Question Easy:
A patient presents with classic symptoms of hypothyroidism. Which of the following laboratory findings would you most likely expect?
A) Increased TSH, decreased free T4
B) Increased TSH, increased free T4
C) Decreased TSH, decreased free T4
D) Decreased TSH, increased free T4
E) Normal TSH, increased free T4
Question Medium:
A 55-year-old male presents with polyuria, polydipsia, and weight loss. His random plasma glucose is 14 mmol/L. Which of the following is the next best step in management?
A) Start metformin
B) Start lifestyle modifications
C) Initiate insulin therapy
D) Measure HbA1c
E) Refer for bariatric surgery
Question Hard:
A 30-year-old female presents with sudden onset of severe headache, visual disturbances, and ophthalmoplegia. Fundoscopy reveals papilledema. She has no significant medical history. What is the most likely diagnosis?
A) Cluster headache
B) Subarachnoid haemorrhage
C) Pituitary apoplexy
D) Migraine with aura
E) Idiopathic intracranial hypertension
Explanations & Answers:
Question Easy Answer:
A) Increased TSH, decreased free T4
Question Easy Explanation:
In hypothyroidism, the thyroid gland is underactive, leading to low levels of thyroid hormones (T4 and T3). The pituitary gland compensates by secreting more TSH to stimulate the thyroid gland, hence increased TSH and decreased free T4 are typical findings. This is well-aligned with NICE guidelines.
Question Medium Answer:
D) Measure HbA1c
Question Medium Explanation:
For a patient presenting with hyperglycaemia symptoms and a random plasma glucose of 14 mmol/L, an HbA1c test is warranted to confirm the diagnosis of diabetes mellitus and to guide further management. According to NHS guidelines, an HbA1c of 48 mmol/mol (6.5%) or higher is diagnostic of diabetes.
Question Hard Answer:
C) Pituitary apoplexy
Question Hard Explanation:
Pituitary apoplexy presents with sudden headache, visual disturbances, and ophthalmoplegia due to haemorrhage or infarction of the pituitary gland. Urgent MRI is usually required for diagnosis, and it is a clinical emergency. This condition correlates with BNF and NICE management guidelines.
Medical fact of the day:
The pineal gland, which is part of the brain, produces melatonin, a hormone that regulates sleep-wake cycles. Disorders of melatonin secretion can lead to sleep disturbances and are often addressed in neuroendocrine practice.
Quote of the day:
“Empathy is at the heart of quality healthcare – never underestimate the power of a compassionate word or gesture 🌟.”