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AANP FNP CERTIFICATION EXAM
2025 LATEST REAL QUESTIONS
AND CORRECT ANSWERS GRADE A
Cranial nerves responsible for extraocular eye movements - ANSWER- CN 3,4, Definition of metabolic syndrome - ANSWER- cluster of conditions that increase risk of heart disease, stroke, diabetes. diagnose trichomoniasis - ANSWER- wet prep Elderly presents with atrophic vaginitis, small uterus, palpable 4x5 ovary, what do you do next? - ANSWER- Pelvic US Epistaxis is most common in the area of the nose known as kiesselbachs triangle, where is this located? - ANSWER- Anterior septum Definitive diagnosis of acute bacterial prostatitis - ANSWER- urinalysis and culture GERD treatment - ANSWER- H2 is first line, give hs Grade 3 cells on Pap, treatment? - ANSWER- LEEP excision hematoma treatment? - ANSWER- drill hole and drain blood? Fingernail Increased risk of ectopic pregnancy - ANSWER- Salpingitis, or history of abortion, PID, Koplick spots - ANSWER- Measles (rubeola). Grains of salt lesions inside mouth in Measles Koplick spots - ANSWER- Measles (rubeola). Grains of salt lesions inside mouth in Measles
Legg-Calve-Perthes Disease - ANSWER- Avascular necrosis of the proximal femoral head Lipid level of 1500, increased risk for? - ANSWER- Pancreatitis Low HGB, Low HCT, High MCV indicates what? - ANSWER- Macrocytic anemia, B12 Def Man with BPH, prostate feels on digital exam? - ANSWER- Enlarged, symmetrical, smooth Man with HTN, CAD, present femoral pulses but absent pedal - ANSWER- Arterial Insufficiency McMurray's Sign (+) palpable or audible click while extending with varus stress - ANSWER- Meniscus tears Lachman's Test - ANSWER- pivot shift test (ACL tear) Newborn with foot turned in, what do you do? - ANSWER- refer to orthopedist Osgood-Schlatter disease - ANSWER- Knee pain. inflammation or irritation of the tibia at its point of attachment with the patellar tendon Patient forgot to start Thanksgiving dinner and husband states she has trouble remembering tasks and trouble with organization. What is this indicative of? - ANSWER- Alzheimer's Pt has Barretts Esophagus, insurance no longer covers GI who was treating condition. Pt at FNP office wanting refill prescriptions. What do you do? - ANSWER- Refer to oncologist Pt presents with rash on shoulder, erythematous maculopapular rash with center clearing and scaling? - ANSWER- Tinea Corporis Pt presents with "bag of worms:, indicates? - ANSWER- Varicocele
- On the fourth day, the fever disappears and the rash appears, first on chest and trunk, then less prominently on the face and limbs. - High fever, pink flat or raised rash Treatment for chronic alcoholism: - ANSWER- 12 step program Treatment for Gonorrhea? - ANSWER- Rocephin 250mg IMx1 plus Azithromycin 1 gm orally x1 to cover chlamydia. , or doxy 100 mg BID x7d. Green colored vaginal discharge, friable cervix. EXAM Report to health department Young female want birth control, forgets to take pills, does not want to get pregnant for at least 5 years: - ANSWER- IUD Basal cell cancer - ANSWER- Waxy, pearly, telangiectasia, ulcer center lesion
- most common type of skin cancer caused by UV exposure. Metastatic is rare Actinic Keratosis - ANSWER- Scaly red to yellow located in sun exposed area
- a precancerous skin growth that occurs on sun-damaged skin Actinic Keratosis - ANSWER- Numerous round dry pink to red areas. Scaly red to yellow located in sun exposed area
- a pre squamous cell carcinoma occurs on sun-damaged skin biopsy cryo or 5fu cream subungual hematoma tx - ANSWER- Make a hole and drain the blood Moderate acne treatment - ANSWER- Without inflammation: Topical retinoid Moderate inflammation: Topical Retinoid or benzoyl peroxide or Azaleic acic ( very expensive and hard to get covered)
PLUS ADD
Oral antibiotics: doxycycline or tetracycline or minocycline- (tetracyclines has been proven most affective for inflammatory acne) Minocycline- long term use has been linked with pseudotumor cerebri Oral contraceptives for hormone related Spironolactone heart murmur with holosystolic or pan systolic Heart mumur with mid systolic - ANSWER- MR - radiate axilla, 5th ICS MCL, apex, AS - radiate neck, 2ICS right sternal border MR ASSH Coarctation of Aorta - ANSWER- COA: bounding radial and weak femoral pulse increase blood pressure in arms, and lower pressure in lower legs. - congenital cardiac condition characterized by a narrowing of the aorta
Murmur Grade III - VI - ANSWER- Loud murmur easily heard JVD caused by - ANSWER- - tension pneumothorax,
- Rt. sided heart failure,
- cardiac tamponade,
- traumatic axphysia from Increase in portal pressure(LIVER) in venous side or cor pulmonale pt. with gradual onset of fever, hemorrhages on nail beds, painful raised red nodules, rash on palms - ANSWER- endocarditis , painful red spots on fingers olser's nodes, janeway legions rash on palms and soles.
3 month old infant with down syndrome, due to milk intolerance, mom started on goats milk; now has pale conjunctiva but otherwise healthy. Low HCT. What additional test would you order? - ANSWER- Iron, TIBC 3 months of synthroid, TSH increased, T4 normal, what do you do? - ANSWER- Increase Medication 3 ways to assess cognitive function in patient with signs/symptoms of memory loss - ANSWER- Mini mental exam 4 month old with strabismus, mom is worried .... .. - ANSWER- tell her it is normal. 4 month old wont keep anything down, what is the main thing you look at? - ANSWER- Growth chart 6 month old closed anterior fontanel. - ANSWER- XRAY Abnormal cells on PAP, what do you do next? - ANSWER- Refer for Colposcopy CAGE ACRONYM - ANSWER- Cut down Annoyed by criticism Guilty about drinking Eye opener drink
Causes of tachycardia - ANSWER- Fever Anemia Hypotension migraine headache - ANSWER- - paroxysmal (sudden, periodic) attacks of mostly unilateral headache, often accompanied by disordered vision, nausea, or vomiting, lasting hours or days and caused by dilation of arteries. 4 - 12 hours, abortive triptans Which among the list can cause increase in respiration - ANSWER- Options include (low oxygen, high oxygen, hypercapnia, hypocapnia)? Which among the list can cause increase in respiration - ANSWER- hypercapnia Osteoporosis Risk Factors (ACCESS) - ANSWER- A-lcohol Use C-orticosteroid Use C-alcium low E-strogen low S-moking S-edentary lifestyle/s ACCESS leads to OSTEOPOROSIS to prevent fracture in a pt. with low vitamin d hydroxyl, high TSH and low Hct - ANSWER- VITAMIN D 600-800, CALCIUM 1000-1200. OSTEOPOROSIS BONE ABSORPTION EXCEED BONE FORMATION.
CAFFE- Conductive lateralize to affected ear Assessment on patient with ascites - ANSWER- Dullness Assessment on patient with ascites - ANSWER- Dullness to percussion Varus Stress Test - ANSWER- application of a lateral force to the medial aspect of a joint in an attempt to create a gap in the lateral joint line, thereby testing the stability of the lateral aspect of the joint LCL Varus Stress Test - ANSWER- TEST LCL (lateral-vaRus) McMurrays- Meniscus CLICK application of a lateral force to the medial aspect of a joint in an attempt to create a gap in the lateral joint line, thereby testing the stability of the lateral aspect of the joint LCL German Measles (Rubella) - ANSWER- Pink, papular rash (similar to measles but paler) first appears on face, then spreads. Distinguished from measles by presence of neck lymphadenopathy and absence of Koplik spots. patient with IOP of 32mmHg, what do you expect during fundoscopic exam - ANSWER- patient with IOP of 32mmHg, what do you expect during fundoscopic exam - ANSWER- increase cup-to-disc ratio retinal hemorrhage optic nerve asymmetry and pallor measured w tonometry BPH and urge incontinence - ANSWER- anticholinergics/oxybutynin, impamine/tricyclic/antidepressant
Anticholinergic- can't think or blink, can't see (Increase eye pressure) or pee, can't spit or shit, SADCCUB sedation, anorexia, dry mouth confusion, constipation, urinary retention, BPH BPH and urge incontinence - ANSWER- TX anticholinergics/oxybutynin, impamine/tricyclic antidepressant seasonal affective disorder (SAD) - ANSWER- a mood disorder caused by the body's reaction to low levels of sunlight in the winter months intussusception - ANSWER- telescoping obstruction of the intestines, cuts off blood supply, fatal, sudden loud crying, comes/goes, vomiting, blood/mucus mixed with stool, SAUSAGE LIKE MASS intussusception - ANSWER- telescoping obstruction of the intestines, cuts off blood supply, fatal, sudden loud crying, comes/goes, vomiting, blood/mucus mixed with stool, SAUSAGE LIKE MASS CURRENT JELLY STOOL IBS (irritable bowel syndrome) - ANSWER- An intestinal disorder causing pain in the belly, gas, diarrhea, and constipation. due to Small intestinal bacterial overgrowth, or SIBO IBS (irritable bowel syndrome) - ANSWER- SS pain in the belly, gas, diarrhea, and constipation. Pencil like stool. Caused by: Small intestinal bacterial overgrowth, or SIBO TX fiber, avoid gas foods, antispasmodics, decrease life stress Osteoporosis treatment - ANSWER- TX first line is bisphosphonates alendronate, Fosamax, calcium500 mg, vitamin d thru food and supplementation, testosterone, wt bearing exercise Osteopenia- increase calcium dark green vegetables, salmon, sardines, soy and OJ Hormone (estrogen) replacement therapy (HRT) slows bone loss
pt has AOM but has hives on Amoxicillin and N/V with erythromycin, what meds to give - ANSWER- TREATMENT: Amoxicillin (first line), then Augmentin, Omnicef, Ceftin, Levaquin. If your patient is only PCN allergic do azithromycin or clarithromycin. chlamydia in pregnancy - ANSWER- Azithromycin 1 gm PO x1 or Amoxicillin 500 mg PO TID x7d. Test of cure 3 weeks after completion of treatment (PREGO). EXAM papilledema - ANSWER- optic disc swollen w/ blurred edges due to increased ICP EXAM actinic keratoses - ANSWER- Precursor to squamous cell carcinoma. "numerous dry round and pink to red lesions" with a rough and scaly texture. Does not heal. Slow growing in sun exposed areas. Diagnosis: BIOPSY Golden Standard. Treatment: Sm. (cryotherapy), Lrg. (5-FU cream)- which causes ur skin to ooze, crust, scab, redness EXAM Allergic Conjunctivitis - ANSWER- "stringy; increased tearing" PO antihistamines. Type I sensitivity. Typically bilateral. Rhinitis and allergic shiner. COPD - ANSWER- COPD- Gold 1- 2 - SABA or SAMA ON EXAM.BASCIALLY ANTICHOLINERGIC FIRST LINE FOR COPD ON EXAM Gold 1-2 that are poor controlled- LAMA or LABA. May use SABA for rescue. Gold 3-4 LAMA first line. If poor use LAMA plus LABA. Alternative is LABA + ICS. Gold 3- 4 - refer SABA- Albuterol, levoalbuterol (terol) LABA- Formeterol, salmeterol (Terol) SAMA- Atrovent Ipatropium (tropium) LAMA- Spiriva Tiotroium (tropium) COPD long term is OXYGEN
CN IX Glossopharyngeal - ANSWER- - Shoulder shrug/ ROMBERG test EXAM CN V Trigeminal - ANSWER- Herpes. CORNEAL ABRASION. EXAM CN VIII Vestibulocochlear - ANSWER- ears 8 EXAM CN VII Facial - ANSWER- BELLS EXAM ACEI contraindicated - ANSWER- pregnancy Safe to give varicella/MMR - ANSWER- Do not give <12 mo. EXAM QUESTION Acne Vulgaris - ANSWER- common acne. Retin-A, acne worsens 4- 6 weeks if no improvement in 8-12 weeks increase dose or add erythromycin, benzoyl peroxide. Acne Rosacea - ANSWER- - chronic small acne like papules/pustules around nose mouth chin. TREATMENT- Metrogel, Azelex. Low dose tetracycline. Clindamycin. EXAM Cataracts - ANSWER- is on EXAM in elderly night vision issues. Opaque Kawasaki disease - ANSWER- - acute high fever, enlarged lymph. BRIGHT RED RASH, conjunctivitis, dry cracked lips, strawberry tongue, Swollen hands, feet, AFTER the fever resides the rash PEELS on hands/feet. Treated with high dose aspirin and gamma globulin. This is TOXIC and VASCULAR, think blood clots, heart problems etc. Treat: high dose aspirin. EXAM Erythema migrans - ANSWER- Erythema Migraines- (stage 1 Lyme) Target bulls-eye, usually appears in 7-14 days POST bitten tick. Rash is hot to touch with rough texture, flu like symptoms. DX: B. Burgdorferi
Fundal Height - ANSWER- Fundal Height 12 weeks above symphysis pubis. EXAM TOPICS Fundus 16 weeks between symphysis pubis and umbilicus. Fundus at 20 weeks is at umbilicus. 2 cm more of less from # of wk gestation is normal if more or less order US. Psoriasis - ANSWER- Psoriasis- Inherited. Pruritic erythematous plaques, fine silvery-white scales with pitted fingernails. Scalp, elbows, knees, sacrum, intergluteal folds. (Koebner phenomenon- new psoriatic plaques form over skin trauma) (Auspitz sign- pinpoint bleeding when plaques are removed). TREATMENT: Topical steroids, Tar preps (mild). For (severe) do anti- TNF, or immunologic. D Dacrocystitis - ANSWER- Darcryotosis lacrimal sac, rub down towards mouth. If think secondary infection abx. EXAM how it presents. Acne Rosacea - ANSWER- Acne Rosacea- chronic small acne like papules/pustules around nose mouth chin. TREATMENT- Metrogel, Azelex. Low dose tetracycline. EXAM Parathyroid hormone - ANSWER- PTH is responsible for calcium loss or gain from bones, kidneys, and GI tract. EXAM Diabetic Retinopathy - ANSWER- Diabetic Retinopathy-Cotton wool spots (moderate retinopathy), micro-aneurysms. ALSO RETINAL HEMORRHAGES ON CENTER OF EYE APPEAR ORANGE RED HTN Retinopathy - ANSWER- Hypertensive Retinopathy- Copper/silver wire arterioles. AV nicking(mild retinopathy). Retinal Hemorrhages. EXAM
Wilms Tumor - ANSWER- Wilms tumor (Nephroblastoma)- Not painful. Asymptomatic abd mass does NOT cross the midline. 2-3 y. o.d. do not palpate. Do ABD US. PUNT. Think Nephro doesn't cross. Stays where kidney is. EXAM Primary Amenorrhea - ANSWER- Primary amenorrhea: NO menarche by 15 y. with or w/o secondary sex characteristics. Aphthous stomatitis - ANSWER- Cancer sores. Aphthous stomatitis: painful shallow ulcers heal 7-10 days. Magic mouthwash. Temporal arteritis - ANSWER- Temporal arteritis- one temple indurated cord like gold stand. Biopsy. Abrupt visual changes blindness, inc. ESR. CPR. Most have POLYMYALGIA RHEUMATICA. Treat high dose steroids. Atopic Dermatitis (eczema) - ANSWER- Inherited. Extremely itchy. On flexural folds, neck, hands. Inc. IgE. "small vesicles that rupture leaving painful, bright-red, weepy lesions" they become lichenified from itching. First line: Topical steroids. Avoid hot water/soaps. PO antihistamines. EXAM Tinea Corporis - ANSWER- ring like itchy rash, slowly enlarge central clearing"-Treatment: most respond to topical antifungals, if severe do oral Lamisil. EXAM AZOLE ending Cellulitis - ANSWER- Deep dermis poor demarcated low legs. EXAM/ MULTIPLE QUESTIONS. DVT RISK, DM WITH CELLULITIS WATCH FOR OSTEOMYLITIS. Erysipelas - ANSWER- Group A strep, painful, Upper dermis, clear demarcated, cheeks, shins. TREATMENT- Dicloxacillin QID x10d. Cephalexin, Clinda. PCN ALLERGY? Do Azithro x5d. MRSA TREATMENT: Bactrim, doxy, mino, clinda. If sulfa allergy do not use Bactrim.
EXAM
Conductive - ANSWER- Conductive: Lateralization to bad ear. Rinne- BC > AC. Rinne (1st mastoid, 2 front of ear, time each area). Weber: Tunning fork midline. CN 8 (acoustic). EXAM Koplik spots - ANSWER- Koplik Spots- "clusters sm. Size red papules w/ white centers in the buccal mucosa by lower molars". Rubeolla. Fever, conjunctivitis, coryza, cough (3c). Morbiliform rash. EXAM Sensorineural - ANSWER- Sensorineural: Lateralization to good ear. Rinne- AC > BC. OME - ANSWER- Ear pressure, popping, muffled hearing, chronic allergic rhinitis, sterile serious fluid is trapped in the middle ear. TM should NOT BED RED. TM may bulge or retract. TREATMENT: Oral decongestants, steroid nasal spray, treat like allergies. Usually Painless. Weber- Lateralization to affected ear. Rhinne- BC > AC. PRECEDES OR USUALLY FOLLOWS AOM. SUPPORTIVE CARE AND WAIT 3 MOS SOMEX. EXAM Presbycusis - ANSWER- sensorineural loss without lateralization. Involves the inner ear. Symmetrical progressive. Human speech lost first. AGING ADULT EXAM OE - ANSWER- Otitis Externa (swimmers ear)- Pseudomonas aeruginosa. (other- S. aureus). External ear pain- d/c itching, hearing loss, tragus, green d/c. TREATMENT: Corticosporin, Cipro EXAM Sinusitis - ANSWER- TX AMOXICILLIN OR AUGMENTIN ALLERGY MACROLIDE Meiniers disease - ANSWER- VERTIGO TINNITUS, HEARING
LOSS.
nystagmas Mono - ANSWER- test heterophile antibody test. ON EXAM MR. ASS - ANSWER- (Systolic Murmur) Only systolic murmurs will radiate to a location on the exam. Mitral Regurg - ANSWER- (Holo/pansystolic)- radiates to axilla. Think Mitral area 5th ics MCL. Aortic Stenosis (mid systolic ejection) radiates to neck. Think 2ics rsb. All diastolic murmurs are pathological. Grades Murmurs - ANSWER- I- barely II-audible III- clearly audible. IV- first time thrill V-Steth edge VI-entire steth. EXAM MVP - ANSWER- MVP- S2 click, followed by systolic murmur. Asymptomatic. MVP with palpitations is treated with BB. LATE SYSTOLIC. S3- HF, S4-LVH stiffening, - ANSWER- S3- HF, Kentucky, early diastole. Abn
- Bell EXAM S4-LVH stiffening, Tennesse, late diastole. "Atrial kick/gallop" EXAM Isolated Systolic HTN - ANSWER- CCB PAD/ PVD - ANSWER- PAD/ PVD (same)- Nocturnal pain relieved by lowering legs, poor pulses, dependent rubor, intermittent claudication, atrophy, shiny, hairless, cold feet. Initial do a pulse check, ABI 0.9 or less is PAD. Ateriography is the most DEFINITIVE test. Try to develop collateral circulation. Otherwise- Trental, Pletal. EXAM CVI - ANSWER- CVI- Impaired venous return. Achy legs relieved by
elevation, edema after prolonged standing, night cramps, brownish discoloration, cold, ulcers. Etc. do support stockings. EXAM blood pressure - ANSWER- BP - ST 1 (140-159/ 90-99), if you know this you will get the rest!! Normal is <120/80. ELERGLY OVER 60
