Passmed Qs

Question 1

1 year old boy with neck lump in anterior triangle (just in front of sternocleidomastoid), biopsy reveals cholesterol crystals in fluid extracted.
What is the diagnosis?

Answer 1

Branchial cyst

Question 2

1st-line treatment for a child with bacterial tonsillitis and a Centor score of 4.

(+ what antibx used if pen. allergic)

Answer 2

Phenoxymethylpenicillin with analgesia

• if pen. allergic –> Clarithromycin

Question 3

2 year old child with neck lump in posterior triangle which transilluminates

Answer 3

Cystic hygroma

Question 3

Most likely electrolyte disturbance/abnormality following a thyroid surgery?

Answer 3

Hypocalcaemia
- due to damage to parathyroid glands

Question 4

Persistent and unexplained mouth ulcer + smoker/older age/heavy drinker. What does this raise suspicions of and what is your management approach?

Answer 4

Raises suspicion of oral cancer (SCC)
- refer to secondary care under 2-week wait

Question 5

Pt presents with peristent vertigo, nausea/vomiting, horizontal nystagmus, and no hearing loss/tinnitus, what test can be used to distinguish between a peripheral cause of vertigo and a central cause?

Answer 5

HiNTS exam
- used to distinguish vestibular neuronitis (peripheral) from posterior circulation stroke (central)

Question 5

Slow growing, painless, mobile lump in parotid gland of older female?
(malignant or benign?)

Answer 5

Pleomorphic adenoma
- benign

Question 6

Unilateral glue ear in an adult.
Why does this require a referral to ENT under a 2-week wait?

Answer 6

? posterior nasal space tumour
- Tumours in the post-nasal space can obstruct the openings of the Eustachian tubes, leading to persistent middle ear effusion

Question 7

What antibiotic (aminoglycoside) is known to be ototoxic?

Answer 7

Gentamicin

Question 7

Young male presents with swollen pinna of the left ear, a diagnosis is made of an auricular haematoma (“cauliflower ear”).
What is the most appropriate course of action?

Answer 7

Refer for urgent assessment by ENT
- untreated auricular hematomas can lead to permanent disfiguration of the ear

Question 8

Case:
- 32 yo female is referred urgently to the ENT specialists with a 1-month-history of severe, unrelenting otalgia, associated with temporal headaches and purulent otorrhoea
- PMH: T1DM, no allergies
- O/E: erythematous external auditory canal and periauricular soft tissue on the left side which is exquisitely tender

What is the most appropriate antibiotic management for this patient + what should you be worried about?

Answer 8

Ciprofloxacin –> treat otitis externa in diabteics with ciprofloxacin to cover Pseudomonas

• Pt has T1DM –> think malignant otitis externa (necrotising otitis externa)

Question 9

Mouth ulcer persisting for greater than 3 weeks, what is the most suitable course of action?

Answer 9

2 week wait referral to oral surgery

Question 10

Case:
- 78 yo lady with known type 2 diabetes presents with a 1-week history of polydipsia, feeling generally unwell and drowsy
- O/E: she looks very dehydrated and is difficult to rouse. She appears confused when she does talk to you
- Her blood glucose is 36 mmol/L

What is the most likely diagnosis and what is the most important first management step?

Answer 10

This patient has HHS (hyperosmolar hyperglycaemic state) –> characterised by sevree hyperglycaemia + dehydration and renal failure + mild/absent ketonuria
.
Rehydrate with 0.9% Saline –> caution with rapid fluid replacement due to risk of cerebral oedema