Question Easy:
A 55-year-old man presents to the GP with increasing thirst, frequent urination, and weight loss over the last three months. He is otherwise well and takes no regular medication. What is the most likely diagnosis?
A) Hyperthyroidism
B) Diabetes mellitus
C) Diabetes insipidus
D) Cushing’s syndrome
E) Addison’s disease
Question Medium:
A 30-year-old woman presents to the clinic with symptoms of fatigue, weight gain, and feeling cold all the time. On examination, she has dry skin and delayed relaxation of ankle reflexes. What is the most likely biochemical abnormality?
A) Decreased TSH, increased T4
B) Increased TSH, decreased T4
C) Decreased TSH, decreased T4
D) Normal TSH, decreased T4
E) Increased TSH, increased T4
Question Hard:
A 68-year-old man presents with a 6-month history of episodes of dizziness, sweating, and confusion that resolve after eating. He has a history of myocardial infarction and is on multiple medications, including aspirin and atenolol. Which of the following is the most appropriate initial investigation?
A) Serum cortisol level
B) 24-hour urinary catecholamines
C) Fasting plasma glucose level
D) HbA1c
E) Serum insulin level
Explanations & Answers:
Question Easy Answer:
B) Diabetes mellitus
Question Easy Explanation:
The classic symptoms of polyuria, polydipsia, and weight loss are indicative of diabetes mellitus. According to NHS guidelines, these are typical hyperglycemia symptoms, and a blood test confirming elevated blood sugar levels would support this diagnosis.
Question Medium Answer:
B) Increased TSH, decreased T4
Question Medium Explanation:
This presentation suggests primary hypothyroidism, where the thyroid gland fails to produce enough hormones. Elevated TSH with low T4 confirms this diagnosis. Per NICE guidelines, the symptoms described align with this thyroid hormone imbalance.
Question Hard Answer:
C) Fasting plasma glucose level
Question Hard Explanation:
The episodes of dizziness, sweating, and confusion, relieved by eating, suggest possible hypoglycemia. According to NICE guidance, a fasting plasma glucose test is the most appropriate initial investigation to evaluate for hypoglycemia and possibly indicate insulinoma or reactive hypoglycemia.
Medical fact of the day:
Did you know? In the UK, diabetes affects more than 4.9 million people. This includes 1 million people who have type 2 diabetes but haven’t yet been diagnosed, emphasizing the importance of screening for early detection among at-risk populations.
Quote of the day:
“In the realm of healing, your compassion is as essential as your knowledge. Every act of kindness lights the path of recovery.”