Question Easy: A 45-year-old woman presents with fatigue, weight gain, and constipation. 👩⚕️ She also reports feeling cold all the time. On examination, you notice dry skin and bradycardia. What is the most likely diagnosis?
A) Hyperthyroidism
B) Addison’s disease
C) Hypothyroidism
D) Cushing’s syndrome
E) Diabetes mellitus
Question Medium: A 60-year-old man presents to the hospital with sudden onset left-sided weakness and slurred speech. 🤕 His CT scan shows no haemorrhage. What is the most urgent treatment you should consider if he is eligible?
A) Clopidogrel
B) Thrombolysis with alteplase
C) Anticoagulation with warfarin
D) Aspirin and ask for a repeat CT
E) Atorvastatin
Question Hard: A 30-year-old man with known Graves’ disease presents with agitation, sweating, and palpitations. 🏃♂️ His thyroid function tests are: TSH <0.01 mU/L, Free T4 38 pmol/L. What is the best initial step in management in this acute presentation?
A) Propranolol
B) Carbimazole
C) Radioactive iodine
D) Surgical thyroidectomy
E) Levothyroxine
Explanations & Answers:
Question Easy Answer: C) Hypothyroidism
Question Easy Explanation: The patient’s symptoms of fatigue, weight gain, feeling cold, dry skin, and bradycardia align with hypothyroidism. According to NICE guidelines, these are classic symptoms, and a TSH and free T4 test would confirm the diagnosis.
Question Medium Answer: B) Thrombolysis with alteplase
Question Medium Explanation: For a patient with acute ischaemic stroke, if within the therapeutic window (usually within 4.5 hours according to NHS guidelines), thrombolysis with alteplase is the urgent treatment to restore blood flow and improve outcomes.
Question Hard Answer: A) Propranolol
Question Hard Explanation: In a patient with acute thyrotoxic crisis or “thyroid storm,” the most immediate concern is to control symptoms such as tachycardia and agitation. Beta-blockers like propranolol are used before antithyroid drugs, providing rapid symptom relief, as per BNF guidelines.
Medical fact of the day: Did you know that pituitary adenomas are the most common type of intracranial tumours in adults? Despite their prevalence, many remain small and asymptomatic for years!
Quote of the day: “In the heart of every health care worker lies a compass pointing to care, compassion, and commitment.” 🌟