Question Easy: A 45-year-old woman presents with symptoms of fatigue, weight gain, and constipation. On examination, she has dry skin and a slow heart rate. Blood tests reveal a high TSH level with a low free T4. What is the most likely diagnosis? 😴
A) Addison’s disease
B) Hyperthyroidism
C) Hypothyroidism
D) Cushing’s syndrome
E) Type 2 diabetes mellitus
Question Medium: A 62-year-old man presents with a new tremor, slowness of movement, and stiffness. He notices the tremor is worse at rest and improves with activity. What neurotransmitter is most likely deficient in this condition? 🤔
A) Acetylcholine
B) Serotonin
C) Dopamine
D) GABA
E) Histamine
Question Hard: A 17-year-old female is brought to A&E due to severe headaches, palpitations, and sweating episodes. Her blood pressure is significantly high on multiple readings. Further investigation reveals an adrenal mass. Which biochemical test would confirm the diagnosis of pheochromocytoma? 🔬
A) Plasma renin activity
B) Serum cortisol
C) Urinary free cortisol
D) Plasma metanephrines
E) Serum aldosterone
Explanations & Answers:
Question Easy Answer: C) Hypothyroidism
Question Easy Explanation: The combination of fatigue, weight gain, constipation, dry skin, bradycardia, and the lab findings suggest hypothyroidism, a condition prevalent in the UK. According to NICE guidelines, a raised TSH with a low T4 is diagnostic of primary hypothyroidism.
Question Medium Answer: C) Dopamine
Question Medium Explanation: The symptoms described are classic for Parkinson’s disease, a progressive neurological disorder. The tremor at rest, bradykinesia (slowness), and rigidity point to a dopamine deficiency, particularly in the nigrostriatal pathway. NICE emphasizes the importance of recognizing this neurotransmitter deficit.
Question Hard Answer: D) Plasma metanephrines
Question Hard Explanation: The triad of headaches, palpitations, and sweating coupled with hypertension strongly suggests pheochromocytoma. NICE, NHS, and BNF guidelines recommend plasma metanephrines or 24-hour urinary metanephrines as the confirmatory test for diagnosing this catecholamine-secreting tumour.
Medical fact of the day: The pituitary gland, often called the “master gland,” is not larger than a pea and weighs less than 1 gram. Yet, it has a profound effect on growth, metabolism, and regeneration in the body!
Quote of the day: “In the art of healing, compassion is the canvas, hope is the brush, and every patient is a masterpiece in progress.” 🌟