ENT AKT

A 22 year old male is referred to the ENT clinic after he has reported six light nose bleeds from his left nostril in the last three weeks. On examination of his left nostril he is found to have a small visible bleeding point.

What would be the next MOST APPROPRIATE management choice from the list below? Select ONE option only.

A 35 year old male is referred to the ENT clinic, after reporting recurrent foul smelling discharge from his right ear for the last six weeks. His tuning fork tests show a conductive hearing loss on the affected side. On otoscopy you see the following:

What is the MOST LIKELY diagnosis? Select ONE option only.

Which part of the ear anatomy is electrically stimulated by a cochlear implant? Select ONE option only.

A 52 year old female reports mild discomfort and thickening of her gums. There are no other symptoms of note. On examination you note gingival hyperplasia. She is currently taking a few medications as she has an extensive past medical history. She thinks her symptoms started within a few weeks of stating a new medication.

Which ONE of the following medications is the MOST LIKELY cause? Select ONE option only.

A parent attends your clinic asking for some advice about her daughter’s acute viral tonsillitis, which was diagnosed yesterday.

According to NICE, how long should this illness last? Select ONE option only.

A 16 -month-old girl is brought to the surgery as her mother is concerned about her hearing.

Which ONE of the following conditions is LEAST associated with hearing problems in children? Select ONE option only.

A 33 year old male presents with a gradual loss of hearing in both ears over the last 12 months. He also reports some mild tinnitus. He has no past medical history and does not take any medications. He mentions his father suffered with hearing loss at a young age. His otoscopy examination is normal, but you do the Rinne’s test and Weber test and note he has a conductive hearing loss.

What is the MOST LIKELY diagnosis? Select ONE option only.

A 22 year old male is referred to the ENT clinic after he has reported six light nose bleeds from his left nostril in the last three weeks. On examination of his left nostril he is found to have a small visible bleeding point.

What would be the next MOST APPROPRIATE management choice from the list below? Select ONE option only.

A 45 year old male is referred to the ENT clinic to have a cochlear implant due to his sensorineural hearing loss.

Which part of the ear anatomy is electrically stimulated by a cochlear implant? Select ONE option only.

A 52 year old female reports mild discomfort and thickening of her gums. There are no other symptoms of note. On examination you note gingival hyperplasia. She is currently taking a few medications as she has an extensive past medical history. She thinks her symptoms started within a few weeks of stating a new medication.

Which ONE of the following medications is the MOST LIKELY cause? Select ONE option only.

A parent attends your clinic asking for some advice about her daughter’s acute viral tonsillitis, which was diagnosed yesterday.

According to NICE, how long should this illness last? Select ONE option only.

A 16 -month-old girl is brought to the surgery as her mother is concerned about her hearing.

Which ONE of the following conditions is LEAST associated with hearing problems in children? Select ONE option only.

A 7 year old girl attends your clinic with her father. Her father states that she has a midline neck lump that is painless. On examination it moves upwards on protrusion of the tongue.

What is the MOST LIKELY diagnosis? Select ONE option only.

A 27 year old male comes in to see you complaining of left sided hearing loss. He tell you his symptoms started while playing rugby on the weekend. He noted some mild clear discharge at the time. On examination Rinne’s test is louder when the tuning fork is placed on the left mastoid bone. The Weber’s test localises to the left ear. The otoscopy findings are shown below.

What is the MOST LIKELY diagnosis? Select ONE option only.

———–

A 49 year old male presents with a 2 day history of vertigo which is triggered by looking over his shoulders. His symptoms last for a few seconds before resolving. His ENT examination, heart sounds, pulse and lying and standing blood pressure are all normal. You suspect benign paroxysmal positional vertigo.

Which ONE option below would be the best option to MANAGE this condition? Select ONE option only.

A 26 year old female presents with mild episodes of recurrent sneezing, nasal itching, nasal discharge and nasal congestion in both of her nostrils. She tends to get the symptoms during late spring and early summer every year. Her ENT examination today is normal. You suspect allergic rhinitis. She has tried some self help measures with no response noted.

What would be the MOST APPROPRIATE drug treatment option? Select ONE option only.

A 22 year old female attends your clinic in April stating that each year she experiences a runny nose and repeated episodes of sneezing whenever she goes outside. You note from her records that she had a background of asthma. She prefers to avoid tablets if possible.

What is the MOST APPROPRIATE treatment? Select ONE option only.

A 29 year old male presents with a 5 month history of pain along both of his temporomandibular joints, which happens when he yawns or chews food. He also mentions a clicking sound when opening and closing his jaw. He has no history of trauma. On examination today he has an audible click on opening and closing his mouth and some pain over both masseter muscles to deep palpation. You suspect a temporomandibular disorder.

Which ONE of the following medications may be given to a patient with a CHRONIC temporomandibular disorder? Select ONE option only.

A 49 year old lady presents with a 3 day history of vertigo and tinnitus which can last a few hours. She has previously seen ENT and been diagnosed with Meniere’s disease. She used to be on a medication to help prevent the attacks.

Which ONE of the following medications is most suitable to PREVENT her vertigo attacks? Select ONE option only.

A 37 year old female presents with right ear pain, and a right sided facial droop. On examination you note her right sided facial droop, she is unable to smile and she has several vesicles in her right ear canal. Her neurological limb examination and pupillary reactions are normal.

What is the MOST LIKELY diagnosis? Select ONE option only.

A 29 year old lady asks you to have a look at her tongue (shown below) it has been like this for sometime. She occasionally gets a burning feeling in her tongue after eating certain foods.

What is the MOST LIKELY diagnosis? Select ONE option only.

A 74 year old male presents with his wife. Over the last few months he has noted dysphagia, regurgitation of food, chronic cough, a feeling he has a lump in his throat and his wife mentions he suffers from halitosis. He has no other symptoms of note. He is a non smoker. Examination of his neck and abdomen is normal.

What is the MOST LIKELY diagnosis? Select ONE option only.

A 38 year old man attends your clinic with a 3 month history of ongoing vertigo, tinnitus and hearing loss in the left ear. On examination you notice an absent corneal reflex on the left side.

What is the MOST LIKELY diagnosis? Select ONE option only.

A 64 year old lady presents with a 6 month history of deafness affecting her left ear. She has had intermittent episodes of vertigo, tinnitus and vomiting each lasting a few hours. The whispered voice test is diminished in her left ear. You perform a tuning fork test.

Which is the SINGLE MOST likely result of the tuning fork tests? Select ONE option only.

A 4 year old girl presents with a right sided earache and some yellowish foul smelling discharge. On examination you note a perforation at the attic and a conductive hearing loss. She previously had some grommets inserted into both ears for recurrent ear infections.

What is the MOST LIKELY diagnosis? Select ONE option only.

A 27 year old male presents with a 4cm neck mass anterior to the sternocleido-mastoid muscle on the left side in its upper third. He states that the swelling has been treated with antibiotics for infection in the past but has never gone away. There are no other signs or symptoms of note.

What is the MOST LIKELY cause? Select ONE option only.

A 34 year old man attends your clinic for a review, following a nasendoscopy due to recurrent voice hoarseness. The report from the ENT specialist states that the left vocal cord was immobile.

What is the MOST LIKELY diagnosis? Select ONE option only.

A 44 year old lady with a background of a neck goitre, develops sudden onset breathlessness and stridor.

What is the MOST LIKELY diagnosis? Select ONE option only.

A 21 year old singer attends your clinic with an 8 week history of voice loss. He thinks this might be related to the thyroid surgery he had 3 months ago.

Which nerve has MOST likely been affected? Select ONE option only

A 42 year old man attends your clinic. He states that he is being investigated for obstructive sleep apnoea. He would like some advice on driving. He states that he does not get drowsy when driving, although he does drink a lot of coffee.

What is the MOST APPROPRIATE advice to give? Select ONE option only.

A 10 year old boy attends your clinic for 2 episodes of nose bleeds. The bleeding has just restarted again, as he enters your clinic.

What measure should be taken to stop the bleeding? Select ONE option only.

A 70 year old man presents with a 4 week history of a left sided neck lump which is gradually getting worse. On examination you note a pulsatile mass on the left side of his neck. It does not move up or down when you ask him to protrude his tongue or swallow.

What is the MOST LIKELY diagnosis? Select ONE option only.

A 4 year old boy attends your clinic with his father, who is concerned about a lump in the neck. On examination you note a midline lump in the neck which moves up on swallowing.

What is the MOST likely diagnosis? Select ONE option only.

A 22 year old man attends your clinic as he is concerned about a slow growing, painless lump in the left side of his neck over the last 6 months. On examination you note a fluctuant lump on the left side of the neck between the upper third and lower two thirds of the anterior border of the sternomastoid.

What is the MOST LIKELY diagnosis? Select ONE option only.

Which ONE of the following tests can be best used to assess for benign paroxysmal positional vertigo? Select ONE option only.

A 40 year old lady attends your clinic with a 3 month history of a diffuse neck lump that moves upwards on swallowing.

What is the MOST LIKELY diagnosis? Select ONE option only.

A 7 year old boy attends your clinic with his mother. She says he has had gradual hearing loss over the last 2 months. He is otherwise well and has no other symptoms of note. On examination, both ear canals are clear but the tympanic membranes appear dull. You suspect a diagnosis of glue ear.

Which ONE of the following is NOT a recommended management option? Select ONE option only.

Which ONE of the following is NOT a risk factor for ‘otitis media with effusion’? Select ONE option only.

Which ONE of the following is NOT part of the Centor criteria? Select ONE option only.

A 7 year old girl attends your clinic with her mother. Her mother states that she had a nose bleed from the left nostril earlier today that lasted about 5 minutes, before it stopped spontaneously. There is no other history of note and your examination is unremarkable.

Which ONE of the following statements should be recommended to the mother as advice? Select ONE option only.

A 6 year old girl is brought in by her dad. She presents with a 3 week history of left sided earache. On examination she has a temperature of 38.7oC, a pulse rate of 125, and a red, bulging, left tympanic membrane. You also notice the following behind her ear, which is very tender to touch.

What is the MOST likely diagnosis? Select ONE option only.

An 80 year old male attends your clinic with a three month history of dysphagia, regurgitation, cough and halitosis. On examination you note a midline lump which gurgles on palpation.

What is the MOST LIKELY diagnosis? Select ONE option only.

A 33 year old woman presents with a widespread erythematous rash over her chest and abdomen following a course of antibiotics for a 2 week history of a severe sore throat associated with fevers and enlarged neck glands.

Which ANTIBIOTIC has most likely caused this rash? Select ONE option only.

A 64 year old man attends your clinic with a two week history of right ear pain and fevers. On examination you are unable to insert the otoscope and notice the following:

What is the MOST LIKELY diagnosis? Select ONE option only.

A 19 year old Rugby player attends your clinic with a two day history of right ear pain. On examination you note the following:

What is the MOST LIKELY diagnosis? Select ONE option only.

A 65 year old man attends your clinic with a 1 day history of left ear pain and left sided facial paralysis. On examination you note the following:

What is the MOST likely diagnosis? Select ONE option only.

A 32 year old lady presents with hearing loss in both ears. Otoscopy examination is unremarkable. Rinnes test shows bone conduction is louder than air conduction on both sides. She tells you her mum and sister had a history of similar hearing loss.

What is the MOST LIKELY diagnosis? Select ONE option only.

A 41 year old man presents with a 3 day history of dizziness. This occurs whenever he looks upwards and the dizzyness lasts no more than 10 seconds. He has no other symptoms of note. On examination his otoscopy examination and cranial nerves are unremarkable.

What is the MOST likely diagnosis? Select ONE option only.

A 30 year old man presents with a 7 day history of dizziness on moving his head. It is associated with nausea and lasts 50 seconds. He has no other symptoms of note. On examination his otoscopy and cranial nerve examinations are unremarkable.

What is the MOST appropriate management option? Select ONE option only.

A 79 year old lady presents with severe pain, discharge and progressive hearing loss from her left ear. She was seen at the walk in centre 3 days ago and given a course of gentamicin ear drops. On examination you note a swollen left ear canal with some mild clear discharge, a temperature of 38.2 oC, pulse rate 100 and some tenderness in the bony structures around her left ear. Her past medical history includes type 2 diabetes.

What is the MOST LIKELY diagnosis? Select ONE option only.

A 32 year old lady presents with a three day history of a painful left ear. She has also noted some mild clear discharge. On examination you note a moderately inflamed left ear canal, with no discharge or debris noted. The tympanic membrane is just about visible, with no perforation noted. You suspect acute otitis externa.

What is the MOST APPROPRIATE management option? Select ONE option only.

A 29 year old man attends your clinic with a 5 day history of nausea and vertigo. He tells you he had a blocked nose and a sore throat a few days before it all started. He states that he had associated hearing loss and tinnitus in both ears. His otoscopy and general examination are normal.

What is the MOST LIKELY diagnosis? Select ONE option only.

A 32 year old male presents with recurrent nasal congestion, discharge and pain over his frontal sinuses. You suspect a sinus infection.

After how MANY WEEKS of symptoms would his sinusitis be classified as chronic sinusitis? Select ONE option only.

A 47 year-old male presents to his GP with a swelling on the right side of his face, which is excerbated by eating. On examination you note a small erythematous swelling on the right side of his face below his jaw, and their is a loss of the angle of his jaw on that side. His temperature is 37.8 and his pulse rate is 86. You note poor dental hygiene when examining his mouth.

Which is the MOST LIKELY diagnosis? Select ONE option only.

A 54 year old male, has been getting recurrent purulent ear discharge from his right ear for several weeks, which has not responded to 3 recent courses of antibiotics. On examination you note a deep retraction pocket in the tympanic membrane, with mild white discharge and some skin debris.

What is the MOST LIKELY diagnosis? Select ONE option only.

A 72 year old female presents with a 6 week history of recurrent pain and swelling over the right hand side of her face below her jaw which occurs after eating. She is fine at other times. Her observations and ENT examination today are normal.

What is the MOST LIKELY diagnosis? Select ONE option only.

An 18 month old boy is brought into children’s ED by his mother, as she has noticed recurrent foul smelling green discharge from his left nostril over the last 24 hours. On examination he is apryexial, 02 saturation’s are 98% on room air and the rest of his observations are normal. His left nostril is very congested and his right nostril is fine.

What is the MOST LIKELY diagnosis? Select ONE option only

A 27 year old lady has just returned from a holiday in Spain, and she has had ongoing pain and mild discharge from her right ear. She did a lot of swimming while away and does use cotton buds once or twice a week to clean her ears. On examination she has a swollen, red, and mildy eczematous ear canal. You diagnose her with otitis externa.

Which ONE ORGANISM listed below is MOST LIKELY to cause otitis externa? Select ONE option only.

A 5 year old boy is seen with his mother, she has noted a small tender neck lump which came up last week. He is otherwise well, and there is no family history of note. On examination you note a 1 cm slightly tender midline anterior neck swelling. The swelling moves upwards on tongue protrusion. His observations and general examination are normal.

What is the MOST LIKELY diagnosis? Select ONE option only.

A 27 year old male reports ongoing intermittent sneezing, nasal itching and congestion. He has tried various over the counter treatments. He seems to get the symptoms throughout spring and summer and they tend to ease off over winter. His ENT examination today is normal. You suspect allergic rhinitis.

What would be the MOST APPROPRIATE treatment for mild to moderate allergic rhinitis? Select ONE option only

A 24 year old lady comes into see her GP, with a three day history of a sore throat and croyzal symptoms. She thinks she has tonsillitis and would like to have some antibiotics. You begin to examine her to decide on the most appropriate management option.

Which ONE of the following features is NOT part of the centor criteria? Select ONE option only.

An 18 year old male comes to see you for some advice. He has had 2 nosebleeds from his left nostril in the last week. The last episode was yesterday and it lasted about 10 minutes. He is now completely well. He would like some first aid advice should it happen again. He has no past medical history of note.

Which ONE management option listed below would be the correct option to use should another nosebleed start? Select ONE option.

A 45 year old lady presents to her a GP with a 5 day history of rotational vertigo which lasts half a day, when the head is still and seems to get worse when she moves her head. She has just recovered from a 5 day cold. She has had some mild nausea but this has settled down today. She denies any hearing loss or tinnitus. On examination you note fine horizontal nystamgus but the rest of her ENT and neurological examinations are normal.

What is the MOST LIKELY diagnosis? Select ONE option only.

A 45 year old lady is reviewed in the ENT clinic and diagnosed with Meniere’s disease after ongoing vertigo and tinnitus for several weeks. Her audigram confimed a sensorineural hearing loss. She would like to start some medication to help prevent attacks.

Which ONE of the following medications can be used for the PREVENTION of Meniere’s disease attacks? Select ONE option only.

A 34 year old lady woke up this morning with right sided facial weakness, right ear pain, inability to close her right eye and difficulty chewing. On examination her pupils are equal and reactive to light, she has normal power/sensation/reflexes in her limbs, and her ears examination is normal. You can clearly see is unable to smile on the right side, her right eye is open, and her forehead is not spared. You suspect Bell’s palsy.

Within what TIME LIMIT should a course of steroids be considered in a patient with Bell’s palsy? Select ONE option only.

A 35 year old lady presents with weakness on the right side of her face, which developed in the past 24 hours. She is diagnosed with Bell’s palsy.

What is the mainstay of treatment for this condition? Select one option only.

A 6 year old boy attends your clinic with a history of breathing through his mouth, snoring at night and nasal speech. A working diagnosis of obstructive sleep apnoea is made.

What is the single most likely cause of sleep apnoea in this child? Select one option only.

d. Epiglottitis

A 28 year old woman complains of recurrent attacks of vertigo and nausea that last around 30 minutes to a few hours. They occur several times a week, but between attacks she is asymptomatic. She also reports some mild hearing loss in the left ear and a ‘roaring’ sound during acute spells.

What is the most appropriate treatment during an acute spell? Choose one option only

A 32 year old woman complains of recurrent attacks of vertigo and nausea that last around 30 minutes to a few hours. They occur several times a week, but between attacks she is asymptomatic. She also reports some mild hearing loss in the left ear and a ‘roaring’ sound during acute spells.

A 4 year old boy is rushed to A&E after he accidentally swallowed a piece of lego toy. On arrival to the department you can see that he is coughing and has severe stridor and a peri-arrest team is called. A few seconds later he loses consciousness and collapses.

What is the MOST APPROPRIATE management? Select ONE option only.

A 38 year old man presents with a 4 day history of dizziness on moving his head. It is associated with nausea and lasts about 20 seconds. He has no other symptoms of note. On examination his otoscopy and cranial nerve examinations are unremarkable. You suspect Benign Paroxysmal Positional Vertigo (BPPV).

Which ONE STRUCTURE listed below is MOST LIKELY to be effected? Select ONE option only.

A 27 year old female presents with recurrent right sided nose bleeds, which have been ongoing now for the last few weeks. They tend to settle after 10 minutes of first aid. She cannot think of any triggers.

What is the NAME given to the network of blood vessels easily damaged leading to a nose bleed? Select ONE option only.

A 16 year old girl presents with a sore throat and fevers. On examination you note she has bilateral tonsillar enlargement with exudate, palpable neck glands and a temperature of 38.6. You diagnose her with bacterial tonsillitis and start her on treatment. Her mother tells you she has had this a few times over the last two years and that she would like her to be referred for a tonsillectomy.

Which ONE criteria listed below would warrant a referral to ENT for consideration for a tonsillectomy? Select ONE option only.

A 9 year old girl attends your clinic with her mother. Her mother informs you that her daughter has been increasing the volume of the television to an excessive level over the last few weeks. She also informs you that she needs them to repeat herselves constantly. On examination, bone conduction is normal, but air conduction is reduced bilaterally

What is the most likely diagnosis? Choose one option only.

A 29 year old man with a background of asthma attends your clinic with bilateral nasal discharge and a feeling of the left nostril being blocked. He also complains of a reduced sense of smell.

What is the most likely diagnosis? Choose one option only.

A 24 year old female has noticed a gradual loss of hearing in both ears and some mild tinnitus over the last 6 months. She has no other symptoms of note. She does not take any medications and does not have any past medical history. She tells you that her father and one uncle had hearing loss which started at a young age. Her otoscopy examination is normal. Her rinne’s test and webers test confirm a conductive hearing loss.

What is the MOST LIKELY diagnosis? Select ONE option only.

A 33 year old female presents with a five month history of pain along both of her jaw angles. It happens when she yawns or chews food. She also mentions a clicking sound when opening and closing her mouth. She was seen by her a dentist a week ago who diagnosed her with a temporomandibular disorder. On examination today she has an audible click on opening and closing her mouth and some pain over both masseter muscles to deep palpation. You also suspect a temporomandibular disorder.

Which ONE of the following medications maybe given to a patient with a CHRONIC temporomandibular disorder? Select ONE option only.

A 50 year old man has a 9 month history of deafness affecting his left ear. He has had intermittent episodes of vertigo, tinnitus and vomiting each lasting a few hours. The whispered voice test is diminished in his left ear. You perform a tuning fork test.

Which is the SINGLE MOST likely result of the tuning fork tests? Select ONE option only.

A 48 year old man with severe hearing loss is offered a cohclear implant by the ENT specialists.

What is the mechanism of action for cochlear implants? Select ONE option only.

A 42 year old woman presents with dizzyness and left sided facial weakness. On examination, you find that she has a vesicular rash around her external auditory meatus and impaired hearing on her left side.

What is the most likely cause of these clinical findings? Select ONE answer only.

A 61 year old man complains of recurrent spontaneous attacks of hearing loss, vertigo and tinnitus. He tells you that the attacks usually last for up to 2 hours and are sometimes associated with vomiting.

What is the most likely cause of these clinical findings? Select ONE answer only.

A 66 year old woman complains of vomiting, dizzyness and difficulty swallowing. You examine her and find that she has a loss of pain and temperature on the right side of her face and left sided miosis and ptosis.

What is the most likely cause of these clinical findings? Select ONE answer only.

A 49 year old man complains of dizzyness when getting out of bed, rolling over and bending over. On examination, you find that his hearing is normal.

What is the most likely cause of these clinical findings? Select ONE answer only.

Having suffered from symptoms of flu for several days, a 21 year old man presents with dizzyness. On examination his hearing appears to be normal.

What is the most likely cause of these clinical findings? Select ONE answer only.

A 72 year old lady presents with a mouth ulcer which has been present for 5 weeks. She has tried two treatments from her chemist to no effect. She is a non smoker with no other past medical or family history of note.

What would be the MOST APPROPRIATE management option? Select ONE option only