Question Easy:
A 30-year-old woman presents with a tremor in her hands. It worsens when she tries to use her hands, like holding a cup or writing ✍️. The tremor disappears when she is at rest. What is the most likely diagnosis?
A) Essential tremor
B) Parkinson’s disease
C) Multiple sclerosis
D) Huntington’s disease
E) Wilson’s disease
Question Medium:
A 45-year-old man comes in with complaints of fatigue, polyuria, and polydipsia. His blood tests show a fasting plasma glucose of 8.5 mmol/L. His BMI is 32. What is the most appropriate initial management according to NICE guidelines?
A) Lifestyle advice and metformin
B) Insulin therapy
C) Lifestyle advice alone
D) Sulfonylurea therapy
E) DPP-4 inhibitor
Question Hard:
A 52-year-old woman with a history of Hashimoto’s thyroiditis presents with progressive weakness, dysphonia, and difficulty swallowing 🍽️. Physical examination reveals ptosis and a masked facial expression. Given her history and symptoms, what additional diagnostic test should be performed to confirm the diagnosis?
A) Brain MRI
B) Serum anti-acetylcholine receptor antibodies
C) TSH and free T4 levels
D) EMG (electromyography)
E) Serum calcium and phosphate levels
Explanations & Answers:
Question Easy Answer: A
Question Easy Explanation: Essential tremor is characterized by a bilateral action tremor of the hands, usually without any other neurological symptoms. It often worsens with voluntary movements and is distinctly different from the resting tremor seen in Parkinson’s disease. Treatment can include beta-blockers or anticonvulsants.
Question Medium Answer: A
Question Medium Explanation: According to NICE guidelines, the initial management for type 2 diabetes involves lifestyle modifications (diet and exercise) in addition to metformin. This approach helps in glycemic control especially when the patient has a raised BMI, indicative of possible insulin resistance.
Question Hard Answer: B
Question Hard Explanation: The patient’s symptoms suggest myasthenia gravis, an autoimmune disorder often associated with Hashimoto’s thyroiditis. Serum anti-acetylcholine receptor antibodies are pivotal in diagnosing myasthenia gravis. Electromyography (EMG) can also aid in confirming the diagnosis.
Medical fact of the day: The London Bridge Station is home to one of the world’s largest escalator systems, which interestingly reflects the complexity and extensive connectivity of the human brain’s neuronal network.
Quote of the day: “In the tapestry of UK healthcare, each thread – from student to seasoned professional – weaves a story of dedication, resilience, and hope.” 🌟