18/09/2024 – Endo and Neuro

Question Easy:
A 35-year-old woman presents with fatigue, weight gain, and cold intolerance. You note dry skin and a slow heart rate on examination. Which is the most likely diagnosis?
A) Addison’s disease
B) Hyperthyroidism
C) Hypothyroidism
D) Cushing’s syndrome
E) Pheochromocytoma

Explanations & Answers:

Question Easy Answer: C) Hypothyroidism

Question Easy Explanation: Hypothyroidism often presents with symptoms like fatigue, weight gain, and cold intolerance. The physical signs such as dry skin and bradycardia further support this diagnosis. NICE guidelines recommend checking thyroid function tests (TFTs) to confirm.

Question Medium:
A 45-year-old man presents with visual field defects and bitemporal hemianopia. He also complains of headaches and reduced libido. What is the most likely underlying pathology?
A) Pituitary adenoma
B) Optic neuritis
C) Temporal arteritis
D) Multiple sclerosis
E) Migraine

Question Medium Answer: A) Pituitary adenoma

Question Medium Explanation: Bitemporal hemianopia is classically associated with a pituitary adenoma compressing the optic chiasm. Accompanying symptoms like headaches and reduced libido are common due to hormonal imbalances. NICE guidelines recommend MRI for diagnosis.

Question Hard:
A 60-year-old woman with a history of hypertension and hyperlipidemia presents with sudden-onset left-sided weakness and dysarthria. On CT scan, there is no evidence of hemorrhage. What is the most appropriate next step in management?
A) Thrombolysis with alteplase
B) Aspirin and dipyridamole
C) Heparin infusion
D) Carotid endarterectomy
E) Steroid therapy

Question Hard Answer: A) Thrombolysis with alteplase

Question Hard Explanation: In the absence of hemorrhage and within the window for thrombolysis (usually 4.5 hours from symptom onset), thrombolysis with alteplase is recommended for ischemic stroke management according to NHS guidelines. Immediate initiation can significantly improve outcomes.

Medical fact of the day: The UK has a high prevalence of diabetes with around 3.9 million people currently living with a diagnosis of diabetes, primarily type 2 diabetes. This has significant implications for both endocrine and neurological health, as diabetes is a known risk factor for conditions such as diabetic neuropathy and stroke.

Quote of the day: “In the chaos of medical practice, remember that every act of kindness and every word of encouragement can be a life-saving intervention.” 🌟