Question Easy: A 32-year-old woman presents to the GP with symptoms of fatigue, weight gain, and cold intolerance. Her laboratory results show an elevated TSH and low free T4. What is the most likely diagnosis? 🩺
A) Hyperthyroidism
B) Hypothyroidism
C) Subclinical hyperthyroidism
D) Euthyroid sick syndrome
E) Pheochromocytoma
Question Medium: A 45-year-old man has been experiencing headaches, excessive sweating, and palpitations. Physical examination reveals high blood pressure and tachycardia. Which diagnostic test is most appropriate to confirm pheochromocytoma? 🔬
A) Serum thyroid-stimulating hormone (TSH)
B) 24-hour urinary metanephrines
C) Serum cortisol
D) CT scan of the brain
E) Fasting blood glucose
Question Hard: A 67-year-old woman known to have type 2 diabetes presents with sudden onset of right-sided weakness and slurred speech. Her blood pressure is 180/110 mmHg. CT scan shows an ischaemic stroke. What is the most appropriate immediate management for this patient assuming she is within the window for intervention? 🧠
A) Commence aspirin 300 mg per oral
B) Administer intravenous alteplase
C) Start antihypertensive therapy to lower BP
D) Initiate clopidogrel
E) Begin a high-intensity statin
Explanations & Answers:
Question Easy Answer: B) Hypothyroidism
Question Easy Explanation: The patient’s symptoms and lab results are indicative of hypothyroidism, a condition characterized by elevated thyroid-stimulating hormone (TSH) and low free T4 levels, often leading to fatigue, weight gain, and cold intolerance. According to NICE guidelines, levothyroxine is the treatment of choice.
Question Medium Answer: B) 24-hour urinary metanephrines
Question Medium Explanation: Pheochromocytoma is diagnosed by measuring catecholamine metabolites such as metanephrines and normetanephrines in a 24-hour urine collection. NICE and BNF recommend this test due to its high sensitivity and specificity for this condition.
Question Hard Answer: B) Administer intravenous alteplase
Question Hard Explanation: The patient is presenting with an ischaemic stroke, and given she is within the therapeutic window (usually 4.5 hours from symptom onset), the administration of intravenous alteplase, a thrombolytic agent, is the recommended immediate management as per NHS and NICE guidelines.
Medical fact of the day: Acromegaly, a hormonal disorder caused by excess growth hormone, can lead to serious complications if not treated. In the UK, transsphenoidal surgery is often the first-line treatment to remove the pituitary adenoma causing the condition.
Quote of the day: “In every challenge lies a chance to grow and shine. Keep your heart, mind, and resilience strong, for the world needs your healing touch.” 🌟