Question Easy:
A 45-year-old woman presents with weight gain, cold intolerance, and dry skin. Laboratory tests reveal elevated thyroid-stimulating hormone (TSH) and low free thyroxine (FT4) levels. What is the most likely diagnosis? 🧐
A) Hyperthyroidism
B) Hypothyroidism
C) Cushing’s syndrome
D) Addison’s disease
E) Pheochromocytoma
Explanations & Answers:
Question Easy Answer:
B) Hypothyroidism
Question Easy Explanation:
Hypothyroidism is characterised by elevated TSH and low FT4 levels, indicating an underactive thyroid. Symptoms include weight gain, cold intolerance, fatigue, and dry skin. Treatment typically involves levothyroxine therapy as per NICE guidelines.
Question Medium:
A 35-year-old man presents with episodic palpitations, sweating, and headaches. His blood pressure is consistently elevated, and a 24-hour urine collection shows elevated catecholamines. Which of the following tests would best confirm the diagnosis? 🩺
A) Serum cortisol
B) Serum aldosterone
C) MRI of the abdomen
D) Plasma metanephrines
E) Serum ACTH
Explanations & Answers:
Question Medium Answer:
D) Plasma metanephrines
Question Medium Explanation:
The most sensitive and specific test for diagnosing pheochromocytoma is the measurement of plasma metanephrines. Elevated catecholamines in the 24-hour urine collection also support this diagnosis. MRI of the abdomen can be used subsequently to localise the tumour.
Question Hard:
A 70-year-old man with a history of hypertension and type 2 diabetes mellitus presents with confusion, muscle weakness, and polydipsia. Investigations reveal a serum sodium of 124 mmol/L and serum osmolality of 260 mOsm/kg. His urine osmolality is 510 mOsm/kg. Which of the following is the most appropriate initial treatment? 💊
A) Fluid restriction
B) Hypertonic saline
C) Intravenous furosemide
D) Oral sodium chloride
E) Desmopressin
Explanations & Answers:
Question Hard Answer:
A) Fluid restriction
Question Hard Explanation:
The patient likely has the syndrome of inappropriate antidiuretic hormone secretion (SIADH), as indicated by hyponatremia and elevated urine osmolality. The initial treatment is fluid restriction to prevent further dilution of the plasma sodium, adhering to NICE guidelines.
Medical fact of the day:
Endocrine fact: Addison’s disease, a rare disorder involving the adrenal glands, can often be misdiagnosed because its symptoms like fatigue, weight loss, and hyperpigmentation can resemble more common conditions. Early recognition and management are crucial!
Quote of the day:
“In every challenge faced in healthcare, there’s a chance to learn, grow, and make a difference. Keep pressing on with compassion and resilience. 🌟”