Question Easy:
A 45-year-old woman presents with fatigue, weight gain, constipation, and dry skin. Blood tests reveal a high TSH and low free T4. Which of the following is the most likely diagnosis? 🤔
A) Hypoparathyroidism
B) Hyperthyroidism
C) Hypothyroidism
D) Addison’s disease
E) Cushing’s syndrome
Explanations & Answers:
Question Easy Answer: C) Hypothyroidism
Question Easy Explanation: This patient exhibits classic symptoms of hypothyroidism. The blood test results show a high TSH and low free T4, indicating primary hypothyroidism, which aligns with the symptoms. According to NICE guidelines, these findings support the diagnosis of hypothyroidism.
Question Medium:
A 50-year-old man presents with headaches, palpitations, and sweating. Blood pressure readings reveal consistent hypertension. Urinary metanephrines levels are elevated. What is the most likely cause of this patient’s symptoms? 🚑
A) Conn’s syndrome
B) Adrenal adenoma
C) Phaeochromocytoma
D) Cushing’s disease
E) Primary hyperaldosteronism
Explanations & Answers:
Question Medium Answer: C) Phaeochromocytoma
Question Medium Explanation: The triad of headaches, sweating, and palpitations, along with persistent hypertension and elevated urinary metanephrines, strongly suggests a phaeochromocytoma. According to NHS guidelines, phaeochromocytoma is a rare tumour of the adrenal glands that secretes catecholamines, leading to these symptoms.
Question Hard:
A 65-year-old female presents with a sudden-onset headache described as “the worst ever,” alongside neck stiffness and photophobia. CT brain scan is negative for haemorrhage. A subsequent lumbar puncture shows xanthochromia. What is the likely diagnosis? 🧠
A) Meningitis
B) Subdural haematoma
C) Migraine
D) Subarachnoid haemorrhage
E) Tension headache
Explanations & Answers:
Question Hard Answer: D) Subarachnoid haemorrhage
Question Hard Explanation: The presentation of a thunderclap headache (“worst ever”), alongside neck stiffness and photophobia, is suggestive of a subarachnoid haemorrhage (SAH). A negative CT does not rule out SAH if performed late; however, the presence of xanthochromia on lumbar puncture confirms a subarachnoid bleed. This aligns with NICE’s clinical knowledge summary on investigating suspected SAH when initial CT is negative.
Medical fact of the day: In the UK, Addison’s disease, a rare disorder of the adrenal glands, affects roughly 6,000-12,000 people. It is essential to recognize its symptoms, as it can be life-threatening without treatment, particularly during an Addisonian crisis.
Quote of the day: “Caring for life is a marathon, not a sprint. Pace yourself, nurture your spirit, and spread kindness along the way.” 🌟