AANP Board Exam 2026/2027 – 150 Practice
Questions with Verified Answers and Rationales
Q1: A 32-year-old female presents with a 12-hour history of right lower quadrant (RLQ)
abdominal pain, anorexia, and nausea. On physical exam, you note rebound tenderness at
McBurney’s point. Her temperature is 100.8°F (38.2°C). What is the most likely diagnosis?
A. Ovarian Cyst
B.Appendicitis
C. Uterine Fibroid
D. Gastroenteritis
Correct Answer: B
Rationale: The best answer is Appendicitis. The classic presentation of appendicitis includes
RLQ pain, anorexia, nausea/vomiting, and fever. Rebound tenderness at McBurney’s point
suggests peritoneal irritation. Ovarian cysts can cause pain but are often associated with a
menstrual cycle history and lack the specific peritoneal signs.
Q2: According to the USPSTF, which of the following screening recommendations for cervical
cancer is correct for a 30-year-old female with no risk factors?
A. Pap smear alone every year
B. Pap smear alone every 3 years
C. HPV testing alone every 5 years
D. Pap smear and HPV co-testing every 5 years
Correct Answer: D
Rationale: The best answer is Pap smear and HPV co-testing every 5 years. For women aged
30–65, the preferred screening option is cytology (Pap) and HPV co-testing every 5 years.
Alternatively, Pap testing alone every 3 years is acceptable. Annual screening is not
recommended.
,Q3: A 55-year-old male presents with chest pain at rest. An ECG reveals ST-segment depression
in the anterior leads. Cardiac enzymes are elevated. He is currently on aspirin and atenolol.
Which of the following medications should be added immediately to reduce mortality?
A. Clopidogrel (Plavix)
B. Nitroglycerin
C. Unfractionated Heparin
D. High-intensity Statin (Atorvastatin)
Correct Answer: A
Rationale: The best answer is Clopidogrel (Plavix). This patient is having an acute coronary
syndrome (NSTEMI). Dual antiplatelet therapy (Aspirin plus a P2Y12 inhibitor like clopidogrel)
is a standard of care to reduce mortality. While heparin, nitrates, and statins are also important
components of management, the addition of a second antiplatelet agent is critical for preventing
stent thrombosis and recurrent events.
Q4: A 4-year-old child presents with a "barking" cough, stridor, and low-grade fever. The
symptoms began abruptly last night. What is the first-line pharmacologic treatment for this
condition?
A. Albuterol Nebulizer
B. Oral Dexamethasone
C. Azithromycin
D. Epinephrine Injection
Correct Answer: B
Rationale: The best answer is Oral Dexamethasone. Croup is the most likely diagnosis.
Corticosteroids (dexamethasone or prednisolone) are the mainstay of treatment to reduce airway
edema and improve symptoms. Nebulized epinephrine is reserved for severe respiratory distress
(stridor at rest). Albuterol is ineffective as the pathology is upper airway obstruction, not
bronchospasm.
Q5: A 24-year-old female presents with dysuria, urgency, and suprapubic pain. A urine dipstick is
positive for leukocyte esterase and nitrites. She has no known drug allergies. What is the most
appropriate treatment?
A. Nitrofurantoin Macrocrystals 100 mg BID for 5 days
,B. Trimethoprim/Sulfamethoxazole DS BID for 14 days
C. Ciprofloxacin 500 mg BID for 7 days
D. Phenazopyridine 200 mg TID for 3 days
Correct Answer: A
Rationale: The best answer is Nitrofurantoin Macrocrystals 100 mg BID for 5 days. This is a
first-line treatment for uncomplicated cystitis. Treatment duration is typically 5 days. TMP-SMX
is also first-line but resistance rates may vary locally. Ciprofloxacin is reserved for complicated
cases. Phenazopyridine is a urinary analgesic, not an antibiotic.
Q6: Which of the following patients meets the criteria for initiating statin therapy for primary
prevention of cardiovascular disease?
A. A 40-year-old female with LDL 130 mg/dL, no other risk factors.
B. A 55-year-old male with LDL 130 mg/dL, hypertension, and smoking.
C. A 30-year-old male with LDL 160 mg/dL, no other risk factors.
D. A 60-year-old female with LDL 110 mg/dL and well-controlled hypertension.
Correct Answer: B
Rationale: The best answer is A 55-year-old male with LDL 130 mg/dL, hypertension, and
smoking. According to ACC/AHA guidelines, adults aged 40–75 with an LDL 70–189 mg/dL
should be assessed for 10-year ASCVD risk. This patient has multiple risk factors which likely
push his risk over the threshold (≥7.5% or ≥10% depending on specific guidelines) where statin
benefit outweighs risk.
Q7: A 65-year-old male with COPD presents for a follow-up. He is currently on Tiotropium. He
reports he still experiences dyspnea on exertion daily. According to GOLD guidelines, what is
the next step?
A. Add a Short-Acting Beta-Agonist (SABA) prn
B. Add a Long-Acting Beta-Agonist (LABA)
C. Switch to an Inhaled Corticosteroid (ICS) alone
D. Add Theophylline
Correct Answer: B
, Rationale: The best answer is Add a Long-Acting Beta-Agonist (LABA). For patients with
COPD who remain symptomatic on a Long-Acting Muscarinic Antagonist (LAMA), guidelines
recommend adding a LABA (LAMA + LABA) or a LABA/ICS combination. A SABA is for
rescue, not maintenance control.
Q8: A 28-year-old female presents with a "bad headache" for the past two hours. She describes it
as unilateral, throbbing, with photophobia and nausea. She notes she gets these around her
menstrual period. What is the best abortive treatment?
A. Sumatriptan (Imitrex)
B. Propranolol
C. Topiramate
D. Butalbital/Acetaminophen/Caffeine (Fioricet)
Correct Answer: A
Rationale: The best answer is Sumatriptan (Imitrex). The description is classic for migraine.
Triptans are the first-line abortive therapy for moderate to severe migraines. Propranolol and
Topiramate are preventive medications. Butalbital is generally not recommended due to
habituation and medication-overuse headache risk.
Q9: A 2-month-old infant is brought in because the mother noticed he looks "pale." You examine
him and note central cyanosis. The infant is breastfeeding well and has no respiratory distress.
What is the most important diagnostic test to order first?
A. Complete Blood Count (CBC)
B. Chest X-Ray
C. Echocardiogram
D. Pulse Oximetry
Correct Answer: D
Rationale: The best answer is Pulse Oximetry. Central cyanosis in a newborn requires immediate
quantification of hypoxemia. Persistent central cyanosis with a low oxygen saturation suggests
congenital heart disease. While an echocardiogram is the definitive diagnostic tool for structural
heart disease, pulse ox is the immediate bedside test to confirm hypoxemia and urgency.
Questions with Verified Answers and Rationales
Q1: A 32-year-old female presents with a 12-hour history of right lower quadrant (RLQ)
abdominal pain, anorexia, and nausea. On physical exam, you note rebound tenderness at
McBurney’s point. Her temperature is 100.8°F (38.2°C). What is the most likely diagnosis?
A. Ovarian Cyst
B.Appendicitis
C. Uterine Fibroid
D. Gastroenteritis
Correct Answer: B
Rationale: The best answer is Appendicitis. The classic presentation of appendicitis includes
RLQ pain, anorexia, nausea/vomiting, and fever. Rebound tenderness at McBurney’s point
suggests peritoneal irritation. Ovarian cysts can cause pain but are often associated with a
menstrual cycle history and lack the specific peritoneal signs.
Q2: According to the USPSTF, which of the following screening recommendations for cervical
cancer is correct for a 30-year-old female with no risk factors?
A. Pap smear alone every year
B. Pap smear alone every 3 years
C. HPV testing alone every 5 years
D. Pap smear and HPV co-testing every 5 years
Correct Answer: D
Rationale: The best answer is Pap smear and HPV co-testing every 5 years. For women aged
30–65, the preferred screening option is cytology (Pap) and HPV co-testing every 5 years.
Alternatively, Pap testing alone every 3 years is acceptable. Annual screening is not
recommended.
,Q3: A 55-year-old male presents with chest pain at rest. An ECG reveals ST-segment depression
in the anterior leads. Cardiac enzymes are elevated. He is currently on aspirin and atenolol.
Which of the following medications should be added immediately to reduce mortality?
A. Clopidogrel (Plavix)
B. Nitroglycerin
C. Unfractionated Heparin
D. High-intensity Statin (Atorvastatin)
Correct Answer: A
Rationale: The best answer is Clopidogrel (Plavix). This patient is having an acute coronary
syndrome (NSTEMI). Dual antiplatelet therapy (Aspirin plus a P2Y12 inhibitor like clopidogrel)
is a standard of care to reduce mortality. While heparin, nitrates, and statins are also important
components of management, the addition of a second antiplatelet agent is critical for preventing
stent thrombosis and recurrent events.
Q4: A 4-year-old child presents with a "barking" cough, stridor, and low-grade fever. The
symptoms began abruptly last night. What is the first-line pharmacologic treatment for this
condition?
A. Albuterol Nebulizer
B. Oral Dexamethasone
C. Azithromycin
D. Epinephrine Injection
Correct Answer: B
Rationale: The best answer is Oral Dexamethasone. Croup is the most likely diagnosis.
Corticosteroids (dexamethasone or prednisolone) are the mainstay of treatment to reduce airway
edema and improve symptoms. Nebulized epinephrine is reserved for severe respiratory distress
(stridor at rest). Albuterol is ineffective as the pathology is upper airway obstruction, not
bronchospasm.
Q5: A 24-year-old female presents with dysuria, urgency, and suprapubic pain. A urine dipstick is
positive for leukocyte esterase and nitrites. She has no known drug allergies. What is the most
appropriate treatment?
A. Nitrofurantoin Macrocrystals 100 mg BID for 5 days
,B. Trimethoprim/Sulfamethoxazole DS BID for 14 days
C. Ciprofloxacin 500 mg BID for 7 days
D. Phenazopyridine 200 mg TID for 3 days
Correct Answer: A
Rationale: The best answer is Nitrofurantoin Macrocrystals 100 mg BID for 5 days. This is a
first-line treatment for uncomplicated cystitis. Treatment duration is typically 5 days. TMP-SMX
is also first-line but resistance rates may vary locally. Ciprofloxacin is reserved for complicated
cases. Phenazopyridine is a urinary analgesic, not an antibiotic.
Q6: Which of the following patients meets the criteria for initiating statin therapy for primary
prevention of cardiovascular disease?
A. A 40-year-old female with LDL 130 mg/dL, no other risk factors.
B. A 55-year-old male with LDL 130 mg/dL, hypertension, and smoking.
C. A 30-year-old male with LDL 160 mg/dL, no other risk factors.
D. A 60-year-old female with LDL 110 mg/dL and well-controlled hypertension.
Correct Answer: B
Rationale: The best answer is A 55-year-old male with LDL 130 mg/dL, hypertension, and
smoking. According to ACC/AHA guidelines, adults aged 40–75 with an LDL 70–189 mg/dL
should be assessed for 10-year ASCVD risk. This patient has multiple risk factors which likely
push his risk over the threshold (≥7.5% or ≥10% depending on specific guidelines) where statin
benefit outweighs risk.
Q7: A 65-year-old male with COPD presents for a follow-up. He is currently on Tiotropium. He
reports he still experiences dyspnea on exertion daily. According to GOLD guidelines, what is
the next step?
A. Add a Short-Acting Beta-Agonist (SABA) prn
B. Add a Long-Acting Beta-Agonist (LABA)
C. Switch to an Inhaled Corticosteroid (ICS) alone
D. Add Theophylline
Correct Answer: B
, Rationale: The best answer is Add a Long-Acting Beta-Agonist (LABA). For patients with
COPD who remain symptomatic on a Long-Acting Muscarinic Antagonist (LAMA), guidelines
recommend adding a LABA (LAMA + LABA) or a LABA/ICS combination. A SABA is for
rescue, not maintenance control.
Q8: A 28-year-old female presents with a "bad headache" for the past two hours. She describes it
as unilateral, throbbing, with photophobia and nausea. She notes she gets these around her
menstrual period. What is the best abortive treatment?
A. Sumatriptan (Imitrex)
B. Propranolol
C. Topiramate
D. Butalbital/Acetaminophen/Caffeine (Fioricet)
Correct Answer: A
Rationale: The best answer is Sumatriptan (Imitrex). The description is classic for migraine.
Triptans are the first-line abortive therapy for moderate to severe migraines. Propranolol and
Topiramate are preventive medications. Butalbital is generally not recommended due to
habituation and medication-overuse headache risk.
Q9: A 2-month-old infant is brought in because the mother noticed he looks "pale." You examine
him and note central cyanosis. The infant is breastfeeding well and has no respiratory distress.
What is the most important diagnostic test to order first?
A. Complete Blood Count (CBC)
B. Chest X-Ray
C. Echocardiogram
D. Pulse Oximetry
Correct Answer: D
Rationale: The best answer is Pulse Oximetry. Central cyanosis in a newborn requires immediate
quantification of hypoxemia. Persistent central cyanosis with a low oxygen saturation suggests
congenital heart disease. While an echocardiogram is the definitive diagnostic tool for structural
heart disease, pulse ox is the immediate bedside test to confirm hypoxemia and urgency.
