Question Easy:
A 45-year-old woman presents with fatigue, weight gain, and depression. On examination, you find coarse skin and bradycardia. What is the most likely diagnosis? 🩺
A) Hyperthyroidism
B) Hypothyroidism
C) Addison’s disease
D) Cushing’s syndrome
E) Hyperparathyroidism
Explanations & Answers:
Question Easy Answer: B) Hypothyroidism
Question Easy Explanation: The symptoms described align closely with hypothyroidism, which is characterized by fatigue, weight gain, depression, coarse skin, and bradycardia. NICE guidelines recommend thyroid function tests to confirm the diagnosis. Treatment usually involves levothyroxine replacement therapy, as per BNF and NHS recommendations.
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Question Medium:
A 24-year-old man presents with a history of intermittent headaches, sweating, and palpitations. He also mentions recently being diagnosed with hypertension. What is the most appropriate initial investigation? 🔍
A) Random plasma glucose
B) ECG
C) CT scan of the head
D) 24-hour urinary metanephrines
E) Serum prolactin
Explanations & Answers:
Question Medium Answer: D) 24-hour urinary metanephrines
Question Medium Explanation: The presentation is suggestive of pheochromocytoma, a rare catecholamine-secreting tumor. NICE guidelines recommend measuring 24-hour urinary metanephrines as the initial test for diagnosing pheochromocytoma. This is corroborated by NHS advice on developing a thorough plan based on biochemical assessments.
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Question Hard:
A 35-year-old woman presents with left-sided hemiparesis and aphasia. She has a history of migraine with aura. MRI reveals a right-sided ischemic stroke. Which underlying condition is most likely present? 🧠
A) Patent foramen ovale
B) Carotid artery dissection
C) Multiple sclerosis
D) Temporal arteritis
E) Arteriovenous malformation
Explanations & Answers:
Question Hard Answer: A) Patent foramen ovale
Question Hard Explanation: The combination of a right-sided ischemic stroke with a history of migraines with aura should raise the suspicion for a patent foramen ovale (PFO). PFO can facilitate paradoxical embolism, leading to stroke in younger patients without traditional risk factors. NICE supports echocardiography to identify a PFO as per NHS stroke guidelines.
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Medical fact of the day: Multiple endocrine neoplasia type 1 (MEN1) is a hereditary condition involving tumours of the parathyroid glands, pancreas, and pituitary gland. Early identification and management are crucial to mitigate life-threatening consequences.
Quote of the day: “In the realm of healthcare, compassion is the bridge that connects knowledge with humanity.” 🌟