A patient presents with weight loss, fatigue, nausea, vomiting, and abdominal pain. Laboratory tests reveal hypoglycemia and elevated insulin levels. Which endocrine disorder is most likely responsible for these symptoms?

Correct Answer: D

Rationale: Insulinoma is a rare neuroendocrine tumor that arises from pancreatic beta cells, leading to excessive production and secretion of insulin. The symptoms described in the patient, such as weight loss, fatigue, nausea, vomiting, abdominal pain, hypoglycemia, and elevated insulin levels, are characteristic of insulinoma.

Correct Answer: C

Rationale: Hurthle cell carcinoma is a type of thyroid cancer that arises from the Hurthle cells of the thyroid gland. Patients with Hurthle cell carcinoma may present with a thyroid nodule and signs of hyperthyroidism, which can mimic other thyroid disorders such as Graves' disease. Fine-needle aspiration biopsy revealing Hurthle cells and cellular atypia is suggestive of a Hurthle cell neoplasm, particularly Hurthle cell carcinoma. It is important to differentiate Hurthle cell carcinoma from benign Hurthle cell adenomas or other thyroid conditions to guide appropriate management and treatment.

Correct Answer: D

Rationale: Takotsubo cardiomyopathy, also known as stress-induced cardiomyopathy or broken heart syndrome, presents with symptoms similar to acute coronary syndrome, such as chest pain and ECG changes. In Takotsubo cardiomyopathy, chest pain typically occurs during emotional stress and resolves spontaneously, similar to the scenario described in the question. The ECG may show transient ST-segment elevation. This condition is characterized by a reversible left ventricular dysfunction that can mimic a myocardial infarction. Unlike stable angina (Choice A) and unstable angina (Choice B), Takotsubo cardiomyopathy is not related to coronary artery disease. Acute myocardial infarction (Choice C) typically presents with persistent ST-segment elevation on ECG and is caused by atherosclerotic plaque rupture leading to myocardial infarction, which is not consistent with the transient ST-segment elevation seen in

Correct Answer: D

Rationale: The clinical presentation of chest pain, dyspnea, and a friction rub heard on auscultation is suggestive of pericarditis. The diffuse ST-segment elevation seen on the electrocardiogram (ECG) is a classic finding in pericarditis, known as the "universal sign." In contrast, stable angina typically presents with chest pain on exertion that is relieved by rest or nitroglycerin, while unstable angina presents with chest pain at rest or with minimal exertion. Acute myocardial infarction would typically present with ST-segment elevation in specific leads correlating with the area of myocardial ischemia/infarction. However, in the context of diffuse ST-segment elevation and symptoms suggestive of inflammation (friction rub), the most likely diagnosis is pericarditis.

Correct Answer: B

Rationale: The most appropriate intervention for a patient with difficulty swallowing due to end-stage ALS and concerns about choking is to refer the patient to a speech therapist for swallowing exercises and techniques (Choice B). Speech therapists are trained to assess and manage swallowing difficulties in patients, especially those with neurodegenerative diseases like ALS. They can provide specific exercises and strategies to help the patient swallow safely and reduce the risk of choking. This intervention focuses on addressing the underlying issue causing the difficulty swallowing and aims to improve the patient's quality of life by enhancing their ability to eat and drink. The other options are not as effective or appropriate in addressing the patient's concerns.