AACN AGACNP boards Questions and answers
2024/2025
Cushing's fSyndrome/Disease f- fAnswerscortisol fexcess ftypically fcaused fby fpituitary
fadenoma f60-70% fof fcases. f
Central fobesity fw/ fextremity fwasting.
dorsocervical ffat fpad.
rounded ffacies.
spontaneous fbruising.
purple fstriae
hyperpigmentation
poor fwound fhealing/ fskin finfections.
Dexamethasone fsuppression ftest.
1mg fdexamethasone fat f2300 fhours fand fmeasure fserum fcortisol fat f0800. f
Remove fsources fof fexcess fand fmanage fconsequences f( fHTN, fhypokalemia,
fhyperglycemia.)
Addison's fdisease f- fAnswersPrimary
Caused fby fdamage fto fthe fadrenal fcortex f(autoimmune, fTB, fmetastatic fdisease,
fdeposition fdiseases, fand fdrug finduced) fleading fto fa fdecrease fin fcortisol fproduction.
Secondary
Caused fby fpituitary ffailure fto frelease fACTH f(in fany fhypopituitary fdisorder) fcausing fa
fdecrease fin fcortisol fproduction. f
Sudden fwithdrawal fof fsystemic fcorticosteroids fleading fto fa fdecrease fin fcortisol
fproduction ffrom finduced fcorticosteroid fsuppression.
diabetes finsipidus f(DI) f- fAnswersInsufficient fADH for fdecreased fsensitivity fto fADH
Nephron fcannot fconserve fwater.
Commonly fcaused fby fdamage fto fthe fpituitary fgland for fhypothalamus f(surgery, ftumor,
fmeningitis, fhead finjury).
Can fbe fnephrogenic fwhere fthe fkidney fin funable fto frespond fto fADH. f
Serum: fHypernatremia fand fhyperosmolarity.
Urine: fHyponatremia fand fhypoosmolality. f
Replaced fADH fand fsupportive ffluid freplacement.
Syndrome fof fInapropriate fAntidiuretic fHormone f(SIADH) f- fAnswersExcess fADH
fproduction.
, Nephron fconserves fexcess fwater. f
Caused fby fhead finjury fand flung fcancers.
Serum: fHyponatremia fand fhypoosmolality.
Urine: fHypernatremia fand fhyperosmolarity.
Fluid foverload.
Treat fwith: f
Free fwater frestriction
Loop fdiuretic fand fNS
IN fextremes f3% fsaline
Transudate fpleural feffusion f- fAnswersCHF
Constrictive fpericarditis
Cirrhosis
SG f<1.015
Protein f<3 fg/dl
LDH f< f200
Fluid-serum fprotein fratio f<0.5
Fluid f-serum fLDH fratio f<0.5
Exudate fpleural feffusion f- fAnswersLung fparenchymal finfection
Malignancy
PE
SG f>1.015
Protein f>3 fg/dl
LDH f>200
Fluid-serum fprotein fratio f>0.5
Fluid-serum fLDH fratio f>0.5
Fibrinolysis fContraindications f- fAnswersAbsolute
Hx fof fcerebrovascular fevent f(ICH, fintracranial fneoplasm, faneurysm, fAVM)
Non-hemorrhagic fstroke for fhead ftrauma f<3 fmonths fago.
Cranial for fspinal ftrauma f<2 fmonths fago. f
Known fbleeding fdisorder.
Active finternal fbleeding.
Relative
Hx fof fsevere/poorly fcontrolled fHTN for fsevere, funcontrolled farterial fHTN fSBP>180
fand fDBP f>110
Ischemic fstroke f>3 fmonths fago.
2024/2025
Cushing's fSyndrome/Disease f- fAnswerscortisol fexcess ftypically fcaused fby fpituitary
fadenoma f60-70% fof fcases. f
Central fobesity fw/ fextremity fwasting.
dorsocervical ffat fpad.
rounded ffacies.
spontaneous fbruising.
purple fstriae
hyperpigmentation
poor fwound fhealing/ fskin finfections.
Dexamethasone fsuppression ftest.
1mg fdexamethasone fat f2300 fhours fand fmeasure fserum fcortisol fat f0800. f
Remove fsources fof fexcess fand fmanage fconsequences f( fHTN, fhypokalemia,
fhyperglycemia.)
Addison's fdisease f- fAnswersPrimary
Caused fby fdamage fto fthe fadrenal fcortex f(autoimmune, fTB, fmetastatic fdisease,
fdeposition fdiseases, fand fdrug finduced) fleading fto fa fdecrease fin fcortisol fproduction.
Secondary
Caused fby fpituitary ffailure fto frelease fACTH f(in fany fhypopituitary fdisorder) fcausing fa
fdecrease fin fcortisol fproduction. f
Sudden fwithdrawal fof fsystemic fcorticosteroids fleading fto fa fdecrease fin fcortisol
fproduction ffrom finduced fcorticosteroid fsuppression.
diabetes finsipidus f(DI) f- fAnswersInsufficient fADH for fdecreased fsensitivity fto fADH
Nephron fcannot fconserve fwater.
Commonly fcaused fby fdamage fto fthe fpituitary fgland for fhypothalamus f(surgery, ftumor,
fmeningitis, fhead finjury).
Can fbe fnephrogenic fwhere fthe fkidney fin funable fto frespond fto fADH. f
Serum: fHypernatremia fand fhyperosmolarity.
Urine: fHyponatremia fand fhypoosmolality. f
Replaced fADH fand fsupportive ffluid freplacement.
Syndrome fof fInapropriate fAntidiuretic fHormone f(SIADH) f- fAnswersExcess fADH
fproduction.
, Nephron fconserves fexcess fwater. f
Caused fby fhead finjury fand flung fcancers.
Serum: fHyponatremia fand fhypoosmolality.
Urine: fHypernatremia fand fhyperosmolarity.
Fluid foverload.
Treat fwith: f
Free fwater frestriction
Loop fdiuretic fand fNS
IN fextremes f3% fsaline
Transudate fpleural feffusion f- fAnswersCHF
Constrictive fpericarditis
Cirrhosis
SG f<1.015
Protein f<3 fg/dl
LDH f< f200
Fluid-serum fprotein fratio f<0.5
Fluid f-serum fLDH fratio f<0.5
Exudate fpleural feffusion f- fAnswersLung fparenchymal finfection
Malignancy
PE
SG f>1.015
Protein f>3 fg/dl
LDH f>200
Fluid-serum fprotein fratio f>0.5
Fluid-serum fLDH fratio f>0.5
Fibrinolysis fContraindications f- fAnswersAbsolute
Hx fof fcerebrovascular fevent f(ICH, fintracranial fneoplasm, faneurysm, fAVM)
Non-hemorrhagic fstroke for fhead ftrauma f<3 fmonths fago.
Cranial for fspinal ftrauma f<2 fmonths fago. f
Known fbleeding fdisorder.
Active finternal fbleeding.
Relative
Hx fof fsevere/poorly fcontrolled fHTN for fsevere, funcontrolled farterial fHTN fSBP>180
fand fDBP f>110
Ischemic fstroke f>3 fmonths fago.
