AGNP AANP TIPS MAIN ANSWERS AND QUESTIONS
SET A+
✔✔asthma rescue tx - ✔✔SABA (albuterol) as needed + ICS for tx of inflammation
✔✔asthma PFT dx - ✔✔if FEV1 post bronchodilator changes >12% or 200cc
✔✔asthma management - ✔✔SABA prn + ICS (low, med, or high dose)
ICS-LABA when moderate sx (sx most days)
Add LAMA to ICS-LABA when sx severe (daily)
✔✔chronic bronchitis & emphysema (COPD) - ✔✔chronic bronchitis- productive cough
3+ months in 2 consecutive years
emphysema- permanent enlargement of alveoli (structural)
✔✔chronic bronchitis sx - ✔✔intermittent dyspnea, onset after age 35
copious purulent sputum***, stocky obese body***, chest AP diameter normal***
CXR shows hyperinflation, HCT increased
✔✔emphysema sx - ✔✔progressive constant dyspnea, onset after age 50
mild clear sputum***, chest AP increased***, hyperresonant percussion
HCT normal, total lung capacity increase, thin wasted body
✔✔airflow obstruction dx (GOLD) - ✔✔GOLD 1: FEV1 >80%
GOLD 2: FEV1 50-79%
GOLD 3: FEV1 30-49%
GOLD 4: FEV1 <30%
,post bronchodilator FEV1/FVC <0.7 = dx
expiratory prolongation & max expiratory airflow < inspiratory ariflow = dx
✔✔airflow obstruction categories & tx - ✔✔category A:
-</= 1 mod exacerbation without hospitalization
-mMRC dyspnea scale 0-1
-CAT <10
-tx: bronchodilator
category B:
-</=1 exacerbation without hospitalization
-mMRC dyspnea scale >/=2
-CAT >10
-tx: LABA + LAMA
category E:
>/=2 exacerbations or >/=1 exacerbation requiring hospitalization
-tx: LABA + LAMA; ICS if eosinophils >300
✔✔pneumonia - ✔✔lower respiratory tract infection; 10% of admits to medical services
streptococcus pneumoniae = most common agent of CAP***
✔✔typical pneumonia sx - ✔✔lung consolidation (left lower lobe common)***
fever, chills, purulent sputum, malaise, increased fremitus
✔✔atypical pneumonia sx - ✔✔cough, HA, sore throat, sweats, fever, sore chest
atypical pathogens: legionella pneumophila, mycoplasma pneumoniae, chlamydophila
pneumoniae***
✔✔pneumonia labs/dx - ✔✔increased WBCs, infiltrates on CXR***
✔✔low severity outpatient CAP management - ✔✔healthy, no recent abx in past 3
months, no comorbidities or RFs for MRSA or pseudomonas aeruginosa
#1 amoxicillin 1g TID or #2 doxy 100mg BID or #3 macrolide (azithromycin or
clarithromycin)
✔✔moderate to high severity outpatient CAP management - ✔✔comorbidities or RFs
Augmentin or cephalosporin + macrolide or doxy (ex. augmentin + Zpak)
,OR
monotherapy- respiratory fluoroquinolone (levofloxacin or moxifloxacin) - AE: tendon
rupture, dizziness in elderly
✔✔tuberculosis - ✔✔systemic disease due to M. tuberculosis
pulmonary sx most common
other sites**: lymphatics, GU, bone, meninges, peritoneum, heart
✔✔TB RFs - ✔✔crowded living conditions, HIV (+), DM, renal insufficiency, malignancy,
malnutrition, immunosuppressed
✔✔TB s/sx - ✔✔***dry cough progressing to productive with blood tinge, night sweats
weight loss, fatigue, fever, anorexia, asymptomatic
✔✔TB labs/dx - ✔✔definitive dx = culture of M. tuberculosis x3***
CXR = UPPER lobes infiltrate***
PPD shows exposure, NOT diagnostic, repeat CXR in 6 months
✔✔TB management - ✔✔notify health department
only hospitalize if pt non compliant
✔✔TB Meds - ✔✔"RIPE" -isoniazid, rifampin, pyrazinamide, ethambutol daily
-1st 3 drugs daily x2 months, then INH & RIF daily x4 months
-HIV pt tx for 9 months
✔✔TB color vision test - ✔✔color vision test, ethambutol can cause red/green color
blindness
✔✔TB treatment monitoring - ✔✔pt with pulmonary TB- weekly sputum & cultures for
1st 6 weeks after start of tx, then monthly until cultures negative***
continued sx or (+) cultures for >3 months - think drug resistance
✔✔TB baseline eval - ✔✔LFTs, CBC, serum creatinine, color vision test
✔✔TB chemoprophylaxis - ✔✔if skin test (+) - give INH for 6 months
, 5mm (+) for HIV pts, known contact with confirmed case, TB on CXR
10mm (+) for immigrants, high risk groups, health care workers
15mm (+) for others not in high risk groups
✔✔pertussis - ✔✔aka whooping cough, contagious d/t Bordetella pertussis - get TDAP
vaccine!
✔✔pertussis s/sx - ✔✔early last 1-2 weeks: runny nose, low grade fever, mild
occasional cough
later stage for 10+ weeks: paroxysms followed by "whoop", vomiting and exhaustion
after coughing
✔✔pertussis dx - ✔✔PCR
✔✔pertussis tx - ✔✔antibiotics (azithromycin, clarithromycin, or erythromycin) within 1st
3wks of infection***
NO COUGH MEDS
pregnant women- TDAP vaccine during 3rd trimester**
fluids, small frequent meals
✔✔pulmonary function tests: airflow rates - ✔✔FVC, FEV1, FEV25-75, PEFR
reduced airflow rates = obstructive disease****; lung volumes WNL or >
✔✔FVC - ✔✔forced vital capacity- gas volume forcefully expelled post inspiration
✔✔FEV1 - ✔✔forced expiratory volume in 1 second- gas volume expelled in 1st second
of FVC
✔✔FEV25-75 - ✔✔Maximal mid-expiratory airflow rate
✔✔PEFR - ✔✔peak expiratory flow rate- max airflow rate in FVC
✔✔pulmonary function tests: volumes - ✔✔TLC, FRC, RV
reduced volumes = restrictive disease
✔✔TLC - ✔✔total lung capacity- gas volume in lungs post inspiration
SET A+
✔✔asthma rescue tx - ✔✔SABA (albuterol) as needed + ICS for tx of inflammation
✔✔asthma PFT dx - ✔✔if FEV1 post bronchodilator changes >12% or 200cc
✔✔asthma management - ✔✔SABA prn + ICS (low, med, or high dose)
ICS-LABA when moderate sx (sx most days)
Add LAMA to ICS-LABA when sx severe (daily)
✔✔chronic bronchitis & emphysema (COPD) - ✔✔chronic bronchitis- productive cough
3+ months in 2 consecutive years
emphysema- permanent enlargement of alveoli (structural)
✔✔chronic bronchitis sx - ✔✔intermittent dyspnea, onset after age 35
copious purulent sputum***, stocky obese body***, chest AP diameter normal***
CXR shows hyperinflation, HCT increased
✔✔emphysema sx - ✔✔progressive constant dyspnea, onset after age 50
mild clear sputum***, chest AP increased***, hyperresonant percussion
HCT normal, total lung capacity increase, thin wasted body
✔✔airflow obstruction dx (GOLD) - ✔✔GOLD 1: FEV1 >80%
GOLD 2: FEV1 50-79%
GOLD 3: FEV1 30-49%
GOLD 4: FEV1 <30%
,post bronchodilator FEV1/FVC <0.7 = dx
expiratory prolongation & max expiratory airflow < inspiratory ariflow = dx
✔✔airflow obstruction categories & tx - ✔✔category A:
-</= 1 mod exacerbation without hospitalization
-mMRC dyspnea scale 0-1
-CAT <10
-tx: bronchodilator
category B:
-</=1 exacerbation without hospitalization
-mMRC dyspnea scale >/=2
-CAT >10
-tx: LABA + LAMA
category E:
>/=2 exacerbations or >/=1 exacerbation requiring hospitalization
-tx: LABA + LAMA; ICS if eosinophils >300
✔✔pneumonia - ✔✔lower respiratory tract infection; 10% of admits to medical services
streptococcus pneumoniae = most common agent of CAP***
✔✔typical pneumonia sx - ✔✔lung consolidation (left lower lobe common)***
fever, chills, purulent sputum, malaise, increased fremitus
✔✔atypical pneumonia sx - ✔✔cough, HA, sore throat, sweats, fever, sore chest
atypical pathogens: legionella pneumophila, mycoplasma pneumoniae, chlamydophila
pneumoniae***
✔✔pneumonia labs/dx - ✔✔increased WBCs, infiltrates on CXR***
✔✔low severity outpatient CAP management - ✔✔healthy, no recent abx in past 3
months, no comorbidities or RFs for MRSA or pseudomonas aeruginosa
#1 amoxicillin 1g TID or #2 doxy 100mg BID or #3 macrolide (azithromycin or
clarithromycin)
✔✔moderate to high severity outpatient CAP management - ✔✔comorbidities or RFs
Augmentin or cephalosporin + macrolide or doxy (ex. augmentin + Zpak)
,OR
monotherapy- respiratory fluoroquinolone (levofloxacin or moxifloxacin) - AE: tendon
rupture, dizziness in elderly
✔✔tuberculosis - ✔✔systemic disease due to M. tuberculosis
pulmonary sx most common
other sites**: lymphatics, GU, bone, meninges, peritoneum, heart
✔✔TB RFs - ✔✔crowded living conditions, HIV (+), DM, renal insufficiency, malignancy,
malnutrition, immunosuppressed
✔✔TB s/sx - ✔✔***dry cough progressing to productive with blood tinge, night sweats
weight loss, fatigue, fever, anorexia, asymptomatic
✔✔TB labs/dx - ✔✔definitive dx = culture of M. tuberculosis x3***
CXR = UPPER lobes infiltrate***
PPD shows exposure, NOT diagnostic, repeat CXR in 6 months
✔✔TB management - ✔✔notify health department
only hospitalize if pt non compliant
✔✔TB Meds - ✔✔"RIPE" -isoniazid, rifampin, pyrazinamide, ethambutol daily
-1st 3 drugs daily x2 months, then INH & RIF daily x4 months
-HIV pt tx for 9 months
✔✔TB color vision test - ✔✔color vision test, ethambutol can cause red/green color
blindness
✔✔TB treatment monitoring - ✔✔pt with pulmonary TB- weekly sputum & cultures for
1st 6 weeks after start of tx, then monthly until cultures negative***
continued sx or (+) cultures for >3 months - think drug resistance
✔✔TB baseline eval - ✔✔LFTs, CBC, serum creatinine, color vision test
✔✔TB chemoprophylaxis - ✔✔if skin test (+) - give INH for 6 months
, 5mm (+) for HIV pts, known contact with confirmed case, TB on CXR
10mm (+) for immigrants, high risk groups, health care workers
15mm (+) for others not in high risk groups
✔✔pertussis - ✔✔aka whooping cough, contagious d/t Bordetella pertussis - get TDAP
vaccine!
✔✔pertussis s/sx - ✔✔early last 1-2 weeks: runny nose, low grade fever, mild
occasional cough
later stage for 10+ weeks: paroxysms followed by "whoop", vomiting and exhaustion
after coughing
✔✔pertussis dx - ✔✔PCR
✔✔pertussis tx - ✔✔antibiotics (azithromycin, clarithromycin, or erythromycin) within 1st
3wks of infection***
NO COUGH MEDS
pregnant women- TDAP vaccine during 3rd trimester**
fluids, small frequent meals
✔✔pulmonary function tests: airflow rates - ✔✔FVC, FEV1, FEV25-75, PEFR
reduced airflow rates = obstructive disease****; lung volumes WNL or >
✔✔FVC - ✔✔forced vital capacity- gas volume forcefully expelled post inspiration
✔✔FEV1 - ✔✔forced expiratory volume in 1 second- gas volume expelled in 1st second
of FVC
✔✔FEV25-75 - ✔✔Maximal mid-expiratory airflow rate
✔✔PEFR - ✔✔peak expiratory flow rate- max airflow rate in FVC
✔✔pulmonary function tests: volumes - ✔✔TLC, FRC, RV
reduced volumes = restrictive disease
✔✔TLC - ✔✔total lung capacity- gas volume in lungs post inspiration
