Question Easy:
A 45-year-old woman comes to the clinic complaining of feeling constantly tired, gaining weight, and experiencing hair loss. On examination, she has dry skin and slight puffiness around the eyes. Which endocrine disorder is most likely?
A) Hyperthyroidism
B) Hypothyroidism
C) Addison’s disease
D) Diabetes mellitus
E) Cushing’s syndrome
Question Medium:
A 32-year-old man presents with sudden unilateral facial weakness, unable to wrinkle his forehead or close his eye on one side. He reports no pain but a slight tingling sensation. What is the most likely diagnosis?
A) Stroke
B) Bell’s palsy
C) Trigeminal neuralgia
D) Multiple sclerosis
E) Guillain-Barre syndrome
Question Hard:
A 56-year-old man presents with polyuria, polydipsia, and unintentional weight loss over the past three months. His fasting blood glucose is 15 mmol/L, and his HbA1c is 9%. Additionally, he has bilateral hand tremors and has developed a staring gaze. What is the most probable mixed endocrine and neurological diagnosis?
A) Hypoparathyroidism and essential tremor
B) Type 2 diabetes mellitus and hyperthyroidism
C) Addison’s disease and intention tremor
D) Hyperaldosteronism and Parkinson’s disease
E) Phaeochromocytoma and cerebellar ataxia
Explanations & Answers:
Question Easy Answer:
B) Hypothyroidism
Question Easy Explanation:
This patient’s symptoms and signs, including tiredness, weight gain, hair loss, dry skin, and puffiness around the eyes, are classic for hypothyroidism. According to NICE guidelines, hypothyroidism is often associated with these clinical features and can be diagnosed with a simple blood test measuring thyroid-stimulating hormone (TSH) and free thyroxine (T4) levels.
Question Medium Answer:
B) Bell’s palsy
Question Medium Explanation:
The sudden onset of unilateral facial weakness without pain but with some tingling sensations is indicative of Bell’s palsy. NICE guidelines note that Bell’s palsy typically presents without forehead sparing, which helps differentiate it from a stroke.
Question Hard Answer:
B) Type 2 diabetes mellitus and hyperthyroidism
Question Hard Explanation:
The patient’s symptoms of polyuria, polydipsia, and elevated blood glucose are indicative of diabetes mellitus. The additional symptoms of bilateral hand tremors and a staring gaze suggest hyperthyroidism, creating a possible diagnosis of coexisting Type 2 diabetes mellitus and hyperthyroidism. NICE guidelines point towards these findings as indicative of Graves’ disease, which can present with tremor and eye symptoms.
Medical fact of the day:
Did you know that Cushing’s syndrome can be caused not only by endogenous overproduction of cortisol but also by chronic use of corticosteroid medication? This is particularly relevant in patients with chronic inflammatory conditions.
Quote of the day:
“Every challenge in medicine is a chance to improve someone’s life. Keep learning, keep striving, and make a difference every day.”