1. A 27 year old woman presents with tiredness, weight gain and she says she's been feeling depressed lately. Her blood results come back with haemoglobin 140g/L (normal is 115-165), 9AM cortisol 420 nmol/L (normal is >350), fT4 5.4 pmol/L (normal is 9-23), TSH 16 mU/L (normal is 0.3-4.2). What would be the next best course of action?

A) Anterior pituitary MRI

B) Give levothyroxine

C) Start her on hydrocortisone

D) Rehydrate her with normal saline

E) Whole blood transfusion

Explanation: The correct answer is B because this patient has primary hypothyroidism- the low free T4 and high TSH indicates this. Because of this, the best course of action would be to give this patient replacement thyroid hormone in the form of levothyroxine

A- The cause of the hypothyroidism is more likely to be a problem with the thyroid gland rather than a pituitary tumour since there is a high TSH because of the lack of negative feedback from the low T4 (if there was low TSH then this would be more indicative of a pituitary tumour since the thyrotrophs aren't working properly)

C- This would be useful as a cortisol replacement if the patient had low cortisol, but cortisol is normal here

D- This would be useful if the patient had blood loss or primary adrenal failure but both her haemoglobin and cortisol are normal

E- Again, since her haemoglobin is normal she won't require a blood transfusion

2. A 46 year old fell and injured his back at T9 and when examined, a lesion was found in his left lateral corticospinal tract and left dorsal column. Which of the following are true?

A) He has no movement in his right leg

B) He can move his left leg completely fine

C) His feeling of pain and temperature in his left leg is impaired

D) His feeling of fine touch and vibration is impaired in his left leg

E) His feeling of pain and temperature in his right leg is impaired