7 - Cushings Part 2

Question 1

What diagnostic test can function as a screening test and cushings test

Answer 1

B?

Question 2

When would cushings have no clinical signs

Answer 2

Elevated liver enzymes

Question 3

How to rule out exogenous steroids

Answer 3

Skin creams, allergies pill

Question 4

Discontinue all steroids for how long before cushings test

Answer 4

24 hours

Question 5

If your are trying to test the HPAA for cushing u should be off corticosteroids for

Answer 5

4 - 6 weeks

Question 6

How to prepare patient for cushings test

Answer 6

Low stress, and fasting if possible

Question 7

What steroid does not mess with cortisol measurement

Answer 7

Dexamethasone

Question 8

Screening test for cushings

Answer 8

UCCR, ACTH stimulation , LDDST

Question 9

Differential test for pituitary or adrenal

Answer 9

LDDST, HDDST, abdominal ultrasound, brain CT

Question 10

Best test for suspecting cushings

Answer 10

LDDST

Question 11

LDDST is less

Answer 11

Specific - may be false positive

Question 12

If ACTH is positive -

Answer 12

Can believe it more if negative you can’t rule it out

Question 13

How much more Dex is given in Low versus high

Answer 13

10x as much

Question 14

HDDST cannot replace

Answer 14

LDDST - can get false negatives

Question 15

What is the gold standard for differentiation

Answer 15

Endogenous ACTH levels

Question 16

Sensitivity

Answer 16

Ability to accurately detect all dogs with cushings

Question 17

High sensitivity =

Answer 17

Few false negatives

Question 18

Specific

Answer 18

Positive test is definitely diagnostic of cushings

Question 19

High specifics =

Answer 19

Few false positives

Question 20

Very specific does it rule diagnosis in or out

Answer 20

In

Question 21

UCCR

Answer 21

Urine cortisol to creating

Question 22

UCCR is sensitive or specific

Answer 22

Sensitive

Question 23

Don’t run UCCR when

Answer 23

Patient is super stressed

Question 24

UCCR indicates

Answer 24

Blood level over time

Question 25

Is UCCR specific

Answer 25

No

Question 26

UCCR is good at saying

Answer 26

It is not cushings

Question 27

What value suggest cushings with UCCR

Answer 27

High

Question 28

ACTH stimulation testing the

Answer 28

Adrenal glands

Question 29

Gold standard test for adrenal reserve

Answer 29

ACTH stimulation

Question 30

Adrenal reserve

Answer 30

How much cortisol can you make

Question 31

ACTH stim test

Answer 31

Collect baseline sample, give ACTH, 1 hour later

Question 32

ACTH test what feedback loop

Answer 32

Positive

Question 33

Gold standard for DX iatrogenic cushings disease

Answer 33

ACTH

Question 34

What is diagnostic of cushings disease with ACTH stim test

Answer 34

Excessive response

Question 35

What do you use to monitor therapeutic response

Answer 35

ACTH test

Question 36

ACTH reliable in cats

Answer 36

no

Question 37

LDDST test

Answer 37

Adrenal/pituitary response to negative feedback

Question 38

LDDST - a normal dog should

Answer 38

Spurred

Question 39

Normal dog suppresses at ___ with LDDST

Answer 39

4 hour and 8 hour

Question 40

With LDDST, ADH no suppression at

Answer 40

4 hour sand 8 hours

Question 41

With LDDST, PDH there is

Answer 41

40% no suppression at 4 hours and 8 hours, 60% suppression at 4 hours

Question 42

What is the test of choice for cushings

Answer 42

LDDST

Question 43

Basal serum cortisol has little value in DX of

Answer 43

PDH

Question 44

With PDH what are teh ACTH levels

Answer 44

High

Question 45

With ADH what are the ACTH levels

Answer 45

Low

Question 46

Endogenous acth high

Answer 46

PDH

Question 47

If endogenous act is high and LDDST is diagnostic for cushings what do you know

Answer 47

PDH