The condition typically resolves on its own within 24-72 hours without the need for antibiotics. Pain relief medication can be used to alleviate discomfort and reduce fever during this time. However, if symptoms persist for more than 4 days or worsen, parents should seek medical attention. Immediate antibiotic prescription is not recommended unless the child is under 2 years old, has bilateral otitis media, otorrhoea, or is immunocompromised. Amoxicillin is the first-line therapy, while erythromycin and clarithromycin are alternative options for children allergic to penicillin. Topical antibiotics are not recommended for treating otitis media, and oral antibiotics should be used if necessary. Referral to the emergency department is not necessary unless there are signs of complications such as acute mastoiditis, meningitis, or facial nerve paralysis. Swabbing the ear is not useful, even if there is discharge present, as the condition is likely to have resolved before culture results become available.
Acute otitis media is a common condition in young children, often caused by bacterial infections following viral upper respiratory tract infections. Symptoms include ear pain, fever, and hearing loss, and diagnosis is based on criteria such as the presence of a middle ear effusion and inflammation of the tympanic membrane. Antibiotics may be prescribed in certain cases, and complications can include perforation of the tympanic membrane, hearing loss, and more serious conditions such as meningitis and brain abscess.
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This question is part of the following fields:
- Ear, Nose And Throat, Speech And Hearing
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Question 18
Incorrect
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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.Your Answer:
Correct Answer: Amoxicillin
Explanation:Antibiotics for Acute Otitis Media in Children: When to Prescribe and Which Antibiotic to Use
Acute otitis media (AOM) is a common childhood infection, and antibiotics are often prescribed to treat it. However, a Cochrane review found that antibiotics only provide a small benefit, with an increase in resolution at 1 week of only 13%. Two trials found that the numbers needed to treat (NNT) to prevent one treatment failure ranged from 8 to 17.
Despite these findings, there are certain indications for prescribing antibiotics. Children under 2 years of age with bilateral disease or any child with significant systemic symptoms (fever above 38.5oC, vomiting) or bulging drums or otorrhoea should receive antibiotics. For most other children with mild disease, a wait-and-see policy is justified. Antibacterial treatment may be started after 4 days if there has been no improvement, and a delayed prescription is an option.
When antibiotics are used, a broad-spectrum antibiotic is prescribed for 5 days. The most common pathogens are Streptococcus pneumoniae, Haemophilus influenza, and Moraxella catarrhalis. Amoxicillin is still the antibiotic of choice, with clarithromycin for penicillin-allergic patients. If there is no improvement within 48 hours or symptoms reoccur within 14 days, treatment failure may have occurred, and co-amoxiclav should be considered.
It is important to note that ciprofloxacin doesn’t have a license in young children for this indication. Overall, the decision to prescribe antibiotics for AOM should be based on individual patient factors and the potential risks and benefits of treatment.
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This question is part of the following fields:
- Ear, Nose And Throat, Speech And Hearing
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Question 19
Incorrect
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A 30-year-old woman presents with bilateral inflamed tonsils, an inability to swallow both solids and liquids, and inflamed cervical lymph nodes.
Select the most appropriate management option.Your Answer:
Correct Answer: Referral to hospital for admission
Explanation:When to Admit a Patient with a Sore Throat: Indications and Recommendations
Admission to the hospital for a sore throat is necessary in certain cases. One such case is when the patient cannot swallow, making oral treatments ineffective. A Paul-Bunnell test may be considered, but it is not the first-line management. An ultrasound scan is only necessary for unexplained cervical lymphadenopathy.
According to NICE, hospital admission is recommended for sore throat cases that are immediately life-threatening, such as acute epiglottitis or Kawasaki disease. Other indications include dehydration or reluctance to take fluids, suppurative complications like quinsy, immunosuppression, and signs of being markedly systemically unwell.
It is important to be aware of these indications and recommendations to ensure proper management and treatment of sore throat cases.
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This question is part of the following fields:
- Ear, Nose And Throat, Speech And Hearing
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Question 20
Incorrect
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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?
Your Answer:
Correct Answer: Vestibular neuronitis
Explanation:A typical case of vestibular neuritis involves a patient who has recently recovered from an upper respiratory tract infection and experiences recurrent episodes of vertigo accompanied by nausea and vomiting. There is usually no hearing loss or tinnitus present. Prior to the onset of symptoms, the patient may have experienced viral symptoms. Unlike labyrinthitis, vestibular neuritis doesn’t cause hearing loss or tinnitus. If a patient experiences any neurological symptoms or signs, acute deafness, new types of headaches, or vertical nystagmus, urgent referral should be considered.
Vertigo is a condition characterized by a false sensation of movement in the body or environment. There are various causes of vertigo, each with its own unique characteristics. Viral labyrinthitis, for example, is typically associated with a recent viral infection, sudden onset, nausea and vomiting, and possible hearing loss. Vestibular neuronitis, on the other hand, is characterized by recurrent vertigo attacks lasting hours or days, but with no hearing loss. Benign paroxysmal positional vertigo is triggered by changes in head position and lasts for only a few seconds. Meniere’s disease, meanwhile, is associated with hearing loss, tinnitus, and a feeling of fullness or pressure in the ears. Elderly patients with vertigo may be experiencing vertebrobasilar ischaemia, which is accompanied by dizziness upon neck extension. Acoustic neuroma, which is associated with hearing loss, vertigo, and tinnitus, is also a possible cause of vertigo. Other causes include posterior circulation stroke, trauma, multiple sclerosis, and ototoxicity from medications like gentamicin.
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This question is part of the following fields:
- Ear, Nose And Throat, Speech And Hearing
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Question 21
Incorrect
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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?Your Answer:
Correct Answer: Offer manual syringing
Explanation:Guidelines for earwax Removal
According to NICE guidelines, if earwax irrigation is unsuccessful, patients should repeat the use of wax softeners or instil water into the ear canal 15 minutes before attempting ear irrigation again. If the second attempt is also unsuccessful, patients should be referred to a specialist ear care service or ENT. It is important to note that manual syringing should not be offered as a method of earwax removal. These guidelines aim to ensure safe and effective earwax removal practices.
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This question is part of the following fields:
- Ear, Nose And Throat, Speech And Hearing
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Question 22
Incorrect
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A 2-year-old boy has cerebral palsy. He presents with profuse rhinorrhoea, pyrexia and noisy respiration. The noise is a heavy-snoring inspiratory sound. His tonsils are enlarged and inflamed.
Which of the following describes the sound that this child is making?
Your Answer:
Correct Answer: Stertorous
Explanation:Stertorous refers to a noisy and laboured breathing sound, often heard during deep sleep or coma, caused by obstruction in the upper airways. Hypernasal speech is an abnormal voice resonance due to increased airflow through the nose during speech, caused by an incomplete closure of the soft palate and/or velopharyngeal sphincter. Rales, also known as crackles or crepitations, are clicking or crackling noises heard during auscultation, caused by the popping open of small airways and alveoli collapsed by fluid or exudate during expiration. Stridor is a high-pitched sound occurring during inhalation or exhalation, indicating respiratory obstruction, commonly caused by croup, foreign bodies, or allergic reactions. Wheezing is a high-pitched whistling sound made while breathing, caused by narrowed airways, typically in asthma.
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This question is part of the following fields:
- Ear, Nose And Throat, Speech And Hearing
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Question 23
Incorrect
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A 20-year-old woman has been experiencing recurrent painful mouth ulceration for several years. The ulcers typically heal in just over a week, and she remains symptom-free until the next recurrence. She denies any associated symptoms or rash, and her father had a similar history as a teenager. She doesn't smoke and denies excessive alcohol use or drug use. Although there is no dental or periodontal disease, she has three discrete, 4-mm-round ulcers with inflammatory haloes on the buccal mucosa.
What is the most likely diagnosis?Your Answer:
Correct Answer: Apthous ulcers
Explanation:There are several types of oral ulcers that can occur. Recurrent aphthous ulcers are the most common, affecting up to 66% of people at some point in their life. These ulcers appear on movable oral tissue and can recur frequently. Treatment options include topical corticosteroids, antimicrobial mouthwash, and topical analgesics. Herpes simplex stomatitis is another type of oral ulcer that mostly affects children and is caused by the herpes simplex virus. Symptoms include fever, malaise, and painful intraoral vesicles that can lead to ulcers. Oral candidiasis, or thrush, presents as white patches on the oral mucosa and tongue that can be wiped off to reveal a raw, erythematous base. Oral hairy leukoplakia is a white patch on the side of the tongue with a hairy appearance that is caused by Epstein-Barr virus and usually occurs in immunocompromised individuals. Oral lichen planus presents as a symmetrical, white, lace-like pattern on the buccal mucosa, tongue, and gums, and may be accompanied by erosions and ulcers.
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This question is part of the following fields:
- Ear, Nose And Throat, Speech And Hearing
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Question 24
Incorrect
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A 55-year-old man who gave up smoking ten years ago presents at surgery with hoarseness.
It has been present for four weeks and is not improving. He has no systemic illness to explain it and the only thing of note is that he is a heavy whisky drinker.
You suspect he may have laryngeal cancer.
Which of the following symptoms would augment that suspicion?Your Answer:
Correct Answer: Odynophagia
Explanation:Symptoms of Laryngeal and Lung Cancer
Laryngeal cancer can present with two main symptoms: dysphagia and odynophagia, which are difficulty and painful swallowing, respectively. On the other hand, lung cancer may cause bovine cough, a distinct coughing sound, and recurrent laryngeal palsy. Hoarseness is a common symptom of both types of cancer, but submandibular swelling may indicate other head and neck cancers. It is important to note that vomiting is not typically a symptom of these cancers, except in advanced stages. Early detection and treatment are crucial for improving outcomes in cancer patients.
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This question is part of the following fields:
- Ear, Nose And Throat, Speech And Hearing
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Question 25
Incorrect
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A parent is concerned about her 9-month-old child’s prominent ears.
Your Answer:
Correct Answer: Delay operation until the age of 8
Explanation:Prominent Ears: Causes, Diagnosis, and Treatment Options
Prominent ears affect a small percentage of the population and are usually inherited. This condition arises due to the lack or malformation of cartilage during ear development in the womb, resulting in abnormal helical folds or lateral growth. While some babies are born with normal-looking ears, the problem may arise within the first three months of life.
Before six months of age, the ear cartilage is soft and can be molded and splinted. However, after this age, surgical correction is the only option. Pinnaplasty or otoplasty can be performed on children from the age of five, but the ideal age for the procedure is around eight years old. This allows enough time to see if the child perceives the condition as a problem, while also avoiding potential teasing or bullying at school.
While some prominent ears may become less visible over time, it is best not to delay corrective procedures. Younger ears tend to produce better results after surgery, and waiting too long may increase the risk of bullying at school. Overall, understanding the causes, diagnosis, and treatment options for prominent ears can help individuals make informed decisions about their care.
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This question is part of the following fields:
- Ear, Nose And Throat, Speech And Hearing
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Question 26
Incorrect
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A 5-year-old child presents with a sore throat and polymorphous rash. He has had a fever for five to six days. He is well, drinking fluids, not vomiting, and passing urine normally.
On examination, he is alert, well hydrated with no photophobia or neck stiffness. His temperature is 38.7°C, HR 140, RR 30, and CRT<2 sec. His chest is clear.
He has generalised blanching macular rash and bilateral conjunctival injection. His lips are dry and chapped, tonsils are erythematous with no exudate. His eardrums look normal and he has moderate cervical lymphadenopathy. Urine dipstick is positive for protein and leucocytes.
What is the most appropriate management?Your Answer:
Correct Answer: Give penicillin V, take throat swab and send home with worsening advice
Explanation:Understanding Kawasaki Disease
Kawasaki disease is a leading cause of acquired heart disease in children in the UK. Although its prevalence is low, the risk of complications is high due to late diagnosis. As such, it is important to have a good understanding of the disease, which may be tested in the AKT exam.
The exact cause of Kawasaki disease is unknown, but it is believed to be due to a microbiological toxin. If left untreated, it can lead to coronary aneurysms. To diagnose Kawasaki disease, consider it in children with fever lasting over five days and who have four of the following five features: bilateral conjunctival injection, change in mucous membranes in the upper respiratory tract, change in the extremities, polymorphous rash, or cervical lymphadenopathy. In rare cases, incomplete or atypical Kawasaki disease may be diagnosed with fewer features.
To help remember the features of Kawasaki disease, think All Red + Cervical Lymphadenopathy. This stands for red eyes, red mouth, red rash, red hands, and cervical lymphadenopathy. By being aware of these symptoms, healthcare professionals can diagnose and treat Kawasaki disease promptly, reducing the risk of complications.
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This question is part of the following fields:
- Ear, Nose And Throat, Speech And Hearing
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Question 27
Incorrect
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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?Your Answer:
Correct Answer: Reassure, but explain that if symptoms persist in four months' time you will refer to plastic surgery
Explanation:If a patient with Bell’s palsy experiences residual weakness after six months, it is appropriate to refer them to a plastics specialist. It is important to provide reassurance and safety netting regarding the referral. However, ordering an MRI head is not necessary if the symptoms are consistent with Bell’s palsy and the patient has responded to treatment. Neurology referral is also not necessary unless there is doubt about the initial diagnosis or if there are other clinical features suggestive of stroke. It is important to monitor patients with persistent symptoms and refer them to a specialist if necessary. Simply reassuring the patient may not be appropriate in cases where specialist review is required.
Bell’s palsy is a sudden, one-sided facial nerve paralysis of unknown cause. It typically affects individuals between the ages of 20 and 40, and is more common in pregnant women. The condition is characterized by a lower motor neuron facial nerve palsy that affects the forehead, while sparing the upper face. Patients may also experience post-auricular pain, altered taste, dry eyes, and hyperacusis.
The management of Bell’s palsy has been a topic of debate, with various treatment options proposed in the past. However, there is now consensus that all patients should receive oral prednisolone within 72 hours of onset. The addition of antiviral medications is still a matter of discussion, with some experts recommending it for severe cases. Eye care is also crucial to prevent exposure keratopathy, and patients may need to use artificial tears and eye lubricants. If they are unable to close their eye at bedtime, they should tape it closed using microporous tape.
Follow-up is essential for patients who show no improvement after three weeks, as they may require urgent referral to ENT. Those with more long-standing weakness may benefit from a referral to plastic surgery. The prognosis for Bell’s palsy is generally good, with most patients making a full recovery within three to four months. However, untreated cases can result in permanent moderate to severe weakness in around 15% of patients.
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This question is part of the following fields:
- Ear, Nose And Throat, Speech And Hearing
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Question 28
Incorrect
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Samantha is a 50-year-old factory worker whose hearing has been gradually declining over the past 4 years. She has been exposed to loud noises in her workplace for many years.
Samantha finally decided to visit her doctor 3 months ago, as she was hesitant to seek help, and her hearing has now severely deteriorated. After undergoing audiology testing, she was diagnosed with bilateral sensorineural hearing loss.
What would be the most suitable course of action for managing Samantha's condition?Your Answer:
Correct Answer: Trial of hearing aids
Explanation:Before considering a cochlear implant, both children and adults must undergo an assessment by a multidisciplinary team. As part of this assessment, they should have tried using an acoustic hearing aid for at least three months. Cochlear implantation is recommended for individuals with severe to profound deafness who do not receive sufficient benefit from hearing aids.
Mark should try to avoid noisy environments, including his current workplace, to prevent further damage to his hearing. However, it is not advisable for him to immediately stop working. Instead, he should discuss his situation with his occupational health team to explore options for working in a quieter environment.
While education on sign language and lip reading may be helpful, it is important to note that adults who become deaf are unlikely to become proficient in sign language.
It is incorrect to tell Mark that nothing more can be done. He may be eligible for a trial of hearing aids and referral for a cochlear implant if necessary.
A cochlear implant is an electronic device that can be given to individuals with severe-to-profound hearing loss. The suitability for a cochlear implant is determined by audiological assessment and/or difficulty developing basic auditory skills in children, and a trial of appropriate hearing aids for at least 3 months in adults. The causes of severe-to-profound hearing loss can be genetic, congenital, idiopathic, infectious, viral-induced sudden hearing loss, ototoxicity, otosclerosis, Ménière disease, or trauma. Prior to an assessment for the cochlear implant, patients should have exhausted all medical therapies aimed at targeting any underlying pathological process contributing to the loss of hearing.
Surgical implantation may be complicated by infection, facial paralysis due to nerve injury intra-operatively, cerebrospinal fluid (CSF) leakage, and meningitis. Patients are discharged for the postoperative physical recovery of the implantation site and generally return to outpatient clinic 3-5 weeks post-op for device stimulation. Contraindications to consideration for cochlear implant include lesions of cranial nerve VIII or in the brain stem causing deafness, chronic infective otitis media, mastoid cavity or tympanic membrane perforation, and cochlear aplasia.
The device has both internal and external components. Externally, the microphone recognises the environmental sound and sends it to the sound processor. This, in turn, transforms the impulses received into a digital signal that which is then transferred to the transmitter coil. The transmitter coil conveys the signal to the internal components. Internally, a receiver, which magnetically connected to, and sits directly above the transmitter coil, and receives the impulses from the external apparatus which are then processed by a set of electrodes. The electrodes do the work that would be performed by the inner ear hair cells in a ‘normal’ ear. The brain can then process these signals to comprehend sound.
Rechargeable batteries can be used to power the apparatus and life span depends upon usage and the individual device. Hearing link describes cochlear implants as ‘…the world’s most successful medical prostheses in that less than 0.2% of recipients reject it or do not use it and the failure rate needing reimplantation is around 0.5%.’ It is important for patients to demonstrate an understanding of what to expect from cochlear implantation, including comprehension of the likely limitations of the device. Patients should also demonstrate an interest in using the
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This question is part of the following fields:
- Ear, Nose And Throat, Speech And Hearing
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Question 29
Incorrect
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An 80-year-old man presents to the emergency department with worsening pain and fever following a dental extraction 5 days ago. He is usually in good health. On examination, he has a tender swelling in the left submandibular region and mild trismus. His tongue is slightly displaced upwards and he is unable to protrude it. There is no respiratory distress or stridor. What is the best course of action for management?
Your Answer:
Correct Answer: Arrange a 999 ambulance for immediate transfer to hospital
Explanation:Ludwig’s Angina is a medical emergency that falls under the domain of ENT. The patient in question is displaying symptoms and indications that suggest the presence of this rare infection, which affects the soft tissues of the neck and the floor of the mouth. While it is typically caused by dental issues, it can also arise from other types of soft tissue infections in the neck. Due to the effectiveness of modern antibiotics and dental hygiene, Ludwig’s Angina is now quite uncommon, and many physicians may not be familiar with its presentation. However, it can lead to rapid deterioration and airway obstruction within a matter of minutes, necessitating immediate airway management and aggressive surgical intervention. If there is any suspicion of Ludwig’s Angina, it is crucial to transfer the patient to the emergency department without delay.
Understanding Ludwig’s Angina
Ludwig’s angina is a serious form of cellulitis that affects the soft tissues of the neck and the floor of the mouth. It is usually caused by an infection that originates from the teeth and spreads to the submandibular space. The condition is characterized by symptoms such as neck swelling, fever, and difficulty swallowing.
Ludwig’s angina is a medical emergency that requires immediate attention as it can lead to airway obstruction, which can be life-threatening. The management of this condition involves airway management and the administration of intravenous antibiotics.
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This question is part of the following fields:
- Ear, Nose And Throat, Speech And Hearing
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Question 30
Incorrect
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A 35-year-old male patient complains of constant sneezing, nasal congestion, and a persistent runny nose. What is not considered a part of the treatment plan for allergic rhinitis?
Your Answer:
Correct Answer: Oral decongestants
Explanation:Understanding Allergic Rhinitis
Allergic rhinitis is a condition that causes inflammation in the nose due to sensitivity to allergens such as dust mites, grass, tree, and weed pollens. It can be classified into seasonal, perennial, or occupational, depending on the timing and cause of symptoms. Seasonal rhinitis, which occurs due to pollens, is commonly known as hay fever. Symptoms of allergic rhinitis include sneezing, bilateral nasal obstruction, clear nasal discharge, post-nasal drip, and nasal pruritus.
The management of allergic rhinitis involves allergen avoidance and medication. For mild-to-moderate intermittent or mild persistent symptoms, oral or intranasal antihistamines may be prescribed. For moderate-to-severe persistent symptoms or if initial drug treatment is ineffective, intranasal corticosteroids may be recommended. In some cases, a short course of oral corticosteroids may be necessary to cover important life events. Topical nasal decongestants, such as oxymetazoline, may also be used for short periods, but prolonged use can lead to tachyphylaxis and rebound hypertrophy of the nasal mucosa (rhinitis medicamentosa) upon withdrawal.
In summary, allergic rhinitis is a common condition that can cause discomfort and affect daily life. Understanding the different types of allergic rhinitis and its symptoms can help in managing the condition effectively. It is important to consult a healthcare professional for proper diagnosis and treatment.
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This question is part of the following fields:
- Ear, Nose And Throat, Speech And Hearing
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