Question Easy:
A 55-year-old woman presents to the GP with fatigue, weight gain, and cold intolerance. Blood tests reveal elevated thyroid-stimulating hormone (TSH) and low free thyroxine (T4) levels. What is the most likely diagnosis? 🦋
A) Hyperthyroidism
B) Hypothyroidism
C) Graves’ disease
D) Subclinical hyperthyroidism
E) Euthyroid
Question Medium:
A 32-year-old man presents to the A&E with acute onset of severe headache, vomiting, and photophobia. On examination, he has neck stiffness but is alert and oriented. A CT scan of the head is normal. Which investigation is most appropriate to confirm the diagnosis of subarachnoid hemorrhage? 🌡️
A) Repeat CT scan after 24 hours
B) MRI of the brain
C) Lumbar puncture
D) EEG
E) Cerebral angiography
Question Hard:
A 46-year-old man with Addison’s disease presents with sudden weakness, nausea, abdominal pain, and hypotension. He is currently taking hydrocortisone but forgot his morning dose. What is the most appropriate initial management? 🚑
A) Oral hydrocortisone 20mg
B) Intravenous normal saline 1L
C) Intravenous hydrocortisone 100mg
D) Intramuscular hydrocortisone 50mg
E) Oral fludrocortisone
Explanations & Answers:
Question Easy Answer:
B) Hypothyroidism
Question Easy Explanation:
The patient’s symptoms and lab results are consistent with hypothyroidism. Elevated TSH and low T4 levels indicate underactive thyroid function, which aligns with the clinical presentation. NICE guidelines recommend confirmation with thyroid function tests before commencing treatment, typically with levothyroxine.
Question Medium Answer:
C) Lumbar puncture
Question Medium Explanation:
In a case of suspected subarachnoid hemorrhage with a normal CT scan, a lumbar puncture is the next step. It is performed to check for xanthochromia, which confirms the presence of bleeding within the subarachnoid space. NICE guidelines support this approach when initial imaging is inconclusive.
Question Hard Answer:
C) Intravenous hydrocortisone 100mg
Question Hard Explanation:
In an Addisonian crisis, characterized by severe symptoms like shock and hypotension, immediate intravenous administration of hydrocortisone 100mg is crucial. NICE and BNF guidelines recommend this emergency measure to rapidly restore glucocorticoid activity, alongside supportive fluid therapy if needed.
Medical fact of the day: Did you know that neuroendocrine tumors can produce excess hormones leading to conditions like carcinoid syndrome? These rare tumors can arise in various parts of the body, including the gastrointestinal tract and lungs. Early detection and management are crucial for a better outcome.
Quote of the day: “Every breath, every heartbeat, is an opportunity to care, to cure, and to comfort. Embrace the challenge, for you hold the gift of healing in your hands.” 🌟