AANP FNP CERTIFICATION
PRACTICE EXAM (80 QUESTIONS)
Section 1: Cardiovascular
1. A 58-year-old male with a history of hypertension presents with sudden onset of severe, tearing
chest pain radiating to his back. His blood pressure is 160/90 in the right arm and 100/60 in the left
arm. What is the most appropriate next step?
a) Administer sublingual nitroglycerin
b) Obtain a stat chest X-ray
c) Immediate surgical consultation
d) Administer morphine sulfate
Answer: c) Immediate surgical consultation
Rationale: This presentation is classic for aortic dissection (tearing pain, pulse/blood pressure
differential). This is a life-threatening emergency requiring immediate surgical or cardiothoracic vascular
consultation. Nitroglycerin or morphine should not be given until the diagnosis is confirmed and could be
harmful if the right ventricle is involved.
2. A 72-year-old female presents with exertional chest pressure relieved by rest. Her ECG shows sinus
rhythm with non-specific ST changes. Her 10-year ASCVD risk score is 15%. What is the first-line
pharmacologic therapy to reduce mortality?
a) Aspirin 81 mg daily
b) Nitroglycerin as needed
c) High-intensity statin
d) Verapamil
Answer: c) High-intensity statin
*Rationale: In stable ischemic heart disease, high-intensity statins (atorvastatin 40-80mg or rosuvastatin
20-40mg) are indicated for secondary prevention of mortality and morbidity, regardless of baseline LDL.
Aspirin is also indicated, but statins have the strongest mortality benefit in this context.*
3. Which of the following findings on a screening ankle-brachial index (ABI) is diagnostic of peripheral
arterial disease (PAD)?
a) 1.2
,b) 1.0
c) 0.8
d) 1.4
Answer: c) 0.8
*Rationale: An ABI of ≤ 0.90 is considered diagnostic for PAD. Values > 1.3 suggest non-compressible
calcified vessels, often seen in diabetes or chronic kidney disease, indicating a false negative.*
Section 2: Pulmonology
4. A 22-year-old college student presents with acute onset of sharp, pleuritic chest pain and mild
dyspnea. He is tall and thin. Lung sounds are diminished on the left. What is the most likely diagnosis?
a) Acute bronchitis
b) Myocardial infarction
c) Spontaneous pneumothorax
d) Musculoskeletal pain
Answer: c) Spontaneous pneumothorax
Rationale: Spontaneous pneumothorax classically occurs in tall, thin, young males due to rupture of
apical blebs. Pleuritic chest pain with diminished breath sounds is the hallmark.
5. A 6-year-old male presents with a barking cough, stridor, and low-grade fever that worsens at
night. What is the priority intervention?
a) Albuterol nebulizer
b) Oral dexamethasone
c) Chest X-ray
d) Antibiotics
Answer: b) Oral dexamethasone
Rationale: This is croup (laryngotracheobronchitis). Corticosteroids (dexamethasone) are the mainstay of
treatment to reduce airway inflammation. Nebulized epinephrine is used for moderate to severe stridor
at rest, but steroids are the foundational treatment.
6. A 68-year-old male with a 50-pack-year smoking history presents with a new cough and weight loss.
A chest X-ray shows a cavitary lesion in the right upper lobe. What is the next step?
a) Sputum culture and acid-fast bacilli (AFB) smear
b) CT-guided biopsy
c) Positron emission tomography (PET) scan
d) Tuberculin skin test
, Answer: a) Sputum culture and AFB smear
Rationale: While malignancy is possible, a cavitary lesion in the upper lobe is also classic for tuberculosis
(TB). Infection control and ruling out active TB is the priority before proceeding with invasive diagnostics
for cancer.
Section 3: Endocrinology
7. A 45-year-old female presents with fatigue, cold intolerance, weight gain, and constipation. Labs
show TSH 12.0 mIU/mL (high) and free T4 0.6 ng/dL (low). What is the standard of care treatment?
a) Methimazole
b) Levothyroxine
c) Liothyronine
d) Levothyroxine and Liothyronine combination
Answer: b) Levothyroxine
Rationale: This is overt primary hypothyroidism. Levothyroxine (T4) monotherapy is the standard of care.
The body converts T4 to the active T3 as needed.
8. A 52-year-old obese male with a history of hypertension presents with a fasting plasma glucose of
135 mg/dL and an A1c of 7.2%. He has a GFR of 45 mL/min. In addition to metformin, which class of
medication has shown the most significant renal and cardiovascular mortality benefit?
a) DPP-4 inhibitor
b) Thiazolidinedione
c) SGLT2 inhibitor
d) Sulfonylurea
Answer: c) SGLT2 inhibitor
*Rationale: SGLT2 inhibitors (empagliflozin, dapagliflozin) have strong evidence for reducing
cardiovascular mortality, heart failure hospitalizations, and slowing progression of diabetic kidney
disease, even in patients with reduced GFR (down to 20-25 mL/min for some agents).*
9. A 28-year-old male presents with polyuria, polydipsia, and a random glucose of 450 mg/dL. He is
alert and oriented with a pH of 7.32 and serum bicarbonate of 18. He denies prior diabetes diagnosis.
What is the initial management?
a) Oral sulfonylurea
b) IV insulin bolus
c) Subcutaneous insulin and IV fluids
d) Metformin and lifestyle counseling
Answer: c) Subcutaneous insulin and IV fluids
*Rationale: He presents with hyperglycemia and mild metabolic acidosis (likely hyperosmolar
PRACTICE EXAM (80 QUESTIONS)
Section 1: Cardiovascular
1. A 58-year-old male with a history of hypertension presents with sudden onset of severe, tearing
chest pain radiating to his back. His blood pressure is 160/90 in the right arm and 100/60 in the left
arm. What is the most appropriate next step?
a) Administer sublingual nitroglycerin
b) Obtain a stat chest X-ray
c) Immediate surgical consultation
d) Administer morphine sulfate
Answer: c) Immediate surgical consultation
Rationale: This presentation is classic for aortic dissection (tearing pain, pulse/blood pressure
differential). This is a life-threatening emergency requiring immediate surgical or cardiothoracic vascular
consultation. Nitroglycerin or morphine should not be given until the diagnosis is confirmed and could be
harmful if the right ventricle is involved.
2. A 72-year-old female presents with exertional chest pressure relieved by rest. Her ECG shows sinus
rhythm with non-specific ST changes. Her 10-year ASCVD risk score is 15%. What is the first-line
pharmacologic therapy to reduce mortality?
a) Aspirin 81 mg daily
b) Nitroglycerin as needed
c) High-intensity statin
d) Verapamil
Answer: c) High-intensity statin
*Rationale: In stable ischemic heart disease, high-intensity statins (atorvastatin 40-80mg or rosuvastatin
20-40mg) are indicated for secondary prevention of mortality and morbidity, regardless of baseline LDL.
Aspirin is also indicated, but statins have the strongest mortality benefit in this context.*
3. Which of the following findings on a screening ankle-brachial index (ABI) is diagnostic of peripheral
arterial disease (PAD)?
a) 1.2
,b) 1.0
c) 0.8
d) 1.4
Answer: c) 0.8
*Rationale: An ABI of ≤ 0.90 is considered diagnostic for PAD. Values > 1.3 suggest non-compressible
calcified vessels, often seen in diabetes or chronic kidney disease, indicating a false negative.*
Section 2: Pulmonology
4. A 22-year-old college student presents with acute onset of sharp, pleuritic chest pain and mild
dyspnea. He is tall and thin. Lung sounds are diminished on the left. What is the most likely diagnosis?
a) Acute bronchitis
b) Myocardial infarction
c) Spontaneous pneumothorax
d) Musculoskeletal pain
Answer: c) Spontaneous pneumothorax
Rationale: Spontaneous pneumothorax classically occurs in tall, thin, young males due to rupture of
apical blebs. Pleuritic chest pain with diminished breath sounds is the hallmark.
5. A 6-year-old male presents with a barking cough, stridor, and low-grade fever that worsens at
night. What is the priority intervention?
a) Albuterol nebulizer
b) Oral dexamethasone
c) Chest X-ray
d) Antibiotics
Answer: b) Oral dexamethasone
Rationale: This is croup (laryngotracheobronchitis). Corticosteroids (dexamethasone) are the mainstay of
treatment to reduce airway inflammation. Nebulized epinephrine is used for moderate to severe stridor
at rest, but steroids are the foundational treatment.
6. A 68-year-old male with a 50-pack-year smoking history presents with a new cough and weight loss.
A chest X-ray shows a cavitary lesion in the right upper lobe. What is the next step?
a) Sputum culture and acid-fast bacilli (AFB) smear
b) CT-guided biopsy
c) Positron emission tomography (PET) scan
d) Tuberculin skin test
, Answer: a) Sputum culture and AFB smear
Rationale: While malignancy is possible, a cavitary lesion in the upper lobe is also classic for tuberculosis
(TB). Infection control and ruling out active TB is the priority before proceeding with invasive diagnostics
for cancer.
Section 3: Endocrinology
7. A 45-year-old female presents with fatigue, cold intolerance, weight gain, and constipation. Labs
show TSH 12.0 mIU/mL (high) and free T4 0.6 ng/dL (low). What is the standard of care treatment?
a) Methimazole
b) Levothyroxine
c) Liothyronine
d) Levothyroxine and Liothyronine combination
Answer: b) Levothyroxine
Rationale: This is overt primary hypothyroidism. Levothyroxine (T4) monotherapy is the standard of care.
The body converts T4 to the active T3 as needed.
8. A 52-year-old obese male with a history of hypertension presents with a fasting plasma glucose of
135 mg/dL and an A1c of 7.2%. He has a GFR of 45 mL/min. In addition to metformin, which class of
medication has shown the most significant renal and cardiovascular mortality benefit?
a) DPP-4 inhibitor
b) Thiazolidinedione
c) SGLT2 inhibitor
d) Sulfonylurea
Answer: c) SGLT2 inhibitor
*Rationale: SGLT2 inhibitors (empagliflozin, dapagliflozin) have strong evidence for reducing
cardiovascular mortality, heart failure hospitalizations, and slowing progression of diabetic kidney
disease, even in patients with reduced GFR (down to 20-25 mL/min for some agents).*
9. A 28-year-old male presents with polyuria, polydipsia, and a random glucose of 450 mg/dL. He is
alert and oriented with a pH of 7.32 and serum bicarbonate of 18. He denies prior diabetes diagnosis.
What is the initial management?
a) Oral sulfonylurea
b) IV insulin bolus
c) Subcutaneous insulin and IV fluids
d) Metformin and lifestyle counseling
Answer: c) Subcutaneous insulin and IV fluids
*Rationale: He presents with hyperglycemia and mild metabolic acidosis (likely hyperosmolar
