Question Easy:
A 54-year-old woman presents with fatigue, dry skin, and weight gain. She has also noticed some hair loss. Blood tests show an elevated thyroid-stimulating hormone (TSH) and low free thyroxine (T4). What is the most likely diagnosis?
A) Graves’ disease
B) Hashimoto’s thyroiditis
C) Subacute thyroiditis
D) Euthyroid sick syndrome
E) Hyperthyroidism
Question Medium:
A 29-year-old man presents to the clinic with confusion, polyuria, and polydipsia. Blood tests reveal a serum sodium level of 149 mmol/L and a serum osmolality of 310 mOsm/kg. Urine osmolality is measured and found to be 190 mOsm/kg. What is the most likely diagnosis?
A) Syndrome of inappropriate antidiuretic hormone secretion (SIADH)
B) Central diabetes insipidus
C) Nephrogenic diabetes insipidus
D) Hyperosmolar hyperglycemic state
E) Diabetic ketoacidosis
Question Hard:
A 45-year-old man with type 1 diabetes presents with sudden vision loss in his right eye. Examination reveals a pale area with a cherry-red spot at the macula. Which of the following underlying conditions is most likely responsible for this finding?
A) Hypertensive retinopathy
B) Central retinal vein occlusion
C) Central retinal artery occlusion
D) Proliferative diabetic retinopathy
E) Vitreous hemorrhage
Explanations & Answers:
Question Easy Answer:
B) Hashimoto’s thyroiditis
Question Easy Explanation:
The symptoms of fatigue, dry skin, and weight gain, along with the elevated TSH and low free T4, suggest hypothyroidism. In the UK, the most common cause of primary hypothyroidism is Hashimoto’s thyroiditis, an autoimmune condition.
Question Medium Answer:
B) Central diabetes insipidus
Question Medium Explanation:
The presentation of confusion, polyuria, and polydipsia, along with hypernatremia and low urine osmolality, is indicative of diabetes insipidus. The low urine osmolality suggests a failure to concentrate urine, characteristic of central diabetes insipidus, where there is an inadequate secretion of antidiuretic hormone.
Question Hard Answer:
C) Central retinal artery occlusion
Question Hard Explanation:
The sudden vision loss with a pale retina and cherry-red spot at the macula is classic for central retinal artery occlusion. This is a serious vascular event often associated with embolic disease, which can be seen in diabetic patients particularly if there is associated atherosclerosis or other cardiac sources of emboli.
Medical fact of the day:
Did you know that up to 12% of the UK population may have subclinical hypothyroidism? Many individuals are asymptomatic, highlighting the importance of targeted screenings in patients with risk factors.
Quote of the day:
“A single act of kindness can ignite hope in a patient’s heart, while enlightening your own path as a healer.” 🌟