A 13-year-old girl has a three-month history of intermittent diarrhea

A 13-year-old girl has a three-month history of intermittent diarrhea, weight loss, and muscle weakness despite an increased and voracious appetite. She has also experienced intermittent palpitations. Her parents report that her school performance has declined over the past few months. She also gets upset easily, and is unable to concentrate well. Her sleep pattern is irregular. Physical examination detects a mild tremor of the fingers with the arms outstretched. Her palms are moist. Her blood glucose level is 4.5 mmol/L.Use the information above to answer the following questions.

Question 1 (Case 1)

What is the most likely diagnosis? List up to three.


Hyperthyroidism (Graves’ disease) – 1 point
Listing more than 3 answers – 0 points
NOT ACCEPTABLE – Listing “Thyroid disease” as an answer

Question 2 (Case 1)

Which initial investigations will you order at this time?
Select up to three answers.

2.Endoscopic retrograde cholangiopancreatography
3.Erythrocyte sedimentation rate
4.Jejunal biopsy
5.Psychometric testing
6.Rectal biopsy
7.Serum 17 a hydroxy progesterone level
8.Serum amphetamine levels
9.Serum beta-HCG
10.Serum electrolytes
11.Serum growth hormone level
12.Serum Insulin level
13.Serum T4 and T3
14.Serum vanillyl mandelic acid levels
15.Sweat chloride
16.Urine estradiol
17.Urine homovanillic acid levels
18.Urine screen for cannabinoids
Selecting Serum T4 and T3 – 1 point
Selecting more than 3 answers – 0 points