ENT 👂👃

A 34 year old man presents with right sided facial pain felt as upper jaw pain and located at the skin of the right cheek. He gives a history of having a cold 3 days ago. He feels tenderness at the anterior wall below the inferior orbital margin. What is the SINGLE most likely diagnosis?

A 15 year old boy is seen in the GP surgery for an episode of sore throat. He has been having a fever for the past 2 days. He denies any cough. He has no significant medical history. He has a temperature of 38.5°C and a heart rate of 80 beats/minute. A picture of his throat can be seen below:

What is the SINGLE most appropriate medication?

A 15 year old boy is seen in the GP surgery for an episode of sore throat. He has been having a fever for the past 2 days. He denies any cough. He has no significant medical history. He has a temperature of 38.5°C and a heart rate of 80 beats/minute. A picture of his throat can be seen below:

What is the SINGLE most appropriate medication?

A 27 year old man had a fly enter his ear. He is anxious to get the fly removed. He can feel the fly buzzing in his ear. What is the SINGLE most appropriate next step?

A 7 year old boy is brought to the GP surgery by his mother. She says he is always turning up the TV volume and she has to shout to get his attention. There have been recurrent ear infections in the past which were resolved by medication. On examination, a bulging drum is noticed. There is no ear pain or fever. An audiogram reveals a mild bilateral conductive hearing loss. What is the SINGLE most appropriate management?

A 69 year old man is brought to the clinic by his family as they are concerned that he is not hearing well. The family report that the patient expresses a decreased ability to understand speech. He finds hearing difficult, especially in noisy environments. Examination of the eardrum is normal. A pure-tone audiogram reveals a sensorineural hearing loss that is bilateral and worse at high frequencies. What is the SINGLE most likely diagnosis?

A 38 year old man presents with longstanding foul-smelling purulent ear discharge and progressive hearing loss of his right ear. He also suffers from tinnitus on that same ear. The discharge has persisted despite two courses of antibiotic ear drops and a course of oral antibiotics. He has a childhood history of recurrent otitis media. Examination reveals a conductive hearing loss. There is a large amount of keratin accumulation at the upper part of the tympanic membrane. What is the SINGLE most likely diagnosis?

A 56 year old man presents to his GP with severe pain in the right ear, headache and discharge from that ear that started several days ago. He has difficulty hearing in his right ear. He takes immunosuppressants for a renal transplant. On examination, there is a foul-smelling discharge coming from the ear. There is post-auricular swelling and erythema. There is a loss of post-auricular sulcus. He has a temperature of 38.7°C, heart rate of 90 beats/minute, and blood pressure of 130/80 mmHg. What is the SINGLE appropriate management?

A 12 year old boy presents with right sided hearing loss and facial drooping on the right side. He has a headache and feels dizzy. On examination, both ears appear normal with an intact eardrum. Rinne’s test was found to be normal. Weber test lateralized to the left. What is the SINGLE most likely diagnosis?

A 55 year old man presented to the Emergency Department complaining of a nose bleed for the past 3 hours which began while he was reading the newspaper. He reveals that he had been diagnosed with atrial fibrillation a year ago and is on warfarin for the same. On examination, the patient’s heart rate is 90 beats/minute, and blood pressure is 100/70 mmHg. He is actively bleeding and the site of the bleeder cannot be visualised. You advise him to pinch the lower part of his nose while leaning forward for about 15-20 minutes as well as applying an ice pack for the same duration, neither of which are successful in controlling the bleeding. Which of the following is the most appropriate next step in the management of this patient?

A 10 year old child developed fever, severe earache and tonsillitis following an upper respiratory tract infection. On otoscopy, the tympanic membrane is distinctly red. What is the most likely diagnosis?

A 7 year old boy presents with a fever, severe ear ache, and vomiting. Tonsillitis was noted on examination. Otoscopy reveals a red bulging tympanic membrane. His temperature is 38.5°C. On examination, cervical lymphadenopathy was palpated. What is the SINGLE most likely diagnosis?

A 21 year old man presents to the GP surgery with a history of a sore throat worsening over the past three days. He finds it painful to swallow. Examination reveals a unilateral bulge, above and lateral to his left tonsil. The bulge was noted to be red and inflamed and has deviated the uvula. He has a temperature of 38°C. What is the SINGLE most appropriate management?

61 year old woman has episodes of vertigo, tinnitus and fluctuating hearing loss. During the episodes, she becomes nauseated and vomits. She complains of a sensation of ear pressure which occurs before and during the vertigo attack. The attacks can last a few hours and occur in clusters over a few weeks. She feels well between attacks. On examination, she has healthy tympanic membranes on both ears. Her recent MRI scan shows no abnormal masses in the cerebellopontine angle. What is the SINGLE most appropriate treatment during attacks?

A 60 year old man has had progressive difficulty in breathing through his nostrils over the past few months. He describes a reduction in sense of smell. He denies any nasal discharge or bleeding. He has no significant medical history besides asthma. On examination, he has multiple small pedunculated polyps on both nostrils. What is the appropriate management?

A 29 year old diabetic woman presents to her GP surgery with a history of gradual worsening pain in the left ear for the past 5 days. She denies hearing lass. On examination, there is a small, red, tender mass at the outer third of the external canal. Insertion of the otoscope causes severe localised pain. There is no discharge seen. What is the SINGLE most likely diagnosis?

An autistic 8 year old child is seen in the ENT clinic after inserting a green pea in his ear while eating. Otoscopy shows a green coloured object in the ear canal. What is the SINGLE most appropriate approach to remove the green pea?

A 52 year old male with poorly controlled diabetes mellitus presents to his GP with severe pain in the ear and an intense headache. On examination, his skin around the ear is black in colour and there is a foul smelling discharge coming from the ear. He is also noted to have conductive hearing loss. Examination of the cranial nerves reveal a facial nerve palsy. What is the SINGLE most likely diagnosis?

A 52 year old woman has intermittent vertigo, tinnitus and fluctuating hearing loss. She complains of a sensation of ear pressure. The attacks can last for 2 to 3 hours. A MRI scan of the cerebellopontine angles was reported as normal. What is the SINGLE most appropriate treatment?

A 6 year old child presents to the Emergency Department with haematemesis following a tonsillectomy 8 hours ago. Clots are seen in his oral cavity. An estimated 3 cups of blood has been coughed up. He was started on intravenous fluids. He looks pale but his observations are stable and his temperature is 36.7°C. What is the SINGLE most appropriate management?

A 45 year old truck driver attends the sleep centre after being referred by his GP for having episodes of dazing off when driving. He awakes immediately once he realises he is about to fall asleep and has never had an accident. He snores loudly at night. He often has morning headaches that go away after a few hours. He has a BMI of 31 kg/m2. What is the SINGLE most likely diagnosis?

A 5 year old boy attends the Paediatric Emergency Department with his mother for a stuck pea in his right ear canal. He was eating dinner an hour ago and inserted a pea in his right ear. On examination, there is a small pea deep in the external ear canal with wax that is obstructing the tympanic membrane. What is the most appropriate next step?

A 50 year old man presented to the GP with a history of severe headaches, daytime sleepiness and tiredness in the morning. He is worried that he has been sleeping excessively during the day even at his workplace and it has been affecting his job as a typist. He falls asleep while working on his computer on occasion in the morning. He has early morning headaches which fade away by afternoon. His wife has noticed that he snores very loudly, makes gasping or snorting noises and has a very disturbed sleep. He does not have any strange dreams. He says he has no problems driving his car and has never lost any control. On examination, his heart rate is 85 beats/minute, blood pressure is 110/70 mmHg and respiratory rate is 16 breaths/minute. His BMI is 32 kg/m2. He does not exercise and eats mainly fast food everyday. What is the SINGLE most likely diagnosis?

An 5 year old boy was brought by his mother complaining that her child seems to be watching the television at very high volumes. He lacks concentration and is socially withdrawn. He would prefer to read books indoors rather than play outdoors. What is the SINGLE most likely finding to be expected on an otoscopy?

A 28 year old man presents to the Emergency Department with a history of a unilateral sore throat worsening over the past three days. The pain has spread to his left ear and he has difficulty swallowing. Examination reveals a unilateral bulge, above and lateral to his left tonsil. The bulge was noted to be red and inflamed and has deviated the uvula. He has a hot potato voice. The examination of the oral cavity is difficult as he has mild trismus. What is the SINGLE most appropriate management?

A 5 year old boy presents to the GP surgery with his mother with a history of recurrent episodes of sore throat. His mother reports that he has already had three episodes of sore throat in the past 24 months. His episodes are disabling and can last for 7 to 10 days. During the episodes, he is unable to eat and drink well and has to stay home from school. His tonsils are large. He snares loudly and his mother complains that he often has temporary cessation of breathing during sleep. What is the SINGLE most appropriate management?

A 45 year old man with a 25 year history of smoking presents with progressive hoarseness of voice over 4 weeks. He describes difficulty swallowing and occasional episodes of haemoptysis. He mentioned that he used to be a regular cannabis user. What is the SINGLE most likely diagnosis?

A 7 year old boy presents to the clinic with difficulty in hearing. He is inattentive and his hearing fluctuates. He has a history of two ear infections in the past which self-resolved. There is no pain in his ears. Both his parents smoke. On examination, his tympanic membrane is grey and slightly retracted bilaterally. Bone conduction is normal, air conduction is reduced bilaterally, and there is no lateralization in Weber’s test. Audiogram reveals a bilateral hearing loss of 20dB. What is the SINGLE most appropriate action?

A 11 year old girl presents to the clinic with hoarseness of voice. She is a known case of bronchial asthma and has been on oral steroids for half a year. What is the SINGLE most likely cause of her hoarseness of voice?

A 33 year old tennis player has to stop playing tennis competitively because she has recurrent vertigo attacks every time she plays tennis. The vertigo attacks started after a history of a runny nose, cough and fever. Her hearing is not affected. What is the SINGLE most likely diagnosis?

A 17 year old man presents with a sore throat for several days and dysphagia. Examination reveals a unilateral bulge, above and lateral to his left tonsil. The bulge was noted to be red and inflamed. The examination of the oral cavity was proven to be difficult as he had mild trismus. Drooling of the saliva was seen. What is the SINGLE most appropriate management?

A 55 year old man presents with unilateral swelling at the angle of the mandible which is progressively increasing in size over the past 6 months. It is painless, firm and mobile. What is the SINGLE most likely diagnosis?

A 15 year old boy is seen with his mother in the GP surgery for an episode of sare throat. He started having a sore throat 4 days ago. He has been coughing. He finds drinking water and eating more difficult because of the throat pain. He has no significant medical history. He has a temperature of 38.1°C and a heart rate of 75 beats/minute. A picture of his throat can be seen below:

What is the SINGLE most appropriate medication?

A 5 year old child complains of sore throat and earache for the past 3 days. He has a temperature of 38.6°C. Examination shows enlarged, hyperemic tonsils with pus. He has no cough. He is not on any medication. What is the SINGLE most likely diagnosis?

A 66 year old male presents with painful swallowing. He describes it as a burning sensation that radiates to the back everytime he swallows fluid or food. What is the SINGLE most likely causative organism?

A 44 year old woman has been having dizziness and nausea for the past 3 weeks. She describes this as everything around her is spinning. They last for a few seconds but accur several times a day. It is worse when she moves her head or bends forward. Occasionally, the dizziness is so severe that she vomits. She denies any tinnitus, ear pain or hearing loss. Her blood pressure lying down is 131/88 mmHg and standing is 140/99 mmHg. Nystagmus is seen during the examination. What is the SINGLE most likely diagnosis?

A 58 year old man has developed intense pain in his right auricle over the past 2 weeks. He has swelling of the right pinna which has progressively worsened over time. He was initially examined and treated in the urgent care centre and was given a 7-day course of flucloxacillin however the infection continued to worsen. He reports no trauma to the ear. His hearing is not affected. He has a temperature of 38.1°C and a heart rate of 80 beats/minute. His right auricle is very tender to touch. A picture of both his ears are seen here:

What is the SINGLE most likely organism?

A 55 year old woman presents with sudden onset of severe vertigo. She has a 4 week history of intermittent dizziness. These episodes typically occur when she suddenly moves her head or roles in bed and are characterised by the sensation that the room is ‘spinning. Most attacks last a few seconds. Neurological examination is unremarkable. She is a known hypertensive who has been on ramipril for the last two years. What is the SINGLE most appropriate management?

A 4 year old girl presents with an anterior midline lump on her neck. It is painless, smooth and measures 1.5 cm. The swelling tends to move upwards when she protrudes her tongue. What is the SINGLE mast likely diagnosis?

A 48 year old postman attends the GP surgery with complaints of hoarseness of voice for the past 8 weeks. He also suffers from upper abdominal pain which has been present for several months. He regularly drinks an average of 21 units of alcohol a week. He has a 14 pack-year history of smoking. His abdominal discomfort is worse after meals especially when lying flat. He has a history of a hiatus hernia seen on an endoscopy 3 years ago. His observations are within normal limits. What is the SINGLE most appropriate action?

A 22 year old man is seen in the Emergency Department with a sore throat that has been worsening over the past week. He has a fever of 39.9°C. A large unilateral swelling of the soft palate is seen with exudates. The pain is worse on the right side of the throat. What is the most appropriate management?

A 5 year old boy is brought to the GP clinic by his mother with concerns of a lump in his neck. She noticed the lump a year ago but would like it to be checked as her friend recently died from thyroid cancer. On examination, the mass is midline, below the hyoid bone. The mass is soft and non-tender. It measures around 2 cm in diameter. The mass moves on tongue protrusion and swallowing. What is the SINGLE most likely diagnosis?

A 70 year old male presents to his general practitioner with the complaint of dysphagia. He describes a steady worsening of difficulty to swallow over a few weeks. The patient also complains of right sided ear pain. There is no significant past medical history of note and the patient does not take any long term medications. He is a heavy smoker and drinks around 8 units of alcohol a week. Examination of the patient’s oropharyngeal cavity reveals a 1 cm by 1 cm deep red lesion with central ulceration on the right palatine tonsil that bleeds upon touch. What is the SINGLE most likely diagnosis in this patient?

A 48 year old man has a lump on his mandible. It has rapidly increased in size over the past 8 months. On examination, there is an induration of the skin overlying the mass. The mass is free and mobile. What is the SINGLE most appropriate investigations?

A 61 year old man comes to the GP surgery complaining of decreased hearing in his left ear over a period of weeks. He denies any fever, pain, tinnitus or discharge. His tympanic membrane is obstructed with ear wax. A Rinne’s test shows bone conduction is better than air conduction in his left ear. What is the SINGLE most likely diagnosis?

A 3 year old girl attends the ENT clinic with her parents with left ear pain. She had stuck a small piece of a toy in her ear earlier today and could not remove it. She is crying, restless and holding her ear. She is difficult to examine as she pulls away. A difficult examination using otoscopy reveals the toy obstructing the tympanic membrane. What is the most appropriate next step?

A new mother presents to the paediatric clinic with her 6 month old son. She says that she is worried about his development since he does not respond to loud noises. His motor milestones are normal and the patient’s mother says that he vocalises well. The pregnancy and birth were unremarkable. What is the SINGLE best management strategy for this child?

A 72 year old man presents to the outpatient clinic with the complaint of a sore throat. He says that he has had a sore throat for over three weeks now and that the over the counter medication that he’s gotten from his local pharmacy is not helping. Upon further questioning, the patient reveals that he has difficulty and pain upon swallowing and his wife has noticed that his voice has gotten more hoarse over the course of the past three weeks. He says that when he tries to swallow, it feels like there’s a persistent lump in his throat. He has no neck pain, no ear pain and no history of weight loss. There is a 2 x 3 cm palpable lump on the anterolateral portion of his neck. What is the SINGLE most likely diagnosis in this patient?

An 8 year old boy who has recently returned from Spain complains of severe pain in one ear. On examination, pus is seen in the auditory canal. The tympanic membrane looks normal. What is the SINGLE most appropriate treatment to prescribe?

A 16 year old boy has recurrent nasal bleeding. He bleeds on his left nostril once a week. The bleeding usually stops after 10 minutes of pinching his nose firmly. There is no history of trauma. On examination, small amounts of erythema and crusting at the Little’s area of the left nostril are observed. There are no polyps. What is the SINGLE mast appropriate management?

A 31 year old man has decreased hearing in his left ear for the past 4 weeks. He denies any pain, fever or ear discharge. The picture below can be seen using an otoscope of his left ear:

Bone conduction is better than air conduction when tested on the left ear. Weber’s test lateralised to the affected ear. Amongst the options, which is the most appropriate action?

A 6 year old girl has a left earache for 4 days. The earache then subsided 2 hours ago with the onset of a purulent discharge which relieved the pain. Her temperature is 39.2°C. What is the SINGLE most appropriate antibiotic to prescribe?

A 46 year old man has a long history of chronic sinusitis. He feels that his nose is blocked and it does not clear and he occasionally sees blood when he blows his nose. He now presents with pressure in his upper teeth, recent cheek swelling, and double vision. On examination, left maxillary tenderness is noted along with epiphora of the left eye. What is the SINGLE most likely diagnosis?

A 29 year old rugby player obtains a traumatic hit to his right ear during a match. He presents to the Emergency Department with a large haematoma of the pinna of the right ear. The external auditory meatus and tympanic membrane look healthy without any visible trauma. There are no visible lacerations. His hearing in both ears is unaffected. What is the most appropriate management?

A 5 year old girl has a history of recurrent otitis media caused by enlarged adenoids. She develops heavy bleeding from her mouth and nose while in postoperative care after her adenoidectomy 12 hours ago. She has a heart rate of 140 beats/minute, blood pressure of 110/70 mmHg and respiratory rate of 20 breaths/minute. What would be the most appropriate management?

A 30 year old man was camping and an insect got stuck in his ear which he has been unable to remove. He complains that he can still hear the buzzing in the ear. On inspection, the insect is clearly visible in the ear canal. What is the SINGLE most appropriate initial management?

A 29 year old woman presents to the GP surgery with a headache, pain over her cheekbones and nasal blockage. She has to breathe through her mouth most of the time. Her symptoms started after a fever and cough a week ago. She is penicillin allergic. Her temperature taken today is 37.5°C. What is the SINGLE most appropriate treatment to offer this patient?

A 45 year old woman presents with rotational vertigo, nausea and vomiting which is worse when moving her head. She also had a similar episode 2 years ago. These episodes typically follow an event of a runny nose, cough and fever. Examination of the eardrums and cranial nerves are normal. What is the SINGLE most likely diagnosis?

A 25 year old man presents with a history of pain and swelling in the submandibular region that has been present for weeks. The pain is unilateral and more prominent during eating. The area is tender on palpation. What is the SINGLE most likely diagnosis?

A 5 year old girl has been increasing the volume of the television to an excessive level. Her parents complain that she needs them to repeat themselves constantly. On examination, bone conduction is normal, air conduction is reduced bilaterally. She is sent for an audiogram. What is the SINGLE most likely diagnosis?

A 7 year old boy is brought to the clinic by his mother. His mother complains that he has been getting in trouble in school because he is inattentive in class. The mother also mentions that he sits close to the television at home. These problems have been worsening gradually over the past 12 months. There is no pain or fever. Examination of his ears reveal a grey, retracted tympanic membrane bilaterally. An audiometry highlights conductive hearing loss at 30-dB with a tympanogram showing no peak (flattened curve). This was repeated 3 months later which showed similar findings. What is the SINGLE most appropriate management?

A 47 year old man has difficulty hearing on his right ear. Air conduction (AC) is better than bone conduction in both ears. The sound was localised towards the left side on Weber’s test. What is the SINGLE most likely diagnosis?

A 15 year old boy injured his right ear during a rugby match. He reports pain around the right pinna. On examination, the pinna of the right ear is red and tender. The tympanic membrane was found to be normal. What is the SINGLE most appropriate next step?

A 5 year old boy with Down syndrome attends the GP surgery with his mother with concerns regarding his hearing. The mother describes him as having to look at faces intently when people are speaking to him. He also lacks response when his name is called. He sits up close to the TV to listen to the sound. He is able to understand instructions and follow them. On examination, there is a diffuse light reflex on both tympanic membranes. What is the most appropriate test to perform?

A 63 year old woman complains of tinnitus and a ringing sound in her ears which have been ongoing for a few months. She describes it as hearing music but she is certain that no one is playing music around her. She denies hearing voices. She denies any visual hallucinations. She has no history of depression or psychosis. She has a normal neurological examination. She is alert and fully oriented. What would be the initial investigation to request?

A 33 year old patient has a 2 year history of progressive sensorineural hearing loss and loss of corneal reflex on the left side. He is noted to have reduced facial sensation on that same side. He also complains of tinnitus and vertigo. What is the SINGLE most definitive investigation?

A 6 year old boy was playing at home alone when he stuck super glue into his ear. His mother has brought him to A&E and is extremely concerned. On inspection, the adhesive is in contact with the tympanic membrane. What is the SINGLE most appropriate management?

A 6 year old boy attends the Paediatric Emergency Department with his mother and is seen by the paediatrician. He was playing in the playground when he stuck a seed into his ear 2 hours ago. His mother has been unable to remove it and the child remains to be in a calm manner. On inspection, the seed is clearly visible in the ear canal. What is the SINGLE most appropriate management?

A 45 year old man presents with progressive hoarseness. He has swollen vocal cords. He has a body mass index is 34 kg/m 2 and he smokes 20 cigarettes a day. He also drinks 2 pints of beer a day. He has been suffering from heartburn since he was mid twenties. His diet involves eating large amounts of red meat. Investigations reveal that he has laryngeal cancer. What is the SINGLE most likely cause of his cancer?

A 68 year old male presents with swelling in the lower pole of the parotid gland. This swelling has been slow growing for the past 7 years. On examination, the parotid gland is firm in consistency. What is the SINGLE most probable diagnosis?

A 41 year old woman, with no previous history of ear complaints, presents with a 6 day history of pain in the right ear which is extremely tender to examine. Prior to the onset of pain, she was complaining of itch and discharge in her right ear. She has reduced hearing in the right ear. On examination, there is tenderness with movement of the tragus. A picture of the auditory canal can be seen below:

What is the SINGLE most likely diagnosis?

A 6 year old down syndrome boy was playing at home alone when he stuck a small piece of toy into his ear. His mother has brought him to a GP clinic and is extremely concerned. On inspection, a small foreign object is visible in the ear canal. The child is uncooperative and does not understand why his mother has brought him here. What is the SINGLE most appropriate management?

A 17 year old woman, with no previous history of ear complaints, presents with a two day history of severe pain in the right ear which is extremely tender to examine. Prior to the onset of pain, she was complaining of itch in her right ear. On examination, there is tenderness with movement of the tragus. Otoscopy reveals a serous discharge seen in the auditory canal. What is the SINGLE most likely diagnosis?

A 44 year old man presents to the GP surgery with a 3-month history of intermittent purulent left ear discharge. The discharge is foul-smelling. He feels his left ear is blocked and cannot hear well out of the left ear. He has had two courses of topical antibiotics and one course of oral antibiotics but his symptoms still persist. He denies any fever. An image using an otoscope can be seen below:

What is the SINGLE most appropriate action?

Tim, a 7 year old boy, is accompanied by his mom. He is healthy and has no complaints at present, however, his mother has a few concerns that she was looking forward to discussing with you. She tells you that Tim had 3 episodes of tonsillitis in the past six months with the most recent episode being 2 weeks ago and is worried about the recurrent nature of this problem and its implications. What is the SINGLE best course of action?

A 45 year old man comes to your office complaining of dizzy spells which are associated with nausea. He mentions that these attacks occur when turning his head, he starts to perceive that the room is rotating, he almost loses his balance and feels like vomiting. Each attack lasts less than 20 seconds. On examination, a geotropic rotatory nystagmus which is fatigable is noted. His neurological examination is otherwise unremarkable. Hearing is normal. What structure is most likely affected?

A 48 year old woman presents with sudden onset of vertigo which started 2 weeks ago. The symptoms worsen when she lies down, turns in bed or bends over. The vertigo typically lasts 30 seconds followed by complete resolution. She has no hearing impairment. She does not have any tinnitus. A Dix-Hallpike manoeuvre is positive. What is the SINGLE most appropriate management?

A 2 year old boy has a discharge which comes out of his left nostril once or twice a day for the past 2 months. Over the past 2 weeks, the discharge has been coming out more frequent and has become foul-smelling. The discharge is not blood-stained. He does not describe facial pain. He has not been coughing. He has no visual problems. His medical history includes asthma. What is the SINGLE most likely diagnosis?

A 28 year old man has a headache that worsens on bending his head forward. He has no nausea or vomiting. The headache tends to be at its worst first thing in the morning and improves by the afternoon. He has been having these symptoms for 15 weeks. He complains of facial pressure and nasal congestion. What is the SINGLE most likely diagnosis?

A 28 year old man has a headache that worsens on bending his head forward. He has no nausea or vomiting. The headache tends to be at its worst first thing in the morning and improves by the afternoon. He has been having these symptoms for 15 weeks. He complains of facial pressure and nasal congestion. What is the SINGLE most likely diagnosis?

A 50 year old woman complains of dizziness, nausea, and anxiety which keeps coming from time to time. She notices that the attacks are associated with sudden change in pasture and these episodes last only a few seconds. The symptoms are worse in the morning when she gets out of bed. She describes the sensation as “the room spinning around her”. She takes indapamide and enalapril for her hypertension. Her sitting blood pressure in the clinic is 140/80 mmHg and standing is 135/75 mmHg. What is the SINGLE most likely diagnosis?

A 5 year old boy attends the GP surgery accompanied by his father with complaints of a right ear pain. The pain started 2 days ago together with a sore throat. There is no discharge coming out of the ear. He does not have a fever. He has no problems with hearing. On examination, there is a bulging erythematous tympanic membrane. His pharynx is erythematous and there are palpable submandibular lymph nodes. What is the SINGLE most likely diagnosis?

A 41 year old man presents with longstanding foul smelling brown ear discharge and progressive hearing loss of his right ear. The discharge has persisted despite three courses of antibiotic ear drops. Otoscopy shows perforation of the pars flaccida. A pearly white soft matter is seen at the posterior margin of the perforation. What is the SINGLE most likely diagnosis?

A 28 year old woman presents to the GP with complaints of nasal blockage and discharge. She says she has been feeling facial pressure over the past 2 weeks. She has a reduced sense of smell. She also complains of a frontal headache. Her nasal discharge is clear. On examination, she is tender over her cheekbones. She has a temperature of 37.8°C and a heart rate of 70 beats/minute. She has no relevant medical history. What is the SINGLE most appropriate treatment to start?

A 15 year old boy presents to the Emergency Department with a nose bleed. The bleeding started 3 hours ago and has not stopped. His blood pressure is 115/70 mmHg. heart rate is 80 bpm and respiratory rate is 18/min. What is the SINGLE most appropriate next course of action?

A 10 year old boy presents to his GP with a nose bleed. He is with his mother and they have not tried any first-aid measures yet. The bleeding started 1 hour ago and has not stopped. He is haemodynamically stable. What is the SINGLE most appropriate next course of action?

A 4 year old girl has a painful right ear. She is irritable and has been crying and coughing. She has a temperature of 38.8°C. Otoscopy reveals a tympanic membrane which appears red. There is no light reflex visible on the tympanic membrane. What is the SINGLE most likely diagnosis?

A 62 year old man with a long history of smoking and alcohol presents with nasal obstruction, and on and off nose bleeds. He has a noticeable lump on his upper neck. He is having difficulty hearing with his left ear and has had worsening ear pain in that ear. Examination reveals conductive hearing loss in the left ear. What is the SINGLE most likely diagnosis?

A 44 year old man presents with muffled hearing and constant high-frequency tinnitus. He also complains of the feeling of pressure in the right ear and vertigo. He has double vision when looking to the right. What is the SINGLE most likely diagnosis?

A 30 year old lady has epistaxis for 30 minutes. Blood results shows:

Haemoglobin 122 g/L

White cell count 8 x 10^9/L

Platelets 200 x 10^9/L

Prothrombin time (PT), Activated partial thromboplastin time (APTT) and bleeding time is normal

What is the SINGLE most likely cause of the bleed?

A 2 year old child is brought by his mother. The mother had hearing impairment in her early childhood and is now concerned about the child having a similar condition. What is the SINGLE best investigation to be done for the child?

A 5 year old boy is brought to the GP surgery by his mother. She says he is always turning up the TV volume, and she has to shout to get his attention. These events have been occurring over the past 2 months. There is no delay in the child reaching his milestones. On examination, a retracted tympanic membrane is seen in both ears. A Rinne’s test suggests that it is conductive hearing loss rather than sensorineural hearing loss. There is no ear pain or fever. What is the SINGLE most appropriate management?

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 year. Between attacks she is asymptomatic. She also reports a mild hearing loss in the left ear. What is the SINGLE most appropriate treatment??

A 35 year old woman has dull pain in her right ear which has been present for several weeks. The pain is located in front of the tragus of the right ear and spreads along the cheek and mandible. Chewing increases the pain. Her husband has mentioned that she grinds her teeth when she sleeps at night. The eardrum appears normal and there is no discharge. What is the SINGLE most likely diagnosis?

A 47 year old diabetic man is seen in the ENT clinic for follow up of his histopathology results. His histopathology results reveal mild squamous dysplasia of his larynx. His symptoms include hoarseness. A laryngoscope done on his last visit reveals a visible white patch seen over his vocal cords. He is a smoker. What is the SINGLE most appropriate action?

A 26 year old woman has become aware of an increasing right-sided hearing loss since her last pregnancy. On otoscopy, her eardrums look normal. Her hearing tests show bone conduction (BC) is better than air conduction (AC) in the right ear. Weber’s test lateralizes to the right ear. What is the SINGLE most likely diagnosis?

A 45 year old man has noticed difficulty hearing over the telephone. His hearing has been progressively getting worse over the last few years. He is concerned because his father has had similar problems around his age. Rinnes and Weber’s test demonstrate conductive hearing loss. An audiogram shows moderate hearing loss in both ears across all frequencies. What is the SINGLE most likely diagnosis?

An obese 55 year old man sees his GP for fatigue and daytime sleepiness. His wife states that he has excessive daytime sleepiness, snores loudly at night and occasionally abruptly awakens. He denies smoking and is a social drinker. He is a lorry driver. Examination of the oropharynx is normal. What is the most appropriate next step in the management of this patient?

A 45 year old man presents with hearing loss and tinnitus in the right ear. A 512 Hz tuning fork is used which highlights Rinne’s test having AC > BC bilaterally. Weber test lateralizes to the left. What is the SINGLE next best investigation?

A 22 year old woman has been having gradual hearing loss over a period a months during her pregnancy. She is now 30 weeks gestation. On otoscopy, her eardrums look normal. Her hearing tests show bone conduction (BC) is better than air conduction (AC) in both ears. Weber’s test does not lateralize. What is the SINGLE most likely diagnosis?

A 48 year old man has difficulty hearing. Bone conduction is better than air conduction in the left ear. The sound was localised towards the left side on Weber’s test. What is the SINGLE most likely diagnosis?

A 29 year old man with a medical history that includes late-onset asthma attends the clinic with rhinorrhoea and bilateral painless nasal obstruction. He complains of a reduced sense of smell. His symptoms have been ongoing for months. He has never suffered with any allergy as a child. What is the SINGLE most likely diagnosis?

A 33 year old man attends his GP surgery for the management of his recurrent episodes of epistaxis. He has had 3 episodes of epistaxis in the past month. His last episode was 2 days ago where there was bleeding from both nostrils which lasted 10 minutes. On examination, visible blood vessels and raw areas are seen on the anteroinferior part of the nasal septum bilaterally. There is no active bleeding. What is the most appropriate management?

An 8 year old child presents to the Emergency Department with bleeding from the nose that has been ongoing for the past 30 minutes. The mother gives you a history of frequent nose picking by the child. On examination, the child is leaning forwards and complying well with instructions. As you perform a rhinoscopy and locate the bleeder in the Little’s area, the child has a few bouts of cough and starts to bleed again from the nose. Which of the following is the most appropriate next step in the management of this patient?

A 38 year old man was slapped over his right ear during a fight. There is blood coming from his right external auditory canal. He describes the pain as intense and he also has ringing in his ears. He is also noted to have decreased hearing on that ear. What is the SINGLE most appropriate initial investigation?

A 55 year old woman has episodes of vertigo, tinnitus and fluctuating hearing loss. During the episodes, she feels nauseous and vomits. She complains of a sensation of ear pressure which occurs before the vertigo attack. The attacks can last for 2 to 3 hours and occur in clusters over a few weeks. The examination of her ear is unremarkable. What is the SINGLE most appropriate treatment to prevent further episodes?

A 7 year old girl has been referred for assessment of hearing as she is finding difficulty in hearing her teacher in the class. When speaking to her friends, she often has to ask them to repeat. Her hearing tests show that bone conduction is normal and symmetrical air conduction threshold is reduced bilaterally. Weber test does not lateralize. What is the SINGLE most likely diagnosis?

A 5 year old girl has had an upper respiratory tract infection for 3 days and has been treated with paracetamol by her mother. In the last 12 hours, she has been irritable and with severe pain in her right ear. She has a temperature of 38.3°C. What is the SINGLE most likely diagnosis?

A 22 year old man presents with haemoptysis. He had a tonsillectomy done 7 days ago. His blood pressure is 120/80 mmHg, pulse rate is 115 beats/minute and respiratory rate is 18 breaths/minute. On examination of his oropharynx, there is a small visible active bleed within the tonsillar fossa but without any large clots present. What is the SINGLE most appropriate next step?

A 3 year old boy presents to the GP surgery with his mother who is concerned about his tonsils. He had three episodes of tonsillitis over the past 12 months requiring antibiotics. He has bad breath which has been ongoing for the past few months. He also struggles to breathe when he sleeps at night and snores loudly. His sister had her tonsils removed when she was 4 years old. What is the most likely reason, if any, to refer this child for a tonsillectomy?

A 33 year old man attends the GP surgery for severe vertigo over the past week. He had a recent upper respiratory tract infection 3 weeks ago and after recovery he started experiencing vertigo. He finds the vertigo worse over the course of the day. The vertigo is exacerbated by changes of head position but present even when the head is still. There is no hearing loss or tinnitus. He has a normal otoscopy examination. What is the SINGLE most appropriate management?

A 45 year old man who works in a busy shipyard has been experiencing ringing in his ears and depression of sound that began soon after the onset of tinnitus. This has been going on over the past few months with worsening severity. He experiences difficulty in understanding what is said over the phone or when a few people are talking all at once in a large room. He feels that sounds seem to be gradually more muffled. What is the SINGLE most likely term to describe his condition?

A 39 year old man has a history of swelling in the region of the submandibular region, which became more prominent and painful on chewing. He also gives a history of sour taste in the mouth and having a dry mouth. On palpation, the area is tender. What is the SINGLE most likely underlying diagnosis?

A 33 year old man comes to the clinic complaining of hearing loss in one ear. There is no earache, fever, vertigo or tinnitus. On inspection, a buildup of earwax is observed. What is the SINGLE most appropriate initial management?

A 5 year old boy is brought to the GP clinic for recurrent episodes of sore throat. His mother reports that he has already had three episodes of sore throat in the past 12 months and that his latest episode started four days ago. He has a mild cough and runny nose. You examine his throat and find mild inflammation on his tonsils with no exudates. He has a temperature of 37.8°C. He has no palpable cervical lymph nodes. What is the SINGLE most appropriate management?

A 52 year old patient is complaining of vertigo whenever she moves sideways on the bed while lying supine. She would feel as if the room is spinning and she would feel nauseous. This goes away after a few minutes but returns when she moves her head.

What is the SINGLE most appropriate test to perform?

A 41 year old woman presents to clinic with vertigo, vomiting and a feeling of aural fullness. The attacks of vertigo can last for several hours. She also states that she has difficulty hearing. She had a similar attack last year. Recently, she has experienced ringing in her ears. MRI scan was done and was found to be normal. What is the SINGLE mast likely diagnosis?

A 19 year old boy has a sore throat that has been worsening over the past week. He has been taking penicillin-V which was prescribed by one of the GPs 5 days ago. He has a fever of 38.9°C. A large swelling of the soft palate is seen with exudates. The pain is worse on one side of the throat. What is the most likely diagnosis?

A 28 year old woman presents to the Emergency Department with a severe headache and unilateral facial pain that started 2 days ago. She has lost the sense of smell. She has a history of recurrent foul smelling nasal discharge that improves temporarily with antibiotics. This episode is associated with left supraorbital pain. What is the SINGLE mast appropriate investigation?

A 6 year old child fell on his nose 3 days ago. His parents have now brought him to the hospital as he is having difficulty in breathing and feeling unwell. He has general malaise and complains of nasal pain. On examination, nasal bones are seen to be straight however there is tenderness over the dorsum of the nose. He has a temperature of 38.9°C. What is the SINGLE most likely diagnosis?

A 29 year old teacher had a respiratory infection for which she was prescribed antibiotics. A few days after she finished the antibiotic course, she rejoins school but she has a weak, altered voice which was not present previously. What is the SINGLE most appropriate diagnosis?

A 15 year old boy presents to the Emergency Department with the complaint of nasal bleeding. He notes that he was playing football when his apponent punched him in the face after a heated argument. He started bleeding from the nose immediately, which continued for 2 hours. He did not receive first aid to stop the bleeding for this duration. On assessment, his heart rate is 80 beats/minute, blood pressure is 110/70 mmHg, and his respiratory rate is 13 breaths/minute. On inspection, he is neither actively bleeding, nor is there evidence of any clear fluid leakage. The skin of his nose is intact but bruised. Additionally, his nose appears grossly deviated to the right side. Which of the following is the next appropriate step in managing this patient?

A 43 year old man attends the Emergency Department for the management of epistaxis. He started having a nasal bleed 45 minutes ago. He has had 2 episodes of epistaxis in the past month. His last episode was 2 days ago where there was bleeding from both nostrils which lasted 20 minutes. On examination, visible blood vessels and raw areas are seen on the anteroinferior part of the nasal septum bilaterally. There is still an active bleed on both nostrils. What is the most appropriate management?

A 4 year old girl has been reported by her parents to be increasing the volume of the television to an excessive level. A hearing test conducted at school shows a symmetrical loss of 40db. A grey, bulging tympanic membrane is seen on otoscopy on both ears. What is the SINGLE most likely diagnosis?

A 24 year old woman presents to the GP complaining of pain over her cheeks for the past 5 days. She reports that her face feels full as though there is pressure building up inside. She reports having some fever, cough and sneezing last week which have since gone away on their own. There is associated clear nasal discharge. What is the SINGLE most appropriate treatment to offer this patient?

A 75 year old man presents with symptoms of progressive sensorineural hearing loss an the right. He also complains of dizziness and tinnitus. The external auditory meatus and tympanic membrane appear to be normal. What is the SINGLE most appropriate investigation?

A mother of a 2 day old infant is concerned about the infant’s ability to hear. The mather is still in the hospital with her newborn recovering from her caesarean section. The infant is otherwise well and born with good Apgar scores. The concern from the mother comes from the fact that the mother has had a moderate degree of permanent hearing loss during her teenage years and has to wear hearing aids. What is the SINGLE most appropriate test to perform?

A 6 year old boy presents with a fever, cough and a sore throat. On examination, the tonsils are erythematous but without any exudates. There are no palpable lymphadenopathy. He had 3 similar episodes last year which were self limiting. He has a temperature of 38.3°C. The diagnosis of tonsillitis is given. What is the SINGLE most appropriate management for this child?

A 60 year old man has progressive hearing loss. He finds it difficult to comprehend speech as they sound muffled. He was referred for a hearing test which evidences bilateral sensorineural hearing loss. Otoscopy of the ear reveals a normal tympanic membrane. What is the SINGLE most likely diagnosis?

A 59 year old man with a diagnosis of squamous cell carcinoma of the tonsils a few months ago has worsening trismus over the past month. He has pain in his throat and jaw. Which structure has likely been involved in the local spread of the disease?

A 73 year old man comes to the GP surgery complaining of decreased hearing in both his ears over a period of months. He finds it difficult to hear his wife speak to him in noisy environments. He also has tinnitus in both his ears. On examination, he has bilateral ear wax obstructing the tympanic membrane seen in both external ear canals. A Rinne’s test shows bone conduction is better than air conduction. There was no lateralization on Weber’s test. What is the SINGLE most likely diagnosis?

A 33 year old man initially had sneezing, nasal itching and rhinorrhoea for the past 2 weeks. He has been taking xylometazoline intranasally for the past 10 days but feels his nasal congestion worsening. He has plans to continue it as his nose is blocked at night and he has to breathe through his mouth. On examination, there is no evidence of nasal polyps. What is the SINGLE most appropriate action?