A 50-year-old male patient presents with facial rounding, central obesity, and purple striae on the abdomen. Laboratory results show high levels of ACTH. What is the most likely underlying cause of his condition?
Adrenal insufficiency.
Pheochromocytoma.
Cushing Disease.
Hyperthyroidism.
The Correct Answer is C
Choice A Reason:
Adrenal insufficiency, also known as Addison’s disease, is characterized by insufficient production of cortisol and aldosterone by the adrenal glands. Symptoms typically include fatigue, weight loss, low blood pressure, and hyperpigmentation of the skin. High levels of ACTH are not associated with adrenal insufficiency; instead, ACTH levels are usually elevated in response to low cortisol levels.
Choice B Reason:
Pheochromocytoma is a rare tumor of the adrenal gland that produces excess catecholamines, leading to symptoms such as hypertension, palpitations, and headaches. It does not cause high levels of ACTH or the physical manifestations described in the patient, such as facial rounding and purple striae.
Choice C Reason:
Cushing Disease is caused by a pituitary adenoma that secretes excess adrenocorticotropic hormone (ACTH), leading to overproduction of cortisol by the adrenal glands. This results in symptoms such as facial rounding (moon face), central obesity, purple striae on the abdomen, and high levels of ACTH. These clinical features align with the patient’s presentation, making Cushing Disease the most likely underlying cause.
Choice D Reason:
Hyperthyroidism is characterized by excessive production of thyroid hormones, leading to symptoms such as weight loss, heat intolerance, palpitations, and tremors. It does not cause high levels of ACTH or the specific physical changes seen in Cushing Disease.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is A
Explanation
Choice A Reason:
Administering intravenous acetazolamide is a critical intervention for acute narrow-angle glaucoma. Acetazolamide is a carbonic anhydrase inhibitor that reduces the production of aqueous humor, thereby lowering intraocular pressure (IOP) quickly. Reducing IOP is essential to prevent optic nerve damage and preserve vision. Normal IOP ranges from 10 to 21 mmHg, and in acute narrow-angle glaucoma, it can exceed 30 mmHg. Rapid reduction of IOP is crucial to alleviate symptoms and prevent further complications.
Choice B Reason:
Applying warm compresses to the affected eye is not an appropriate intervention for acute narrow-angle glaucoma. Warm compresses may provide temporary relief for some eye conditions, but they do not address the underlying issue of elevated intraocular pressure. In fact, warm compresses can potentially increase blood flow to the eye, which might exacerbate the condition.
Choice C Reason:
Encouraging the patient to drink plenty of fluids to stay hydrated is generally good advice for overall health, but it is not a prioritized intervention for acute narrow-angle glaucoma. Hydration does not directly impact intraocular pressure or alleviate the acute symptoms of glaucoma. The primary focus should be on reducing IOP to prevent optic nerve damage.
Choice D Reason:
Administering a mydriatic agent to dilate the pupil is contraindicated in acute narrow-angle glaucoma. Mydriatic agents can worsen the condition by further narrowing the anterior chamber angle, increasing intraocular pressure, and potentially causing more damage to the optic nerve. It is crucial to avoid pupil dilation in this scenario.
Correct Answer is D
Explanation
Choice A Reason:
Primary hyperparathyroidism is characterized by elevated PTH levels, which lead to increased serum calcium levels and decreased serum phosphate levels. The patient’s lab results show low PTH and low serum calcium, which are not consistent with primary hyperparathyroidism.
Choice B Reason:
Chronic kidney disease (CKD) can cause disturbances in calcium and phosphate metabolism, but it typically presents with elevated PTH levels due to secondary hyperparathyroidism. The patient’s low PTH levels make CKD an unlikely diagnosis in this context.
Choice C Reason:
Vitamin D deficiency can lead to low serum calcium levels, but it usually results in elevated PTH levels as the body attempts to compensate for the low calcium. The patient’s low PTH levels do not align with a diagnosis of vitamin D deficiency.
Choice D Reason:
Hypoparathyroidism is characterized by low serum calcium, low PTH levels, and elevated serum phosphate levels. This condition occurs when the parathyroid glands do not produce enough PTH, leading to the observed lab results and symptoms such as tingling, muscle cramps, and fatigue. The patient’s lab results are consistent with hypoparathyroidism.
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