Choice A reason:

Tremors are not typically associated with Cushing’s syndrome. Cushing’s syndrome is characterized by an excess of cortisol, which leads to various symptoms, but tremors are not commonly among them. Tremors are more often associated with conditions affecting the nervous system, such as Parkinson’s disease or essential tremor.

Choice B reason:

A buffalo hump, which is a fat deposit on the back of the neck and upper back, is a common manifestation of Cushing’s syndrome. This occurs due to the redistribution of fat caused by prolonged exposure to high levels of cortisol. The buffalo hump is a distinctive physical sign that helps in diagnosing Cushing’s syndrome.

Choice C reason:

Moon face, characterized by a rounded, puffy face, is another hallmark of Cushing’s syndrome. This symptom results from fat deposits accumulating in the facial area due to elevated cortisol levels. The moon face is often one of the first noticeable signs of Cushing’s syndrome.

Choice D reason:

Hypertension, or high blood pressure, is a common symptom of Cushing’s syndrome. Cortisol increases blood pressure by enhancing the sensitivity of blood vessels to catecholamines and by promoting sodium and water retention. This leads to an increase in blood volume and, consequently, higher blood pressure.

Choice E reason:

Purple striae, or stretch marks, are also indicative of Cushing’s syndrome. These marks typically appear on the abdomen, thighs, breasts, and arms and are caused by the thinning of the skin and weakening of connective tissue due to excessive cortisol. The striae are often wide and have a purplish hue, distinguishing them from regular stretch marks.

Choice A reason: You sound overwhelmed. Let’s talk about this some more. This response acknowledges the mother’s feelings and opens the door for further discussion. However, it does not directly address her specific concerns about physical activities. While it is empathetic, it lacks the focus needed to explore her worries about her son’s participation in school activities.

Choice B reason: I agree. His well-being is the most important. This response validates the mother’s concern but may inadvertently reinforce her fears without providing a balanced perspective. It does not encourage a discussion about the benefits of physical activity for children with diabetes or how to manage his condition safely during such activities.

Choice C reason: Tell me more about how you are feeling about your son’s activities. This response is the most appropriate as it invites the mother to express her specific concerns and feelings. It shows empathy and a willingness to understand her perspective, which can lead to a more productive conversation about managing her son’s diabetes while allowing him to participate in physical activities.

Choice D reason: You might want to use tutors to home-school him. This response suggests an alternative that may not be necessary or beneficial. Home-schooling might isolate the child and prevent him from enjoying social interactions and physical activities that are important for his overall development. It does not address the mother’s concerns directly and may not be the best solution.