Question Easy:
A 30-year-old woman presents with fatigue, weight gain, and cold intolerance. On examination, her thyroid is tender and slightly enlarged. What is the most likely diagnosis? 🌡️
A) Graves’ disease
B) Toxic multinodular goitre
C) Subacute thyroiditis
D) Hashimoto’s thyroiditis
E) Thyroid cancer
Question Medium:
A 45-year-old man is brought to A&E with a headache, nausea, and vomiting. His blood pressure is 190/120 mmHg. Fundoscopy reveals grade IV hypertensive retinopathy. He has a history of a pheochromocytoma. What is the first-line treatment to manage his hypertensive crisis? 🚨
A) ACE inhibitor
B) Beta-blocker
C) Nitroprusside
D) Calcium channel blocker
E) Loop diuretic
Question Hard:
A 65-year-old male presents with progressive difficulty walking, falls, and a feeling of imbalance. He has difficulty with tandem gait and widespread cerebellar signs. Imaging shows cerebellar atrophy. What’s the most likely type of cerebellar degeneration associated with this presentation? 🧠
A) Multiple system atrophy
B) Spinocerebellar ataxia
C) Multiple sclerosis
D) Friedreich’s ataxia
E) Alcohol-induced cerebellar degeneration
Explanations & Answers:
Question Easy Answer: D) Hashimoto’s thyroiditis
Question Easy Explanation: Hashimoto’s thyroiditis, an autoimmune thyroid disorder, often presents with symptoms of hypothyroidism, including fatigue, weight gain, and cold intolerance. The presence of a tender thyroid can be an atypical feature, though subclinical thyroiditis could also present similarly. However, Hashimoto’s is the more common cause of hypothyroidism in this demographic.
Question Medium Answer: C) Nitroprusside
Question Medium Explanation: In a hypertensive crisis with severe retinopathy, nitroprusside is often used due to its rapid and potent vasodilatory effects. It’s particularly relevant in situations where quick management of blood pressure is critical. NICE guidelines recommend rapid-acting intravenous medications in hypertensive emergencies. It’s crucial to avoid beta-blockers initially in pheochromocytoma without prior alpha-blockade.
Question Hard Answer: B) Spinocerebellar ataxia
Question Hard Explanation: Spinocerebellar ataxias are hereditary ataxias characterized by progressive issues with coordination and balance, often presenting in mid to late adulthood. The widespread cerebellar signs and imaging showing cerebellar atrophy make this the most likely diagnosis among the options. Management usually involves supportive measures and genetic counseling.
Medical fact of the day: In the UK, Addison’s disease, a disorder affecting the adrenal glands, can lead to pigmentation changes in the skin due to increased levels of adrenocorticotropic hormone (ACTH), which shares pathways with melanocyte-stimulating hormone. 🌞
Quote of the day: “In the hustle of healing, never underestimate the power of hope and the human spirit.” 🌟