Question Easy: A 25-year-old woman comes to the GP complaining of fatigue, weight gain, and feeling cold all the time ❄️. On examination, she has a dry skin and bradycardia. What is the most likely diagnosis?
A) Hyperthyroidism
B) Hypothyroidism
C) Addison’s disease
D) Cushing’s syndrome
E) Polycystic ovary syndrome
Question Medium: A 50-year-old man presents with episodes of severe unilateral headache associated with nasal congestion and watery eyes on the same side. These attacks occur once or twice daily, mainly at night, and last for about an hour ⏰. What is the most likely diagnosis?
A) Migraine
B) Tension-type headache
C) Cluster headache
D) Temporal arteritis
E) Sinusitis
Question Hard: A 60-year-old woman is experiencing diplopia 👀 and ptosis. On examination, she has difficulty with upward and lateral gaze. The rest of her neurological exam is normal, and she reports no double vision when her eyes are closed. What is the most likely diagnosis?
A) Bell’s palsy
B) Myasthenia gravis
C) Multiple sclerosis
D) Horner’s syndrome
E) Oculomotor nerve palsy
Explanations & Answers:
Question Easy Answer: B) Hypothyroidism
Question Easy Explanation: This patient presents with classic symptoms of hypothyroidism according to NICE guidelines, including fatigue, weight gain, cold intolerance, dry skin, and bradycardia. These occur due to the reduced metabolic rate associated with low thyroid hormone levels.
Question Medium Answer: C) Cluster headache
Question Medium Explanation: Cluster headaches are characterized by severe unilateral pain with ipsilateral autonomic symptoms such as tearing and nasal congestion. The attacks typically last 15-180 minutes, occurring in clusters, often at the same time each day. NHS guidelines stress the use of oxygen therapy and triptans for acute attacks.
Question Hard Answer: B) Myasthenia gravis
Question Hard Explanation: The symptoms of diplopia and ptosis that worsen with muscle use suggest myasthenia gravis, an autoimmune disorder affecting neuromuscular transmission. Diplopia resolves when the eyes are closed, which aligns with the characteristic muscular fatigue seen as per BNF guidance. Edrophonium or ice pack test can be used for diagnosis, and management involves acetylcholinesterase inhibitors and immunosuppressants.
Medical fact of the day: Approximately 1 in 4,000 people in the UK is affected by Addison’s disease, an endocrine disorder that requires lifelong hormone replacement therapy.
Quote of the day: “Every patient you touch is a story in progress. Write your chapter with compassion and excellence.”