RM, a 38-year-old woman who is attending graduate school and is very sedentary, comes to a community outpatient clinic. Her chief complaint is overwhelming fatigue that is not relieved by rest. She is so exhausted that she has difficulty walking to classes and trouble concentrating when studying. She reports a recent weight gain of 15 pounds (6.8 kg) over 2 months without clear changes in her dietary habits. Her face looks puffy, she has experienced excessive hair loss, and her skin is dry and pale. She says she has general body aches and pains with frequent muscle cramps and constipation. You note she is dressed inappropriately warmly for the weather. The physician orders lab work. The lab results are as follows:

WBC - WNL

HGB - WNL

Glucose - WNL

Amylase - WNL

Cholesterol - WNL

T4 (thyroxine) -↓

T3 (triiodothyronine) -↓

Thyroid-stimulating hormone (TSH) -↑

The physician diagnoses RM with an endocrine disorder. The assessment findings and lab work are consistent with which endocrine problem?

Choice A reason: "It must have been from sharing needles with my roommate." This statement is incorrect because hepatitis A is not typically transmitted through sharing needles. Hepatitis A is primarily spread through the fecal-oral route, which involves ingestion of contaminated food or water.
Choice B reason: "It is likely transmitted through kissing or sexual activity." This statement is also incorrect. Hepatitis A is not commonly spread through kissing or sexual activity. It is mainly transmitted through consuming contaminated food or water or close contact with an infected person.
Choice C reason: "I think I caught it because I have a family history of liver problems." This statement reflects a misunderstanding of how hepatitis A is transmitted. Hepatitis A is not linked to genetic predisposition or family history of liver problems. It is an infectious disease spread through the fecal-oral route.
Choice D reason: "I probably got it from drinking contaminated water or eating food handled by someone who didn't wash their hands properly." This statement is correct and indicates an accurate understanding of how hepatitis A is transmitted. The virus is often spread through consumption of contaminated food or water, particularly in areas with poor sanitation.

Choice A reason: While CT or MRI scans can be helpful in identifying structural changes in the brain associated with dementia, such as atrophy or the presence of strokes, they are not sufficient on their own to diagnose dementia. These imaging techniques are often used to rule out other causes of cognitive impairment and to support a clinical diagnosis, but they do not provide a complete picture of a patient's cognitive function.
Choice B reason: Patient history and cognitive assessment are the primary methods for diagnosing dementia. The clinical diagnosis is based on a thorough evaluation of the patient's medical history, including any changes in cognitive function, behavior, and daily living activities. Cognitive assessments, such as the Mini-Mental State Examination (MMSE) or Montreal Cognitive Assessment (MoCA), are used to evaluate memory, attention, language, and other cognitive abilities. These assessments help to determine the presence and severity of cognitive impairment and differentiate dementia from other conditions that may cause similar symptoms.
Choice C reason: A brain biopsy is not a standard procedure for diagnosing dementia. It is an invasive procedure that involves taking a small sample of brain tissue for examination under a microscope. While it can provide definitive information about certain types of dementia, such as Creutzfeldt-Jakob disease, it is rarely used due to its invasiveness and associated risks.
Choice D reason: An electroencephalogram (EEG) is a test that measures electrical activity in the brain. It can be useful in diagnosing certain neurological conditions, such as epilepsy, but it is not typically used to diagnose dementia. EEGs do not provide detailed information about cognitive function or the structural changes in the brain associated with dementia.