Question Easy:
A 55-year-old woman is brought to the GP by her husband because she has been feeling lethargic, is sensitive to cold, and has gained weight despite having a poor appetite. On examination, her skin is dry, and her reflexes are slow. Which of the following is the most likely diagnosis?
A) Hyperthyroidism
B) Addison’s disease
C) Cushing’s syndrome
D) Hypothyroidism 🙂
E) Polycystic ovarian syndrome
Question Medium:
A 62-year-old man with a history of hypertension presents with sudden-onset right-sided weakness and slurred speech. His symptoms started 2 hours ago. On examination, there is weakness of the right facial muscles, and right upper and lower limb weakness with Babinski’s sign present on the right side. What is the most appropriate initial investigation?
A) CT head without contrast
B) MRI head with contrast
C) Carotid Doppler ultrasound
D) ECG
E) Echocardiogram
Question Hard:
A 34-year-old woman presents with episodes of palpitations, sweating, and headaches. She reports these episodes happening suddenly, and they last about 20 minutes. Blood pressure during the episode is consistently elevated. Which of the following biochemical tests would you first order to confirm your suspicion?
A) Serum TSH and T4
B) Serum cortisol
C) Plasma metanephrines
D) Serum catecholamines
E) 24-hour urine cortisol
Explanations & Answers:
Question Easy Answer: D) Hypothyroidism
Question Easy Explanation: The symptoms of lethargy, cold intolerance, weight gain, dry skin, and slow reflexes align with hypothyroidism. This condition is characterized by a deficiency of thyroid hormones, leading to a reduced metabolic rate, which matches the clinical presentation described. According to NICE guidelines, clinical features are crucial for diagnosis before confirming with a thyroid function test.
Question Medium Answer: A) CT head without contrast
Question Medium Explanation: Given the clinical presentation of acute stroke symptoms and the time window since the onset of symptoms, the most appropriate initial investigation is a non-contrast CT head. This is crucial to differentiate between ischemic and hemorrhagic stroke, as per NHS stroke management pathways, allowing for timely intervention with thrombolytics if ischemic stroke is confirmed and no contraindications are present.
Question Hard Answer: C) Plasma metanephrines
Question Hard Explanation: The episodic symptoms of palpitations, sweating, headaches, and hypertension raise suspicion for a pheochromocytoma, a catecholamine-secreting tumor. Plasma metanephrines are the first-line test for this condition as recommended by endocrine guidelines, due to their high sensitivity for detecting catecholamine excesses.
Medical fact of the day: Did you know that the pituitary gland, often called the “master gland,” not only regulates most of the hormonal balances in our body but can also be impacted by psychosocial stress, influencing both endocrine and psychological functions?
Quote of the day: “In the quiet commitments of care, the heart learns its strongest beat. Persist, for each small act of kindness is a face of healing.”