AACN AGACNP Review Questions and
Correct Solutions 2024/2025
Addison'sxdiseasex-xCORRECTxANSWER-Primary
Causedxbyxdamagextoxthexadrenalxcortexx(autoimmune,xTB,xmetastaticxdisease,xdepositio
nxdiseases,xandxdrugxinduced)xleadingxtoxaxdecreasexinxcortisolxproduction.
Secondary
CausedxbyxpituitaryxfailurextoxreleasexACTHx(inxanyxhypopituitaryxdisorder)xcausingxaxdecr
easexinxcortisolxproduction.x
Suddenxwithdrawalxofxsystemicxcorticosteroidsxleadingxtoxaxdecreasexinxcortisolxproduction
xfromxinducedxcorticosteroidxsuppression.
Aorticxregurgitationx-xCORRECTxANSWER-Gradex1-
3/4xhighxpitchedxblowingxdiastolicxmurmurxheardxbestxatx3rdxLICS.x
Mayxbexenhancedxbyxforcedxexpiration,xleaningxforward.
UsuallyxS3,xwidexpulsexpressure,xsustainedxthrustingxapicalximpulses.x
Morexcommonxinxmenxusuallyxfromxrheumaticxheartxdiseasexandxoccasionallyxduextoxtertiar
yxSyphilis.
Aorticxsclerosisx-xCORRECTxANSWER-Gradex2-
3/6xsystolicxejectionxmurmurxbestxheardxatxRICS.
Carotidxupstrokexfull,xnotxdelayed,xnoxS4,xabsencexofxsymptoms.x
Benignxthickeningxofxthexaorticxvalvexleaflets.
Noxchangexinxvalvexpressurexgradient.
50xoverx50x(foundxinx50%xofxthosexoverx50)
AorticxStenosisxMurmurx-xCORRECTxANSWER-Gradex1-
4/6xharshxsystolicxmurmur,xusuallyxcrescendo-decrescendoxpattern.x
Heardxbestxatx2ndxRICS,xapex,xandxsoftensxwithxstanding.x
Radiatesxtoxcarotids,xmayxhavexdiminishedxS2,xslowxfillingxcarotidxpulse,xnarrowxpulsexpres
sure,xloudxS4,xheavingxPMI.x
Greatxthexdegreexofxstenosisxthexlaterxthexpeakxofxmurmur.x
Youngerxadultsxduextoxbicuspidxvalve.
Olderxadultsxduextoxcalcificx/rheumatic.x
Dizzinessxandxsyncopexarexanxominousxsignxpointingxtoxseverelyxdecreasedxcardiacxoutpu
t.
AtrialxSeptalxDefectxASDx-xCORRECTxANSWER-Gradex1-
3/6xsystolicxejectionxmurmurxinxthexpulmonicxarea.
, WidelyxsplitxS2,xrightxventricularxheave.x
TypicallyxwithoutxsymptomsxandxthenxmiddlexagedxHF.
Persistentxostiumxsecundiumxinxmidxseptum.
WillxresolvexwithxASDxcorrection.
BacterialxMeningitisx-xCORRECTxANSWER-Glucosex<45xmg/dl
Proteinx>50xmg/dl
Openingxpressurexisxmarkedlyxhigh.
Cellxcountx200-20,000xPMN/microliter.
Bouchard'sxnodesx-xCORRECTxANSWER-MiddlexJointxofxfinger.
Brudzinski'sxSignx-xCORRECTxANSWER-
Severexneckxstiffnessxcausesxaxpatient'sxhipsxandxkneesxtoxflexxwhenxthexneckxisxflexed.
Cushing'sxSyndrome/Diseasex-xCORRECTxANSWER-
cortisolxexcessxtypicallyxcausedxbyxpituitaryxadenomax60-70%xofxcases.x
Centralxobesityxw/xextremityxwasting.
dorsocervicalxfatxpad.
roundedxfacies.
spontaneousxbruising.
purplexstriae
hyperpigmentation
poorxwoundxhealing/xskinxinfections.
Dexamethasonexsuppressionxtest.
1mgxdexamethasonexatx2300xhoursxandxmeasurexserumxcortisolxatx0800.x
Removexsourcesxofxexcessxandxmanagexconsequencesx(xHTN,xhypokalemia,xhyperglyce
mia.)
diabetesxinsipidusx(DI)x-xCORRECTxANSWER-
InsufficientxADHxorxdecreasedxsensitivityxtoxADH
Nephronxcannotxconservexwater.
Commonlyxcausedxbyxdamagextoxthexpituitaryxglandxorxhypothalamusx(surgery,xtumor,xme
ningitis,xheadxinjury).
CanxbexnephrogenicxwherexthexkidneyxinxunablextoxrespondxtoxADH.x
Serum:xHypernatremiaxandxhyperosmolarity.
Urine:xHyponatremiaxandxhypoosmolality.x
ReplacedxADHxandxsupportivexfluidxreplacement.
Correct Solutions 2024/2025
Addison'sxdiseasex-xCORRECTxANSWER-Primary
Causedxbyxdamagextoxthexadrenalxcortexx(autoimmune,xTB,xmetastaticxdisease,xdepositio
nxdiseases,xandxdrugxinduced)xleadingxtoxaxdecreasexinxcortisolxproduction.
Secondary
CausedxbyxpituitaryxfailurextoxreleasexACTHx(inxanyxhypopituitaryxdisorder)xcausingxaxdecr
easexinxcortisolxproduction.x
Suddenxwithdrawalxofxsystemicxcorticosteroidsxleadingxtoxaxdecreasexinxcortisolxproduction
xfromxinducedxcorticosteroidxsuppression.
Aorticxregurgitationx-xCORRECTxANSWER-Gradex1-
3/4xhighxpitchedxblowingxdiastolicxmurmurxheardxbestxatx3rdxLICS.x
Mayxbexenhancedxbyxforcedxexpiration,xleaningxforward.
UsuallyxS3,xwidexpulsexpressure,xsustainedxthrustingxapicalximpulses.x
Morexcommonxinxmenxusuallyxfromxrheumaticxheartxdiseasexandxoccasionallyxduextoxtertiar
yxSyphilis.
Aorticxsclerosisx-xCORRECTxANSWER-Gradex2-
3/6xsystolicxejectionxmurmurxbestxheardxatxRICS.
Carotidxupstrokexfull,xnotxdelayed,xnoxS4,xabsencexofxsymptoms.x
Benignxthickeningxofxthexaorticxvalvexleaflets.
Noxchangexinxvalvexpressurexgradient.
50xoverx50x(foundxinx50%xofxthosexoverx50)
AorticxStenosisxMurmurx-xCORRECTxANSWER-Gradex1-
4/6xharshxsystolicxmurmur,xusuallyxcrescendo-decrescendoxpattern.x
Heardxbestxatx2ndxRICS,xapex,xandxsoftensxwithxstanding.x
Radiatesxtoxcarotids,xmayxhavexdiminishedxS2,xslowxfillingxcarotidxpulse,xnarrowxpulsexpres
sure,xloudxS4,xheavingxPMI.x
Greatxthexdegreexofxstenosisxthexlaterxthexpeakxofxmurmur.x
Youngerxadultsxduextoxbicuspidxvalve.
Olderxadultsxduextoxcalcificx/rheumatic.x
Dizzinessxandxsyncopexarexanxominousxsignxpointingxtoxseverelyxdecreasedxcardiacxoutpu
t.
AtrialxSeptalxDefectxASDx-xCORRECTxANSWER-Gradex1-
3/6xsystolicxejectionxmurmurxinxthexpulmonicxarea.
, WidelyxsplitxS2,xrightxventricularxheave.x
TypicallyxwithoutxsymptomsxandxthenxmiddlexagedxHF.
Persistentxostiumxsecundiumxinxmidxseptum.
WillxresolvexwithxASDxcorrection.
BacterialxMeningitisx-xCORRECTxANSWER-Glucosex<45xmg/dl
Proteinx>50xmg/dl
Openingxpressurexisxmarkedlyxhigh.
Cellxcountx200-20,000xPMN/microliter.
Bouchard'sxnodesx-xCORRECTxANSWER-MiddlexJointxofxfinger.
Brudzinski'sxSignx-xCORRECTxANSWER-
Severexneckxstiffnessxcausesxaxpatient'sxhipsxandxkneesxtoxflexxwhenxthexneckxisxflexed.
Cushing'sxSyndrome/Diseasex-xCORRECTxANSWER-
cortisolxexcessxtypicallyxcausedxbyxpituitaryxadenomax60-70%xofxcases.x
Centralxobesityxw/xextremityxwasting.
dorsocervicalxfatxpad.
roundedxfacies.
spontaneousxbruising.
purplexstriae
hyperpigmentation
poorxwoundxhealing/xskinxinfections.
Dexamethasonexsuppressionxtest.
1mgxdexamethasonexatx2300xhoursxandxmeasurexserumxcortisolxatx0800.x
Removexsourcesxofxexcessxandxmanagexconsequencesx(xHTN,xhypokalemia,xhyperglyce
mia.)
diabetesxinsipidusx(DI)x-xCORRECTxANSWER-
InsufficientxADHxorxdecreasedxsensitivityxtoxADH
Nephronxcannotxconservexwater.
Commonlyxcausedxbyxdamagextoxthexpituitaryxglandxorxhypothalamusx(surgery,xtumor,xme
ningitis,xheadxinjury).
CanxbexnephrogenicxwherexthexkidneyxinxunablextoxrespondxtoxADH.x
Serum:xHypernatremiaxandxhyperosmolarity.
Urine:xHyponatremiaxandxhypoosmolality.x
ReplacedxADHxandxsupportivexfluidxreplacement.
