Ms. Major, a 60-year-old female, presents to the emergency department after falling off a 25-foot ladder while cleaning the gutters. She complains of right-sided hip pain and is unable to bear weight. She has contusions on her right side and some scrapes and scratches but denies hitting her head or sustaining other injuries. She is diagnosed with a hip fracture. Ms. Major is a small-framed woman, very active, follows a healthy diet, and is well engaged in her community with many friends. What factor(s) make her more at risk for a hip fracture?

Choice A reason: Dawn phenomenon involves morning hyperglycemia, not hunger, tachycardia, or confusion. Hypoglycemia from exercise causes these acute symptoms, so this is incorrect for the described episode in Type 1 diabetes.

Choice B reason: Hypoglycemia, often triggered by increased exercise, causes hunger, lightheadedness, tachycardia, pallor, headache, and confusion due to low blood sugar. This matches the symptoms, making it the correct cause for the patient’s episode.

Choice C reason: Hyperglycemia causes thirst, urination, and fatigue, not tachycardia or confusion. Hypoglycemia from exercise aligns with the acute, neuroglycopenic symptoms described, so this is incorrect for the cause.

Choice D reason: Somogyi effect involves rebound hyperglycemia after nocturnal hypoglycemia, not acute symptoms like hunger and confusion. Exercise-induced hypoglycemia fits the immediate presentation, so this is incorrect for the cause.

Choice A reason: The initial stage of Alzheimer’s involves subtle short-term memory loss, mild personality changes, and forgetting details. This accurately describes early disease progression, aligning with clinical staging, making it a correct choice for Alzheimer’s stages.

Choice B reason: The moderate stage includes impaired higher cortical functions (language, spatial skills), not “no change.” This incorrect description of cognitive decline makes it an inaccurate choice for Alzheimer’s moderate stage characteristics.

Choice C reason: The moderate stage involves global cognitive impairment, including language and spatial deficits, disorientation, and inability to perform daily activities. This accurate description of moderate Alzheimer’s makes it a correct choice for the disease’s stages.

Choice D reason: The severe stage of Alzheimer’s includes loss of environmental response, requiring total care and often bedridden status. This reflects advanced disease progression, making it a correct selection for Alzheimer’s stages.

Choice E reason: Initial Alzheimer’s affects short-term, not long-term, memory. Long-term memory loss occurs later, so this inaccurate description of the initial stage makes it incorrect for Alzheimer’s early manifestations.

Choice F reason: The severe stage involves complete, not slight, loss of environmental response. This underestimation of severe Alzheimer’s dependency and disability makes it incorrect for the disease’s advanced stage.