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Exam (elaborations)

AG-ACNP Boards – endocrine Questions and Answers

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  • ACNP
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AG-ACNP Boards – endocrine Questions and Answers

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  • November 11, 2024
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  • 2024/2025
  • Exam (elaborations)
  • Questions & answers
  • ACNP
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AG-ACNP Boards – endocrine Questions
and Answers
SIADH Correct Ans--Inappropriate Water RETENTION, release of ADH occurs independent
of osmolality or volume dependent stimulation



-2/2 paraneoplastic syndrome classically lung, CNS disorder, Chronic lung disease, pneumonia,
skull fx/head trauma



S/S of SIADH Correct Ans--Neurologic changes: mild H/A, seizures, coma (D/T
hyponatremia)



-Decreased DTRs



-hypothermia/cold intolerance



-weight gain/edema



-n/v



Lab/Diagnosis of SIADH Correct Ans-Hyponatremia: yet euvolemic



Decreased serum osmolality (<280)

,Increased urine osmolality (>100)



Urine Sodium >20



Renal, cardiac, thyroid function normal



SIADH urine sodium Correct Ans--Na+ handling is regulated by aldosterone - hypervolemia
= low aldosterone production = high Na excretion.



-the urine Na+ concentration reflects Na+ intake, which is generally more than 40 mEq/d
(usually 50-100 mEq/d)



SIADH treatment Correct Ans-*fluid restriction



*treatment of underlying disorder



*ADH receptor antagonist:

-Demeclocycline

-lithium

-vasopressin receptor antagonists

, SIADH fluid restriction guidelines Correct Ans-Mild (asymptomatic with sodium 120-130
meq/L) = 1000ml/24h Fl R



Moderate (asymptomatic with sodium 110-120 meq/L) = 500ml/24h Fl R



Severe (symptomatic) = Loop diuretic + normal saline 0.9% or hypertonic saline 3% saline



Diabetes Insipidus Correct Ans-*Central: Related to pituitary or hypothalamus damage
resulting in ADH deficiency



*Nephrogenic: due to defect in the renal tubules resulting in renal insensitivity to ADH.

-Acquired due to phelonephritis

-K+ depletion

-sickle cell anemia

-chronic hypercalcemia causing renal failure

-medications (lithium, demeclocycline)



S/S of DI Correct Ans--Fluid intake 5-20L/day



-polyuria 2-20L/day



-weight loss, fatigue, tachycardia, hypotension

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