AGACNP Exam Questions with Correct Answers
Question 1:
What causes fever?
Answer:
*ABCDEFGHIMN*
*Auto-immune* - SLE, GCA
*Blood* - Heme/Onc - Leukemia/Lymphoma
*Cancer*
*Drugs* - Amphotericin B, Beta-lactam abx, procainamide
*Endo* - hyperthyroidism, pheochromocytoma
*Familial mediterranean fever*
*GI* - intra-abdominal abscess, IBD
*Heart*- MI, endocarditis
*Infection* - bacterial, viral, fungal, parasites, etc.
*Misc* - Hematoma
*Neuro* - tumor, ICH, MS - interfere w/ thermoregulatory process
Question 2:
What is malignant hyperthermia?
Answer:
*high fever d/t succinylcholine* usu given in OR to relax laryngeal muscle
Question 3:
contraindicated to succs? hyperkalemia
*Tx: dantrolene - reversal for succs* What is the treatment for fever?
Answer:
1. antimicrobials only when a microbe is present antipyretics
tx underlying condition
Question 4:
What are the causes of non-infectious post-op fever?
Answer:
1. post-op atelectasis increased basic metabolic rate dehydration
drug reactions: Amphotericin B, trimethoprim-sulfamethazole, beta-lactam (abx),
procainamide, isoniazid, alpha-methyldopa, quinidine, etc.
,Question 5:
What would prompt you to think that a post-op fever is infectious?
Answer:
1. usu accompanied by subjective complaints & a WBC elevation with *left shift* (i.e.,
bandemia) WBC >30k is usu not d/t infection
*surgical incisions*
*point of entry for any catheter, culture it* UTI
lungs sinusitis
abscess (e.g., intra-abd)
normal WBC - 5-10k sinusitis - 12k cellulitis - 17k septic shock - 20-22k leukemia - 30k
Question 6:
what is the initial tx for post-op fever in the absence of information of infection?
Answer:
Hydration
+ measures to expand lungs
Question 7:
what is the treatment for infectious post-op fever?
Answer:
-IVF + APAP
-tx underlying source
-gram stain, C&S, all invasive lines or catheters, as indicated
**before cultures, do not give APAP or IVF. Do not suppress anti-inflammatory response bec
you want to culture at maximum inflammation response, then broad spectrum abx, IVF, &
APAP, then narrow once culture comes back.
Question 8:
what are the components of headache evaluation?
Answer:
1. chronology - most impt hx item location, duration, quality
associated activity - i.e. exertion, sleep, tension, relaxation timing of menstrual cycle
presence of assoc symptoms presence of "triggers"
Question 9:
What is the lab/diagnostic test and treatment for tension headache?
Answer:
- no lab/diagnostic test specific for tension h/a tx is OTC analgesics & relaxation
,Question 10:
What is the pathophysiology behind migraine headaches?
Answer:
- migraine headaches are related to dilation & excessive pulsation of branches of the external
carotid artery
typically lasts 2-72 hours following the trigeminal nerve pathway
Question 11:
What are the physical exam findings you may find in a migraine headache?
Answer:
-many times appear normal, +/- neuro deficits, or appear ill
-neuro deficits - visual disturbances, aphasia, numbness/tingling, N/V,
photophobia/phonophobia
*careful neuro exam for focal deficits or findings supportive of tumor
Question 12:
What labs/diagnostic tests do you order in pts w/ new migraine h/a?
Answer:
CBC, BMP VDRL - r/o syphilis ESR - elevated in GCA
head CT - r/o tumor & bleed, esp in young pt w/ ha other studies as indicated by H&P
Question 13:
What is the management for a migraine headache?
Answer:
1. Avoidance of trigger factors (very impt) relaxation/stress mgt
PPX daily if attacks occure >2-3x/month
-amitryptyline(Elavil)
-divalproex(Depakote)
-propanolol(Inderal)
-Imipramine(Tofranil)
-clonodine(Catapres)
-verapamil(Calan)
-topiramate(Topamax)
, Question 14:
What is the management for a migraine headache?
Answer:
1. Avoidance of trigger factors (very impt) relaxation/stress mgt
PPX daily if attacks occure >2-3x/month
-amitryptyline(Elavil)
-divalproex(Depakote)
-propanolol(Inderal)
-Imipramine(Tofranil)
-clonodine(Catapres)
-verapamil(Calan)
-topiramate(Topamax)
-gabapentin(Neurontin)-methysergide(Sansert)-magnesium***not an inclusive
list**-gabapentin(Neurontin)-methysergide(Sansert)-magnesium***not an inclusive list**
-gabapentin(Neurontin)
-methysergide(Sansert)
-magnesium
***not an inclusive list**
-gabapentin(Neurontin)
-methysergide(Sansert)
-magnesium
***not an inclusive list**
Question 15:
What is the management for an acute attack of migraine headache?
Answer:
1. rest in dark, quiet room
simple analgesic (ASA) taken right away may provide some relief Sumatriptan(Imitrex) 6mg SQ
at onset, may repeat in 1hr (total of 3x/day) Sumatriptan 25mg PO at onset of headache
Question 16:
Cluster headaches affect mostly ?
Answer:
middle-aged men, very painful syndromes
Question 1:
What causes fever?
Answer:
*ABCDEFGHIMN*
*Auto-immune* - SLE, GCA
*Blood* - Heme/Onc - Leukemia/Lymphoma
*Cancer*
*Drugs* - Amphotericin B, Beta-lactam abx, procainamide
*Endo* - hyperthyroidism, pheochromocytoma
*Familial mediterranean fever*
*GI* - intra-abdominal abscess, IBD
*Heart*- MI, endocarditis
*Infection* - bacterial, viral, fungal, parasites, etc.
*Misc* - Hematoma
*Neuro* - tumor, ICH, MS - interfere w/ thermoregulatory process
Question 2:
What is malignant hyperthermia?
Answer:
*high fever d/t succinylcholine* usu given in OR to relax laryngeal muscle
Question 3:
contraindicated to succs? hyperkalemia
*Tx: dantrolene - reversal for succs* What is the treatment for fever?
Answer:
1. antimicrobials only when a microbe is present antipyretics
tx underlying condition
Question 4:
What are the causes of non-infectious post-op fever?
Answer:
1. post-op atelectasis increased basic metabolic rate dehydration
drug reactions: Amphotericin B, trimethoprim-sulfamethazole, beta-lactam (abx),
procainamide, isoniazid, alpha-methyldopa, quinidine, etc.
,Question 5:
What would prompt you to think that a post-op fever is infectious?
Answer:
1. usu accompanied by subjective complaints & a WBC elevation with *left shift* (i.e.,
bandemia) WBC >30k is usu not d/t infection
*surgical incisions*
*point of entry for any catheter, culture it* UTI
lungs sinusitis
abscess (e.g., intra-abd)
normal WBC - 5-10k sinusitis - 12k cellulitis - 17k septic shock - 20-22k leukemia - 30k
Question 6:
what is the initial tx for post-op fever in the absence of information of infection?
Answer:
Hydration
+ measures to expand lungs
Question 7:
what is the treatment for infectious post-op fever?
Answer:
-IVF + APAP
-tx underlying source
-gram stain, C&S, all invasive lines or catheters, as indicated
**before cultures, do not give APAP or IVF. Do not suppress anti-inflammatory response bec
you want to culture at maximum inflammation response, then broad spectrum abx, IVF, &
APAP, then narrow once culture comes back.
Question 8:
what are the components of headache evaluation?
Answer:
1. chronology - most impt hx item location, duration, quality
associated activity - i.e. exertion, sleep, tension, relaxation timing of menstrual cycle
presence of assoc symptoms presence of "triggers"
Question 9:
What is the lab/diagnostic test and treatment for tension headache?
Answer:
- no lab/diagnostic test specific for tension h/a tx is OTC analgesics & relaxation
,Question 10:
What is the pathophysiology behind migraine headaches?
Answer:
- migraine headaches are related to dilation & excessive pulsation of branches of the external
carotid artery
typically lasts 2-72 hours following the trigeminal nerve pathway
Question 11:
What are the physical exam findings you may find in a migraine headache?
Answer:
-many times appear normal, +/- neuro deficits, or appear ill
-neuro deficits - visual disturbances, aphasia, numbness/tingling, N/V,
photophobia/phonophobia
*careful neuro exam for focal deficits or findings supportive of tumor
Question 12:
What labs/diagnostic tests do you order in pts w/ new migraine h/a?
Answer:
CBC, BMP VDRL - r/o syphilis ESR - elevated in GCA
head CT - r/o tumor & bleed, esp in young pt w/ ha other studies as indicated by H&P
Question 13:
What is the management for a migraine headache?
Answer:
1. Avoidance of trigger factors (very impt) relaxation/stress mgt
PPX daily if attacks occure >2-3x/month
-amitryptyline(Elavil)
-divalproex(Depakote)
-propanolol(Inderal)
-Imipramine(Tofranil)
-clonodine(Catapres)
-verapamil(Calan)
-topiramate(Topamax)
, Question 14:
What is the management for a migraine headache?
Answer:
1. Avoidance of trigger factors (very impt) relaxation/stress mgt
PPX daily if attacks occure >2-3x/month
-amitryptyline(Elavil)
-divalproex(Depakote)
-propanolol(Inderal)
-Imipramine(Tofranil)
-clonodine(Catapres)
-verapamil(Calan)
-topiramate(Topamax)
-gabapentin(Neurontin)-methysergide(Sansert)-magnesium***not an inclusive
list**-gabapentin(Neurontin)-methysergide(Sansert)-magnesium***not an inclusive list**
-gabapentin(Neurontin)
-methysergide(Sansert)
-magnesium
***not an inclusive list**
-gabapentin(Neurontin)
-methysergide(Sansert)
-magnesium
***not an inclusive list**
Question 15:
What is the management for an acute attack of migraine headache?
Answer:
1. rest in dark, quiet room
simple analgesic (ASA) taken right away may provide some relief Sumatriptan(Imitrex) 6mg SQ
at onset, may repeat in 1hr (total of 3x/day) Sumatriptan 25mg PO at onset of headache
Question 16:
Cluster headaches affect mostly ?
Answer:
middle-aged men, very painful syndromes
