Question Easy: A 28-year-old woman presents to the GP with weight gain, fatigue, and cold intolerance. On examination, her skin is dry, and she has a slightly swollen neck. 📏 What is the most likely diagnosis?
A) Hashimoto’s thyroiditis
B) Graves’ disease
C) Addison’s disease
D) Cushing’s syndrome
E) Type 1 diabetes mellitus
Question Medium: A 52-year-old man with a 15-year history of type 2 diabetes mellitus visits your clinic with complaints of tingling and numbness in his feet. Deep tendon reflexes are reduced on examination. Which approach is most appropriate for managing his symptoms in line with NICE guidelines? 🦶
A) Amitriptyline
B) Insulin adjustment
C) Lifestyle modification
D) Gabapentin
E) Poor-fitting footwear advice
Question Hard: A 63-year-old woman presents with sudden onset of severe headache, described as “the worst headache of my life,” along with nausea and neck stiffness. What is the most appropriate initial imaging investigation? 🧠
A) MRI of the brain
B) CT scan of the brain without contrast
C) Lumbar puncture
D) EEG
E) Plain skull X-ray
Explanations & Answers:
Question Easy Answer: A) Hashimoto’s thyroiditis
Question Easy Explanation: This patient’s symptoms of weight gain, fatigue, cold intolerance, dry skin, and neck swelling are typical of hypothyroidism, most commonly caused by Hashimoto’s thyroiditis. This condition leads to underactive thyroid gland function and an enlarged thyroid (goitre). NICE guidelines advise thyroid function tests to confirm decreased thyroxine levels and increased TSH.
Question Medium Answer: A) Amitriptyline
Question Medium Explanation: According to NICE guidelines, amitriptyline or other neuropathic pain medications such as gabapentin are recommended for treating diabetic peripheral neuropathy. Lifestyle changes and insulin adjustment are important for overall management of diabetes but do not directly address neuropathic pain.
Question Hard Answer: B) CT scan of the brain without contrast
Question Hard Explanation: A sudden, severe headache described as the “worst headache of my life” often suggests a subarachnoid haemorrhage. NICE guidelines recommend an immediate CT scan of the brain without contrast as the initial investigation to quickly identify potential bleeding. A lumbar puncture may be performed later if the CT scan is negative but suspicion remains high.
Medical fact of the day: The pituitary gland, often dubbed the “master gland,” plays a critical role in regulating vital body functions and general wellbeing. It is small—about the size of a pea—and located at the base of the brain. 🧠
Quote of the day: “In the heartbeat of healthcare, patience and empathy intertwine to create the rhythm of healing.” 🌟