Question Easy: 👂 A 45-year-old woman presents with sudden hearing loss in her left ear. She denies any recent trauma or upper respiratory infections. On examination, there is no wax impaction visible. What is the most appropriate initial management step?
A) Prescribe oral antibiotics
B) Refer to ENT urgently
C) Perform lavage of the ear
D) Prescribe oral steroids
E) Arrange an MRI scan
Question Medium: 👁️ A 29-year-old man reports a gritty sensation in his eyes, along with redness and tearing for a few days. He also mentions a history of hay fever. On examination, his eyelids have a cobblestone appearance. What is the most likely diagnosis?
A) Viral conjunctivitis
B) Bacterial conjunctivitis
C) Allergic conjunctivitis
D) Dry eye syndrome
E) Uveitis
Question Hard: 🌡️ A 67-year-old woman presents with a one-month history of progressive unilateral nasal obstruction, epistaxis, and a decreased sense of smell. She has no significant past medical history. What is the most appropriate investigation to confirm the diagnosis?
A) Nasal endoscopy
B) Plain X-ray of the sinuses
C) CT scan of the sinuses
D) MRI scan of the brain
E) Sinus aspiration and culture
Explanations & Answers:
Question Easy Answer: D) Prescribe oral steroids
Question Easy Explanation: Sudden sensorineural hearing loss is an ENT emergency, and the immediate management often involves high-dose oral corticosteroids unless contraindicated. NICE guidelines recommend urgent referral to ENT for further evaluation and treatment.
Question Medium Answer: C) Allergic conjunctivitis
Question Medium Explanation: The presence of bilateral itchy, red, and watery eyes alongside a history of hay fever strongly suggests allergic conjunctivitis. The cobblestone appearance of the eyelids is indicative of a more chronic allergic conjunctivitis often associated with this condition. Treatment involves avoiding allergens and using antihistamine or mast cell stabilizer eye drops as noted in NHS guidelines.
Question Hard Answer: C) CT scan of the sinuses
Question Hard Explanation: The symptoms described suggest a potential sinonasal malignancy, given the unilateral nasal obstruction and epistaxis. A CT scan of the sinuses is the preferred method to assess for sinonasal mass lesions both in terms of localisation and to guide biopsy, as per NICE guidelines.
Medical fact of the day: Did you know that the most common cause of irreversible blindness in the UK is age-related macular degeneration (AMD)? It’s crucial to encourage patients over 65 to attend regular eye screenings.
Quote of the day: “In the service of others, you find the purpose in healthcare. Every small act of kindness is a step toward healing the world.”