Question Easy:
A 35-year-old woman presents with fatigue, weight gain, and cold intolerance. Her serum TSH level is elevated, and free T4 is low. What is the most likely diagnosis? 🧐
A) Hyperthyroidism
B) Hypothyroidism
C) Cushing’s syndrome
D) Addison’s disease
E) Pheochromocytoma
Question Medium:
A 45-year-old man comes to the clinic with complaints of increased thirst, frequent urination, and fatigue. Lab tests show high serum sodium and low urine osmolality. Which of the following is the most likely underlying condition?
A) Diabetes mellitus type 2
B) Psychogenic polydipsia
C) Central diabetes insipidus
D) Renal tubular acidosis
E) SIADH
Question Hard:
A 60-year-old man presents with recurrent episodes of headache, diaphoresis, and palpitations. Symptoms are particularly pronounced when standing up quickly. His blood pressure is 160/95 mmHg sitting and 90/60 mmHg standing. Which biochemical test is most likely to confirm the diagnosis? 🌡️
A) Serum cortisol level
B) Plasma metanephrines
C) Serum glucose level
D) Serum renin level
E) Dexamethasone suppression test
Explanations & Answers:
Question Easy Answer: B) Hypothyroidism
Question Easy Explanation: The symptoms and lab findings are characteristic of hypothyroidism, which is due to an underactive thyroid gland producing insufficient hormones. According to NICE guidelines, elevated TSH and low free T4 indicate primary hypothyroidism.
Question Medium Answer: C) Central diabetes insipidus
Question Medium Explanation: Central diabetes insipidus is characterised by a deficiency of antidiuretic hormone (ADH). This deficiency results in the kidneys being unable to concentrate urine, leading to high serum sodium and low urine osmolality. The NHS advises the use of a water deprivation test to confirm the diagnosis.
Question Hard Answer: B) Plasma metanephrines
Question Hard Explanation: The symptoms and blood pressure changes suggest a pheochromocytoma—a condition where a tumour of the adrenal medulla secretes excess catecholamines. NICE guidelines recommend measuring plasma free metanephrines as the most sensitive test for confirming this diagnosis.
Medical fact of the day: Did you know that the pituitary gland, often called the “master gland,” releases hormones that regulate many bodily functions and also affects the secretion of hormones from other endocrine glands? It plays a crucial role in growth, metabolism, and reproduction. 🌟
Quote of the day: “In the midst of each clinical challenge lies an opportunity for growth and learning. Keep your heart open and your spirit resilient.” – Unknown