Question Easy:
A 30-year-old woman presents with fatigue, weight gain, and dry skin. Her TSH level is elevated, and her free T4 is low. What is the most likely diagnosis?
A) Hyperthyroidism
B) Hypothyroidism
C) Addison’s disease
D) Cushing’s syndrome
E) Pheochromocytoma
Question Easy Answer:
B)
Question Easy Explanation:
Hypothyroidism is the most likely diagnosis with symptoms of fatigue, weight gain, dry skin, and lab findings of elevated TSH and low free T4. NICE guidelines recommend levothyroxine as the first-line treatment.
Question Medium:
A 45-year-old man experiences a sudden, severe headache, often described as “the worst headache of his life.” He has photophobia and neck stiffness. What is the most likely diagnosis?
A) Tension headache
B) Migraines
C) Cluster headache
D) Subarachnoid haemorrhage
E) Brain tumour
Question Medium Answer:
D)
Question Medium Explanation:
A subarachnoid haemorrhage is suggested by a sudden, severe headache (“thunderclap headache”), photophobia, and neck stiffness. NHS guidelines recommend immediate CT scanning and lumbar puncture if CT is negative but suspicion remains high.
Question Hard:
A patient with known type 1 diabetes presents with confusion, sweating, palpitations, and a blood glucose level of 2.5 mmol/L. What is the best immediate management step?
A) Administer glucagon intramuscularly
B) Give oral glucose tablets
C) Start IV insulin infusion
D) Give a snack containing complex carbohydrates
E) Send the patient home and advise to eat something
Question Hard Answer:
B)
Question Hard Explanation:
For an awake patient with hypoglycemia and blood glucose level of 2.5 mmol/L, the best immediate management is to give oral glucose tablets. This aligns with NICE guidelines for management of hypoglycaemia in diabetic patients.
Medical fact of the day:
Cushing’s syndrome often presents with a plethora of distinctive features such as a round “moon” face, central obesity, and the development of a “buffalo hump” due to fat accumulation. This syndrome is a result of prolonged exposure to high levels of cortisol, often due to prolonged corticosteroid use or adrenal gland abnormalities.
Quote of the day:
“Every patient is a story – listen carefully and you’ll write the chapter that brings them back to health.”