A 62 year old female tells her nurse that she has been experiencing night sweats and weight loss. Upon examination the nurse palpates enlarged cervical lymph nodes that do not seem to be painful. Which of the following cancers should the patient be screened for?

A. Weight loss–muscle wasting: Muscle wasting can occur in Cushing’s disease due to protein catabolism, but it is usually accompanied by weight gain rather than weight loss. Clients typically experience redistribution of fat rather than overall loss of body mass. Weight loss is more characteristic of conditions such as Addison’s disease or hyperthyroidism.

B. Truncal obesity–moon face: Excess cortisol leads to abnormal fat redistribution, resulting in central (truncal) obesity and a rounded “moon face.” These are classic physical assessment findings in clients with Cushing’s disease. The pattern reflects prolonged exposure to high cortisol levels.

C. Pallor–swollen tongue: Pallor and a swollen tongue are more suggestive of anemia or vitamin B12 deficiency. These findings are not associated with the hormonal and metabolic effects of excess cortisol. They do not reflect the typical physical changes seen in Cushing’s disease.

D. Depigmented skin–eyelid lag: Depigmented skin is commonly associated with autoimmune conditions, while eyelid lag is a hallmark of hyperthyroidism. These findings are unrelated to cortisol excess and do not align with the expected assessment findings in Cushing’s disease.

A. Gallstone pain, or biliary colic, is caused by obstruction of the cystic or common bile duct by gallstones. The pain is typically located in the right upper quadrant of the abdomen. Due to shared nerve pathways (referred pain via the phrenic nerve), the pain often radiates to the right shoulder or right scapular area.