Ear, Nose and Throat
CANDIDATE INSTRUCTIONS
You are a resident year 2 doctor working in the GP Clinic. A 41-year-old lady presents with a history of hearing difficulties for the past 4 months.
Take a focused patient's history.
At 7 minutes, the examiner will stop you to ask you some questions.
2 Minutes Reading Time
10 Minutes Station Time
Total 12 Minutes
EXAMINER INSTRUCTIONS
Timing Instructions: At 7 minutes, stop the candidate and ask the following questions:
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Answer 1: Acoustic Neuroma (1 mark) of the LEFT EAR (1 mark)
Note: Please specify which ear for FULL diagnosis.
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Answer 2:
Rinne's test is normal bilaterally
Weber's test shows localisation to the left side (the affected side)
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Acoustic Neuroma of the LEFT EAR (also known as Vestibular Schwannoma)
PATIENT INSTRUCTIONS
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Name: Amy Gray
Age: 41 Years Old
Date of Birth: 2nd May 1983
Location: GP Clinic
Occupation: Office Clerk
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“I have been having difficulty hearing for the past 4 months!”.
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“My husband told me that I have been increasing the television volume very frequently!”
No exposure to loud music/ sounds
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Site : Left ear
Onset : 4 months
Character : N/A
Radiating : N/A
Associated symptoms
Balance problems
Dizziness
Numbness on the left side of the face
Timing: Intermittent
Exacerbating : None
Alleviating factors : None
Severity : Nil
Red flag symptoms :
No acute trauma/ barotrauma, recent/recurrent otitis media
No tenderness on palpation posterior to the right ear (Mastoiditis)
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Ideas: “No idea Doctor"
Expectations: “Please help me doctor”
Concerns: “Am I going to be deaf forever??”
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Otherwise, NO fever, recent infections
NO headache, nausea, rashes around the face
NO chest pain, palpitations, shortness of breath,
NO vomiting, diarrhea, abdominal pain.
Normal urinary flow and bowel habits.
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Previous hospital admissions: None
Previous surgeries: None
Medical conditions: None
Medications:
None. Especially no ototoxic drugs.
Over the counters:
None.
Allergies:
None.
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Father had a similar problem but doesn’t know exactly what it was
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Smoking: Does not smoke
Alcohol: Does not dirnk alcohol
Recreational drugs: Never
Diet: Eats a well-balanced meal
Exercise: Never
Ill contacts: None
Home: Stays with husband and 2 kids
Active Daily Living: Works at the office, 9-5 job
Occupation: Office Clerk
No recent travels
MARK SCHEME
Introduction
Chief Complaint
History of Presenting Complaint
Systems Review
Past Medical History
Drug History
Family History
Social History
Questions
Patient Scores
Enter Your Score Here: /33
SCORE GUIDE
Pass: 19-33
Borderline Pass: 12 – 18
Fail: 0-11
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