A client diagnosed with myxedema reports having experienced a lack of energy, cold intolerance, and puffiness around the eyes and face. Based on the patient's presentation, which of the following hormones is the patient most likely deficient in? Select all that apply.

Adrenocorticotropic hormone (ACTH)

Aldosterone

Thyroid Stimulating Hormone (TSH)

Thyroxine (T4)

Triiodothyronine (T3)

Answer and Explanation

Correct Answer : D,E

Myxedema represents a severe form of hypothyroidism characterized by the dermal accumulation of mucopolysaccharides, leading to non-pitting edema. Systemic metabolic deceleration occurs due to inadequate glandular output, resulting in profound lethargy, hypothermia, and significant bradycardia. This condition reflects a failure in the thermogenic and chronotropic regulation of cellular processes.

Rationale:

A. Adrenocorticotropic hormone is secreted by the anterior pituitary to stimulate the adrenal cortex. Deficiencies in ACTH lead to secondary adrenal insufficiency, not the specific dermatological and metabolic changes seen in myxedema. Myxedema is specifically a clinical manifestation of thyroid hypofunction rather than pituitary-adrenal axis failure.

B. Aldosterone is a mineralocorticoid responsible for sodium retention and potassium excretion within the renal tubules. While its deficiency causes electrolyte imbalances and hypotension, it does not produce the periorbital puffiness or cold intolerance typical of myxedema. It is primarily regulated by the renin-angiotensin system rather than the thyroid-stimulating pathway.

C. In primary hypothyroidism, which causes myxedema, Thyroid Stimulating Hormone levels are typically elevated due to the loss of negative feedback. TSH is a pituitary hormone, not a thyroid hormone. Therefore, the patient is not deficient in TSH; rather, the thyroid gland fails to respond to its stimulation.

D. Thyroxine is the primary prohormone secreted by the thyroid gland and is severely depleted in myxedema. Low T4 levels lead to the systemic slowing of metabolic functions and the physical findings of facial edema. This deficiency is the fundamental cause of the clinical symptoms described in the patient assessment.

E. Triiodothyronine is the most biologically active thyroid hormone, and its deficiency directly results in decreased cellular oxygen consumption. A lack of T3 prevents normal heat production, leading to the reported cold intolerance. This hormone is essential for maintaining the basal metabolic rate and energetic homeostasis.

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Correct Answer is C

Explanation

Breast self-examination (BSE) is a self-screening technique aimed at early detection of breast tissue changes, including masses, skin retraction, nipple discharge, and asymmetry. It is timed according to hormonal fluctuations in the menstrual cycle to improve consistency in identifying abnormal findings versus cyclical physiological changes.

Rationale:

A. Daily breast self-examination is not recommended because normal hormonal changes throughout the menstrual cycle can cause transient breast tenderness and nodularity. Daily assessment increases false-positive findings and anxiety without improving cancer detection rates.

B. Yearly breast self-examination is insufficient for detecting early changes such as small masses or subtle asymmetry. Significant pathological changes can develop between annual intervals, reducing the effectiveness of this frequency as a self-screening strategy.

C. Monthly breast self-examination is recommended because it allows consistent monitoring at the same phase of the menstrual cycle, typically 5–7 days after menses begins when breast tissue is least hormonally influenced, improving detection of abnormal structural changes.

D. Weekly breast self-examination is unnecessary and not evidence-based. Frequent examination increases detection of benign cyclical changes related to hormonal variation, leading to unnecessary anxiety and potential over-reporting of normal physiological breast variations.

A. Cerumen impaction B. Presbycusis C. Sensorineural hearing loss D. Conductive hearing loss E. Foreign body obstruction

Correct Answer is ["D","E"]

Explanation

Pediatric unilateral hearing reduction commonly results from external auditory canal obstruction leading to impaired sound wave transmission to the tympanic membrane, producing conductive hearing loss due to mechanical blockage rather than cochlear or neural dysfunction processes.

Rationale:

A. Cerumen impaction involves accumulation of hardened earwax obstructing the external auditory canal. It can reduce hearing but does not specifically describe a visible bright green object. This condition is common but does not confirm foreign material presence. Therefore it is not the best match here.

B. Presbycusis is age-related degenerative hearing loss affecting elderly patients due to cochlear hair cell degeneration. It does not occur in kindergarten-aged children. It is a bilateral progressive sensorineural process unrelated to acute unilateral obstruction or visible foreign object in ear canal.

C. Sensorineural hearing loss results from cochlear or vestibulocochlear nerve damage affecting sound processing. It is not caused by visible external objects in the ear canal. There is no mechanical obstruction visible on inspection. Therefore it does not match the clinical finding described.

D. Conductive hearing loss occurs when sound transmission is blocked in external or middle ear structures. A visible foreign object obstructing the canal directly prevents sound conduction. This produces unilateral hearing loss consistent with reported symptoms in pediatric patients.

E. Foreign body obstruction is presence of external object in ear canal causing mechanical blockage. Bright green object strongly indicates inserted material such as toy fragment. This leads to acute unilateral hearing loss and is common in children due to exploratory behavior.

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A client diagnosed with myxedema reports having experienced a lack of energy, cold intolerance, and puffiness around the eyes and face. Based on the patient's presentation, which of the following hormones is the patient most likely deficient in? Select all that apply.

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Naxlex Comprehensive Predictor Exams

How often should women perform breast self exams?

Correct Answer is C

Explanation

The kindergarten student tells the school nurse that she can't hear out of her left ear. The nurse inspects the ear canal and sees a bright green object. Which condition does the nurse suspect? Select all that apply.

Correct Answer is ["D","E"]

Explanation

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