Question Easy: A 5-year-old girl presents to the GP with an itchy red eye 👁️. On examination, the conjunctiva is hyperaemic, and there is watery discharge. She also has a runny nose 🤧. What is the most likely diagnosis?
A) Bacterial conjunctivitis
B) Viral conjunctivitis
C) Allergic conjunctivitis
D) Keratitis
E) Uveitis
Question Medium: A 55-year-old man complains of persistent hearing loss and tinnitus in his left ear. On examination, there is no external ear abnormality, but Rinne’s test shows air conduction greater than bone conduction in both ears while Weber’s test lateralizes to the right ear. What type of hearing loss is most likely in the left ear?
A) Conductive hearing loss
B) Sensorineural hearing loss
C) Mixed hearing loss
D) Presbycusis
E) Otitis media
Question Hard: A 30-year-old woman presents with sudden onset of loss of taste and inability to close her left eye. On examination, she has a left-sided facial droop 😞 and inability to smile symmetrically. What is the most appropriate immediate management?
A) Oral prednisolone
B) Intravenous acyclovir
C) Referral to ENT for assessment
D) MRI of the brain
E) Artificial tears
Explanations & Answers:
Question Easy Answer: C) Allergic conjunctivitis
Question Easy Explanation: The presentation of itchy, red eyes with a watery discharge and concurrent runny nose is characteristic of allergic conjunctivitis. It is often seen in conjunction with other allergic symptoms such as rhinitis. According to NICE guidelines, this is typically managed with antihistamines or mast cell stabilizers.
Question Medium Answer: B) Sensorineural hearing loss
Question Medium Explanation: The Rinne test showing air conduction greater than bone conduction on both sides indicates that at least some of the hearing test was normal; thus, it would not support a diagnosis of conductive hearing loss. The Weber test, which lateralizes to the side opposite the reported hearing loss, suggests sensorineural hearing loss on the affected side. The NICE guidelines describe this pattern for differentiating types of hearing loss.
Question Hard Answer: A) Oral prednisolone
Question Hard Explanation: The presentation describes Bell’s palsy, characterized by rapid onset facial paralysis affecting the muscles on one side of the face. According to NICE and NHS guidelines, early treatment with oral steroids such as prednisolone can improve recovery. Artificial tears may also be used as supportive care for eye protection, but they are not immediate first-line management.
Medical fact of the day: Did you know? The human ear can distinguish over 400,000 different sounds! This remarkable range is evidence of the sophisticated processing capabilities of the auditory system, crucial in both everyday communication and complex auditory environments.
Quote of the day: “The soul of healthcare floats on the wings of compassion and the quiet strength of gentle courage.”