A 39-year-old Hispanic woman with a history of obesity and diabetes mellitus (DM) presents with velvety darkening of the skin on the back of the neck and her axilla. Which of the following is most consistent with this presentation?
Acanthosis nigricans
Diabetic dermopathy
Scleroderma diabeticorum
Necrobiosis lipoidica
The Correct Answer is A
Choice A reason: Acanthosis nigricans is characterized by hyperpigmented, velvety plaques typically found on the neck, axillae, and other skin folds. It is strongly associated with insulin resistance and is common in individuals with obesity and type 2 diabetes.
Choice B reason: Diabetic dermopathy presents as small, round or oval, brownish atrophic patches usually on the shins. It does not involve the neck or axilla and lacks the velvety texture seen in acanthosis nigricans.
Choice C reason: Scleroderma diabeticorum involves thickening and hardening of the skin, usually on the upper back and neck, but it is less common and lacks the characteristic velvety hyperpigmentation.
Choice D reason: Necrobiosis lipoidica typically affects the lower legs and presents as yellow-brown plaques with telangiectasia and central atrophy. It is not associated with the axilla or neck and does not have a velvety appearance.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is B
Explanation
Choice A reason: Bupropion is an antidepressant that may improve energy and libido, but the PHQ-9 score of 4 indicates minimal depressive symptoms. The primary concern here is reduced libido and weight gain, which may be better addressed by evaluating testosterone levels.
Choice B reason: Testosterone deficiency is common in men with type 2 diabetes and can contribute to reduced libido, weight gain, and mood changes. Given the low PHQ-9 score and symptoms suggestive of hypogonadism, testosterone replacement therapy is the most appropriate next step after confirming low serum testosterone levels.
Choice C reason: Fluoxetine is a selective serotonin reuptake inhibitor (SSRI) used for depression. However, SSRIs can further reduce libido and are not indicated for mild depressive symptoms. This choice does not address the patient's primary concerns.
Choice D reason: Dulaglutide is a GLP-1 receptor agonist used to improve glycemic control and promote weight loss. While it may help with weight, it does not address libido or mood directly and is not the most targeted intervention for the current symptoms.
Correct Answer is C
Explanation
Choice A reason: While pain and pallor are features of compartment syndrome, the inability to perform passive movements is not a hallmark sign. In fact, pain with passive movement is more indicative of increased intracompartmental pressure. This choice omits critical signs such as paresthesia and pulselessness, which are essential for diagnosis.
Choice B reason: This option includes pain and weakness, which may be present, but again lacks the specificity of pain with passive movement and the full spectrum of neurovascular compromise. Weakness alone is not sufficient to confirm compartment syndrome, and the absence of paresthesia and pulselessness makes this choice incomplete.
Choice C reason: This choice correctly lists the classic “5 P’s” of acute compartment syndrome: pain, pulselessness, paresthesia, paralysis, and pallor. These signs reflect severe neurovascular compromise due to increased pressure within the compartment. Pain is typically out of proportion to the injury and worsens with passive stretch. Pulselessness and paralysis are late findings, indicating advanced ischemia.
Choice D reason: Pain with passive movement is a key early sign of compartment syndrome, but the inability to perform active movement and weakness alone do not encompass the full clinical picture. This option lacks paresthesia and pulselessness, which are critical for diagnosis.
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