AACN AGACNP Exam Review with
100% Correct Answers
cortisol excess typically caused by pituitary adenoma 60-70% of cases.
Central obesity w/ extremity wasting.
dorsocervical fat pad.
rounded facies.
spontaneous bruising.
purple striae
hyperpigmentation
poor wound healing/ skin infections.
Dexamethasone suppression test.
1mg dexamethasone at 2300 hours and measure serum cortisol at 0800.
Remove sources of excess and manage consequences ( HTN, hypokalemia,
hyperglycemia.) - ANS-Cushing's Syndrome/Disease
Primary
Caused by damage to the adrenal cortex (autoimmune, TB, metastatic disease,
deposition diseases, and drug induced) leading to a decrease in cortisol production.
Secondary
Caused by pituitary failure to release ACTH (in any hypopituitary disorder) causing a
decrease in cortisol production.
Sudden withdrawal of systemic corticosteroids leading to a decrease in cortisol
production from induced corticosteroid suppression. - ANS-Addison's disease
Insufficient ADH or decreased sensitivity to ADH
Nephron cannot conserve water.
Commonly caused by damage to the pituitary gland or hypothalamus (surgery, tumor,
meningitis, head injury).
Can be nephrogenic where the kidney in unable to respond to ADH.
Serum: Hypernatremia and hyperosmolarity.
Urine: Hyponatremia and hypoosmolality.
, Replaced ADH and supportive fluid replacement. - ANS-diabetes insipidus (DI)
Excess ADH production.
Nephron conserves excess water.
Caused by head injury and lung cancers.
Serum: Hyponatremia and hypoosmolality.
Urine: Hypernatremia and hyperosmolarity.
Fluid overload.
Treat with:
Free water restriction
Loop diuretic and NS
IN extremes 3% saline - ANS-Syndrome of Inapropriate Antidiuretic Hormone (SIADH)
CHF
Constrictive pericarditis
Cirrhosis
SG <1.015
Protein <3 g/dl
LDH < 200
Fluid-serum protein ratio <0.5
Fluid -serum LDH ratio <0.5 - ANS-Transudate pleural effusion
Lung parenchymal infection
Malignancy
PE
SG >1.015
Protein >3 g/dl
LDH >200
Fluid-serum protein ratio >0.5
Fluid-serum LDH ratio >0.5 - ANS-Exudate pleural effusion
Absolute
Hx of cerebrovascular event (ICH, intracranial neoplasm, aneurysm, AVM)
Non-hemorrhagic stroke or head trauma <3 months ago.
Cranial or spinal trauma <2 months ago.
Known bleeding disorder.
Active internal bleeding.
Relative
100% Correct Answers
cortisol excess typically caused by pituitary adenoma 60-70% of cases.
Central obesity w/ extremity wasting.
dorsocervical fat pad.
rounded facies.
spontaneous bruising.
purple striae
hyperpigmentation
poor wound healing/ skin infections.
Dexamethasone suppression test.
1mg dexamethasone at 2300 hours and measure serum cortisol at 0800.
Remove sources of excess and manage consequences ( HTN, hypokalemia,
hyperglycemia.) - ANS-Cushing's Syndrome/Disease
Primary
Caused by damage to the adrenal cortex (autoimmune, TB, metastatic disease,
deposition diseases, and drug induced) leading to a decrease in cortisol production.
Secondary
Caused by pituitary failure to release ACTH (in any hypopituitary disorder) causing a
decrease in cortisol production.
Sudden withdrawal of systemic corticosteroids leading to a decrease in cortisol
production from induced corticosteroid suppression. - ANS-Addison's disease
Insufficient ADH or decreased sensitivity to ADH
Nephron cannot conserve water.
Commonly caused by damage to the pituitary gland or hypothalamus (surgery, tumor,
meningitis, head injury).
Can be nephrogenic where the kidney in unable to respond to ADH.
Serum: Hypernatremia and hyperosmolarity.
Urine: Hyponatremia and hypoosmolality.
, Replaced ADH and supportive fluid replacement. - ANS-diabetes insipidus (DI)
Excess ADH production.
Nephron conserves excess water.
Caused by head injury and lung cancers.
Serum: Hyponatremia and hypoosmolality.
Urine: Hypernatremia and hyperosmolarity.
Fluid overload.
Treat with:
Free water restriction
Loop diuretic and NS
IN extremes 3% saline - ANS-Syndrome of Inapropriate Antidiuretic Hormone (SIADH)
CHF
Constrictive pericarditis
Cirrhosis
SG <1.015
Protein <3 g/dl
LDH < 200
Fluid-serum protein ratio <0.5
Fluid -serum LDH ratio <0.5 - ANS-Transudate pleural effusion
Lung parenchymal infection
Malignancy
PE
SG >1.015
Protein >3 g/dl
LDH >200
Fluid-serum protein ratio >0.5
Fluid-serum LDH ratio >0.5 - ANS-Exudate pleural effusion
Absolute
Hx of cerebrovascular event (ICH, intracranial neoplasm, aneurysm, AVM)
Non-hemorrhagic stroke or head trauma <3 months ago.
Cranial or spinal trauma <2 months ago.
Known bleeding disorder.
Active internal bleeding.
Relative
