Focused notes on past themes
Case 1: Epistaxis in an Anticoagulated Patient
Date Tested: March 2022
Vignette:
A 65-year-old man presents to the emergency department with a severe nosebleed that started 2 hours ago. He is anticoagulated with warfarin for atrial fibrillation, with an INR of 3.2. The bleeding is brisk, and anterior nasal packing has failed to control it.
Follow-up Questions:
-
What further steps would you take to manage this patient's epistaxis?
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How would you reverse the effects of warfarin in this case?
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When would you consider surgical intervention?
​
​
Case 2: Airway Obstruction in a Patient with a Foreign Body
Date Tested: September 2020
Vignette:
A 40-year-old woman presents with acute respiratory distress after attempting to eat a piece of meat. She is in obvious distress, unable to speak, and has audible wheezing. On examination, she is cyanotic, and you suspect upper airway obstruction due to a foreign body.
Follow-up Questions:
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How would you assess the severity of the obstruction?
-
What immediate steps should be taken to relieve the airway obstruction?
-
How would you confirm the diagnosis of a foreign body in the airway?
Case 3: Anaphylaxis Due to Penicillin Allergy
Date Tested: December 2021
Vignette:
A 32-year-old male with a known history of penicillin allergy presents with acute shortness of breath, facial swelling, and a rash after receiving an intravenous dose of penicillin for a suspected chest infection. His blood pressure is 80/60 mmHg, and he is tachypneic.
Follow-up Questions:
-
How would you assess the severity of this patient's anaphylaxis?
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What immediate management steps would you take?
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After initial stabilization, what further management steps would you recommend?
Case 4: Severe Anterior Neck Trauma with Suspected Tracheal Injury
Date Tested: October 2020
Vignette:
A 45-year-old male presents with a history of blunt trauma to the neck following a road traffic accident. He is visibly distressed, with subcutaneous emphysema and difficulty breathing. There is bruising around the neck, and you suspect a tracheal injury.
Follow-up Questions:
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What initial investigations would you perform?
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How would you manage this patient in the immediate setting?
-
What are the signs of a complete tracheal rupture, and how would you manage them?
Case 5: Acute Laryngeal Trauma in a Child
Date Tested: July 2019
Vignette:
A 10-year-old child presents after being accidentally struck in the neck during a sporting activity. The child is hoarse, and there is visible bruising around the neck. On examination, there is swelling over the larynx and difficulty speaking.
Follow-up Questions:
-
What are the most important concerns in a child with laryngeal trauma?
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How would you assess the severity of the injury?
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What immediate management would you provide?
Case 6: Tension Pneumothorax in a Trauma Patient
Date Tested: April 2020
Vignette:
A 30-year-old male presents after a high-speed motorcycle accident. He is in respiratory distress with hypotension and tachycardia. There is absent breath sounds on the right side of the chest, and subcutaneous emphysema is noted. You suspect a tension pneumothorax.
Follow-up Questions:
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What immediate steps would you take to manage a tension pneumothorax?
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How would you confirm the diagnosis of pneumothorax in this patient?
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What complications might arise if tension pneumothorax is not managed promptly?
Case 7: Severe Stridor in a 3-year-old with Croup
Date Tested: May 2021
Vignette:
A 3-year-old child presents with a history of 2 days of cough, fever, and increasing stridor. On examination, the child is anxious, with a barking cough and significant inspiratory stridor. You suspect acute viral croup.
Follow-up Questions:
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What are the signs that indicate worsening croup and a need for further intervention?
-
How would you manage this child with suspected croup?
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When would you consider using steroids or nebulized adrenaline in this case?
Case 8: Acute Peritonsillar Abscess
Date Tested: June 2021
Vignette:
A 20-year-old woman presents with fever, severe sore throat, and difficulty swallowing. On examination, there is asymmetric swelling of the tonsils, and you note trismus and drooling. You suspect an acute peritonsillar abscess.
Follow-up Questions:
-
How would you confirm the diagnosis of peritonsillar abscess?
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What is the initial management for this patient?
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How would you manage the patient if the abscess fails to resolve with initial therapy?
Case 9: Bilateral Hearing Loss After Head Trauma
Date Tested: February 2019
Vignette:
A 35-year-old man presents with bilateral hearing loss after a blow to the head during a boxing match. He reports hearing a “popping” sound during the impact and has developed a sense of fullness in both ears.
Follow-up Questions:
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What are the potential causes of this patient’s bilateral hearing loss?
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What steps would you take to assess this patient?
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How would you manage the patient based on your findings?
Case 10: Acute Onset Hoarseness After Viral Infection
Date Tested: August 2020
Vignette:
A 50-year-old woman presents with a 3-day history of hoarseness following a recent upper respiratory tract infection. She has no pain or difficulty breathing but is concerned about her voice quality.
Follow-up Questions:
-
What is the most likely cause of this patient’s hoarseness?
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What examination would you perform?
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What is your management plan?
Case 11: Laryngeal Foreign Body in a Child
Date Tested: November 2021
Vignette:
A 5-year-old child presents to the emergency department with a sudden onset of choking and coughing. They have been playing with small objects and have had difficulty breathing.
Follow-up Questions:
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What initial steps would you take to manage this child?
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How would you confirm the diagnosis of a foreign body aspiration?
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What is the preferred method of removing a foreign body in a pediatric patient?
Case 12: Acute Diphtheria in an Unvaccinated Patient
Date Tested: January 2022
Vignette:
A 22-year-old woman presents with a sore throat, fever, and difficulty swallowing. She has no history of childhood vaccinations and has been living in a high-risk area for diphtheria.
Follow-up Questions:
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What is the most likely diagnosis in this case?
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How would you manage this patient?
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What complications can arise from diphtheria, and how would you prevent them?
Case 13: Post-operative Bleeding Following Tonsillectomy
Date Tested: March 2020
Vignette:
A 10-year-old child is 12 hours post-tonsillectomy and presents with bright red blood in the mouth. The child is alert, and there are no signs of airway compromise.
Follow-up Questions:
-
What is the cause of post-operative bleeding following tonsillectomy?
-
What immediate steps would you take to manage this bleeding?
-
When would you consider further surgical intervention?
Case 14: Epiglottitis in a Young Child
Date Tested: November 2020
Vignette:
A 4-year-old child presents with fever, drooling, and difficulty swallowing. There is stridor, and the child is sitting in a tripod position. You suspect epiglottitis.
Follow-up Questions:
-
How would you secure the airway in this child with suspected epiglottitis?
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What investigations would you perform to confirm the diagnosis?
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What are the first-line treatments for epiglottitis?
​
Case 15: Traumatic Rupture of the Tympanic Membrane
Date Tested: October 2019
Vignette:
A 25-year-old man presents after an accident in which a sharp object struck his ear. He complains of ear pain, hearing loss, and dizziness. On examination, you find a perforated tympanic membrane.
Follow-up Questions:
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How would you assess the extent of the tympanic membrane rupture?
-
What is the immediate management for this condition?
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When should surgical intervention be considered for tympanic membrane perforation?
Case 16: Acute Angioedema of the Larynx
Date Tested: August 2019
Vignette:
A 40-year-old man with a history of hypertension presents with acute difficulty swallowing and breathing. There is swelling in the neck and oral cavity, with difficulty phonating. You suspect acute laryngeal angioedema.
Follow-up Questions:
-
What is the immediate management of acute laryngeal angioedema?
-
How would you differentiate between anaphylactic and non-anaphylactic causes of angioedema?
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What further investigations would you perform in this patient after stabilization?
Case 17: Nasal Fracture with Septal Hematoma
Date Tested: May 2020
Vignette:
A 22-year-old male presents with a painful, deformed nose following a physical altercation. He has significant bruising and swelling around the nose and a possible septal hematoma.
Follow-up Questions:
-
How would you assess this patient for septal hematoma?
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What is the immediate management for a septal hematoma?
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What are the potential complications of untreated septal hematoma?
Case 18: Retropharyngeal Abscess in a Pediatric Patient
Date Tested: April 2021
Vignette:
A 6-year-old child presents with fever, drooling, and difficulty swallowing. The child has neck stiffness, and you suspect a retropharyngeal abscess.
Follow-up Questions:
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How would you confirm the diagnosis of a retropharyngeal abscess in this child?
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What is the management of a retropharyngeal abscess in a pediatric patient?
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What are the potential complications of this condition?
Case 19: Sudden Hearing Loss After a Car Accident
Date Tested: September 2019
Vignette:
A 30-year-old woman presents after a motor vehicle accident with sudden, painless hearing loss in one ear. She also reports tinnitus and a sensation of fullness in the affected ear.
Follow-up Questions:
-
What is the most likely cause of her hearing loss following trauma?
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How would you investigate her sudden hearing loss?
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What is the management plan for sudden sensorineural hearing loss?
Case 20: Septic Shock Due to Acute Sinusitis
Date Tested: February 2021
Vignette:
A 50-year-old man with diabetes mellitus presents with fever, headache, and severe facial pain. On examination, there is purulent nasal discharge, and he appears septic with hypotension.
Follow-up Questions:
-
How would you assess the severity of this patient's condition?
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What are the first-line management steps for septic shock?
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What complications can arise from this condition, and how would you prevent them?
Case 21: Complicated Sinusitis with Orbital Cellulitis
Date Tested: December 2021
Vignette:
A 16-year-old female presents with fever, proptosis, and swelling around the eye following a 10-day history of sinusitis. You suspect orbital cellulitis.
Follow-up Questions:
-
How would you confirm the diagnosis of orbital cellulitis?
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What are the immediate management steps for orbital cellulitis?
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How would you differentiate orbital cellulitis from preseptal cellulitis?
Case 22: Facial Trauma with Suspected Zygomatic Fracture
Date Tested: January 2020
Vignette:
A 28-year-old male presents with facial pain and swelling following a blow to the face. On examination, there is a step-off deformity over the zygomatic arch, and you suspect a zygomatic bone fracture.
Follow-up Questions:
-
How would you assess the extent of the zygomatic fracture?
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What imaging would you perform to confirm the fracture?
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What are the indications for surgical intervention in this patient?
Case 23: Acute Parotitis in a 75-Year-Old
Date Tested: March 2019
Vignette:
A 75-year-old man presents with a painful, swollen parotid gland. He has dry mouth, fever, and signs of sepsis. You suspect acute parotitis, possibly secondary to dehydration or a viral infection.
Follow-up Questions:
-
What are the possible causes of acute parotitis in this patient?
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What investigations would you perform to confirm the diagnosis?
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What are the treatment options for acute parotitis?
Case 24: Sudden Onset Diplopia in a Young Adult
Date Tested: May 2021
Vignette:
A 22-year-old woman presents with double vision that started suddenly. She reports pain when moving the eyes and a history of recent upper respiratory infection.
Follow-up Questions:
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What is your differential diagnosis for sudden-onset diplopia in this patient?
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How would you investigate this patient?
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What is the management plan for a patient with diplopia and suspected orbital pathology?
Case 25: Cervical Abscess Following Dental Infection
Date Tested: July 2019
Vignette:
A 50-year-old man presents with fever, neck pain, and difficulty swallowing. He has a history of chronic dental issues and you suspect a cervical abscess secondary to a dental infection.
Follow-up Questions:
-
How would you assess the severity of this patient's condition?
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What imaging would you use to confirm the presence of a cervical abscess?
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What is the appropriate management for this patient?
Case 26: Septic Shock After Acute Otitis Media
Date Tested: September 2020
Vignette:
A 35-year-old male presents with fever, ear pain, and a sense of fullness in the ear. He is febrile and tachycardic, with signs of sepsis. You suspect that he is developing septic shock secondary to acute otitis media.
Follow-up Questions:
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How would you confirm the diagnosis of septic shock?
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What would your first steps in management be for this patient?
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When would you consider drainage for an acute otitis media leading to septic shock?
Case 27: Sudden Loss of Vision After Facial Trauma
Date Tested: January 2021
Vignette:
A 27-year-old male presents following a car accident with facial trauma. He reports sudden loss of vision in his right eye. Upon examination, you notice bruising around the eye and reduced visual acuity.
Follow-up Questions:
-
What are the possible causes of sudden vision loss in this patient?
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How would you investigate the cause of his visual impairment?
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What is the initial management for a patient with facial trauma and loss of vision?
Case 28: Acute Hoarseness in a Patient with a History of Smoking
Date Tested: March 2020
Vignette:
A 60-year-old male smoker presents with a 1-week history of hoarseness, without pain or other symptoms. He is concerned about his voice and has a history of smoking for 30 years.
Follow-up Questions:
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What is your differential diagnosis for hoarseness in this patient?
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How would you manage this patient initially?
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When should you refer for further investigation?
Case 29: Sudden Swelling of the Parotid Gland with Pain
Date Tested: June 2020
Vignette:
A 50-year-old male presents with sudden pain and swelling in the right parotid gland. He has a dry mouth and fever, and his blood pressure is slightly elevated.
Follow-up Questions:
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What are the potential causes of parotid swelling in this patient?
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How would you confirm the diagnosis?
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What is the most appropriate treatment for this condition?
Case 30: Severe Sore Throat with Difficulty Swallowing in an Immunocompromised Patient
Date Tested: December 2020
Vignette:
A 40-year-old female with leukemia presents with a severe sore throat and difficulty swallowing. She is immunocompromised and has been experiencing low-grade fever for 3 days.
Follow-up Questions:
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What are the key concerns for this patient, given her immunocompromised status?
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What investigations would you order to assess for a serious infection?
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How would you manage her sore throat in this context?
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Case 31: Sudden Onset Tinnitus and Hearing Loss
Date Tested: May 2020
Vignette:
A 50-year-old man presents with sudden onset tinnitus and hearing loss in his right ear. He reports no trauma, and his medical history is significant for hypertension.
Follow-up Questions:
-
What are the possible causes of sudden tinnitus and hearing loss?
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How would you assess the degree of hearing loss?
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What are the first-line management steps for this patient?
Case 32: Acute Epiglottitis in a 5-Year-Old
Date Tested: August 2020
Vignette:
A 5-year-old child presents with fever, sore throat, difficulty swallowing, and a muffled voice. The child is drooling, and there is stridor on examination. You suspect acute epiglottitis.
Follow-up Questions:
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How would you confirm the diagnosis of epiglottitis?
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What is the immediate management for this condition?
-
What are the potential complications of untreated epiglottitis?
Case 33: Foreign Body in the Upper Airway
Date Tested: June 2020
Vignette:
A 3-year-old child presents with coughing, wheezing, and stridor following an episode of playing with small objects. The parents are concerned that the child may have aspirated a foreign body.
Follow-up Questions:
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What steps would you take to assess the presence of a foreign body in the airway?
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What is the immediate management of this case?
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What are the potential complications of foreign body aspiration?
Case 34: Life-Threatening Bleeding After Tonsillectomy
Date Tested: October 2021
Vignette:
A 10-year-old child undergoes a routine tonsillectomy and is discharged the following day. The parents call you 24 hours later reporting that the child is bleeding profusely from the throat.
Follow-up Questions:
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What is your initial response to this emergency?
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What are the steps involved in controlling the bleeding?
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When would you consider re-operating or other interventions?
Case 35: Acute Anaphylaxis After Peanut Allergy Exposure
Date Tested: November 2020
Vignette:
A 25-year-old woman with a known peanut allergy presents to the emergency department with acute respiratory distress, urticaria, and swelling of the tongue and throat. She is suspected to be having anaphylaxis.
Follow-up Questions:
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What is the first-line treatment for anaphylaxis?
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How would you assess the severity of the anaphylaxis in this patient?
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What is the role of adrenaline in the management of this condition?
Case 36: Severe Foreign Body Aspiration in an Elderly Patient
Date Tested: February 2021
Vignette:
An 80-year-old woman presents with choking and respiratory distress after eating a meal. She is unable to speak and is cyanotic. You suspect a large foreign body obstruction in the airway.
Follow-up Questions:
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What would be your immediate management for this patient?
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How would you assess whether the foreign body is obstructing the upper or lower airway?
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What are the potential risks if the foreign body is not removed promptly?
Case 37: Nasal Foreign Body in a Young Child
Date Tested: September 2020
Vignette:
A 4-year-old child presents with a history of playing with small toys and now has nasal discharge with a foul smell coming from one nostril. You suspect a foreign body.
Follow-up Questions:
-
How would you assess for a foreign body in the nose?
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What are the possible complications if the foreign body is not removed?
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What would be the next steps in managing this case?
Case 38: Acute Laryngitis in a Singer
Date Tested: July 2020
Vignette:
A 30-year-old professional singer presents with a 4-day history of hoarseness, which has worsened with vocal use. She reports no pain or systemic symptoms.
Follow-up Questions:
-
What is the most likely diagnosis for this patient?
-
How would you manage this patient conservatively?
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When would you refer this patient for further evaluation?
Case 39: Acute Dizziness After Upper Respiratory Infection
Date Tested: March 2021
Vignette:
A 45-year-old male presents with dizziness that started after a recent upper respiratory infection. He describes a spinning sensation that worsens when he moves his head.
Follow-up Questions:
-
What is your differential diagnosis for dizziness in this patient?
-
How would you differentiate between peripheral and central causes of vertigo?
-
What investigations would you order for this patient?
Case 40: Complicated Pharyngitis in a Diabetic Patient
Date Tested: June 2019
Vignette:
A 55-year-old man with poorly controlled diabetes presents with a sore throat, fever, and a red, swollen uvula. You suspect a bacterial cause, and the patient is now showing signs of systemic infection.
Follow-up Questions:
-
How would you assess the severity of this infection?
-
What are the immediate steps in managing this patient?
-
How would diabetes influence the management of this patient?
Case 41: Acoustic Neuroma with Hearing Loss
Date Tested: May 2021
Vignette:
A 40-year-old woman presents with progressive unilateral hearing loss and tinnitus over the last 6 months. She has also noticed balance problems and a sensation of fullness in the ear.
Follow-up Questions:
-
What is your differential diagnosis for this patient’s symptoms?
-
How would you confirm the diagnosis of an acoustic neuroma?
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What are the treatment options for acoustic neuroma?
Case 42: Epistaxis in a 60-Year-Old with Hypertension
Date Tested: October 2020
Vignette:
A 60-year-old male with a history of hypertension presents with an episode of spontaneous epistaxis that has lasted for 30 minutes. He is on anticoagulation therapy.
Follow-up Questions:
-
How would you initially manage this patient’s epistaxis?
-
What are the concerns with anticoagulation therapy in this context?
-
When would you consider surgical intervention for this patient?
Case 43: Subglottic Stenosis in a Neonate
Date Tested: January 2021
Vignette:
A neonate presents with respiratory distress, hoarseness, and a high-pitched breathing sound (stridor). You suspect congenital subglottic stenosis.
Follow-up Questions:
-
How would you confirm the diagnosis of subglottic stenosis in a neonate?
-
What is the immediate management for this condition in a neonate?
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What are the long-term management options for subglottic stenosis?
Case 44: Trauma-Induced Hemotympanum
Date Tested: December 2020
Vignette:
A 45-year-old man presents with ear pain and hearing loss following blunt trauma to the head. On examination, you notice a red, blood-tinged appearance to the tympanic membrane (hemotympanum).
Follow-up Questions:
-
What are the potential complications of a hemotympanum?
-
How would you assess the extent of the injury to the ear?
-
What is the appropriate management for this condition?
Case 45: Acute Otitis Media in an Immunocompromised Patient
Date Tested: February 2021
Vignette:
A 50-year-old woman with a history of leukemia presents with fever, ear pain, and a bulging tympanic membrane. She is immunocompromised and you are concerned about the risk of complications.
Follow-up Questions:
-
How would you manage acute otitis media in an immunocompromised patient?
-
What are the risk factors for complications in this group of patients?
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When would you consider referral to a specialist or surgical intervention?
Case 46: Meningitis Due to Chronic Otitis Media
Date Tested: July 2019
Vignette:
A 40-year-old male with a history of chronic otitis media presents with fever, headache, and neck stiffness. You suspect meningitis as a complication of chronic otitis media.
Follow-up Questions:
-
What investigations would you perform to confirm the diagnosis of meningitis?
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How would you manage this patient once meningitis is suspected?
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What are the risks and complications of chronic otitis media that can lead to meningitis?
Case 47: Laryngeal Cancer with Hoarseness
Date Tested: August 2021
Vignette:
A 60-year-old male with a long history of smoking and alcohol use presents with persistent hoarseness and a lump in his neck. He reports no pain or difficulty swallowing.
Follow-up Questions:
-
What is the most likely diagnosis for this patient?
-
How would you confirm the diagnosis of laryngeal cancer?
-
What is the management and prognosis for this condition?
Case 48: Acute Sinusitis in a Pregnant Woman
Date Tested: March 2021
Vignette:
A 30-year-old pregnant woman at 18 weeks gestation presents with facial pain, nasal congestion, and a headache. She reports no fever or systemic symptoms.
Follow-up Questions:
-
What is your diagnosis for this patient?
-
What are the treatment options for sinusitis in pregnancy?
-
Are there any concerns about prescribing medications to this patient?
Case 49: Sleep Apnoea in a 50-Year-Old Male
Date Tested: September 2020
Vignette:
A 50-year-old male presents with snoring, excessive daytime sleepiness, and reported apnoeic episodes at night. His BMI is 32.
Follow-up Questions:
-
What is your differential diagnosis for this patient’s symptoms?
-
What investigations would you order to confirm sleep apnoea?
-
How would you manage this patient?
Case 50: Vocal Cord Paralysis Following Neck Surgery
Date Tested: November 2020
Vignette:
A 45-year-old woman presents with hoarseness and difficulty speaking following a thyroidectomy performed 2 days ago.
Follow-up Questions:
-
What is the likely cause of her symptoms?
-
What investigations would you order to confirm the diagnosis?
-
What is the management plan for vocal cord paralysis following neck surgery?
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Case 51: Chronic Rhinosinusitis
Date Tested: January 2021
Vignette:
A 40-year-old man presents with a 6-month history of nasal congestion, facial pain, and loss of smell. He reports using over-the-counter nasal decongestants without improvement.
Follow-up Questions:
-
What is your diagnosis and how would you confirm it?
-
What are the first-line treatments for chronic rhinosinusitis?
-
When would you consider surgical intervention?
Case 52: Unilateral Hearing Loss in a Young Adult
Date Tested: February 2021
Vignette:
A 25-year-old woman presents with progressive unilateral hearing loss over the past 3 months. She also reports a sensation of fullness in the affected ear.
Follow-up Questions:
-
What is your differential diagnosis for unilateral hearing loss?
-
What tests would you perform to confirm the diagnosis?
-
What treatment options are available for this patient?
Case 53: Benign Paroxysmal Positional Vertigo (BPPV)
Date Tested: March 2021
Vignette:
A 50-year-old man presents with a 2-week history of dizziness, particularly when turning his head in bed. He denies any hearing loss or neurological symptoms.
Follow-up Questions:
-
What is the likely diagnosis?
-
What tests would you perform to confirm BPPV?
-
What is the first-line treatment for BPPV?
Case 54: Post-Operative Hoarseness in a Patient After Thyroidectomy
Date Tested: April 2021
Vignette:
A 45-year-old female presents with hoarseness 5 days after a total thyroidectomy. She has no difficulty breathing or swallowing.
Follow-up Questions:
-
What is the most likely cause of her hoarseness?
-
How would you assess the extent of vocal cord involvement?
-
What is the management plan for this condition?
Case 55: Eustachian Tube Dysfunction
Date Tested: May 2021
Vignette:
A 30-year-old man presents with a feeling of fullness in his ears, decreased hearing, and occasional popping sounds in his ears. He has a history of recurrent colds.
Follow-up Questions:
-
What is the likely diagnosis?
-
What treatment options are available for this condition?
-
How would you counsel this patient on lifestyle modifications?
Case 56: Post-Nasal Drip and Chronic Cough
Date Tested: June 2021
Vignette:
A 55-year-old woman presents with a persistent cough that has lasted for several weeks, particularly at night. She also reports a sensation of mucus dripping down the back of her throat.
Follow-up Questions:
-
What is your differential diagnosis for this patient’s symptoms?
-
How would you investigate further?
-
What treatments would you recommend?
Case 57: Impacted Cerumen in a 70-Year-Old Patient
Date Tested: July 2021
Vignette:
A 70-year-old man presents with hearing loss, which has been progressive over the past few weeks. On examination, you notice impacted ear wax.
Follow-up Questions:
-
What is the best approach for managing impacted cerumen in this patient?
-
How would you assess whether the hearing loss is due to the wax or another underlying cause?
-
What are the risks of improperly removing ear wax?
Case 58: Acoustic Neuroma with Vertigo
Date Tested: August 2021
Vignette:
A 45-year-old woman presents with a 3-month history of unilateral hearing loss, tinnitus, and episodic vertigo. She is concerned about her balance and quality of life.
Follow-up Questions:
-
What is your differential diagnosis for this patient’s symptoms?
-
What investigations would you perform to confirm the diagnosis?
-
What is the management plan for this patient?
Case 59: Chronic Laryngitis in a Non-Smoker
Date Tested: September 2021
Vignette:
A 35-year-old woman presents with hoarseness for the past 2 months. She is a professional singer and denies smoking or alcohol use.
Follow-up Questions:
-
What is your likely diagnosis for this patient?
-
What investigations would you consider for this condition?
-
What are the treatment options available?
Case 60: Sinonasal Polyposis in a 40-Year-Old Male
Date Tested: October 2021
Vignette:
A 40-year-old male presents with progressive nasal congestion, anosmia, and facial pressure over the past year. He has a history of asthma and allergic rhinitis.
Follow-up Questions:
-
What is your likely diagnosis?
-
What would be your first-line management?
-
When would you refer for surgery?
Case 61: Vocal Cord Nodules in a Teacher
Date Tested: November 2021
Vignette:
A 38-year-old female teacher presents with hoarseness and vocal fatigue, especially at the end of the day. She has a 10-year history of teaching and frequently uses her voice.
Follow-up Questions:
-
What is the most likely diagnosis?
-
How would you assess the severity of her vocal cord nodules?
-
What treatment would you recommend?
Case 62: Allergic Rhinitis in a Young Adult
Date Tested: December 2021
Vignette:
A 25-year-old man presents with a 2-year history of sneezing, nasal congestion, and itchy eyes, which worsens in the spring and fall.
Follow-up Questions:
-
What is your diagnosis for this patient?
-
What would be the first-line treatment for allergic rhinitis?
-
How would you advise this patient to manage his symptoms long-term?
Case 63: Acute Otitis Externa
Date Tested: January 2022
Vignette:
A 35-year-old woman presents with a 2-day history of ear pain, itching, and drainage of fluid from her ear. She has a history of swimming in chlorinated water.
Follow-up Questions:
-
What is the likely diagnosis?
-
What are the first-line treatments for acute otitis externa?
-
How would you advise the patient on preventing future occurrences?
Case 64: Chronic Tinnitus with No Hearing Loss
Date Tested: February 2022
Vignette:
A 60-year-old man presents with chronic tinnitus in both ears, but he has no significant hearing loss or other systemic symptoms.
Follow-up Questions:
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What is your differential diagnosis for this patient’s tinnitus?
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What investigations would you order to rule out other causes?
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What is the management for chronic tinnitus?
Case 65: Chronic Tonsillitis in a 25-Year-Old
Date Tested: March 2022
Vignette:
A 25-year-old female presents with recurrent sore throats and difficulty swallowing. She reports having 4-5 episodes per year over the past few years, each lasting several days.
Follow-up Questions:
-
What is your diagnosis?
-
What investigations would you consider?
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What are the treatment options for this condition?
Case 66: Sudden Loss of Smell in a 60-Year-Old
Date Tested: April 2022
Vignette:
A 60-year-old male presents with a sudden loss of smell over the past week. He has a history of smoking and occasional nasal congestion but no other significant medical history.
Follow-up Questions:
-
What are the possible causes of sudden anosmia in this patient?
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What tests would you perform to determine the cause?
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How would you treat this condition if it is related to sinusitis or a viral infection?
Case 67: Pharyngitis in a Pregnant Woman
Date Tested: May 2022
Vignette:
A 28-year-old pregnant woman at 16 weeks gestation presents with sore throat, fever, and mild headache. She is concerned about the safety of medications during her pregnancy.
Follow-up Questions:
-
What is the most likely cause of her symptoms?
-
What investigations would you perform?
-
How would you treat this patient while considering the safety of the pregnancy?
Case 68: Unilateral Nasal Congestion in a Non-Smoker
Date Tested: June 2022
Vignette:
A 40-year-old man presents with a 6-month history of unilateral nasal congestion, particularly when lying down. He has no history of smoking and no known allergies.
Follow-up Questions:
-
What is your differential diagnosis for this presentation?
-
What investigations would you consider?
-
How would you manage this patient?
Case 69: Oropharyngeal Candidiasis in a Diabetic Patient
Date Tested: July 2022
Vignette:
A 60-year-old diabetic male presents with white lesions in his mouth and a sore throat. He has a history of poorly controlled diabetes and a reduced immune response.
Follow-up Questions:
-
What is the likely diagnosis?
-
How would you confirm the diagnosis of oral candidiasis?
-
What is the treatment plan for this condition?
Case 70: Dysphagia in a 45-Year-Old Male
Date Tested: August 2022
Vignette:
A 45-year-old man presents with difficulty swallowing both solids and liquids for the past 3 weeks. He reports no pain with swallowing but has noticed food getting stuck in his throat.
Follow-up Questions:
-
What are the possible causes of dysphagia in this patient?
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What investigations would you perform?
-
How would you manage this patient?
Case 71: Granulomatosis with Polyangiitis (Wegener’s) in a 50-Year-Old Female
Date Tested: September 2022
Vignette:
A 50-year-old woman presents with recurrent sinus infections, nasal ulcers, and progressive hearing loss. She has a history of renal dysfunction.
Follow-up Questions:
-
What is your differential diagnosis?
-
How would you confirm the diagnosis of granulomatosis with polyangiitis?
-
What is the treatment approach for this condition?
Case 72: Laryngeal Trauma in a 30-Year-Old Patient
Date Tested: October 2022
Vignette:
A 30-year-old male presents with hoarseness and difficulty swallowing following a motor vehicle accident. He has no breathing difficulties but is concerned about long-term effects.
Follow-up Questions:
-
What is your differential diagnosis for this patient?
-
How would you assess the extent of laryngeal trauma?
-
What is the management plan for this patient?
Case 73: Epistaxis in a 70-Year-Old Male
Date Tested: November 2022
Vignette:
A 70-year-old man presents with a history of recurrent nosebleeds over the past few months. The bleeds are often spontaneous, especially at night, and are not associated with any trauma.
Follow-up Questions:
-
What is your differential diagnosis for epistaxis in this patient?
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What would be your initial approach to managing this case?
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What treatments are available for recurrent epistaxis in elderly patients?
Case 74: Chronic Post-Tonsillectomy Pain
Date Tested: December 2022
Vignette:
A 25-year-old male presents with ongoing throat pain and difficulty swallowing 3 weeks after having a tonsillectomy. He is concerned about the duration of recovery.
Follow-up Questions:
-
What is your likely diagnosis?
-
How would you investigate further?
-
What is the management plan for post-tonsillectomy pain?
Case 75: Otitis Media with Effusion in a Child
Date Tested: January 2023
Vignette:
A 6-year-old child presents with a history of recurrent ear infections, muffled hearing, and speech delay. The child has had multiple episodes of otitis media in the past year.
Follow-up Questions:
-
What is the most likely diagnosis?
-
How would you manage this patient?
-
When would you consider surgical intervention for this child?
Case 76: Tinnitus in a Young Adult
Date Tested: February 2023
Vignette:
A 28-year-old woman presents with a 3-month history of ringing in her ears. She denies hearing loss or any significant history of ear trauma.
Follow-up Questions:
-
What are the possible causes of tinnitus in this patient?
-
What investigations would you order to further assess her condition?
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What treatments or counseling might help her cope with the tinnitus?
Case 77: Laryngopharyngeal Reflux Disease (LPRD)
Date Tested: March 2023
Vignette:
A 50-year-old man presents with persistent hoarseness and a sore throat that worsens after eating. He also complains of frequent heartburn and regurgitation.
Follow-up Questions:
-
What is your differential diagnosis for his symptoms?
-
What investigations would you consider to confirm LPRD?
-
How would you manage this condition?
Case 78: Hearing Loss in a 50-Year-Old Woman
Date Tested: April 2023
Vignette:
A 50-year-old woman presents with gradual hearing loss in both ears over the past year. She denies tinnitus, vertigo, or any recent ear infections.
Follow-up Questions:
-
What is your differential diagnosis for this presentation?
-
What investigations would you order to further assess the hearing loss?
-
What treatment options are available for age-related hearing loss?
Case 79: Angioedema of the Upper Airway
Date Tested: May 2023
Vignette:
A 45-year-old male presents with swelling of the tongue, lips, and throat, which has progressively worsened over the last few hours. He has a history of angioedema episodes after taking ACE inhibitors.
Follow-up Questions:
-
What is your diagnosis?
-
How would you assess the severity of this patient’s symptoms?
-
What is the management for this condition in the acute setting?
Case 80: Snoring and Sleep Apnoea in a 55-Year-Old Male
Date Tested: June 2023
Vignette:
A 55-year-old man presents with loud snoring and excessive daytime sleepiness. His partner reports that he stops breathing briefly during sleep. His BMI is 35.
Follow-up Questions:
-
What is your differential diagnosis?
-
What tests would you perform to diagnose sleep apnoea?
-
What is the first-line treatment for this condition?
Case 81: Sore Throat in a 35-Year-Old Woman
Date Tested: July 2023
Vignette:
A 35-year-old woman presents with a 2-week history of sore throat, difficulty swallowing, and low-grade fever. She also complains of general fatigue.
Follow-up Questions:
-
What are the possible causes of her sore throat?
-
What investigations would you order?
-
What is the treatment plan for this condition?
Case 82: Hoarseness in a 50-Year-Old Male with Smoking History
Date Tested: August 2023
Vignette:
A 50-year-old man who has smoked for 30 years presents with hoarseness for the last 2 months. He denies pain, but his voice has been progressively weakening.
Follow-up Questions:
-
What is your differential diagnosis for this patient?
-
What investigations would you perform to rule out serious pathology?
-
What management options are available for this patient?
Case 83: Severe Rhinitis with Polyps
Date Tested: September 2023
Vignette:
A 40-year-old male presents with chronic nasal congestion, reduced sense of smell, and occasional headaches. Examination reveals large nasal polyps.
Follow-up Questions:
-
What is the most likely diagnosis?
-
What are the first-line treatments for nasal polyps?
-
When would you consider surgical intervention?
Case 84: Cleft Lip and Palate in a Newborn
Date Tested: October 2023
Vignette:
A newborn infant presents with a cleft lip and palate. The mother is concerned about feeding difficulties and the future implications for the child’s development.
Follow-up Questions:
-
What are the immediate concerns in managing this condition?
-
What interdisciplinary team members would you involve in this patient’s care?
-
What are the long-term management options?
Case 85: Chronic Nasal Congestion and Allergies in a 45-Year-Old
Date Tested: November 2023
Vignette:
A 45-year-old male presents with ongoing nasal congestion, sneezing, and itchy eyes that worsen during the spring and summer months. He reports a history of asthma.
Follow-up Questions:
-
What is the likely diagnosis?
-
What treatments would you recommend for this patient?
-
How would you educate the patient about lifestyle modifications to manage his symptoms?
Case 86: Epistaxis in a Child with Von Willebrand Disease
Date Tested: December 2023
Vignette:
A 10-year-old child with a known history of von Willebrand disease presents with recurrent nosebleeds that are difficult to control.
Follow-up Questions:
-
What is the first-line management of epistaxis in a child with a bleeding disorder?
-
What are the challenges in managing this condition?
-
What preventive measures should be discussed with the parents?
Case 87: Sudden Deafness in a Middle-Aged Woman
Date Tested: January 2024
Vignette:
A 42-year-old woman presents with sudden-onset deafness in her right ear over the past 24 hours. She reports no pain or associated symptoms like vertigo or tinnitus.
Follow-up Questions:
-
What is your initial differential diagnosis for sudden hearing loss?
-
What investigations would you order to assess the cause?
-
What is the management for sudden sensorineural hearing loss?
Case 88: Obstructive Sleep Apnoea in a Middle-Aged Obese Man
Date Tested: February 2024
Vignette:
A 50-year-old obese male presents with loud snoring, choking episodes during sleep, and excessive daytime sleepiness. His BMI is 38.
Follow-up Questions:
-
What is the likely diagnosis?
-
How would you assess the severity of his condition?
-
What treatments would you consider for managing this patient?
Case 89: Retropharyngeal Abscess in a Child
Date Tested: March 2024
Vignette:
A 6-year-old child presents with fever, neck pain, and difficulty swallowing. The child appears anxious and is drooling.
Follow-up Questions:
-
What is your differential diagnosis for this child’s presentation?
-
How would you investigate further?
-
What is the management for a retropharyngeal abscess?
Case 90: Facial Nerve Paralysis Following Acoustic Neuroma Surgery
Date Tested: April 2024
Vignette:
A 60-year-old man presents with facial weakness and inability to close his eye on one side, following recent surgery for an acoustic neuroma.
Follow-up Questions:
-
What is the likely cause of the facial nerve paralysis?
-
How would you assess the degree of facial nerve dysfunction?
-
What treatment options are available to improve facial nerve function?
Case 91: Sinus Cancer in an Elderly Patient
Date Tested: May 2024
Vignette:
An 80-year-old man presents with a progressively worsening nasal obstruction, epistaxis, and pain in his face. He has a history of smoking for 40 years.
Follow-up Questions:
-
What are your concerns regarding this presentation?
-
What investigations would you perform to confirm the diagnosis?
-
What are the treatment options for sinus cancers?
Case 92: Snoring and Difficulty Sleeping in a 40-Year-Old
Date Tested: June 2024
Vignette:
A 40-year-old male presents with loud snoring and difficulty sleeping, resulting in daytime fatigue. He has no significant past medical history.
Follow-up Questions:
-
What are the potential causes of this patient’s symptoms?
-
What investigations would you consider to diagnose the problem?
-
What is the management for sleep apnea?
Case 93: Hoarseness with Neck Lump in an Elderly Patient
Date Tested: July 2024
Vignette:
A 65-year-old man presents with progressive hoarseness over the last month and a palpable lump in his neck. He has a history of smoking for 50 years.
Follow-up Questions:
-
What is your likely diagnosis?
-
How would you assess the neck lump?
-
What treatment plan would you consider for this patient?
Case 94: Meniere’s Disease in a 40-Year-Old Female
Date Tested: August 2024
Vignette:
A 40-year-old female presents with episodes of vertigo, hearing loss, and tinnitus in her right ear. The episodes have been occurring intermittently for the past 6 months.
Follow-up Questions:
-
What is the most likely diagnosis?
-
What investigations would you perform?
-
How would you manage this condition?
Case 95: Eczema of the External Ear Canal
Date Tested: September 2024
Vignette:
A 30-year-old woman presents with itching, redness, and occasional discharge from her ear canal. She has a history of eczema.
Follow-up Questions:
-
What is the likely diagnosis?
-
What treatment options are available for this patient?
-
How would you counsel the patient on preventing flare-ups?
Case 96: Foreign Body in the Ear of a Child
Date Tested: October 2024
Vignette:
A 5-year-old child presents with ear pain and crying. The child’s mother reports that the child was playing with small beads and may have inserted one into the ear canal.
Follow-up Questions:
-
What is your approach to examining the ear?
-
How would you remove a foreign body safely from the ear?
-
What complications might arise from this condition?
Case 97: Acute Pharyngitis in a 30-Year-Old
Date Tested: November 2024
Vignette:
A 30-year-old female presents with sore throat, fever, and difficulty swallowing for the past 3 days. She also reports malaise and headache.
Follow-up Questions:
-
What are the most common causes of acute pharyngitis?
-
What investigations would you perform to differentiate bacterial from viral causes?
-
What would be your treatment plan?
Case 98: Parotitis in an Elderly Patient
Date Tested: December 2024
Vignette:
A 75-year-old man presents with swelling and pain in front of his ears and fever. He also has dry mouth and difficulty swallowing.
Follow-up Questions:
-
What is your differential diagnosis for this condition?
-
How would you investigate further?
-
What is the treatment plan for parotitis?
Case 99: Nasopharyngeal Cancer in a 55-Year-Old
Date Tested: January 2025
Vignette:
A 55-year-old male presents with progressive nasal obstruction, blood-tinged nasal discharge, and unexplained weight loss. He has a history of smoking.
Follow-up Questions:
-
What is your differential diagnosis?
-
What investigations would you order to confirm the diagnosis?
-
What treatment options are available?
Case 100: Laryngeal Papillomatosis in a 10-Year-Old
Date Tested: February 2025
Vignette:
A 10-year-old child presents with a progressive change in voice and difficulty breathing. The child’s mother reports that the symptoms started after a cold.
Follow-up Questions:
-
What is your likely diagnosis?
-
How would you confirm the diagnosis?
-
What management options would you consider for this condition?