Question Easy:
A 40-year-old man comes to the GP complaining of feeling tired and lethargic. He also reports gaining weight and feeling cold all the time. 😟 On examination, he has a low heart rate and dry skin. What is the most likely diagnosis?
A) Hyperthyroidism
B) Hypothyroidism
C) Diabetes mellitus
D) Addison’s disease
E) Depression
Explanations & Answers:
Question Easy Answer:
B) Hypothyroidism
Question Easy Explanation:
This patient’s symptoms align with hypothyroidism, which is characterised by fatigue, weight gain, cold intolerance, bradycardia, and dry skin. NICE guidelines recommend checking TSH and free T4 levels to confirm the diagnosis.
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Question Medium:
A 28-year-old woman presents with a severe headache, nausea, and blurred vision. She has no significant medical history and denies any head trauma. Her blood pressure is 210/115 mmHg. 😰 Fundoscopy shows papilledema. Which condition should you suspect?
A) Phaeochromocytoma
B) Primary hyperaldosteronism
C) Hypertensive encephalopathy
D) Intracranial haemorrhage
E) Migraine
Explanations & Answers:
Question Medium Answer:
C) Hypertensive encephalopathy
Question Medium Explanation:
The severe hypertension combined with neurological symptoms and papilledema is suggestive of hypertensive encephalopathy. According to NICE and NHS guidelines, urgent reduction of blood pressure with IV agents is recommended in cases of hypertensive emergency to prevent further complications.
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Question Hard:
A 55-year-old man has had recurrent episodes of confusion, sweating, palpitations, and tremors that resolve with eating. Blood tests show high insulin levels but low C-peptide levels during hypoglycemic episodes. What is the most likely cause?
A) Sulfonylurea use
B) Factitious hypoglycemia due to insulin
C) Insulinoma
D) Reactive hypoglycemia
E) Addison’s disease
Explanations & Answers:
Question Hard Answer:
B) Factitious hypoglycemia due to insulin
Question Hard Explanation:
The key clue is the low C-peptide level, indicating exogenous insulin administration, as endogenous insulin production would lead to elevated C-peptide. Non-medical use of insulin is sometimes observed in factitious disorders, leading to hypoglycemic episodes. Consistent with NHS guidelines, differentiating factitious hypoglycemia from insulinoma is critical as it alters management strategies.
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Medical fact of the day: Did you know that the pituitary gland, despite its small size (approximately the size of a pea), is often referred to as the “master gland” because it controls the function of most other endocrine glands in the body? 🤯
Quote of the day: “In the midst of healing others, remember to pause and listen to the heartbeat of your own soul.” 🌱