Question Easy: A 25-year-old woman presents with weight loss, anxiety, increased sweating, and palpitations. On examination, she has a resting tremor and exophthalmos. Which of the following is the most likely diagnosis? 🤔
A) Hyperthyroidism
B) Hypothyroidism
C) Addison’s disease
D) Cushing’s syndrome
E) Pheochromocytoma
Question Medium: A 55-year-old man is brought in by his wife because he has been complaining of headaches, sweating, and palpitations. His blood pressure is recorded as 180/110 mmHg. Which biochemical test is indicated to confirm the clinical suspicion of his condition?
A) Serum cortisol level
B) Urinary 5-HIAA
C) Plasma metanephrines
D) Serum thyroglobulin
E) Serum prolactin
Question Hard: A 60-year-old woman presents with muscle weakness, polydipsia, polyuria, and mood changes. Higher than normal serum calcium and low phosphate levels are observed. Which is the most appropriate initial treatment to manage her condition? 💊
A) Levothyroxine
B) Propylthiouracil
C) Bisphosphonates
D) Thiazide diuretics
E) Hydrocortisone
Explanations & Answers:
Question Easy Answer: A) Hyperthyroidism
Question Easy Explanation: The symptoms of weight loss, anxiety, increased sweating, palpitations, resting tremor, and exophthalmos are classic signs of hyperthyroidism, particularly Graves’ disease. According to NICE guidelines, clinical suspicion of hyperthyroidism is supported by these symptoms, warranting further investigation with thyroid function tests.
Question Medium Answer: C) Plasma metanephrines
Question Medium Explanation: The symptoms described are suggestive of pheochromocytoma, a catecholamine-secreting tumour. The most sensitive and specific test for pheochromocytoma is plasma free metanephrines or urinary metanephrines. The NHS also advises these levels to confirm diagnosis due to the secretion of adrenaline and noradrenaline by the tumour, explaining the hypertension and other symptoms.
Question Hard Answer: C) Bisphosphonates
Question Hard Explanation: The described symptoms, along with hypercalcaemia, are indicative of primary hyperparathyroidism. The initial treatment to prevent complications such as fractures or renal stones involves the use of bisphosphonates to lower serum calcium levels by inhibiting bone resorption, as suggested by NICE guidelines. Hydration is also crucial to manage acute symptomatic hypercalcaemia.
Medical fact of the day: In the UK, a mutation in the RET proto-oncogene is commonly seen in multiple endocrine neoplasia type 2 (MEN2), leading to medullary thyroid carcinoma. Genetic testing and counselling are vital in identifying and managing affected families.
Quote of the day: “In every challenging moment, remember there’s a life you’ve impacted and a future you’ve inspired. Keep healing, keep inspiring. 🌟”