Question Easy: A 45-year-old woman presents to her GP with weight gain, fatigue, and cold intolerance. Her TSH level is elevated, and her free T4 is low. What is the most likely diagnosis? 🩺
A) Hyperthyroidism
B) Hypothyroidism
C) Cushing’s syndrome
D) Addison’s disease
E) Diabetes mellitus
Question Medium: A 60-year-old man presents with headaches and bitemporal hemianopia. An MRI shows a sellar mass compressing the optic chiasm. What is the most likely type of pituitary tumour? 👁️🗨️
A) Prolactinoma
B) Somatotroph adenoma
C) Corticotroph adenoma
D) Non-functioning adenoma
E) Thyrotroph adenoma
Question Hard: A 55-year-old woman reports feeling anxious, sweaty, and experiencing palpitations. She also notes episodes of intense headaches and high blood pressure. An abdominal CT scan reveals a mass on one adrenal gland. Which of the following is the most appropriate first step in management? 💊
A) Surgery to remove the adrenal mass
B) Initiate beta-blocker therapy
C) Prescribe alpha-blocker therapy
D) Begin corticosteroid replacement therapy
E) Monitor symptomatically
Explanations & Answers:
Question Easy Answer: B
Question Easy Explanation: This patient’s symptoms and biochemical findings suggest hypothyroidism, characterised by elevated TSH and low free T4. This condition is usually treated with levothyroxine according to NHS guidelines.
Question Medium Answer: D
Question Medium Explanation: The clinical presentation of headaches and bitemporal hemianopia with a sellar mass on MRI is indicative of a non-functioning adenoma. Such adenomas can cause symptoms through mass effect rather than hormone hypersecretion. NICE guidelines recommend considering transsphenoidal surgery based on clinical symptoms and imaging findings.
Question Hard Answer: C
Question Hard Explanation: The symptoms and imaging findings suggest a pheochromocytoma, a catecholamine-secreting tumour. According to BNF recommendations, initiating alpha-blocker therapy is the first step to control blood pressure and prevent intraoperative complications before any surgical intervention.
Medical fact of the day: Did you know that acromegaly is most commonly caused by a benign pituitary tumour known as a somatotroph adenoma? Despite its insidious onset, timely diagnosis and management can significantly improve patient outcomes and quality of life.
Quote of the day: “In the practice of medicine, let the heartbeat of compassion echo in every choice you make. 🌟”