Rationale of Week | Mystery Condition

For our April 20th Question of the Week, 44% of respondents chose the best answer. We wanted to “take a closer look” into this question.

Before we start though, if you don’t want any spoilers and haven’t tried the question yet, you can answer below: Answer Question

Question: ML has had type two diabetes for 12 years, a BMI of 33.7, an A1 C of 8.3%, and elevated triglycerides and LDL cholesterol levels. You notice ML’s palms are deeply red.

Which of the following conditions is ML most likely experiencing in addition to diabetes?

Answer Choices:

  1. Non-alcoholic fatty liver disease
  2. Dermatomyositis secondary to  inflammation
  3. Auto immune renal hypertension
  4. Acanthosis Nigricans of the palmar surface

As shown above, the most common choice was option 1, the second most common answer was option 2, then option 4, and finally option 3.

Getting to the Best Answer

If you are thinking about taking the certification exam, the content of this practice test question will set you up for success. The exam will present questions that require test takers to be familiar with identifying common diabetes co-conditions, screening guidelines and interventions.

Answers & Rationale

Answer 1 is correct, 44.67% chose this answer, “Non-alcoholic fatty liver disease.” Good job! Up to 20% of people with diabetes are living with non alcoholic steatohepatitis (NASH) which can lead to cirrhosis, liver failure and cancer. Risk factors associated with NASH include hyperlipidemia, hyperglycemia, and a BMI of 30 or greater. People with NASH may have elevated liver enzymes including ALT and AST. Physical symptoms include acanthosis nigricans, abdominal pain, sense of fullness, facial spider angiomas and red palms.

The major focus of treatment includes weight loss, increased activity, aggressive management of lipids and glucose. Some research also indicates that Actos, Vitamin E and liraglutide may improve liver histology. Join our Critical Assessment Course to learn more about NASH and other diabetes co-conditions.

Answer 2 is incorrect, 25.81% of you chose this answer, “Dermatomyositis secondary to  inflammation.” This rare autoimmune condition is usually associated with type 1 diabetes. Signs of dermatomyositis include a dusky red rash on the face and eyelids, and in areas around the nails, knuckles, elbows, knees, chest, and back. Muscle weakness is frequent.

ML’s profile doesn’t match the clinical manifestations of this condition.

Answer 3 is incorrect, 12.02% of you chose this answer, “Auto immune renal hypertension.” This juicy answer with a fancy name suggests that ML has this rare condition. However, since ML has type 2 diabetes, test takers would be suspicious of any answer that points to autoimmune conditions. Type 2 is not an immune mediated condition, but a condition of inflammation.

ML’s profile doesn’t match the clinical manifestations of this condition.

Answer 4 is incorrect, 17.50% of you chose this answer, “Acanthosis Nigricans of the palmar surface.” Acanthosis nigricans (AN) is a dermatologic indicator of insulin resistance. However, it does not present on the palms, nor is it red in color. AN is a darkening and thickening of the skin often coupled with the appearance of skin tags. Common locations for AN include folds of skin in the neck, axilla, groin, elbows, knees and ankles.

We hope you appreciate this week’s rationale! Thank you so much for taking the time to answer our Question of the Week and participate in this fun learning activity!

Want to learn more? Join Coach Beverly and the Critical Assessment Course. It is ready for viewing!

 Level 2 – Critical Assessment – Fine-Tuning your Diabetes Detective Skills – 2.0 CEs.

Diabetes Education Services Online University Courses are an excellent way to study for your exam anytime and anywhere that is convenient for you. You will have immediate access to your courses for 1 year after your purchase date. Each individual online course includes a: 90-minute video presentation, podcast, practice test, and additional resources.

This course integrates the ADA Standard of Care on elements of a comprehensive medical assessment (Standard 4) of the individual living with prediabetes, diabetes, or hyperglycemia. Through case studies and real-life situations, we discover often hidden causes of hyperglycemia and other complications, such as liver disease, sleep apnea, pancreatitis, autoimmune diseases, fractures, and more. We delve into therapy for complicated situations and discuss management strategies for other conditions associated with hyperglycemia such as Cystic Fibrosis, and Transplants. Join us for this unique and interesting approach to assessing and evaluating the hidden complications of diabetes.

Topics Include:

  • Identify common yet often underdiagnosed complications associated with type 1 and type 2 diabetes.
  • State strategies to identify previously undiscovered diabetes complications during assessments.
  • Discuss links between hyperglycemia and other conditions including, transplant, cystic fibrosis and liver disease.

Intended Audience: These courses are knowledge-based activities designed for individual or groups of diabetes educators, including RNs, RDs, Pharmacists, Nurse Practitioners, Clinical Nurse Specialists, Physician Assistants, and other health care providers interested in enhancing their diabetes assessment skills.

Instructor: Beverly Thomassian RN, MPH, CDCES, BC-ADM is a working educator and a nationally recognized diabetes expert.

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