Question Easy:
A 45-year-old woman presents with symptoms of fatigue, weight gain, and constipation. Her partner mentions she seems to be more forgetful than usual. Blood tests reveal elevated TSH and low free T4. What is the most likely diagnosis? 🤔
A) Graves’ disease
B) Hypothyroidism
C) Addison’s disease
D) Hyperthyroidism
E) Cushing’s syndrome
Question Medium:
A 60-year-old man is brought to the emergency department with a 2-hour history of left-sided weakness. CT scan of the head shows a large infarct in the right middle cerebral artery territory. Which of the following signs is most likely present?
A) Right-sided sensory loss
B) Right-sided motor weakness
C) Left-sided neglect
D) Right-sided neglect
E) Left-sided sensory loss
Question Hard:
A 30-year-old man with no significant past medical history presents with recurrent episodes of headache, sweating, and palpitations. He mentions the episodes seem to occur randomly and last about 15-30 minutes. On examination, his blood pressure is 170/100 mmHg. Which of the following tests is most appropriate to confirm the diagnosis? 🏥
A) Serum insulin level
B) Serum ACTH level
C) Plasma metanephrines
D) Serum cortisol level
E) Serum calcium level
Explanations & Answers:
Question Easy Answer: B
Question Easy Explanation: The patient exhibits classic symptoms of hypothyroidism, including fatigue, weight gain, and forgetfulness (often described as “brain fog”). Elevated TSH with low free T4 confirms the diagnosis. According to NICE guidelines, these lab results are indicative of primary hypothyroidism.
Question Medium Answer: C
Question Medium Explanation: A right middle cerebral artery infarct typically results in left-sided weakness as well as left-sided neglect due to the involvement of the parietal lobe which is responsible for attention and spatial processing. NICE and NHS guidelines emphasize recognising unilateral neglect as a common sign in stroke involving the MCA territory.
Question Hard Answer: C
Question Hard Explanation: The symptoms of headache, sweating, palpitations, and episodic hypertension are suggestive of pheochromocytoma. Plasma metanephrines are considered the most sensitive test for confirming this diagnosis, in line with the BNF and NICE guidelines.
Medical fact of the day: The adrenal medulla is the only part of the endocrine system that secretes hormones directly into the bloodstream in response to nerve signals, a process essential for the “fight or flight” response.
Quote of the day: The cure for anything is not objection, but understanding. In healthcare, every challenge met is a step towards a healthier tomorrow.