Question Easy: A 45-year-old woman presents to the GP with symptoms consistent with hypothyroidism, including fatigue, weight gain, and cold intolerance 🥶. Which of the following blood test results would be indicative of primary hypothyroidism?
A) Low TSH, low free T4
B) High TSH, high free T4
C) High TSH, low free T4
D) Normal TSH, low free T4
E) Low TSH, high free T4
Question Medium: A 65-year-old man with a history of type 2 diabetes presents with a new onset of left-sided hemiparesis and expressive aphasia. A CT scan shows an ischaemic stroke in the territory of the middle cerebral artery. According to NICE guidelines, what is the appropriate initial management to improve outcomes?
A) Immediate administration of aspirin 300 mg
B) Start anticoagulation therapy immediately
C) Administer alteplase (thrombolysis) within 4 hours
D) Provide oxygen to maintain saturation above 90%
E) Perform a carotid endarterectomy urgently
Question Hard: A 30-year-old man presents with unintentional weight loss, hyperpigmentation, and fatigue. His blood tests reveal low sodium, high potassium, and low cortisol levels both at baseline and after an ACTH stimulation test. What is the most likely diagnosis?
A) Cushing’s syndrome
B) Primary hyperaldosteronism
C) Addison’s disease
D) Hyperpituitarism
E) Secondary adrenal insufficiency
Explanations & Answers:
Question Easy Answer: C
Question Easy Explanation: In primary hypothyroidism, the thyroid gland is underactive, leading to low levels of thyroid hormones (free T4). To compensate, the pituitary gland releases more thyroid-stimulating hormone (TSH), resulting in high TSH levels. This is in agreement with NICE guidelines for diagnosing hypothyroidism. 🧐
Question Medium Answer: C
Question Medium Explanation: According to NICE guidelines, if an ischaemic stroke occurs within 4.5 hours of onset and there are no contraindications, thrombolysis with intravenous alteplase is recommended. This can notably improve neurological outcomes. Aspirin should be administered after 24 hours if thrombolysis is given. 💉
Question Hard Answer: C
Question Hard Explanation: The clinical picture of hyperpigmentation, fatigue, weight loss, along with laboratory findings of low sodium, high potassium, and low cortisol, particularly after ACTH stimulation, is classic for Addison’s disease. This adrenal insufficiency is primarily caused by an autoimmunological destruction of the adrenal cortex, limiting cortisol production. 🌿
Medical fact of the day: Did you know that Addison’s disease was first fully described in 1855 by Thomas Addison, an English physician? In the UK, autoimmune Addison’s is more common, reflecting specific genetic predispositions seen in European populations.
Quote of the day: “In the heart of uncertainty, healthcare workers paint hope. Let your dedication be the masterpiece that inspires healing and compassion in every patient’s journey.”