AANP FNP CERTIFICATION EXAM
QUESTIONS AND VERIFIED SOLUTIONS NEW
LATEST UPDATE
All diastolic murmurs are pathological. Grades Murmurs - ✔✔✔
Correct Answer > I-barely II-audible III- clearly audible. IV- first time thrill V-Steth edge
VI-entire steth. EXAM
MVP - ✔✔✔ Correct Answer > MVP- S2 click, followed by systolic murmur.
Asymptomatic. MVP with palpitations is treated with BB. LATE SYSTOLIC.
S3- HF,
S4-LVH stiffening, - ✔✔✔ Correct Answer > S3- HF, Kentucky, early diastole. Abn >35.
Bell EXAM
S4-LVH stiffening, Tennesse, late diastole. "Atrial kick/gallop"
EXAM
Isolated Systolic HTN - ✔✔✔ Correct Answer > CCB
PAD/ PVD - ✔✔✔ Correct 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-
Page 1 of 38
,Trental, Pletal. EXAM
CVI - ✔✔✔ Correct 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 - ✔✔✔ Correct Answer > BP - ST 1 (140-159/ 90-99), if you know this you
will get the rest!! Normal is <120/80. ELERGLY OVER 60 150/90 IS OK. ISH WILL
INCREASE SYSTOLIC NOT DIASTOLIC. ON EXAM.
Thiazide diuretics - ✔✔✔ Correct Answer > no sulfa allergies, hyperuricemia, hypokalemia,
hypomagnesia, hyponatremia, hyperglycemia, hypertriglycerides. ON EXAM
Statin - ✔✔✔ Correct Answer > Must check LFT before starting Statin. Know when to start
statins and what to check for to decide modhigh dose statins. ON EXAM
Pulses paradoxus - ✔✔✔ Correct Answer > Pulsus paradox Apical pulse can still be heard
even though the radial pulse is no longer palpable. Certain issues cause impairment with
diastolic filling, 10 or greater drop in the SYSTOLIC pressure. I think her patient had asthma
and their pressure dropped by 10 etc. ON EXAM
Emphysema - ✔✔✔ Correct Answer > Emphysema Lungs-
PercussionHYPERENNOSANCE tactile frem + egophony- dec. CXR- flattened diaphragms
with hyperinflation. Inc. AP diameter, accessory muscles, pursed-lip breathing, weight loss.
ON EXAM
Acute Bacterial Pneumonia- CXR - ✔✔✔ Correct Answer > middle lobe.
ON EXAM
Page 2 of 38
,OSA - ✔✔✔ Correct Answer > does not include Microglossia which is an absent tongue
congenital. EXAM
TB - ✔✔✔ Correct Answer > fatigue, fever, cough. Never do fewer than
3-4 drugs initially if positive, then u can narrow it down. Latent
TB usually treated with INH. If u suspect ACTIVE TB order, NAAT, C&S, AFB. The AFB
is not diagnostic. SPUTUM FOR C & S if gold standard. Deep morning cough collected for
three "consecutive days". TB is usually upper lobes.
TPO - ✔✔✔ Correct Answer > TPO- this lab is off MEANING ELEVATED in BOTH
hyper/hypo thyroidism. TPO is GOLD stand for diagnosis in Hashimotos. But you always
want to order a TSH first, THEN ur thyroid panel do not get ahead of yourself. Check ur TSH
lab on both in 6-8 weeks but never sooner than 6 weeks that is how long these meds take to
work. TOPIC ON EXAM
hyperthyroid - ✔✔✔ Correct Answer > Hyperthyroid- Low TSH, high "FREE" T4/T3.
ALWAYS DO FREEs. Graves disease-autoimmune. Lid lag, exophthalmos, everything is
hyper (body wise).
Treatment: PTU/Tapazole. PTU PREFER IN PREGNANCY
RAIU-no w/ prego. Destroys thyroid, lifelong treatment for hypo then.
A1C > 9 - ✔✔✔ Correct Answer > If you are already on TWO oral drugs for diabetes and
A1c is 9 or higher, start BASAL insulin. If you cannot tolerate metformin and your A1c is 9
or higher start BASAL insulin. ON EXAM
Page 3 of 38
, Parathyroid - ✔✔✔ Correct Answer > For parathyroid- dx blood test. You will have elevated
calcium because your parathyroid is releasing too much from bones and this will just cause it
to float around and not help ur bones. TX: BIPHOSPHANATES FOR SECONDARY
HYPERPARATHY. EXAM
cushings - ✔✔✔ Correct Answer > Central obesity, moon face, purple striae, hairy,
hypertension, elevated plasma CORTISOL in AM. "INC BS, SODIUM" Dec K. You must
draw cortisol levels in the morning.
Fructosamine test - ✔✔✔ Correct Answer > checks sugar for past 2-4 weeks.
triglycerides - ✔✔✔ Correct Answer > causes pancreatitis >500. If >500 treat with Niacin or
Fibrate or Niaspan. If your patient is already on NIACIN you can add a fibrate like
(LOPID/TRICOR). Apparently an insulin infusion works also. ON EXAM
Pancreatitis - ✔✔✔ Correct Answer > diagnosed with amylase / lipase draw. Amylase beings
2-12 h. Lipase 4-8 hours. Lipase however is MORE specific and sensitive to alcoholic
pancreatitis. ACUTE: Grey Turner/ Cullen sign. Abd pain that rates to midback "boring"
epigastric pain. Fever, n/v. EXAM TOPICS
Metformin - ✔✔✔ Correct Answer > Metformin - monitor BUN, Creatinine. contraindicated
renal and liver disease ARF creatinine up and GFR down.
affects liver enzymes, weight loss, avoid in alcohol drinkers, lactic acidosis, diarrhea
flatulence
CT: hold 24 hr before and 48hr after
Page 4 of 38
QUESTIONS AND VERIFIED SOLUTIONS NEW
LATEST UPDATE
All diastolic murmurs are pathological. Grades Murmurs - ✔✔✔
Correct Answer > I-barely II-audible III- clearly audible. IV- first time thrill V-Steth edge
VI-entire steth. EXAM
MVP - ✔✔✔ Correct Answer > MVP- S2 click, followed by systolic murmur.
Asymptomatic. MVP with palpitations is treated with BB. LATE SYSTOLIC.
S3- HF,
S4-LVH stiffening, - ✔✔✔ Correct Answer > S3- HF, Kentucky, early diastole. Abn >35.
Bell EXAM
S4-LVH stiffening, Tennesse, late diastole. "Atrial kick/gallop"
EXAM
Isolated Systolic HTN - ✔✔✔ Correct Answer > CCB
PAD/ PVD - ✔✔✔ Correct 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-
Page 1 of 38
,Trental, Pletal. EXAM
CVI - ✔✔✔ Correct 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 - ✔✔✔ Correct Answer > BP - ST 1 (140-159/ 90-99), if you know this you
will get the rest!! Normal is <120/80. ELERGLY OVER 60 150/90 IS OK. ISH WILL
INCREASE SYSTOLIC NOT DIASTOLIC. ON EXAM.
Thiazide diuretics - ✔✔✔ Correct Answer > no sulfa allergies, hyperuricemia, hypokalemia,
hypomagnesia, hyponatremia, hyperglycemia, hypertriglycerides. ON EXAM
Statin - ✔✔✔ Correct Answer > Must check LFT before starting Statin. Know when to start
statins and what to check for to decide modhigh dose statins. ON EXAM
Pulses paradoxus - ✔✔✔ Correct Answer > Pulsus paradox Apical pulse can still be heard
even though the radial pulse is no longer palpable. Certain issues cause impairment with
diastolic filling, 10 or greater drop in the SYSTOLIC pressure. I think her patient had asthma
and their pressure dropped by 10 etc. ON EXAM
Emphysema - ✔✔✔ Correct Answer > Emphysema Lungs-
PercussionHYPERENNOSANCE tactile frem + egophony- dec. CXR- flattened diaphragms
with hyperinflation. Inc. AP diameter, accessory muscles, pursed-lip breathing, weight loss.
ON EXAM
Acute Bacterial Pneumonia- CXR - ✔✔✔ Correct Answer > middle lobe.
ON EXAM
Page 2 of 38
,OSA - ✔✔✔ Correct Answer > does not include Microglossia which is an absent tongue
congenital. EXAM
TB - ✔✔✔ Correct Answer > fatigue, fever, cough. Never do fewer than
3-4 drugs initially if positive, then u can narrow it down. Latent
TB usually treated with INH. If u suspect ACTIVE TB order, NAAT, C&S, AFB. The AFB
is not diagnostic. SPUTUM FOR C & S if gold standard. Deep morning cough collected for
three "consecutive days". TB is usually upper lobes.
TPO - ✔✔✔ Correct Answer > TPO- this lab is off MEANING ELEVATED in BOTH
hyper/hypo thyroidism. TPO is GOLD stand for diagnosis in Hashimotos. But you always
want to order a TSH first, THEN ur thyroid panel do not get ahead of yourself. Check ur TSH
lab on both in 6-8 weeks but never sooner than 6 weeks that is how long these meds take to
work. TOPIC ON EXAM
hyperthyroid - ✔✔✔ Correct Answer > Hyperthyroid- Low TSH, high "FREE" T4/T3.
ALWAYS DO FREEs. Graves disease-autoimmune. Lid lag, exophthalmos, everything is
hyper (body wise).
Treatment: PTU/Tapazole. PTU PREFER IN PREGNANCY
RAIU-no w/ prego. Destroys thyroid, lifelong treatment for hypo then.
A1C > 9 - ✔✔✔ Correct Answer > If you are already on TWO oral drugs for diabetes and
A1c is 9 or higher, start BASAL insulin. If you cannot tolerate metformin and your A1c is 9
or higher start BASAL insulin. ON EXAM
Page 3 of 38
, Parathyroid - ✔✔✔ Correct Answer > For parathyroid- dx blood test. You will have elevated
calcium because your parathyroid is releasing too much from bones and this will just cause it
to float around and not help ur bones. TX: BIPHOSPHANATES FOR SECONDARY
HYPERPARATHY. EXAM
cushings - ✔✔✔ Correct Answer > Central obesity, moon face, purple striae, hairy,
hypertension, elevated plasma CORTISOL in AM. "INC BS, SODIUM" Dec K. You must
draw cortisol levels in the morning.
Fructosamine test - ✔✔✔ Correct Answer > checks sugar for past 2-4 weeks.
triglycerides - ✔✔✔ Correct Answer > causes pancreatitis >500. If >500 treat with Niacin or
Fibrate or Niaspan. If your patient is already on NIACIN you can add a fibrate like
(LOPID/TRICOR). Apparently an insulin infusion works also. ON EXAM
Pancreatitis - ✔✔✔ Correct Answer > diagnosed with amylase / lipase draw. Amylase beings
2-12 h. Lipase 4-8 hours. Lipase however is MORE specific and sensitive to alcoholic
pancreatitis. ACUTE: Grey Turner/ Cullen sign. Abd pain that rates to midback "boring"
epigastric pain. Fever, n/v. EXAM TOPICS
Metformin - ✔✔✔ Correct Answer > Metformin - monitor BUN, Creatinine. contraindicated
renal and liver disease ARF creatinine up and GFR down.
affects liver enzymes, weight loss, avoid in alcohol drinkers, lactic acidosis, diarrhea
flatulence
CT: hold 24 hr before and 48hr after
Page 4 of 38
