AGNP MIDTERM EXAM UPDATED ACTUAL QUESTIONS AND CORRECT
ANSWERS
✔✔Fever: Mechanism - ✔✔Cytokines comprise the endogenous pyrogens; microbial
surface components account for most of the exogenous ones. Trigging of increased
prostaglandin E2 levels in thermoregulatory parts of the hypothalamus.
✔✔Fever: Symtpoms - ✔✔Sensation of warmth or flushing. malaise, fatigue, muscle
pain (myalgia)
Dramatic symptoms: shaking chill or rigor (uncontrolled violent shaking and trembling)
CNS symptoms: inability to concentrate, confusion, delirium, and stupor.
✔✔Fever: Exam: - ✔✔Vital signs
skin and mucous membranes
sinuses
scalp
tympanic membranes
lymph nodes
breasts
genitorectal
musculoskeletal
Neuro
✔✔Fever: Lab - ✔✔CBC with diff, Sed Rate, UA, Chest radiograph, blood chemistries,
examination of body fluids, blood cultures, microscopic eval,
✔✔Community Acquired Pneumonia: S&S - ✔✔Cough
Shortness of breath
High fever
Crackles or dullness on lung exam
✔✔CAP: Dx test - ✔✔Chest radiograph
Blood culture
Sputum Gram stain and culture (occasionally)
✔✔Acute bronchitis: S&S - ✔✔Cough( 1-3 weeks duration)
Absence of high fever
Normal lung exam
✔✔Acute bronchitis: Dx tst - ✔✔Chest radiograph (if abnormal lung exam, dyspnea or
high fever)
✔✔Influenza: S&S - ✔✔Sudden onset
High fever
Severe myalgias
, December to May
✔✔Influenza: Dx Test - ✔✔Direct immunofluorescence or ELISA can be used
✔✔Aspiration pneumonia: S&S - ✔✔Impaired mentation (dementia, prior stroke,
substance abuse)
Seizure
Vomiting
✔✔Aspiration pneumonia: Dx Test - ✔✔Chest radiograph
✔✔CURB-65 ( Indication for admit, pneumonia) - ✔✔C:Confusion (person, place or
time)
U: Uremia (BUN > 20 mg/dl)
R: Respirations > 30 breaths
B:Blood pressure < 90 mm hg or diastolic BP < 60 mm hg, age > 65
✔✔Aspiration Pneumonia; Types - ✔✔Small volume aspiration, typically oropharyngeal
secretions
Large volume aspiration, typically of gastric contents
✔✔Community acquired aspiration: Tx - ✔✔First line: Clindamycin or
amoxicillin/clavulanate
Amoxicillin with metronidazole.
✔✔Hospital Acquired aspiration: Tx - ✔✔Carbapenem or piperacillin-tazobactam
(Zosyn)
✔✔PCP: Risk factors - ✔✔injection drug use, men who have sex with men, engaging in
se with paid sex workers
✔✔PCP: Dx test - ✔✔HIV
CDC count
Chest radiograph demonstrating diffuse bilateral infiltrates.
✔✔PCP: Tx - ✔✔Antimicrobial therapy: (Trimethoprim-sulfamethoxazole (TMP-
SMX)Allergy= clinidamycin plus primaquine, dapsone plus TMP or atovaquone
Corticosteroids: Prednisone
✔✔Tuberculosis: Risk factors - ✔✔Immigrants from TB areas, TB hx or positive PPD,
homelessness, incarceration
✔✔TB: S&S - ✔✔Weight loss, cough > 2 weeks, night sweats
ANSWERS
✔✔Fever: Mechanism - ✔✔Cytokines comprise the endogenous pyrogens; microbial
surface components account for most of the exogenous ones. Trigging of increased
prostaglandin E2 levels in thermoregulatory parts of the hypothalamus.
✔✔Fever: Symtpoms - ✔✔Sensation of warmth or flushing. malaise, fatigue, muscle
pain (myalgia)
Dramatic symptoms: shaking chill or rigor (uncontrolled violent shaking and trembling)
CNS symptoms: inability to concentrate, confusion, delirium, and stupor.
✔✔Fever: Exam: - ✔✔Vital signs
skin and mucous membranes
sinuses
scalp
tympanic membranes
lymph nodes
breasts
genitorectal
musculoskeletal
Neuro
✔✔Fever: Lab - ✔✔CBC with diff, Sed Rate, UA, Chest radiograph, blood chemistries,
examination of body fluids, blood cultures, microscopic eval,
✔✔Community Acquired Pneumonia: S&S - ✔✔Cough
Shortness of breath
High fever
Crackles or dullness on lung exam
✔✔CAP: Dx test - ✔✔Chest radiograph
Blood culture
Sputum Gram stain and culture (occasionally)
✔✔Acute bronchitis: S&S - ✔✔Cough( 1-3 weeks duration)
Absence of high fever
Normal lung exam
✔✔Acute bronchitis: Dx tst - ✔✔Chest radiograph (if abnormal lung exam, dyspnea or
high fever)
✔✔Influenza: S&S - ✔✔Sudden onset
High fever
Severe myalgias
, December to May
✔✔Influenza: Dx Test - ✔✔Direct immunofluorescence or ELISA can be used
✔✔Aspiration pneumonia: S&S - ✔✔Impaired mentation (dementia, prior stroke,
substance abuse)
Seizure
Vomiting
✔✔Aspiration pneumonia: Dx Test - ✔✔Chest radiograph
✔✔CURB-65 ( Indication for admit, pneumonia) - ✔✔C:Confusion (person, place or
time)
U: Uremia (BUN > 20 mg/dl)
R: Respirations > 30 breaths
B:Blood pressure < 90 mm hg or diastolic BP < 60 mm hg, age > 65
✔✔Aspiration Pneumonia; Types - ✔✔Small volume aspiration, typically oropharyngeal
secretions
Large volume aspiration, typically of gastric contents
✔✔Community acquired aspiration: Tx - ✔✔First line: Clindamycin or
amoxicillin/clavulanate
Amoxicillin with metronidazole.
✔✔Hospital Acquired aspiration: Tx - ✔✔Carbapenem or piperacillin-tazobactam
(Zosyn)
✔✔PCP: Risk factors - ✔✔injection drug use, men who have sex with men, engaging in
se with paid sex workers
✔✔PCP: Dx test - ✔✔HIV
CDC count
Chest radiograph demonstrating diffuse bilateral infiltrates.
✔✔PCP: Tx - ✔✔Antimicrobial therapy: (Trimethoprim-sulfamethoxazole (TMP-
SMX)Allergy= clinidamycin plus primaquine, dapsone plus TMP or atovaquone
Corticosteroids: Prednisone
✔✔Tuberculosis: Risk factors - ✔✔Immigrants from TB areas, TB hx or positive PPD,
homelessness, incarceration
✔✔TB: S&S - ✔✔Weight loss, cough > 2 weeks, night sweats
