SARAH MICHELLE LIVE REVIEW STUDY AANP EXAM
GUIDE QUESTIONS , ANSWERS AND RATIONALE 2025
1. Question: A 55-year-old woman presents with fatigue,
weight gain, and cold intolerance. On examination, she has dry skin,
bradycardia, and delayed deep tendon reflexes. What is the most likely
diagnosis?
Answer: Hypothyroidism
Rationale: The patient's symptoms, including fatigue, weight gain, cold
intolerance, and dry skin, are classic signs of hypothyroidism. The
bradycardia and delayed deep tendon reflexes further support this diagnosis.
Hypothyroidism is a common endocrine disorder, especially in women over
50.
2. Question: A 60-year-old man with a history of hypertension presents
with shortness of breath, fatigue, and swelling in his legs. On
examination, he has bilateral pitting edema, rales in the lungs, and an
S3 gallop. What is the most likely diagnosis?
Answer: Congestive heart failure
Rationale: The patient's symptoms of shortness of breath, fatigue, and leg
swelling, along with physical findings like bilateral pitting edema, rales, and
an S3 gallop, point to congestive heart failure (CHF). CHF often presents
with signs of fluid overload due to the heart's inability to pump effectively.
3. Question: A 30-year-old woman presents with a complaint of joint pain,
particularly in the hands and wrists. She reports morning stiffness that
lasts for more than an hour. On physical examination, there is swelling
and tenderness in the joints, along with warmth. What is the most likely
diagnosis?
Answer: Rheumatoid arthritis
Rationale: The patient's symptoms of morning stiffness lasting for over an
hour, along with swelling, tenderness, and warmth in the joints, are highly
suggestive of rheumatoid arthritis (RA). RA commonly affects the small
, joints in the hands and wrists and is characterized by symmetrical joint
involvement.
4. Question: A 25-year-old man presents with painful, red, and swollen
joints, particularly in the knee and ankle. He has a history of a recent
gastrointestinal infection. What is the most likely diagnosis?
Answer: Reactive arthritis
Rationale: The patient’s history of a recent gastrointestinal infection (such
as Salmonella or Shigella) and his presentation with painful, red, and
swollen joints, especially in the lower extremities, suggests reactive arthritis.
This condition is often triggered by an infection and typically affects the
larger joints.
5. Question: A 45-year-old woman presents with a complaint of heartburn
and regurgitation, particularly after eating large meals. She also
experiences a sour taste in her mouth. What is the most likely
diagnosis?
Answer: Gastroesophageal reflux disease (GERD)
Rationale: The patient's symptoms of heartburn, regurgitation, and a sour
taste in her mouth are characteristic of GERD. This condition is caused by
the backward flow of stomach acid into the esophagus, which can be
triggered by overeating or lying down after meals.
6. Question: A 35-year-old woman presents with a complaint of intense
pain in her right lower abdomen, along with nausea and vomiting. She
reports a history of irregular periods. On examination, she has
tenderness in the right lower quadrant and rebound tenderness. What is
the most likely diagnosis?
Answer: Ectopic pregnancy
Rationale: The patient’s presentation of lower abdominal pain, nausea,
vomiting, and a history of irregular periods raises concern for an ectopic
pregnancy. The tenderness and rebound tenderness suggest a possible
rupture or impending rupture of the ectopic pregnancy, which requires
immediate medical attention.
,7. Question: A 40-year-old man with a history of chronic alcohol use
presents with confusion, ataxia, and nystagmus. What is the most likely
diagnosis?
Answer: Wernicke’s encephalopathy
Rationale: Wernicke’s encephalopathy is a neurological disorder caused by
thiamine deficiency, which is common in chronic alcohol use. The
symptoms of confusion, ataxia, and nystagmus are characteristic signs of
this condition and require prompt treatment with thiamine.
8. Question: A 70-year-old woman with a history of osteoporosis presents
with sudden onset back pain after lifting a heavy object. On
examination, there is localized tenderness over her lower spine, and X-
rays reveal a compression fracture. What is the most likely cause of her
pain?
Answer: Osteoporotic compression fracture
Rationale: In an older woman with osteoporosis, a compression fracture of
the vertebrae is a common cause of sudden onset back pain, especially after
lifting or a minor trauma. Osteoporosis weakens the bones, making them
more susceptible to fractures.
9. Question: A 48-year-old woman presents with a complaint of headaches,
visual changes, and menstrual irregularities. On examination, she has
galactorrhea and a bitemporal hemianopia. What is the most likely
diagnosis?
A) Brain tumor
B) Pituitary adenoma
C) Migraine
D) Multiple sclerosis
Answer: B) Pituitary adenoma
Rationale: The patient's symptoms, including headaches, visual changes
(bitemporal hemianopia), and galactorrhea, are classic signs of a pituitary
adenoma. These tumors can compress the optic chiasm, leading to visual
changes and may cause hormone imbalances, such as prolactin
overproduction, which leads to galactorrhea.
, 10.Question: A 60-year-old male with a history of hypertension presents with a
new complaint of chest pain, shortness of breath, and diaphoresis. On
examination, he has an elevated blood pressure, a heart rate of 110 beats per
minute, and a systolic murmur at the apex. What is the most likely
diagnosis?
A) Acute myocardial infarction
B) Aortic dissection
C) Pulmonary embolism
D) Stable angina
Answer: A) Acute myocardial infarction
Rationale: The patient's presentation of chest pain, shortness of breath,
diaphoresis, and elevated heart rate, combined with his history of hypertension, is
consistent with an acute myocardial infarction (MI). MI often presents with these
symptoms, and a systolic murmur could indicate the presence of a ventricular
septal defect or papillary muscle rupture associated with MI.
11.Question: A 25-year-old woman presents with a complaint of increased
thirst, frequent urination, and fatigue. On examination, she is found to have a
fasting blood glucose of 210 mg/dL. What is the most likely diagnosis?
A) Type 1 diabetes mellitus
B) Type 2 diabetes mellitus
C) Diabetes insipidus
D) Hyperthyroidism
Answer: A) Type 1 diabetes mellitus
Rationale: The patient’s symptoms of excessive thirst, urination, and fatigue,
along with a fasting blood glucose level of 210 mg/dL, suggest diabetes mellitus.
Given her age and the acute nature of the symptoms, type 1 diabetes mellitus is
most likely, which is characterized by an autoimmune destruction of insulin-
producing beta cells in the pancreas.
12.Question: A 40-year-old woman presents with a sudden onset of severe
abdominal pain, bloating, and constipation. She has a history of episodes of
pain and bloating that resolve spontaneously. Her symptoms worsen around
menstruation. What is the most likely diagnosis?
GUIDE QUESTIONS , ANSWERS AND RATIONALE 2025
1. Question: A 55-year-old woman presents with fatigue,
weight gain, and cold intolerance. On examination, she has dry skin,
bradycardia, and delayed deep tendon reflexes. What is the most likely
diagnosis?
Answer: Hypothyroidism
Rationale: The patient's symptoms, including fatigue, weight gain, cold
intolerance, and dry skin, are classic signs of hypothyroidism. The
bradycardia and delayed deep tendon reflexes further support this diagnosis.
Hypothyroidism is a common endocrine disorder, especially in women over
50.
2. Question: A 60-year-old man with a history of hypertension presents
with shortness of breath, fatigue, and swelling in his legs. On
examination, he has bilateral pitting edema, rales in the lungs, and an
S3 gallop. What is the most likely diagnosis?
Answer: Congestive heart failure
Rationale: The patient's symptoms of shortness of breath, fatigue, and leg
swelling, along with physical findings like bilateral pitting edema, rales, and
an S3 gallop, point to congestive heart failure (CHF). CHF often presents
with signs of fluid overload due to the heart's inability to pump effectively.
3. Question: A 30-year-old woman presents with a complaint of joint pain,
particularly in the hands and wrists. She reports morning stiffness that
lasts for more than an hour. On physical examination, there is swelling
and tenderness in the joints, along with warmth. What is the most likely
diagnosis?
Answer: Rheumatoid arthritis
Rationale: The patient's symptoms of morning stiffness lasting for over an
hour, along with swelling, tenderness, and warmth in the joints, are highly
suggestive of rheumatoid arthritis (RA). RA commonly affects the small
, joints in the hands and wrists and is characterized by symmetrical joint
involvement.
4. Question: A 25-year-old man presents with painful, red, and swollen
joints, particularly in the knee and ankle. He has a history of a recent
gastrointestinal infection. What is the most likely diagnosis?
Answer: Reactive arthritis
Rationale: The patient’s history of a recent gastrointestinal infection (such
as Salmonella or Shigella) and his presentation with painful, red, and
swollen joints, especially in the lower extremities, suggests reactive arthritis.
This condition is often triggered by an infection and typically affects the
larger joints.
5. Question: A 45-year-old woman presents with a complaint of heartburn
and regurgitation, particularly after eating large meals. She also
experiences a sour taste in her mouth. What is the most likely
diagnosis?
Answer: Gastroesophageal reflux disease (GERD)
Rationale: The patient's symptoms of heartburn, regurgitation, and a sour
taste in her mouth are characteristic of GERD. This condition is caused by
the backward flow of stomach acid into the esophagus, which can be
triggered by overeating or lying down after meals.
6. Question: A 35-year-old woman presents with a complaint of intense
pain in her right lower abdomen, along with nausea and vomiting. She
reports a history of irregular periods. On examination, she has
tenderness in the right lower quadrant and rebound tenderness. What is
the most likely diagnosis?
Answer: Ectopic pregnancy
Rationale: The patient’s presentation of lower abdominal pain, nausea,
vomiting, and a history of irregular periods raises concern for an ectopic
pregnancy. The tenderness and rebound tenderness suggest a possible
rupture or impending rupture of the ectopic pregnancy, which requires
immediate medical attention.
,7. Question: A 40-year-old man with a history of chronic alcohol use
presents with confusion, ataxia, and nystagmus. What is the most likely
diagnosis?
Answer: Wernicke’s encephalopathy
Rationale: Wernicke’s encephalopathy is a neurological disorder caused by
thiamine deficiency, which is common in chronic alcohol use. The
symptoms of confusion, ataxia, and nystagmus are characteristic signs of
this condition and require prompt treatment with thiamine.
8. Question: A 70-year-old woman with a history of osteoporosis presents
with sudden onset back pain after lifting a heavy object. On
examination, there is localized tenderness over her lower spine, and X-
rays reveal a compression fracture. What is the most likely cause of her
pain?
Answer: Osteoporotic compression fracture
Rationale: In an older woman with osteoporosis, a compression fracture of
the vertebrae is a common cause of sudden onset back pain, especially after
lifting or a minor trauma. Osteoporosis weakens the bones, making them
more susceptible to fractures.
9. Question: A 48-year-old woman presents with a complaint of headaches,
visual changes, and menstrual irregularities. On examination, she has
galactorrhea and a bitemporal hemianopia. What is the most likely
diagnosis?
A) Brain tumor
B) Pituitary adenoma
C) Migraine
D) Multiple sclerosis
Answer: B) Pituitary adenoma
Rationale: The patient's symptoms, including headaches, visual changes
(bitemporal hemianopia), and galactorrhea, are classic signs of a pituitary
adenoma. These tumors can compress the optic chiasm, leading to visual
changes and may cause hormone imbalances, such as prolactin
overproduction, which leads to galactorrhea.
, 10.Question: A 60-year-old male with a history of hypertension presents with a
new complaint of chest pain, shortness of breath, and diaphoresis. On
examination, he has an elevated blood pressure, a heart rate of 110 beats per
minute, and a systolic murmur at the apex. What is the most likely
diagnosis?
A) Acute myocardial infarction
B) Aortic dissection
C) Pulmonary embolism
D) Stable angina
Answer: A) Acute myocardial infarction
Rationale: The patient's presentation of chest pain, shortness of breath,
diaphoresis, and elevated heart rate, combined with his history of hypertension, is
consistent with an acute myocardial infarction (MI). MI often presents with these
symptoms, and a systolic murmur could indicate the presence of a ventricular
septal defect or papillary muscle rupture associated with MI.
11.Question: A 25-year-old woman presents with a complaint of increased
thirst, frequent urination, and fatigue. On examination, she is found to have a
fasting blood glucose of 210 mg/dL. What is the most likely diagnosis?
A) Type 1 diabetes mellitus
B) Type 2 diabetes mellitus
C) Diabetes insipidus
D) Hyperthyroidism
Answer: A) Type 1 diabetes mellitus
Rationale: The patient’s symptoms of excessive thirst, urination, and fatigue,
along with a fasting blood glucose level of 210 mg/dL, suggest diabetes mellitus.
Given her age and the acute nature of the symptoms, type 1 diabetes mellitus is
most likely, which is characterized by an autoimmune destruction of insulin-
producing beta cells in the pancreas.
12.Question: A 40-year-old woman presents with a sudden onset of severe
abdominal pain, bloating, and constipation. She has a history of episodes of
pain and bloating that resolve spontaneously. Her symptoms worsen around
menstruation. What is the most likely diagnosis?
