AG-ACNP questions with verified solutions graded A+ 2023/2024

AG-ACNP What are the physical exam findings in cluster headache? - correct answer - usually normal exam, may see eye redness, rhinorrhea, ipsilateral nasal congestion What does albumin level of <3.5 indicate? - correct answer Protein malnutrition Albumin normal - 3.5 to 5 What is the earliest indication of malnutrition? - correct answer Pre-albumin Urine sodium >20 mEq/L suggests what? - correct answer Urine Na >20 suggests renal salt wasting (i.e., problem with the kidneys) Urine sodium <10 mEq/L suggests what? - correct answer Urine Na <10 suggests renal retention of sodium to compensate for extrarenal fluid losses (i.e., a problem other than the kidneys) Describe isotonic hyponatremia. - correct answer Serum osmolality 284-295 mosm/kg (high) - occurs w/ extreme hyperlipidemia or hyperproteinemia - body water is normal & the pts are asx Tx: cut down fat (i.e., no fluid restriction) What is the serum osmolality in a patient with hypotonic hyponatremia? - correct answer serum osmolality <280 mosm/kg (low) - state of body water excess diluting all body fluids - clinical signs arise from water excess If the patient is hypovolemic-hyponatremic, how do you assess if hyponatremia is due to extrarenal salt losses versus renal salt wasting? - correct answer Differentiate using volume status & urine Na - hypovolemic w/ urine Na <10 - hypovolemic w/ urine Na >20 - hypervolemic, hypotonic hyponatremia What are the causes of hypovolemic, hyponatremia (urine Na <10)? - correct answer - dehydration - diarrhea (like C. diff) - vomiting What are the causes of hypovolemic, hyponatremia (urine Na >20)? - correct answer - diuretics - ACE-inhibitors - mineralocorticoid deficiency (aldosterone) What are the causes of hypervolemic, hypotonic hyponatremia? - correct answer - edematous states - CHF - liver disease - advanced renal failure Tx: need to restrict water as most pts have edema What are the causes of hypertonic, hyponatremia (serum osmolality >290 mosm/kg) - correct answer hyperglycemia (usu HHNK) osmolality is high & Na is low _____ is a major cellular ion and important mediator of neuromuscular and cardiac function. - correct answer Calcium What is a normal total calcium and ionized calcium? - correct answer Total Ca++ 8.5-10.5 mg/dl (2.2-2.6 mmol/L) Ionized Ca++ 4.5-5.5 mg/dl (1.1-1.4 mmol/L)