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Exam (elaborations)

ACNP Endocrine- Questions and Answers

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ACNP Endocrine- Questions and Answers

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  • November 11, 2024
  • 21
  • 2024/2025
  • Exam (elaborations)
  • Questions & answers
  • ACNP
  • ACNP
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ACNP Endocrine- Questions and Answers

Thyroid Crisis Correct Ans-USE OUTPATIENT MEDS IN IV FORM

Propylthiouracil (PTU) 150-250 mg Q6H OR Tapazole 15-25 mg Q6H with the following in 1
hr:

- Lugols 10 gtts TID OR

-Sodium iodide 1 gm slow IV with

- Propanolol 0.5-2 gm IV Q4H or 20-120 mg PO Q6H with

-Hydrocortisone 50 mg Q6H with rapid reduction as situation improves

AVOID ASA--exacerbates thyroid storm by interfering with binding of T3 and T4



Management of Hypothyroidism Correct Ans-Syntrhoid 50-100 mcg Qday, increasing
doseage by 25 mcg every 1-2 weeks until symptoms stabilize.

>60 years of age, decrease dosage



Myxedema Coma Correct Ans-Protect airway

Fluid replacement

Synthroid 400 mcg IV x 1, then 100 mcg daily

Support HOTN

Slow rewarming with blankets (not bear hugger or hyperthermia blankets): to avoid circulatory
collapse

Symptomatic care

,Cushing's Correct Ans-ACTH hypersecretion by the pituitary

Adrenal tumors

Chronic adminsitration of glucocorticoids



Signs and symptoms of Cushings Correct Ans-1. Central obesity--fat mobilizes from
extremities

2. Moon face with buffalo hump

3. Acne

4. Poor wound healing--increased androgens which suppress immune system

5. Purple striae

6. Hirsutism

7. HTN--steroids cause vasoconstriction

8. Weakness

9. Amenorrhea

10. Impotence

11. HA

12. Polyuria and thirst

13. Labile mood

14. Frequent infections



Labs and diagnostics in Cushing's Correct Ans-Hyperglycemia

Hypernatremia

Hypokalemia

, Glycosuria

Leukocytosis

Elevated plasma cortisol in AM >24

Dexamaethasone suppresion test to differentiate cause

Increased serum ACTCH--> cosyntropin



Management of Cushing's Correct Ans-D/C meds inducing symptoms

Transphenoidal resection of a pitutiary adenoma

Surgical removal of adrenal tumors

Resection of ACTH secreting tumors

Manage electrolytes



Normal AM Cortisol Correct Ans-6-24




Addison's Disease Correct Ans-Deficient cortisol, androgens and aldosterone

Autoimmune destruction of the adrenal gland

Metastatic cancer

Bilateral adrenal hemorrhage (e.g. with anticoagulant therapy)

Pituitary failure resulting in decreased ACTH



Signs and symptoms of Addison's Correct Ans-1. Hyperpigmenation in buccal mucosa and
skin creases (especially knuckles, nail beds, nipples, palmar creases, and posterior neck)

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