00
Correct
00
Incorrect
00 : 00 : 00
Session Time
00 : 00
Average Question Time ( Mins)
  • Question 1 - A 44-year-old left-handed man who has played drums for years complains of hearing...

    Incorrect

    • 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: A right-sided conductive hearing loss

      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.

    • This question is part of the following fields:

      • Ear, Nose And Throat, Speech And Hearing
      90.6
      Seconds
  • Question 2 - A 25-year-old female complains of painful chewing and clicking in her jaw accompanied...

    Incorrect

    • 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.

    • This question is part of the following fields:

      • Ear, Nose And Throat, Speech And Hearing
      0
      Seconds
  • Question 3 - A 72-year-old man presents to the General Practitioner with complaints of hearing loss...

    Incorrect

    • A 72-year-old man presents to the General Practitioner with complaints of hearing loss in his left ear. He reports feeling a blockage in the ear and has previously had his ears syringed. Upon examination, the ear is found to be occluded by wax. What is the most appropriate initial management option?

      Your Answer:

      Correct Answer: Ear drops

      Explanation:

      Treatment Options for earwax: Ear Drops, Microsuction, and Manual Removal

      earwax, also known as cerumen, can cause discomfort and hearing problems if it builds up in the ear canal. The first-line treatment for earwax is ear drops, which can soften the wax and make it easier to remove. Microsuction is a safer alternative to irrigation, but it is not widely available. Manual removal using a probe is also an option. However, there is little evidence on the effectiveness of these treatments.

      Various types of ear drops can be used, including sodium bicarbonate, sodium chloride, olive oil, and almond oil. Cerumol® is a commonly used proprietary agent. However, the British National Formulary warns against using docusate sodium (Waxsol®, Molcer®) or urea hydrogen peroxide (Exterol®, Otex®) as they may irritate the external meatus.

      Regardless of the type of ear drop used, the patient should lie with the affected ear uppermost for 5-10 minutes after applying the drops. While using any type of ear drop appears to be better than no treatment, it is uncertain if one type of drop is more effective than another. Therefore, it is important to seek advice from a healthcare professional before attempting to remove earwax at home.

    • This question is part of the following fields:

      • Ear, Nose And Throat, Speech And Hearing
      0
      Seconds
  • Question 4 - A 26-year-old man presents to your emergency clinic with worsening pain in his...

    Incorrect

    • A 26-year-old man presents to your emergency clinic with worsening pain in his right ear. He had previously been diagnosed with otitis externa and started on antibiotic ear drops by another physician four days ago. However, he reports that the pain has only gotten worse and he has been unable to apply the drops for the past 24 hours due to swelling of the canal. Upon examination, you notice that the right external auditory canal is completely swollen shut and you are unable to see any further. The patient's vital signs are normal.

      What is the most appropriate course of action for management?

      Your Answer:

      Correct Answer: Refer to on-call ENT

      Explanation:

      If topical antibiotics do not provide relief for otitis externa, it is recommended to refer the patient to an ear, nose, and throat (ENT) specialist. This is because the infection can cause swelling and narrowing of the ear canal, making it difficult for antibiotic drops to be effective. In such cases, microsuction and insertion of a pope wick may be necessary, which requires the expertise of an ENT specialist.

      Ear syringing should not be performed during an active infection as it will not be helpful.

      Steroids are often included in antibiotic ear drops, but they will not be effective if the drops cannot reach the ear canal.

      Oral antibiotics, such as ciprofloxacin, may be prescribed alongside topical antibiotics if there is concern of a deep tissue infection. However, this is unlikely in a young and otherwise healthy patient, and the primary treatment remains antibiotic drops.

      If necrotising otitis externa is suspected, a CT scan may be helpful, but this would be arranged by an ENT specialist and is not necessary in most cases.

      Understanding Otitis Externa: Causes, Features, and Management

      Otitis externa is a prevalent condition that often prompts primary care visits in the UK. It is characterized by ear pain, itch, and discharge, and can be caused by bacterial or fungal infections, seborrhoeic dermatitis, or contact dermatitis. Swimming is also a common trigger for otitis externa. Upon examination, the ear canal may appear red, swollen, or eczematous.

      The recommended initial management for otitis externa is the use of topical antibiotics or a combination of topical antibiotics with a steroid. However, if the tympanic membrane is perforated, aminoglycosides are traditionally not used. If there is canal debris, removal may be necessary, and if the canal is extensively swollen, an ear wick may be inserted. Second-line options include taking a swab inside the ear canal, considering contact dermatitis secondary to neomycin, or using oral antibiotics such as flucloxacillin if the infection is spreading. Empirical use of an antifungal agent may also be considered.

      It is important to note that if a patient fails to respond to topical antibiotics, they should be referred to an ENT specialist. Malignant otitis externa is a more severe form of the condition that is more common in elderly diabetics. It involves the extension of infection into the bony ear canal and the soft tissues deep to the bony canal, and may require intravenous antibiotics. While some ENT doctors disagree, concerns about ototoxicity may arise with the use of aminoglycosides in patients with perforated tympanic membranes.

    • This question is part of the following fields:

      • Ear, Nose And Throat, Speech And Hearing
      0
      Seconds
  • Question 5 - A 40-year-old man presents to the GP with episodes of dizziness that began...

    Incorrect

    • 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.

    • This question is part of the following fields:

      • Ear, Nose And Throat, Speech And Hearing
      0
      Seconds
  • Question 6 - Samantha is a 50-year-old factory worker whose hearing has been gradually declining over...

    Incorrect

    • 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

    • This question is part of the following fields:

      • Ear, Nose And Throat, Speech And Hearing
      0
      Seconds
  • Question 7 - A 9-year-old patient had a tonsillectomy 4 days ago. His father has brought...

    Incorrect

    • A 9-year-old patient had a tonsillectomy 4 days ago. His father has brought him to the clinic as earlier today he noticed a small amount of bright red bleeding from his mouth. He is otherwise recovering well and has been eating and drinking normally.

      What is the best course of action for managing this patient's bleeding?

      Your Answer:

      Correct Answer: Refer immediately to ENT for assessment

      Explanation:

      If a patient experiences bleeding after a tonsillectomy, it is important to seek urgent assessment from the operating team. While simple analgesia may be appropriate for those experiencing only pain, the presence of bleeding requires immediate attention. Prescribing oral antibiotics in the community would not be appropriate in this context, and techniques such as silver nitrate cautery should only be performed by a specialist after a thorough assessment.

      Complications after Tonsillectomy

      Tonsillectomy is a common surgical procedure that involves the removal of the tonsils. However, like any surgery, it carries some risks and potential complications. One of the most common complications is pain, which can last for up to six days after the procedure.

      Another complication that can occur after tonsillectomy is haemorrhage, or bleeding. There are two types of haemorrhage that can occur: primary and secondary. Primary haemorrhage is the most common and occurs within the first 6-8 hours after surgery. It requires immediate medical attention and may require a return to the operating room.

      Secondary haemorrhage, on the other hand, occurs between 5 and 10 days after surgery and is often associated with a wound infection. It is less common than primary haemorrhage, occurring in only 1-2% of all tonsillectomies. Treatment for secondary haemorrhage usually involves admission to the hospital and antibiotics, but severe bleeding may require surgery.

    • This question is part of the following fields:

      • Ear, Nose And Throat, Speech And Hearing
      0
      Seconds
  • Question 8 - An 80-year-old man presents for follow up of his hoarse voice, which he...

    Incorrect

    • 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?

      Your Answer:

      Correct Answer: Refer urgently to an ear, nose and throat specialist

      Explanation:

      Management of Persistent Hoarse Voice

      A persistent hoarse voice for over three weeks is a ‘red flag’ presentation and should prompt urgent action to investigate for a suspected cancer, such as laryngeal or lung cancer. Risk factors such as smoking history and alcohol history are important to consider but would not alter your management plan.

      NICE guidance on this changed slightly with the release of NG12. NICE advises that you should consider a suspected cancer pathway referral (for an appointment within 2 weeks) for laryngeal cancer in people aged 45 and over with persistent unexplained hoarseness.

      It is important to note that a normal basic examination is not sufficient to rule out a sinister underlying cause. Hoarseness can also be caused by pulmonary pathology, and if you have any suspicions that this may be the case, you should arrange an urgent chest x-ray.

      In summary, a persistent hoarse voice should be taken seriously and investigated promptly to rule out any potential underlying cancer or pulmonary pathology.

    • This question is part of the following fields:

      • Ear, Nose And Throat, Speech And Hearing
      0
      Seconds
  • Question 9 - What combination of findings would be expected in a patient with equal bilateral...

    Incorrect

    • What combination of findings would be expected in a patient with equal bilateral otosclerosis?

      Your Answer:

      Correct Answer: Rinne negative both sides with central Weber

      Explanation:

      Understanding Otosclerosis and its Effects on Hearing

      Otosclerosis is a condition that leads to conductive deafness, which means that bone conduction is better than air conduction. When testing for this condition, you would expect to see bilateral negative Rinne with central Weber. However, if the disease is in its early stages, the Rinne test may be equivocal. It is important to note that the second and third options do not make sense in the context of otosclerosis. Understanding the effects of otosclerosis on hearing can help individuals seek appropriate treatment and management options.

    • This question is part of the following fields:

      • Ear, Nose And Throat, Speech And Hearing
      0
      Seconds
  • Question 10 - A 56-year-old woman presents to the clinic for evaluation. She has been experiencing...

    Incorrect

    • A 56-year-old woman presents to the clinic for evaluation. She has been experiencing bloody, serous discharge from her left nostril for the past three weeks and reports that her nose feels constantly congested. The patient has a 30-year history of smoking 20 cigarettes per day and a medical history of COPD. On examination, her blood pressure is 132/72 mmHg, pulse is regular at 85 beats per minute, and she is unable to breathe through her left nostril. Laboratory results show a hemoglobin level of 120 g/L (normal range 115-160), white blood cell count of 7.0 ×109/L (normal range 4.5-10), and platelet count of 199 ×109/L (normal range 150-450). Her sodium level is 138 mmol/L (normal range 135-145), potassium level is 4.5 mmol/L (normal range 3.5-5.5), and creatinine level is 105 µmol/L (normal range 70-110). An electrocardiogram reveals sinus rhythm. What is the most appropriate course of action?

      Your Answer:

      Correct Answer: ENT referral within 2 weeks

      Explanation:

      Suspected Nasopharyngeal Carcinoma

      The suspicion is that the patient may have an underlying nasopharyngeal carcinoma, likely related to smoking, which is causing a blocked left nostril and bloody, serous discharge. It is important not to delay referral to an ear, nose, and throat (ENT) specialist by performing investigations through the GP outpatient radiology service. Imaging of the sinuses may be appropriate to determine the extent of any tumor, but this would be done as part of the pre-surgery workup rather than as outpatient GP investigations. A trial of intranasal steroids is not appropriate as a diagnosis of allergic rhinitis is unlikely, and this would waste valuable time in addressing any underlying tumor. Nasopharyngeal cancers are more common in people from southern China, including Hong Kong, Singapore, Vietnam, Malaysia, and the Philippines.

    • This question is part of the following fields:

      • Ear, Nose And Throat, Speech And Hearing
      0
      Seconds
  • Question 11 - A 65-year-old man visits his GP with concerns about an unusual patch inside...

    Incorrect

    • A 65-year-old man visits his GP with concerns about an unusual patch inside his cheek. He noticed a red-white patch while brushing his teeth, but he is unsure how long it has been there. He has a smoking history of 35 pack years and drinks approximately 18 units of alcohol per week. There is no family history of oral cancer. On examination, he appears to be in good health, and no cervical lymphadenopathy is detected. There is a 2cm red and white macule with a velvety texture on the buccal vestibule of the oral cavity, consistent with erythroleukoplakia. What is the most appropriate course of action?

      Your Answer:

      Correct Answer: Urgent referral (within 2 weeks) for assessment by head and neck team

      Explanation:

      Immediate investigation is necessary for any oral cavity lesion that appears suspicious for erythroplakia or leukoplakia due to the risk of malignancy.

      When to Refer Patients with Mouth Lesions for Oral Surgery

      Mouth lesions can be a cause for concern, especially if they persist for an extended period of time. In cases where there is unexplained oral ulceration or mass that lasts for more than three weeks, or red and white patches that are painful, swollen, or bleeding, a referral to oral surgery should be made within two weeks. Additionally, if a patient experiences one-sided pain in the head and neck area for more than four weeks, which is associated with earache but doesn’t result in any abnormal findings on otoscopy, or has an unexplained recent neck lump or a previously undiagnosed lump that has changed over a period of three to six weeks, a referral should be made.

      Patients who have persistent sore or painful throats or signs and symptoms in the oral cavity that last for more than six weeks and cannot be definitively diagnosed as a benign lesion should also be referred. It is important to note that the level of suspicion should be higher in patients who are over 40, smokers, heavy drinkers, and those who chew tobacco or betel nut (areca nut). By following these guidelines, healthcare professionals can ensure that patients with mouth lesions receive timely and appropriate care. For more information on this topic, please refer to the link provided.

    • This question is part of the following fields:

      • Ear, Nose And Throat, Speech And Hearing
      0
      Seconds
  • Question 12 - You see a 30-year-old man who reports an acute onset of reduced hearing...

    Incorrect

    • 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?

      Your Answer:

      Correct Answer: Refer to on-call ENT team

      Explanation:

      NICE Guidelines for Managing Sudden Hearing Loss in Adults

      The National Institute for Health and Care Excellence (NICE) released guidelines in June 2018 to provide recommendations on managing sudden or rapid onset hearing loss in adults. This type of hearing loss is not explained by external or middle ear causes.

      According to the guidelines, an immediate referral is recommended if the hearing loss developed suddenly within the past 30 days. If the hearing loss developed suddenly but it has been over 30 days or if it worsened rapidly, a two-week wait referral is advised. The guidelines also provide further recommendations if there are additional symptoms or signs such as facial droop.

      It is important to note that NICE defines sudden hearing loss as within 3 days and rapid worsening as 4-90 days. These guidelines aim to improve the management and treatment of sudden hearing loss in adults.

    • This question is part of the following fields:

      • Ear, Nose And Throat, Speech And Hearing
      0
      Seconds
  • Question 13 - A 32-year-old man presents with recurrent itchy ears.
    Which of the following statements about...

    Incorrect

    • A 32-year-old man presents with recurrent itchy ears.
      Which of the following statements about this condition is correct?

      Your Answer:

      Correct Answer: It may be precipitated by overzealous use of cotton buds

      Explanation:

      Understanding Otitis Externa: Myths and Facts

      Otitis externa, commonly known as swimmer’s ear, is a condition that affects the skin of the external ear canal. Here are some common myths and facts about this condition:

      Myth: Otitis externa is always bacterial in origin.
      Fact: While bacterial pathogens are frequently involved, viral and fungal pathogens may also be seen, particularly after prolonged use of corticosteroid drops.

      Myth: If adequately treated, otitis externa is unlikely to recur.
      Fact: Otitis externa is commonly recurrent, especially in the presence of a predisposing factor, such as a chronic underlying skin disease, immunodeficiency or diabetes.

      Myth: Systemic complications are common.
      Fact: Severe infections may cause local lymphadenitis or cellulitis. Rarely, infection may invade the deeper adjacent structures and progress to necrotising (malignant) otitis externa, a condition that can cause serious morbidity and also mortality. This is mainly seen in immunocompromised individuals, particularly people with diabetes.

      Myth: The use of aminoglycoside antibiotics is contraindicated.
      Fact: In a patient who doesn’t have grommets or a perforated eardrum, aminoglycosides (eg gentamicin) or polymyxin drops are not contraindicated. When the eardrum is not intact, there is concern about ototoxicity. If necessary, they can be used in these circumstances, with caution, by specialists.

      Debunking Myths About Otitis Externa

    • This question is part of the following fields:

      • Ear, Nose And Throat, Speech And Hearing
      0
      Seconds
  • Question 14 - What are the indications for tonsillectomy? ...

    Incorrect

    • What are the indications for tonsillectomy?

      Your Answer:

      Correct Answer: Parental pressure

      Explanation:

      Indications for Tonsillectomy

      The SIGN guidelines for tonsillectomy have been updated to suggest seven acute attacks of proven tonsillitis in one year or five in each of two successive years as an indication for the procedure. Weight loss alone is not a sufficient indication, but complications such as nephritis and rheumatic fever, as well as peritonsillar abscess, are. Children with obstructive sleep apnoea have also been shown to benefit from tonsillectomy. Malignancy is an absolute indication. However, three attacks in two years and two attacks in two months are considered too short a period to warrant tonsillectomy. It is important to note that while children may experience an improvement in general health post-tonsillectomy, weight loss alone is not a valid indication for the procedure.

    • This question is part of the following fields:

      • Ear, Nose And Throat, Speech And Hearing
      0
      Seconds
  • Question 15 - A 24-year-old-man schedules an appointment due to a nose injury he sustained while...

    Incorrect

    • A 24-year-old-man schedules an appointment due to a nose injury he sustained while playing soccer two days ago. He reports that his nose bled for a few minutes after the injury but has not bled since. He also mentions that his nose did not appear deformed after the incident. He has not sought medical attention before this appointment and is generally healthy with no long-term medications.

      During the examination, you notice no signs of nasal bone deviation, but there is significant swelling in the surrounding soft tissue. On anterior rhinoscopy, you observe a bilateral fluctuant swelling of the nasal septum that almost blocks the nostrils.

      What is the most suitable course of action?

      Your Answer:

      Correct Answer: Admit directly to the hospital for same day ENT assessment

      Explanation:

      If there is bilateral purple swelling of the nasal septum, it is likely that the patient has a septal haematoma. It is important to examine the nose for this condition, even if the injury seems minor. A septal haematoma can cause permanent damage to the septal cartilage within 24 hours due to obstructed blood flow. If suspected, the patient should be referred to the on-call ENT team for urgent assessment.

      If a nasal bone fracture is suspected, the patient should also be referred to the ENT emergency clinic. This type of fracture can be corrected under local anaesthetic within 2-3 weeks of the injury.

      Facial bone x-rays are not useful in diagnosing nasal bone fractures.

      If the patient has only experienced simple epistaxis without any other nasal injury, Naseptin may be appropriate.

      If there is a septal deviation, routine ENT referral may be necessary. However, if there is any uncertainty, it is best to seek advice from an ENT specialist.

      Nasal Septal Haematoma: A Complication of Nasal Trauma

      Nasal septal haematoma is a serious complication that can occur after even minor nasal trauma. It is characterized by the accumulation of blood between the septal cartilage and the perichondrium. The most common symptom is nasal obstruction, but pain and rhinorrhoea may also be present. On examination, a bilateral, red swelling arising from the nasal septum is typically seen. It is important to differentiate this from a deviated septum, which will be firm upon probing.

      Prompt treatment is necessary to prevent irreversible septal necrosis, which can occur within 3-4 days if left untreated. This is caused by pressure-related ischaemia of the cartilage, leading to necrosis and potentially resulting in a ‘saddle-nose’ deformity. Management typically involves surgical drainage and intravenous antibiotics. It is crucial to be aware of this complication and to promptly seek medical attention if nasal trauma occurs.

    • This question is part of the following fields:

      • Ear, Nose And Throat, Speech And Hearing
      0
      Seconds
  • Question 16 - A 55-year-old smoker presents with a persistent hoarse voice for the past three...

    Incorrect

    • A 55-year-old smoker presents with a persistent hoarse voice for the past three to four weeks. He saw a colleague two weeks ago who found nothing focal on examination and advised him to seek review if his hoarseness did not settle after a further week. He has no significant past medical history, is not on any regular medication, and has no known drug allergies. He denies any cough, haemoptysis, swallowing problems, weight loss, or any systemic unwellness. Clinical examination reveals no anaemia, clubbing, lymphadenopathy or neck masses. His chest sounds clear, and an urgent chest x-ray is reported as 'normal'. What is the most appropriate next step in this patient's management?

      Your Answer:

      Correct Answer: Refer urgently to an ear, nose and throat specialist

      Explanation:

      Recognizing and Referring Suspected Cancer: The Case of a Persisting Hoarse Voice

      The NICE guidelines on recognizing and referring suspected cancer do not provide a specific time period for what constitutes persistent symptoms. However, most references suggest that further action should be taken if hoarseness persists for three or more weeks. This could indicate a laryngeal cancer or a lung tumor that has infiltrated the recurrent laryngeal nerve. In such cases, an urgent chest x-ray may help direct referral.

      If the chest x-ray is normal, urgent referral to an ENT (or head and neck) specialist is needed to investigate the persisting hoarse voice. However, if the chest x-ray is abnormal and suggestive of lung malignancy, urgent referral to a lung cancer specialist is warranted.

      In summary, recognizing and referring suspected cancer is crucial in cases of persisting hoarseness. While the NICE guidelines do not provide a specific time period for what constitutes persistent symptoms, most references suggest that three or more weeks of hoarseness warrants further action. A normal chest x-ray requires urgent referral to an ENT (or head and neck) specialist, while an abnormal chest x-ray warrants urgent referral to a lung cancer specialist.

    • This question is part of the following fields:

      • Ear, Nose And Throat, Speech And Hearing
      0
      Seconds
  • Question 17 - A 9-year-old girl undergoes pinnaplasty.
    What is the most significant risk of the surgery...

    Incorrect

    • A 9-year-old girl undergoes pinnaplasty.
      What is the most significant risk of the surgery that should be discussed with her parents?

      Your Answer:

      Correct Answer: Imperfect result

      Explanation:

      Pinnaplasty: A Solution for Congenitally Prominent Ears

      Congenitally prominent ears can have a significant impact on a child’s emotional and behavioral well-being. Pinnaplasty, also known as otoplasty, is a surgical procedure that aims to improve the appearance of the auricle. It is typically performed on children between the ages of 5 and 14, but can be done at any age.

      During the procedure, an incision is made behind the ear in the natural fold where the ear meets the head. The necessary amount of cartilage and skin is removed to achieve the desired effect. In some cases, the cartilage may also be trimmed and reshaped before being pinned back with permanent stitches.

      While pinnaplasty is generally safe, incomplete correction of prominent ears is the most common undesirable outcome. Other potential complications include postoperative bleeding or fluid accumulation, infection, and scarring.

      It’s important to note that pinnaplasty only addresses the external ear and doesn’t involve the middle ear or eardrum. As such, other complications are unlikely to occur. Overall, pinnaplasty can be an effective solution for those seeking to improve the appearance of congenitally prominent ears.

    • This question is part of the following fields:

      • Ear, Nose And Throat, Speech And Hearing
      0
      Seconds
  • Question 18 - A 50-year-old woman comes to her General Practitioner with concerns about a lump...

    Incorrect

    • A 50-year-old woman comes to her General Practitioner with concerns about a lump in her throat that she has been feeling for the past six months. She reports feeling the lump even when she is not swallowing. Upon examination, her oropharynx, ears, nose, and neck appear normal. She is also a non-smoker.
      What would be a significant cause for worry in a patient with these symptoms who is 50 years old?

      Your Answer:

      Correct Answer: Left-sided ear pain

      Explanation:

      Understanding Unilateral Ear Pain and Globus Sensation

      Unilateral ear pain in adults with normal otoscopy findings may indicate cancer of the base of the tongue, especially if accompanied by persistent hoarseness, dysphagia, weight loss, or a swelling in the neck. Risk factors for head and neck cancers include smoking and alcohol consumption. However, if the pain is worse between meals and eating or drinking alleviates the symptoms, it is more likely to be globus sensation, which is the feeling of a lump in the throat that doesn’t affect swallowing function. If the symptom persists for six months without affecting swallowing, it is less likely to be a worrying cause such as laryngeal or esophageal cancer. Intermittent symptoms are also less likely to indicate a malignant cause, as they are typical for globus and often exacerbated by stress.

    • This question is part of the following fields:

      • Ear, Nose And Throat, Speech And Hearing
      0
      Seconds
  • Question 19 - A 25-year-old patient presents to you with concerns about burning and irritation of...

    Incorrect

    • 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?

      Your Answer:

      Correct Answer: Geographic tongue

      Explanation:

      Common Oral Conditions and Their Symptoms

      Geographic tongue is a common oral condition that presents with mild burning and irritation of the tongue. It is characterized by single or multiple well-demarcated irregular but smooth red plaques on the dorsum of the tongue. Stress and spicy food may exacerbate the condition.

      Angular chelitis, on the other hand, presents with irritation of the corners of the lips and dryness. Aphthous stomatitis describes solitary or multiple painful ulcers on the mucosal membranes. Oral hairy leukoplakia is an asymptomatic white thickening and accentuation of the folds of the lateral margins of the tongue.

      Lastly, acute necrotising ulcerative gingivitis presents with punched-out ulcers, necrosis, and bleeding of areas between teeth. It is important to be aware of these common oral conditions and their symptoms to seek appropriate management and treatment.

    • This question is part of the following fields:

      • Ear, Nose And Throat, Speech And Hearing
      0
      Seconds
  • Question 20 - A 6-year-old boy comes to you complaining of sudden and severe pain in...

    Incorrect

    • A 6-year-old boy comes to you complaining of sudden and severe pain in his right ear after recently having an ear infection. During examination, you notice a perforated eardrum. He has a soccer game next week and is eager to play. What advice would you give him regarding this situation?

      Your Answer:

      Correct Answer: Avoid swimming until the perforation is completely healed

      Explanation:

      It is recommended to refrain from swimming until a perforated tympanic membrane has fully healed, which typically takes longer than a week. Using a swimming cap may not offer adequate protection. Antibiotics should only be prescribed if there is an infection present, and oral antibiotics are preferred over drops.

      Perforated Tympanic Membrane: Causes and Management

      A perforated tympanic membrane, also known as a ruptured eardrum, is often caused by an infection but can also result from barotrauma or direct trauma. This condition can lead to hearing loss and increase the risk of otitis media.

      In most cases, no treatment is necessary as the tympanic membrane will typically heal on its own within 6-8 weeks. However, it is important to avoid getting water in the ear during this time. Antibiotics may be prescribed if the perforation occurs after an episode of acute otitis media. This approach is supported by the 2008 Respiratory Tract Infection Guidelines from NICE.

      If the tympanic membrane doesn’t heal by itself, myringoplasty may be performed. This surgical procedure involves repairing the perforation with a graft of tissue taken from another part of the body. With proper management, a perforated tympanic membrane can be successfully treated and hearing can be restored.

    • This question is part of the following fields:

      • Ear, Nose And Throat, Speech And Hearing
      0
      Seconds
  • Question 21 - A 42-year-old woman comes to the clinic with a left facial palsy. She...

    Incorrect

    • A 42-year-old woman comes to the clinic with a left facial palsy. She reports that the weakness developed gradually over a few days. She is waiting for a referral to the hospital for a nodular swelling in the left parotid salivary gland, suspected to be caused by a stone. Her husband is currently taking oral aciclovir for shingles.

      During the examination, a hard nodular mass is found over the tail of the left parotid gland, along with a lower motor neurone seventh nerve palsy.

      What is the most appropriate next step?

      Your Answer:

      Correct Answer: Urgent surgical referral

      Explanation:

      Parotid Tumour with Facial Palsy

      The presence of a hard, nodular mass over the tail of the parotid gland and facial palsy strongly suggest a parotid tumour with nerve infiltration. Urgent referral to a hospital for surgical review and possible biopsy under ultrasound guidance is necessary. Unfortunately, facial nerve function recovery is unlikely.

      There is no indication of zoster infection or underlying inflammation, so aciclovir and prednisolone are not appropriate treatments. Sialography is useful for investigating salivary gland ducts and stones, but not for neoplastic disease.

    • This question is part of the following fields:

      • Ear, Nose And Throat, Speech And Hearing
      0
      Seconds
  • Question 22 - A 4-year-old girl is brought to her General Practitioner by her parents because...

    Incorrect

    • A 4-year-old girl is brought to her General Practitioner by her parents because of concerns regarding her hearing. They have noticed she often doesn't respond when spoken to and seems to have difficulty following instructions. Three months ago, she presented with pain and discharge from her right ear and was treated with a course of amoxicillin.
      On examination, she is well. Both tympanic membranes are intact and have a grey appearance, with absent light reflexes.
      What is the single most likely diagnosis?

      Your Answer:

      Correct Answer: Otitis media with effusion

      Explanation:

      Differential diagnosis of hearing impairment in a child with grey eardrum and absent light reflexes

      Otitis media with effusion and other possible causes of conductive hearing loss

      The patient is a child who had received treatment for acute otitis media three months ago. The current presentation includes hearing impairment and a grey eardrum with absent light reflexes. Based on these findings, the most likely diagnosis is otitis media with effusion, which is a common sequelae of acute otitis media and a leading cause of hearing impairment in childhood. Other possible causes of conductive hearing loss include otosclerosis, cholesteatoma, and ossicular discontinuity.

      Otosclerosis is unlikely in this case because it typically presents in the early twenties and involves the fusion of the stapes with the cochlea, which is not evident on otoscopy. Cholesteatoma, on the other hand, would be visible as a perforation or retraction pocket of the tympanic membrane and requires referral to ENT specialists. Ossicular discontinuity is usually caused by trauma, which is not reported by the patient.

      Sensorineural hearing loss is another type of hearing impairment that results from damage to the hair cells in the cochlea or the vestibulocochlear nerve. However, this diagnosis is less likely in this case because the appearance of the eardrum is abnormal, indicating a conductive rather than a sensorineural problem.

    • This question is part of the following fields:

      • Ear, Nose And Throat, Speech And Hearing
      0
      Seconds
  • Question 23 - You see a 65-year-old man with vertigo. He describes the repeated sensation that...

    Incorrect

    • You see a 65-year-old man with vertigo. He describes the repeated sensation that his surroundings are spinning when he moves his head. This has been occurring for the last 2 weeks and the episodes last approximately 30 seconds. He has hypertension but no other past medical history. He had a viral illness 3 weeks ago. You believe the history is consistent with benign paroxysmal positional vertigo (BPPV).

      Which statement is correct regarding BPPV?

      Your Answer:

      Correct Answer: BPPV often has a relapsing and remitting course

      Explanation:

      BPPV can have a recurrent pattern of symptoms that come and go. To diagnose BPPV, the Dix-Hallpike maneuver is used, which can trigger vertigo and a specific type of eye movement called torsional upbeating nystagmus. Treatment for BPPV includes the Epley maneuver and Brandt-Daroff exercises, but medication is typically not effective. While many people recover from BPPV within a few weeks, symptoms can persist and return over time.

      Benign paroxysmal positional vertigo (BPPV) is a common cause of vertigo that occurs suddenly when there is a change in head position. It is more prevalent in individuals over the age of 55 and is less common in younger patients. Symptoms of BPPV include dizziness and vertigo, which can be accompanied by nausea. Each episode typically lasts for 10-20 seconds and can be triggered by rolling over in bed or looking upwards. A positive Dix-Hallpike manoeuvre, which is indicated by vertigo and rotatory nystagmus, can confirm the diagnosis of BPPV.

      Fortunately, BPPV has a good prognosis and usually resolves on its own within a few weeks to months. Treatment options include the Epley manoeuvre, which is successful in around 80% of cases, and vestibular rehabilitation exercises such as the Brandt-Daroff exercises. While medication such as Betahistine may be prescribed, it tends to have limited effectiveness. However, it is important to note that around half of individuals with BPPV may experience a recurrence of symptoms 3-5 years after their initial diagnosis.

    • This question is part of the following fields:

      • Ear, Nose And Throat, Speech And Hearing
      0
      Seconds
  • Question 24 - A 65-year-old woman comes to her doctor complaining of dizziness. She experiences sudden...

    Incorrect

    • A 65-year-old woman comes to her doctor complaining of dizziness. She experiences sudden onset dizziness and nausea when she rolls over in bed in the morning, which goes away after about 20 seconds if she keeps her head still. After these episodes, she feels unsteady and light-headed for several hours. The patient has a history of recurrent otitis media and her family has a history of otosclerosis.

      What is the most crucial initial test that needs to be done?

      Your Answer:

      Correct Answer: Dix-Hallpike manoeuvre

      Explanation:

      The presence of vertigo, tinnitus, and hearing loss are key indicators for the diagnosis of Meniere’s disease, which is a common cause of dizziness. Other factors such as recurrent otitis media and family history of otosclerosis may be misleading. Audiometry is a recommended test for Meniere’s disease, while CT head is useful for otosclerosis and MRI scan is the preferred diagnostic tool for acoustic neuroma.

      Benign paroxysmal positional vertigo (BPPV) is a common cause of vertigo that occurs suddenly when there is a change in head position. It is more prevalent in individuals over the age of 55 and is less common in younger patients. Symptoms of BPPV include dizziness and vertigo, which can be accompanied by nausea. Each episode typically lasts for 10-20 seconds and can be triggered by rolling over in bed or looking upwards. A positive Dix-Hallpike manoeuvre, which is indicated by vertigo and rotatory nystagmus, can confirm the diagnosis of BPPV.

      Fortunately, BPPV has a good prognosis and usually resolves on its own within a few weeks to months. Treatment options include the Epley manoeuvre, which is successful in around 80% of cases, and vestibular rehabilitation exercises such as the Brandt-Daroff exercises. While medication such as Betahistine may be prescribed, it tends to have limited effectiveness. However, it is important to note that around half of individuals with BPPV may experience a recurrence of symptoms 3-5 years after their initial diagnosis.

    • This question is part of the following fields:

      • Ear, Nose And Throat, Speech And Hearing
      0
      Seconds
  • Question 25 - A 41-year-old man presents to the surgery for the second time in the...

    Incorrect

    • A 41-year-old man presents to the surgery for the second time in the past month complaining of a severe sore throat. He has been prescribed a course of co-amoxiclav by your partner for suspected tonsillitis, but tells you this has had no impact on his symptoms. According to his records he has always had large tonsils and has been seen at the surgery for a number of episodes of tonsillitis over the past few years.

      On examination his temperature is 37.7°C, pulse is 70 bpm and regular, BP is 122/82 mmHg. There is some cervical lymphadenopathy. There is a large erythematous nodule on the right hand side of the tonsillar bed.

      What is the most appropriate next step?

      Your Answer:

      Correct Answer: Non-urgent referral for tonsillectomy

      Explanation:

      Unilateral Tonsillar Enlargement: A Red Flag for Tonsillar Lymphoma

      Unilateral tonsillar enlargement is a concerning symptom that may indicate tonsillar lymphoma. Delaying referral to an ENT specialist for biopsy can be detrimental to the patient’s health. Antibiotic therapy may not be effective in treating malignancy, and failure to respond to antibiotics may indicate underlying cancer. Patients with a history of smoking and alcohol consumption are at higher risk of tonsillar cancer, while those with recurrent tonsillitis may be more prone to tonsillar lymphoma.

      Other diagnostic options, such as full blood count and viscosity, may not be abnormal in early lymphoma, and non-urgent referral can cause a delay of several weeks before review by an ENT specialist. Therefore, it is crucial to promptly refer patients with unilateral tonsillar enlargement to an ENT specialist for further evaluation.

      The British Journal of General Practice (BJGP) published an article in November 2014 that provides a helpful table outlining the differences between acute tonsillitis and oropharyngeal carcinoma. This information can aid in the accurate diagnosis of tonsillar enlargement and prevent misdiagnosis.

    • This question is part of the following fields:

      • Ear, Nose And Throat, Speech And Hearing
      0
      Seconds
  • Question 26 - A 36-year-old woman has been receiving treatment for the past three weeks for...

    Incorrect

    • A 36-year-old woman has been receiving treatment for the past three weeks for otitis externa with flumetasone/clioquinol 0.02%/1%, followed by gentamicin 0.3% w/v and hydrocortisone acetate 1% ear drops. She acquired the condition while on vacation in Spain. She is now experiencing increasing itchiness in her ears. During examination, her ears have abundant discharge with black spots on a white background. What is the most appropriate next step in managing this patient?

      Your Answer:

      Correct Answer: Clotrimazole solution

      Explanation:

      Treatment Options for Fungal Otitis Externa

      Fungal otitis externa is a common ear infection that can be difficult to diagnose and treat. Patients who have had prolonged courses of steroid and antibiotic drops are particularly susceptible to this type of infection. Symptoms include pruritus and discharge, which may not respond to antibiotics. The most common fungal agents are Aspergillus and Candida, which can be treated with topical clotrimazole. Topical ciprofloxacin is not effective against fungal infections, and co-amoxiclav tablets should not be used. Sofradex® ear drops, which contain steroids, may exacerbate symptoms. If initial treatment with antifungal medication is unsuccessful, referral to an Ear, Nose and Throat specialist may be necessary for further evaluation and treatment.

    • This question is part of the following fields:

      • Ear, Nose And Throat, Speech And Hearing
      0
      Seconds
  • Question 27 - A 50-year-old chef presents for a follow-up appointment after experiencing a left-sided Bell's...

    Incorrect

    • 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.

    • This question is part of the following fields:

      • Ear, Nose And Throat, Speech And Hearing
      0
      Seconds
  • Question 28 - A 63-year-old man comes to the clinic with his wife for evaluation. He...

    Incorrect

    • 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.

    • This question is part of the following fields:

      • Ear, Nose And Throat, Speech And Hearing
      0
      Seconds
  • Question 29 - A child presents with an inability to swallow, a ‘hot potato’ voice and...

    Incorrect

    • A child presents with an inability to swallow, a ‘hot potato’ voice and an asymmetrical tonsillitis.
      What is the most effective treatment?

      Your Answer:

      Correct Answer: Drainage of abscess

      Explanation:

      Treatment for Quinsy: Drainage, Antibiotics, and Corticosteroids

      Quinsy, also known as peritonsillar abscess, is a serious complication of tonsillitis that requires urgent treatment. Symptoms include a displaced uvula, enlarged oropharynx, and a hot potato voice. The recommended treatment involves drainage of the abscess via needle and scalpel incision, followed by antibiotics such as penicillin, cephalosporins, co-amoxiclav, or clindamycin. In some cases, intravenous corticosteroids may also be beneficial. Watchful waiting is not recommended, as the infection can spread and lead to serious complications. Prompt treatment is necessary to prevent aspiration, airway obstruction, and other life-threatening complications.

    • This question is part of the following fields:

      • Ear, Nose And Throat, Speech And Hearing
      0
      Seconds
  • Question 30 - Ramsey Hunt syndrome ...

    Incorrect

    • 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.

    • This question is part of the following fields:

      • Ear, Nose And Throat, Speech And Hearing
      0
      Seconds

SESSION STATS - PERFORMANCE PER SPECIALTY

Ear, Nose And Throat, Speech And Hearing (0/1) 0%
Passmed