Deaf Nurse Proves Doubters Wrong

Nicole Fleming, RN, once dreamed of a career in music. But in her junior year of college, the world fell silent when she lost her hearing, shattering her plans. Doctors and professors told her she’d never work in medicine. With grit and determination, Nicole silenced her doubters and forged an inspiring path, proving that barriers exist only to be broken.

Deaf Nurse Proves Doubters Wrong

QUIZ QUESTION

56-year-old woman with alcoholic liver disease presents complains of being tired

A 56-year-old woman with alcoholic liver disease presents to you with the complaint of being tired but states that she is otherwise healthy. She currently drinks 3 six-packs of beer every day and tells you she is not interested in alcohol cessation.

On examination, her height is 5 feet 6 inches, she weighs 186 pounds, and her blood pressure is 147/84 mm Hg. She has a buffalo hump and striae in the abdomen that are pink in color. She is able to stand up after squatting. 

Her nonfasting, finger-stick blood glucose test result is 189. On initial work-up, you order a morning cortisol level, which is 16 mg/dL, and a glycated hemoglobin level, which is 7.3%.

You confirm a diagnosis of diabetes but you are concerned the patient may have Cushing syndrome given her elevated cortisol level. You order a dexamethasone suppression test (1 mg), which comes back as 14 mg/dL.

Which of the following statements is true of patients with pseudo-Cushing syndrome associated with alcohol abuse? 

-Chronic alcohol use results in a physiological decrease in serum cortisol levels        

- Patients with pseudo-Cushing syndrome secondary to alcohol abuse require the same treatment as patients with Cushing syndrome

-Cortisol levels in pseudo-Cushing syndrome remain high even after a period of abstinence

-The symptoms of pseudo-Cushing syndrome are often indistinguishable from those of Cushing syndrome