Question Easy:
👂 A 25-year-old woman comes to the GP complaining of a blocked feeling in her right ear and reduced hearing over the past week. She recently had a cold. There is no ear pain or discharge. What is the most likely diagnosis?
A) Acute otitis media
B) Otitis externa
C) Eustachian tube dysfunction
D) Perforated eardrum
E) Cholesteatoma
Question Medium:
👁️ A 40-year-old man presents with a sudden onset of eye pain and visual disturbance in his left eye. He also reports seeing halos around lights and experiencing headaches and nausea. Examination reveals a mid-dilated, non-reactive pupil and a hazy cornea. Which condition is most likely responsible for these symptoms?
A) Retinal detachment
B) Acute angle-closure glaucoma
C) Anterior uveitis
D) Optic neuritis
E) Dry eye syndrome
Question Hard:
👃 A 50-year-old woman is referred to the ENT clinic due to a progressive unilateral decrease in the sense of smell and recurrent nasal obstruction. On examination, there is a unilateral nasal polyp. What is the most important investigation to exclude a serious cause in this scenario?
A) Nasal endoscopy
B) CT scan of the sinuses
C) MRI of the brain
D) Allergy testing
E) Skin prick test
Explanations & Answers:
Question Easy Answer: C
Question Easy Explanation: Eustachian tube dysfunction is common following an upper respiratory tract infection. The symptoms described, such as a blocked feeling and hearing loss without pain or discharge, fit with this diagnosis. NHS guidelines recommend managing this conservatively initially.
Question Medium Answer: B
Question Medium Explanation: The presentation is characteristic of acute angle-closure glaucoma. This is an ocular emergency due to the rapid increase in intraocular pressure. The symptoms include severe eye pain, haloes around lights, and systemic symptoms like nausea, all aligning with NICE guidance for urgent intervention.
Question Hard Answer: C
Question Hard Explanation: In this scenario, MRI of the brain is crucial to exclude olfactory groove meningioma, a potential serious cause of unilateral changes in smell and nasal obstruction. While CT scans assess the sinuses, MRI provides better detail of intracranial structures, as per BNF recommendations for similar presentations.
Medical fact of the day: Did you know that the human eye can detect a candle flame from as far as 14 miles away on a clear, dark night? This highlights the incredible sensitivity of the visual system!
Quote of the day: “In the realm of healing, every genuine connection begins with empathy and ends with hope.”