(FNP) BOARD EXAM QUESTIONS AND ANSWERS
1. A 55-year-old female presents with fatigue, weight gain, cold intolerance,
constipation, and dry skin. Her TSH is 9.8 mIU/L (normal 0.4–4.0), free T4 is
low. Which of the following is the most appropriate initial management?
A. Start levothyroxine 50 mcg daily
B. Start methimazole 10 mg daily
C. Repeat labs in 3 months before treatment
D. Start liothyronine 25 mcg daily
Answer: A. Start levothyroxine 50 mcg daily
Rationale:
The patient presents with classic hypothyroidism symptoms and elevated TSH with
low free T4. Levothyroxine is first-line therapy. Methimazole is for
hyperthyroidism. Liothyronine is not first-line due to short half-life and risk of
cardiac effects.
2. A 42-year-old male with a history of HTN presents with sudden onset of
severe chest pain radiating to the left arm, diaphoresis, and nausea. ECG
shows ST-elevation in leads II, III, and aVF. Which artery is most likely
occluded?
A. Left anterior descending artery
B. Left circumflex artery
C. Right coronary artery
D. Posterior descending artery
Answer: C. Right coronary artery
Rationale:
ST-elevation in leads II, III, and aVF indicates an inferior MI. The most common
culprit artery is the right coronary artery (RCA).
,3. A 25-year-old female presents with fever, sore throat, cervical
lymphadenopathy, and fatigue. Rapid strep test is negative. Which is the most
appropriate next step?
A. Start amoxicillin
B. Order Monospot test
C. Start oseltamivir
D. Prescribe azithromycin
Answer: B. Order Monospot test
Rationale:
In a patient with pharyngitis and fatigue with negative strep test, infectious
mononucleosis should be considered. Amoxicillin can cause rash in mono.
4. A 60-year-old male presents with progressive shortness of breath, chronic
cough, and barrel chest. Pulmonary function tests show FEV1/FVC < 0.7 and
increased residual volume. Which is the most likely diagnosis?
A. Asthma
B. COPD
C. Interstitial lung disease
D. Pulmonary fibrosis
Answer: B. COPD
Rationale:
Obstructive pattern with reduced FEV1/FVC and hyperinflation (increased residual
volume) suggests COPD.
,5. A 32-year-old female complains of irregular menses and hirsutism. Her labs
show elevated LH:FSH ratio and elevated testosterone. What is the most
likely diagnosis?
A. Cushing syndrome
B. PCOS
C. Hypothyroidism
D. Prolactinoma
Answer: B. PCOS
Rationale:
PCOS commonly presents with irregular menses, hirsutism, elevated LH:FSH
ratio, and elevated testosterone.
6. A 70-year-old female with osteoporosis has a new diagnosis of breast
cancer. Which medication is contraindicated?
A. Alendronate
B. Raloxifene
C. Calcium + Vitamin D
D. Denosumab
Answer: B. Raloxifene
Rationale:
Raloxifene is contraindicated in patients with a history of breast cancer due to
estrogen receptor modulation risk.
7. A patient presents with burning epigastric pain that improves with meals.
Which condition is most likely?
A. Gastric ulcer
B. Duodenal ulcer
C. GERD
D. Pancreatitis
, Answer: B. Duodenal ulcer
Rationale:
Duodenal ulcer pain often improves with food; gastric ulcer pain worsens with
food.
8. A 45-year-old male presents with severe RUQ pain after a fatty meal, fever,
and jaundice. Labs show elevated ALP and bilirubin. What is the most likely
diagnosis?
A. Acute pancreatitis
B. Acute cholecystitis
C. Acute cholangitis
D. Hepatitis
Answer: C. Acute cholangitis
Rationale:
Charcot triad (fever, jaundice, RUQ pain) indicates acute cholangitis.
9. A 28-year-old female presents with sudden unilateral pelvic pain, adnexal
tenderness, and positive pregnancy test. What is the most appropriate next
step?
A. Urgent pelvic ultrasound
B. Start methotrexate immediately
C. Start broad-spectrum antibiotics
D. Schedule routine follow-up
Answer: A. Urgent pelvic ultrasound
Rationale:
Suspected ectopic pregnancy requires immediate ultrasound to confirm location
before treatment.
1. A 55-year-old female presents with fatigue, weight gain, cold intolerance,
constipation, and dry skin. Her TSH is 9.8 mIU/L (normal 0.4–4.0), free T4 is
low. Which of the following is the most appropriate initial management?
A. Start levothyroxine 50 mcg daily
B. Start methimazole 10 mg daily
C. Repeat labs in 3 months before treatment
D. Start liothyronine 25 mcg daily
Answer: A. Start levothyroxine 50 mcg daily
Rationale:
The patient presents with classic hypothyroidism symptoms and elevated TSH with
low free T4. Levothyroxine is first-line therapy. Methimazole is for
hyperthyroidism. Liothyronine is not first-line due to short half-life and risk of
cardiac effects.
2. A 42-year-old male with a history of HTN presents with sudden onset of
severe chest pain radiating to the left arm, diaphoresis, and nausea. ECG
shows ST-elevation in leads II, III, and aVF. Which artery is most likely
occluded?
A. Left anterior descending artery
B. Left circumflex artery
C. Right coronary artery
D. Posterior descending artery
Answer: C. Right coronary artery
Rationale:
ST-elevation in leads II, III, and aVF indicates an inferior MI. The most common
culprit artery is the right coronary artery (RCA).
,3. A 25-year-old female presents with fever, sore throat, cervical
lymphadenopathy, and fatigue. Rapid strep test is negative. Which is the most
appropriate next step?
A. Start amoxicillin
B. Order Monospot test
C. Start oseltamivir
D. Prescribe azithromycin
Answer: B. Order Monospot test
Rationale:
In a patient with pharyngitis and fatigue with negative strep test, infectious
mononucleosis should be considered. Amoxicillin can cause rash in mono.
4. A 60-year-old male presents with progressive shortness of breath, chronic
cough, and barrel chest. Pulmonary function tests show FEV1/FVC < 0.7 and
increased residual volume. Which is the most likely diagnosis?
A. Asthma
B. COPD
C. Interstitial lung disease
D. Pulmonary fibrosis
Answer: B. COPD
Rationale:
Obstructive pattern with reduced FEV1/FVC and hyperinflation (increased residual
volume) suggests COPD.
,5. A 32-year-old female complains of irregular menses and hirsutism. Her labs
show elevated LH:FSH ratio and elevated testosterone. What is the most
likely diagnosis?
A. Cushing syndrome
B. PCOS
C. Hypothyroidism
D. Prolactinoma
Answer: B. PCOS
Rationale:
PCOS commonly presents with irregular menses, hirsutism, elevated LH:FSH
ratio, and elevated testosterone.
6. A 70-year-old female with osteoporosis has a new diagnosis of breast
cancer. Which medication is contraindicated?
A. Alendronate
B. Raloxifene
C. Calcium + Vitamin D
D. Denosumab
Answer: B. Raloxifene
Rationale:
Raloxifene is contraindicated in patients with a history of breast cancer due to
estrogen receptor modulation risk.
7. A patient presents with burning epigastric pain that improves with meals.
Which condition is most likely?
A. Gastric ulcer
B. Duodenal ulcer
C. GERD
D. Pancreatitis
, Answer: B. Duodenal ulcer
Rationale:
Duodenal ulcer pain often improves with food; gastric ulcer pain worsens with
food.
8. A 45-year-old male presents with severe RUQ pain after a fatty meal, fever,
and jaundice. Labs show elevated ALP and bilirubin. What is the most likely
diagnosis?
A. Acute pancreatitis
B. Acute cholecystitis
C. Acute cholangitis
D. Hepatitis
Answer: C. Acute cholangitis
Rationale:
Charcot triad (fever, jaundice, RUQ pain) indicates acute cholangitis.
9. A 28-year-old female presents with sudden unilateral pelvic pain, adnexal
tenderness, and positive pregnancy test. What is the most appropriate next
step?
A. Urgent pelvic ultrasound
B. Start methotrexate immediately
C. Start broad-spectrum antibiotics
D. Schedule routine follow-up
Answer: A. Urgent pelvic ultrasound
Rationale:
Suspected ectopic pregnancy requires immediate ultrasound to confirm location
before treatment.
