AACN AGACNP WITH VERIFIED QUESTIONS
AND CORRECT ANSWERS.
1. Addison's disease - ANSWER-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.
Aortic regurgitation - ANSWER-Grade 1-3/4 high pitched blowing diastolic murmur heard best at
3rd LICS.
May be enhanced by forced expiration, leaning forward.
Usually S3, wide pulse pressure, sustained thrusting apical impulses.
More common in men usually from rheumatic heart disease and occasionally due to tertiary
Syphilis.
Aortic sclerosis - ANSWER-Grade 2-3/6 systolic ejection murmur best heard at RICS.
Carotid upstroke full, not delayed, no S4, absence of symptoms.
Benign thickening of the aortic valve leaflets.
No change in valve pressure gradient.
50 over 50 (found in 50% of those over 50)
, Aortic Stenosis Murmur - ANSWER-Grade 1-4/6 harsh systolic murmur, usually crescendo-
decrescendo pattern.
Heard best at 2nd RICS, apex, and softens with standing.
Radiates to carotids, may have diminished S2, slow filling carotid pulse, narrow pulse pressure,
loud S4, heaving PMI.
Great the degree of stenosis the later the peak of murmur.
Younger adults due to bicuspid valve.
Older adults due to calcific /rheumatic.
Dizziness and syncope are an ominous sign pointing to severely decreased cardiac output.
Atrial Septal Defect ASD - ANSWER-Grade 1-3/6 systolic ejection murmur in the pulmonic area.
Widely split S2, right ventricular heave.
Typically without symptoms and then middle aged HF.
Persistent ostium secundium in mid septum.
Will resolve with ASD correction.
Bacterial Meningitis - ANSWER-Glucose <45 mg/dl
Protein >50 mg/dl
Opening pressure is markedly high.
Cell count 200-20,000 PMN/microliter.
Bouchard's nodes - ANSWER-Middle Joint of finger.
Brudzinski's Sign - ANSWER-Severe neck stiffness causes a patient's hips and knees to flex when
the neck is flexed.
AND CORRECT ANSWERS.
1. Addison's disease - ANSWER-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.
Aortic regurgitation - ANSWER-Grade 1-3/4 high pitched blowing diastolic murmur heard best at
3rd LICS.
May be enhanced by forced expiration, leaning forward.
Usually S3, wide pulse pressure, sustained thrusting apical impulses.
More common in men usually from rheumatic heart disease and occasionally due to tertiary
Syphilis.
Aortic sclerosis - ANSWER-Grade 2-3/6 systolic ejection murmur best heard at RICS.
Carotid upstroke full, not delayed, no S4, absence of symptoms.
Benign thickening of the aortic valve leaflets.
No change in valve pressure gradient.
50 over 50 (found in 50% of those over 50)
, Aortic Stenosis Murmur - ANSWER-Grade 1-4/6 harsh systolic murmur, usually crescendo-
decrescendo pattern.
Heard best at 2nd RICS, apex, and softens with standing.
Radiates to carotids, may have diminished S2, slow filling carotid pulse, narrow pulse pressure,
loud S4, heaving PMI.
Great the degree of stenosis the later the peak of murmur.
Younger adults due to bicuspid valve.
Older adults due to calcific /rheumatic.
Dizziness and syncope are an ominous sign pointing to severely decreased cardiac output.
Atrial Septal Defect ASD - ANSWER-Grade 1-3/6 systolic ejection murmur in the pulmonic area.
Widely split S2, right ventricular heave.
Typically without symptoms and then middle aged HF.
Persistent ostium secundium in mid septum.
Will resolve with ASD correction.
Bacterial Meningitis - ANSWER-Glucose <45 mg/dl
Protein >50 mg/dl
Opening pressure is markedly high.
Cell count 200-20,000 PMN/microliter.
Bouchard's nodes - ANSWER-Middle Joint of finger.
Brudzinski's Sign - ANSWER-Severe neck stiffness causes a patient's hips and knees to flex when
the neck is flexed.
