AANP Board Exam 2026/2027
150 Questions with Verified Answers
and Rationales
Q1: A 65-year-old male presents with a sudden onset of severe, tearing chest pain radiating to his
back. His blood pressure is 180/110 mmHg, and his heart rate is 100 bpm. He has a history of
uncontrolled hypertension. Which diagnostic test is the priority for this patient?
A. 12-lead ECG
B. Chest X-ray
C. Computed Tomography (CT) Angiography of the Chest
D. Cardiac Biomarkers (Troponin)
Correct Answer: C
Rationale: The best answer is CT Angiography because the presentation is classic for an aortic
dissection (tearing pain radiating to the back, significant HTN). While an ECG and troponin rule
out MI, they do not visualize the aorta. A chest X-ray may show a widened mediastinum but
lacks the sensitivity to confirm the diagnosis; CT is the gold standard.
Q2: A 24-year-old female presents for a well-woman exam. She has no history of abnormal Pap
smears and is sexually active with one partner. Her last Pap smear was two years ago and was
normal. According to USPSTF guidelines, when should she have her next cervical cancer
screening?
A. In 1 year
B. In 3 years
C. In 5 years
D. In 10 years
,Correct Answer: B
Rationale: The best answer is in 3 years. For average-risk women aged 21–29, cervical cytology
(Pap smear) alone is recommended every 3 years. Women aged 30–65 can extend this to every 5
years with co-testing (HPV and Pap) or Pap alone every 3 years.
Q3: You are evaluating a 4-year-old child for otitis media. The child has a temperature of 102°F,
ear pain for 24 hours, and bulging tympanic membranes with erythema. There is no discharge.
What is the first-line treatment?
A. Amoxicillin 80-90 mg/kg/day
B. Amoxicillin-Clavulanate 90 mg/kg/day
C. Cefdinir 14 mg/kg/day
D. Topical Fluoroquinolone ear drops
Correct Answer: A
Rationale: The best answer is Amoxicillin 80-90 mg/kg/day. High-dose amoxicillin is the first-
line treatment for acute otitis media (AOM) in children without penicillin allergy or recent
antibiotic use (within 30 days). Amoxicillin-clavulanate is reserved for treatment failure or
severe symptoms.
Q4: A 55-year-old female presents with hot flashes, night sweats, and vaginal dryness. She has
not had a menstrual period in 8 months. She is interested in hormone replacement therapy (HRT)
but is concerned about risks. Which factor is an absolute contraindication to HRT?
A. History of migraine headaches
B. History of deep vein thrombosis (DVT)
C. Family history of breast cancer
D. Age greater than 50
Correct Answer: B
Rationale: The best answer is history of deep vein thrombosis (DVT). A history of
thromboembolic disease is an absolute contraindication to estrogen therapy. Migraines and
family history of breast cancer require caution and risk-benefit analysis but are not absolute
contraindications.
,Q5: A 40-year-old male presents with a painful, red, swollen right great toe joint. He had a
similar episode 2 years ago. He consumes alcohol regularly. Aspiration of the joint reveals
needle-shaped, negatively birefringent crystals. What is the first-line pharmacologic treatment
for the acute pain?
A. Allopurinol
B. Febuxostat
C. Indomethacin
D. Probenecid
Correct Answer: C
Rationale: The best answer is Indomethacin. NSAIDs like indomethacin are first-line for acute
gouty arthritis. Allopurinol and febuxostat are urate-lowering therapies used for chronic
management, not acute attacks, and starting them during an attack can worsen symptoms.
Q6: You are counseling a patient about starting metformin for newly diagnosed Type 2 Diabetes
Mellitus. What is the most common side effect the patient should be warned about?
A. Lactic acidosis
B. Weight gain
C. Gastrointestinal distress
D. Hypoglycemia
Correct Answer: C
Rationale: The best answer is gastrointestinal distress. Diarrhea, nausea, and abdominal bloating
are the most common side effects of metformin. Lactic acidosis is a rare but serious
complication. Metformin is weight-neutral and does not cause hypoglycemia when used as
monotherapy.
Q7: A 28-year-old female presents with dysuria, urgency, and frequency for the past 2 days. She
has no fever or flank pain. A urinalysis shows leukocyte esterase and nitrites positive. She has no
known drug allergies. What is the most appropriate treatment?
A. Ciprofloxacin 500 mg BID for 7 days
B. Nitrofurantoin 100 mg BID for 5 days
C. Trimethoprim/Sulfamethoxazole DS BID for 3 days
D. Phenazopyridine 200 mg TID for 3 days
, Correct Answer: C
Rationale: The best answer is Trimethoprim/Sulfamethoxazole DS BID for 3 days. TMP-SMX
is a first-line agent for uncomplicated cystitis in regions where resistance is less than 20%.
Nitrofurantoin (5 days) or Fosfomycin (single dose) are also appropriate first-line options.
Ciprofloxacin is reserved for complicated cases or pyelonephritis due to side effects and
collateral damage.
Q8: A 6-month-old infant is brought in for a well-child visit. The mother is concerned because
the baby has a "flat spot" on the back of his head. You note plagiocephaly on examination. What
is the most appropriate initial management?
A. Referral for a cranial molding helmet
B. X-ray of the skull
C. Reassurance and positioning changes
D. CT scan of the head
Correct Answer: C
Rationale: The best answer is reassurance and positioning changes. Positional plagiocephaly is
managed conservatively with supervised tummy time and repositioning the infant off the affected
side. Helmets and imaging are reserved for severe cases or those not responding to conservative
management or if craniosynostosis is suspected (ridges on skull).
Q9: A 50-year-old male presents with a blood pressure of 150/90 mmHg on three separate
occasions. He has no other medical conditions. What is the initial medication of choice for this
patient?
A. Hydrochlorothiazide
B. Amlodipine
C. Lisinopril
D. Metoprolol
Correct Answer: A
Rationale: The best answer is Hydrochlorothiazide. For non-Black patients, thiazide diuretics,
ACE inhibitors, ARBs, or calcium channel blockers can be used. However, for Black patients,
thiazides or CCBs are preferred first-line. While the prompt does not specify race, thiazides are a
standard, evidence-based first-line option for uncomplicated stage 1 hypertension. (Note: In
150 Questions with Verified Answers
and Rationales
Q1: A 65-year-old male presents with a sudden onset of severe, tearing chest pain radiating to his
back. His blood pressure is 180/110 mmHg, and his heart rate is 100 bpm. He has a history of
uncontrolled hypertension. Which diagnostic test is the priority for this patient?
A. 12-lead ECG
B. Chest X-ray
C. Computed Tomography (CT) Angiography of the Chest
D. Cardiac Biomarkers (Troponin)
Correct Answer: C
Rationale: The best answer is CT Angiography because the presentation is classic for an aortic
dissection (tearing pain radiating to the back, significant HTN). While an ECG and troponin rule
out MI, they do not visualize the aorta. A chest X-ray may show a widened mediastinum but
lacks the sensitivity to confirm the diagnosis; CT is the gold standard.
Q2: A 24-year-old female presents for a well-woman exam. She has no history of abnormal Pap
smears and is sexually active with one partner. Her last Pap smear was two years ago and was
normal. According to USPSTF guidelines, when should she have her next cervical cancer
screening?
A. In 1 year
B. In 3 years
C. In 5 years
D. In 10 years
,Correct Answer: B
Rationale: The best answer is in 3 years. For average-risk women aged 21–29, cervical cytology
(Pap smear) alone is recommended every 3 years. Women aged 30–65 can extend this to every 5
years with co-testing (HPV and Pap) or Pap alone every 3 years.
Q3: You are evaluating a 4-year-old child for otitis media. The child has a temperature of 102°F,
ear pain for 24 hours, and bulging tympanic membranes with erythema. There is no discharge.
What is the first-line treatment?
A. Amoxicillin 80-90 mg/kg/day
B. Amoxicillin-Clavulanate 90 mg/kg/day
C. Cefdinir 14 mg/kg/day
D. Topical Fluoroquinolone ear drops
Correct Answer: A
Rationale: The best answer is Amoxicillin 80-90 mg/kg/day. High-dose amoxicillin is the first-
line treatment for acute otitis media (AOM) in children without penicillin allergy or recent
antibiotic use (within 30 days). Amoxicillin-clavulanate is reserved for treatment failure or
severe symptoms.
Q4: A 55-year-old female presents with hot flashes, night sweats, and vaginal dryness. She has
not had a menstrual period in 8 months. She is interested in hormone replacement therapy (HRT)
but is concerned about risks. Which factor is an absolute contraindication to HRT?
A. History of migraine headaches
B. History of deep vein thrombosis (DVT)
C. Family history of breast cancer
D. Age greater than 50
Correct Answer: B
Rationale: The best answer is history of deep vein thrombosis (DVT). A history of
thromboembolic disease is an absolute contraindication to estrogen therapy. Migraines and
family history of breast cancer require caution and risk-benefit analysis but are not absolute
contraindications.
,Q5: A 40-year-old male presents with a painful, red, swollen right great toe joint. He had a
similar episode 2 years ago. He consumes alcohol regularly. Aspiration of the joint reveals
needle-shaped, negatively birefringent crystals. What is the first-line pharmacologic treatment
for the acute pain?
A. Allopurinol
B. Febuxostat
C. Indomethacin
D. Probenecid
Correct Answer: C
Rationale: The best answer is Indomethacin. NSAIDs like indomethacin are first-line for acute
gouty arthritis. Allopurinol and febuxostat are urate-lowering therapies used for chronic
management, not acute attacks, and starting them during an attack can worsen symptoms.
Q6: You are counseling a patient about starting metformin for newly diagnosed Type 2 Diabetes
Mellitus. What is the most common side effect the patient should be warned about?
A. Lactic acidosis
B. Weight gain
C. Gastrointestinal distress
D. Hypoglycemia
Correct Answer: C
Rationale: The best answer is gastrointestinal distress. Diarrhea, nausea, and abdominal bloating
are the most common side effects of metformin. Lactic acidosis is a rare but serious
complication. Metformin is weight-neutral and does not cause hypoglycemia when used as
monotherapy.
Q7: A 28-year-old female presents with dysuria, urgency, and frequency for the past 2 days. She
has no fever or flank pain. A urinalysis shows leukocyte esterase and nitrites positive. She has no
known drug allergies. What is the most appropriate treatment?
A. Ciprofloxacin 500 mg BID for 7 days
B. Nitrofurantoin 100 mg BID for 5 days
C. Trimethoprim/Sulfamethoxazole DS BID for 3 days
D. Phenazopyridine 200 mg TID for 3 days
, Correct Answer: C
Rationale: The best answer is Trimethoprim/Sulfamethoxazole DS BID for 3 days. TMP-SMX
is a first-line agent for uncomplicated cystitis in regions where resistance is less than 20%.
Nitrofurantoin (5 days) or Fosfomycin (single dose) are also appropriate first-line options.
Ciprofloxacin is reserved for complicated cases or pyelonephritis due to side effects and
collateral damage.
Q8: A 6-month-old infant is brought in for a well-child visit. The mother is concerned because
the baby has a "flat spot" on the back of his head. You note plagiocephaly on examination. What
is the most appropriate initial management?
A. Referral for a cranial molding helmet
B. X-ray of the skull
C. Reassurance and positioning changes
D. CT scan of the head
Correct Answer: C
Rationale: The best answer is reassurance and positioning changes. Positional plagiocephaly is
managed conservatively with supervised tummy time and repositioning the infant off the affected
side. Helmets and imaging are reserved for severe cases or those not responding to conservative
management or if craniosynostosis is suspected (ridges on skull).
Q9: A 50-year-old male presents with a blood pressure of 150/90 mmHg on three separate
occasions. He has no other medical conditions. What is the initial medication of choice for this
patient?
A. Hydrochlorothiazide
B. Amlodipine
C. Lisinopril
D. Metoprolol
Correct Answer: A
Rationale: The best answer is Hydrochlorothiazide. For non-Black patients, thiazide diuretics,
ACE inhibitors, ARBs, or calcium channel blockers can be used. However, for Black patients,
thiazides or CCBs are preferred first-line. While the prompt does not specify race, thiazides are a
standard, evidence-based first-line option for uncomplicated stage 1 hypertension. (Note: In
