Question Easy:
A 45-year-old man presents with increased thirst, frequent urination, and unintentional weight loss over the past few months. He has a family history of type 2 diabetes mellitus. On examination, his BMI is 30 kg/m². What is the most appropriate initial test to screen for diabetes in this patient? 🩸
A) Random plasma glucose
B) Fasting plasma glucose
C) HbA1c
D) Oral glucose tolerance test
E) Glucose urine dipstick
Question Medium:
A 67-year-old woman with a history of hypertension presents with headaches and visual disturbances. MRI shows a 2 cm pituitary tumour with suprasellar extension. Her serum prolactin level is significantly elevated. What is the most suitable initial management for her condition? 🧠
A) Surgical resection
B) Radiotherapy
C) Dopamine agonist therapy
D) Corticosteroid therapy
E) Observation
Question Hard:
A 32-year-old woman presents with episodic palpitations, sweating, and headaches. Her blood pressure is consistently elevated, with readings of 160/100 mmHg. An abdominal CT scan reveals an adrenal mass. Which test is the most appropriate to confirm the underlying diagnosis of her condition? 🌡️
A) Serum cortisol after 1mg dexamethasone
B) Plasma fractionated metanephrines
C) Serum aldosterone-to-renin ratio
D) Serum ACTH
E) Urinary 17-ketosteroids
Explanations & Answers:
Question Easy Answer: C) HbA1c
Question Easy Explanation: HbA1c is the most commonly used initial screening test for type 2 diabetes mellitus as it provides a measure of average blood glucose levels over the past 2-3 months. It is easy to administer and does not require fasting, making it a convenient choice in general practice, as recommended by NICE guidelines.
Question Medium Answer: C) Dopamine agonist therapy
Question Medium Explanation: For a prolactinoma, the first-line treatment is medical therapy with dopamine agonists such as cabergoline or bromocriptine. These medications effectively reduce prolactin levels and tumour size. NICE guidelines recommend this approach as most patients respond well to medical management, avoiding the need for surgery.
Question Hard Answer: B) Plasma fractionated metanephrines
Question Hard Explanation: In suspected cases of pheochromocytoma, plasma fractionated metanephrines are the most sensitive and specific test for diagnosis. Pheochromocytomas secrete catecholamines, and measuring their metabolites, metanephrine and normetanephrine, provides a reliable diagnostic approach, as supported by NHS guidelines.
Medical fact of the day: Hormone replacement therapy (HRT) can reduce the risk of osteoporosis and fractures in postmenopausal women but may increase the risk of breast cancer and thromboembolic events. Clinicians must weigh the benefits and risks in a shared decision-making process with their patients.
Quote of the day: “In the journey of healing, your hands may provide the care, but it’s your heart that infuses the cure.”