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AANP Primary Care FNP Board Exam 2025 - 2026
700+Questions With Correct Verified Answers
Metformin MOA - correct answer>>Insulin sensitizer. Inhibits hepatic glucose output and improves glucose uptake in insulin-sensitive tissues (e.g. muscles) Metformin efficacy on A1c reduction - correct answer>>High (1-2%) Metformin hypoglycemia risk - correct answer>>Low (does not increase insulin release) Metformin adverse effects/caution - correct answer>>GI upset. Better absorption and less diarrhea if taken with food (esp extended release). Discontinue use with eGFR < ml/min/1.73m^2, frailty, and advanced age (increased risk of lactic acidosis) Metformin cost considerations - correct answer>>Low cost metformin compelling indications - correct answer>>First line medication if no contraindication Metformin weight impact - correct answer>>Neutral/loss Thiazolidinediones (TZD) eg Pioglitizone MOA - correct answer>>Insulin sensitization (can use with Metformin) Thiazolidinediones (TZD) eg Pioglitizone efficacy on A1c reduction - correct answer>>High (1-2%) Thiazolidinediones (TZD) eg Pioglitizone hypoglycemia risk - correct answer>>Low Thiazolidinediones (TZD) eg Pioglitizone weight impact - correct answer>>Gain (increased circulating volume) Thiazolidinediones (TZD) eg Pioglitizone adverse effects/caution - correct answer>>Edema, heart failure in at risk patients; do not use with nitrates or insulin due to cardiovascular risk. Insulin sensitizer Thiazolidinediones (TZD) eg Pioglitizone cost considerations - correct answer>>Low cost option
Thiazolidinediones (TZD) eg Pioglitizone compelling indications - correct answer>>Minimal hypoglycemia risk and low cost Sulfonylureas eg Glipizide MOA - correct answer>>Insulin releaser (constant) Sulfonylureas eg Glipizide efficacy on A1c reduction - correct answer>>High (1-2%) Sulfonylureas eg Glipizide hypoglycemia risk - correct answer>>Moderate to high Sulfonylureas eg Glipizide weight impact - correct answer>>Gain Sulfonylureas eg Glipizide adverse effects/caution - correct answer>>Hypoglycemia Sulfonylureas eg Glipizide cost considerations - correct answer>>Low cost Sulfonylureas eg Glipizide compelling indications - correct answer>>Low cost DPP- 4 Inhibitors eg Sitagliptin MOA - correct answer>>Insulin releaser (post glucose rise) DPP-4 Inhibitors eg Sitagliptin efficacy on A1C reduction - correct answer>>Intermediate (0.75%) DPP-4 Inhibitors eg Sitagliptin hypoglycemia risk - correct answer>>Low DPP-4 Inhibitors eg Sitagliptin weight impact - correct answer>>Neutral DPP-4 Inhibitors eg Sitagliptin adverse effects/caution - correct answer>>Rare DPP-4 Inhibitors eg Sitagliptin cost considerations - correct answer>>High cost DPP-4 Inhibitors eg Sitagliptin compelling indications - correct answer>>Minimal hypoglycemia risk GLP-1 agonists eg Exenatide MOA - correct answer>>Insulin releaser, post glucose rise GLP-1 agonists eg Exenatide efficacy on A1C reduction - correct answer>>High (1-2%) GLP-1 agonists eg Exenatide hypoglycemia risk - correct answer>>Low
Insulin (basal and bolus) eg Glargine and Aspart hypoglycemia risk - correct answer>>High Insulin (basal and bolus) eg Glargine and Aspart weight impact - correct answer>>Gain Insulin (basal and bolus) eg Glargine and Aspart adverse effects/caution - correct answer>>Hypoglycemia Insulin (basal and bolus) eg Glargine and Aspart cost considerations - correct answer>>High cost Insulin (basal and bolus) eg Glargine and Aspart compelling indications - correct answer>>When >/-2 drugs including insulin releasers no longer adequate to maintain glycemic control Inhaled short acting beta 2 agonist (SABA eg Albuterol) via MDI therapeutic goal - correct answer>>Relief of broncospasm, usually PRN Inhaled short acting muscarinic antagonist via MDI (SAMA eg ipatropium bromide) therapeutic goal - correct answer>>Relief of broncospasm, usually PRN Inhaled long acting beta 2 agonist via DPI (dry powder inhaler) (LABA eg Salmeterol) therapeutic goal - correct answer>>Protracted duration bronchodilation, usually on a daily set schedule Inhaled long acting muscarinic antagonist via DPI (dry powder inhaler) (LAMA eg Tiotropium bromide) therapeutic goal - correct answer>>Protracted duration bronchodilation. Minimizes risk of COPD exacerbation. Used on a daily set schedule. Inhaled corticosteroid (ICS) via MDI or DPI therapeutic goal - correct answer>>Anti- inflammatory. Minimizes risk of COPD exacerbation, modest increase in PNA risk. Used on a daily set schedule. Oral theophylline therapeutic goal - correct answer>>Bronchodilator. Used on a daily set schedule. Oral PDE-4 inhibitor (Roflumilast) - correct answer>>Minimizes risk of COPD exacerbation. Used on a daily set schedule. Phosphodiesterase inhibitor; decreases inflammation.
COPD Group A definition - correct answer>>Low risk of exacerbation. Less symptoms. 2 or fewer moderate exacerbations per year mMRC 0-1; CAT <10* modified Medical Research Council (mMRC) 0-1 or COPD Assessment Test (CAT) less than 10 COPD Group A initial therapies - correct answer>>Short acting or long acting bronchodilator; short acting beta 2 agonist (albuterol IE Ventolin) OR long acting muscarinic antagonist (tiotropium IE Spiriva) OR long acting beta 2 agonist (salmeterol IE serevent) SABA, LAMA, or LABA Group B COPD definition - correct answer>>Low risk of exacerbation, more symptoms. 1 or fewer moderate exacerbations per year. mMRC >/- 2; CAT >/- 10. modified Medical Research Council (mMRC) 0-1 or COPD Assessment Test (CAT) less than 10 A: few symptoms, better lung function; B: more symptoms, better lung function; C: few symptoms, poor lung function; D: more symptoms, poor lung function. Group B COPD initial therapies - correct answer>>Long acting bronchodilator; long acting muscarinic antagonist (tiotropium IE Spiriva) OR long acting beta2 agonist (salmeterol IE serevent) For patients with severe breathlessness; initial therapy with 2 bronchodilators can be considered Group C COPD definition - correct answer>>High risk for exacerbation, less symptoms. 2 or more exacerbations per year (>/- leading to hospitalization). mMRC >/- 2; CAT >/- 10). *modified Medical Research Council (mMRC) 0-1 or COPD Assessment Test (CAT) less than 10 Group C COPD initial therapies - correct answer>>Long acting muscarinic antagonist (tiotropium IE spiriva)
Mild to moderated COPD exacerbation and antimicrobial therapy - correct answer>>Usually not indicated. If prescribed, use: Doxycycline (covers all pathogens, but has GI SE) or Cephalosporins (cefdinir, cefpodoxime, etc.) (covers all pathogens). *All = strep pneumo, H Flu ( +beta lactamase), moraxella catarrhalis (+beta lactamase). Severe COPD exacerbation and antimicrobial therapy - correct answer>>May be indicated. If prescribed, use: #1 Cephalosporins (cefdinir, cefpodoxime, etc.) (covers all pathogens). Can also use: Amoxicillin + Clav (covers all, GI SE). Do NOT use: macrolides (azithro or clarithro due to QT prolongation) or resp FQs (- floxacins) due to poor DRSP coverage and increased risk of tendon rupture when used with steroid. *All = strep pneumo, H Flu ( +beta lactamase), moraxella catarrhalis (+beta lactamase). Red Flags in Headache (SNOOP): S - correct answer>>S: Systemic symptoms, secondary headache risk factors. Fever, weight loss, etc. Can be HIV, malignancy, pregnancy, intracranial bleeding, marked HTN, infection (meningitis, encephalitis). Red Flags in Headache (SNOOP): N - correct answer>>Neurologic signs and symptoms. New neuro findings, including confusion, impaired consciousness, nuchal rigidity, papilledema, CN dysfunction, motor changes, etc. Can be due to CNS infection, mass lesion, stroke, AV malformation, collagen vascular disease, etc. Red Flags in Headache (SNOOP): O #1 - correct answer>>Onset. Sudden "thunderclap" HA. Onset with exertion, sex, coughing, sneezing = increased ICP.
Can be due to subarachnoid hemorrhage or mass lesion. Red Flags in Headache (SNOOP): O #2 - correct answer>>Onset (age at onset of HA). Older than 50 years of age or younger than 5 years of age. Maybe due to temporal arteritis/giant cell arteritis (older ) or mass lesion (older or younger). Red Flags in Headache (SNOOP): P - correct answer>>Prior HA history, positional, papilledema. Change in quality or frequency of HA. Change in upright vs laying down or with neck position. Visual problems. May be due to med overuse, mass lesion, subdural hematoma. Intracranial hypotension, posterior fossa pathology, cervicogenic HA, encephalitis, meningitis, mass lesion. CURB 65 definition - correct answer>>Can this pt be treated out patient for PNA or do they need inpatient care? CURB 65 components - correct answer>>C: Confusion of new onset. U: Blood urea nitrogen greater than 19 mg/dL (7mmol/L). R: Respiratory rate of 30 breaths per min or greater. B: Blood pressure less than 90 mmHg or diastolic BP of 60 mmHg or less. 65: Age 65 or greater. *Hypovolemia causes narrowing pulse pressure: SBP drops before DBP. HMG-CoA Inhibitors (Statins) examples - correct answer>>Simvastatin (Zocor), Atorvastatin (Lipitor), Rosuvastatin (Crestor), Pravastatin (Pravachol), etc. Statin effects - correct answer>>Decrease LDL as much as 50%. Increase HDL concentration (minor). Decrease TGs (minor). MOA: inhibition of HMG-CoA reductase, the rate-limiting enzyme in the cholesterol biosynthesis pathway.
ACL inhibitor indications - correct answer>>Adjunct therapy for patients on max tolerated dose or statin and or ezetimibe. Can also be used in statin intolerant patients. Omega 3 fatty acid (OTC) therapeutic dose - correct answer>>4g/day Omega 3 fatty acid effects - correct answer>>At 4 g/d (approx 1 lb of salmon): Decreases TGs by up to 30%. Increase HDL (minor). Does not lower LDL. Omega 3 fatty acid adverse effects - correct answer>>Increased risk of bleeding due to modest anti-platelet effect Fibric Acid Derivatives examples - correct answer>>Fenofibrate (Tricor) and Febofibric acid (Trilipix) Fibric Acid Derivative effects - correct answer>>Increase HDL up to 20%. Decrease TGs by up to 50%. Decrease LDL concentration (minor). Fibric Acid Derivatives adverse effects - correct answer>>Myopathy, including rhabdomyolysis esp if taken with a statin Healthy women of reproductive age: Vaginal Discharge - correct answer>>White, clear, flocculent IE physiologic leukorrhea Healthy women of reproductive age: vaginal pH - correct answer>>3.8-4.2 (acidic due to lacto bacillus) Candida vulvovaginitis: vaginal discharge - correct answer>>White, curdy, sometimes increased Candida vulvovaginitis: etiology - correct answer>> 80 - 90% of the time caused by candida albicans Candida vulvovaginitis: common complaints - correct answer>>Itching, burning, and discharge Candida vulvovaginitis: vaginal pH - correct answer>><4.5 (usually normal) Candida vulvovaginitis: amine odor (KOH whiff test) - correct answer>>Usually absent
Candida vulvovaginitis: microscopic examination of vaginal discharge - correct answer>>Mycelia, budding yeast, pseudohyphae with KOH prep Candida vulvovaginitis: interventions - correct answer>>-azole anfifungal (oral fluconazole IE diflucan) or vaginal miconazole IE monistat or terconazole IE Terazole, etc.). Bacterial vaginosis: etiology - correct answer>>Unclear, likely polymicrobial. Associated with G. vaginalis, M. hominis, etc. Bacterial vaginosis: vaginal discharge - correct answer>>Thin, homogenous, white, grey, adherent, often increased (generated by vagina, do not be fooled if it appears to be coming from the cervix). Bacterial vaginosis: vaginal pH - correct answer>> 5 - 7 (elevated) Bacterial vaginosis: amine odor (KOH whiff test) - correct answer>>Present (fishy) Bacterial vaginosis: microscopic examination of vaginal discharge - correct answer>>> clue cells/HPF. Few or no WBCs. Clue cells are vaginal epithelial cells with adherent bacteria attached. Bacterial vaginosis: interventions - correct answer>>Metronidazole (topical metrogel) or oral (Flagyl), Clindamycin vaginal cream or ovules (Cleocin), oral Tindazole (Tindamax), or oral Secindazole (Solosec). Genitourinary syndrome of menopause (GSM) AKA atrophic vaginitis: etiology - correct answer>>Estrogen deficiency Genitourinary syndrome of menopause (GSM) AKA atrophic vaginitis: vaginal discharge - correct answer>>Scant, white, clear Genitourinary syndrome of menopause (GSM) AKA atrophic vaginitis: common complaints - correct answer>>Itching/burning, discharge, but often without symptoms Genitourinary syndrome of menopause (GSM) AKA atrophic vaginitis: microscopic examination of vaginal discharge - correct answer>>Few or absent lactobacilli Genitourinary syndrome of menopause (GSM) AKA atrophic vaginitis: interventions - correct answer>>Topical and or vaginal estrogen if symptomatic and or recurrent UTI.
No vision change or permanent findings. Grade 3 Hypertensive Retinopathy - correct answer>>Usually with DBP >/- 110 mmHg. HTN emergency. Preceding signs with flame shaped hemorrhages. Potential for visual change and permanent retinal findings (blurred spots). Grade 4 Hypertensive Retinopathy - correct answer>>Usually with DBP >/- 130 mmHg. HTN emergency. Papilledema with preceding signs. Potential for visual change and permanent retinal findings (black holes in vision). In papilledema the disc bulges toward the viewer. ALARMS Findings in GERD - correct answer>>A: Anemia (iron deficiency) - chronic low volume blood loss L: Loss of weight (involuntary) A: Anorexia (persistent) R: Recent onset of progressive symptoms in absence of increasing risks and with previously helpful therapy M: Melena (tarry/black stools ) or hematemesis (vomiting bright red blood) - melena is at least 2 oz blood S: Swallowing difficulty (dysphagia and odonyphagia) Genital Herpes: Causative Organism - correct answer>>Human herpes virus 2 (HHV-2) and less commonly HHV-1. Genital Herpes: Clinical Findings - correct answer>>Initial infection: outbreak, classic presentation or painful ulcerated lesions and marked lymphadenopathy. In women: Thin vaginal discharge if lesion located at vagina or introitus. With recurrence, symptoms vary. Asymptomatic transmission common. Genital Herpes: Treatment - correct answer>>First line therapy: Oral acyclovir (Zovirax), Famcyclovir (Famvir), or Valcyclovir (Valtrex). Dose and length of treatment dependent on medication choice, clinical presentation, and treatment goal (initial or subsequent episode, prevention of outbreak). Nongonococcal urethritis and cervicitis: causative organism(s) - correct answer>>Chlamydia trachomatis, ureaplasma urealyticum, mycoplasma genitalium
Nongonococcal urethritis and cervicitis: clinical findings - correct answer>>Irritative voiding symptoms, occasional mucopurulent discharge. In women: cervicitis common. Often without symptoms in either gender. Microscopic examination of discharge: large number of WBCs. Nongonococcal urethritis and cervicitis: treatment - correct answer>>First line therapy: Azithromycin 1g PO as a 1 time dose (preferred). Alternative options include PO doxycycline, erythromycin, olfloxacin, or levofloxacin (multiple days of therapy needed). Gonococcal urethritis and vaginitis: causative organism - correct answer>>Neisseria gonorrhea (gram negative bacteria) Neisseria = negative Gonococcal urethritis and vaginitis: clinical findings - correct answer>>Irritative voiding symptoms, occasional purulent discharge. Often without symptoms in either gender. Microscopic examination of discharge: large number of WBCs. Gonococcal urethritis and vaginitis: treatment - correct answer>>First line therapy: Ceftriaxone 500 mg IM as a one time dose plus doxycycline 100 mg PO BID x 7 days if chlamydia trachomatis infection has not been ruled out. Data are limited for treatment options in face of severe beta lactam allergy. Other option: gemifloxacin 320 mg PO x1 dose plus azithromycin 1 g PO as a single dose. Trichomoniasis: causative organism - correct answer>>Trichomonas vaginalis (protozoan pathogen) Trichomoniasis: clinical findings - correct answer>>Dysuria, itching, vulvo-vaginal irritation, yellow green vaginal discharge, occasionally frothy (30%), cervical petechial hemorrhages (strawberry spots) in about 30%. Often without symptoms in either gender. On microscopic examination: motile organisms and large number of WBCs. Alkaline pH. Trichomoniasis: treatment - correct answer>>First line therapy: Metronidazole 2 mg PO or Tindazole 2 g PO as a one time dose.
Antibiotic treatment for PNA without significant co-morbidities - correct answer>>Oral doxycycline OR oral azithromycin, clarithromycin, erythromycin (if local s. Pneumoniae resistance rate >20%) OR oral amoxicillin. Azithro will not be answer on exam bc national. Likely causative organisms for PNA without significant co-morbidities - correct answer>>S. pneumoniae (gram positive) (most serious). M. pneumoniae (atypical). C. pneumoniae (atypical). Respiratory viruses, including influenza A/B, respiratory syncytial virus (RSV), etc. The PNAs and the viruses Antibiotic treatment for PNA with significant co-morbidities - correct answer>>1) Respiratory fluoroquinolone (moxifloxacin or levofloxacin) OR 2) Doxycycline OR
- Select macrolide (azithromycin or clarithromycin) PLUS beta-lactam like amoxicillin + clavulanate, cefpodoxime, or cefuroxime. Likely causative organisms for PNA with significant co-morbidities - correct answer>>S. pneumoniae (gram positive). H. influenzae (gram negative). M. pneumoniae (atypical). C. pneumoniae (atypical). Legionella species (atypical). Respiratory viruses including influenza A/B, respiratory syncytial virus (RSV), etc. 3 PNAs, H flu, legionella, and viruses. Etiology of Delirium (DELIRIUMS): D - correct answer>>DRUGS. Anticholinergic medications (TCA, first generation antihistamines), 1st and 2nd generation antipsychotics, opioids, opiates, benzodiazepines, alcohol, etc. Etiology of Delirium (DELIRIUMS): E - correct answer>>EMOTIONAL/ELECTROLYTE DISTURBANCES. Depression common/ Hyponatremia and hyperkalemia (renal decline). Etiology of Delirium (DELIRIUMS): L - correct answer>>LOW PO2/LACK OF DRUGS. Hypoxemia from CAP, COPD, MI, PE. Lack of drugs, including withdrawal from alcohol etc. Etiology of Delirium (DELIRIUMS): I #1 - correct answer>>INFECTION. UTI, CAP (most common cause of delirium). Nocturia/incontinence more common than dysuria in elderly.
Etiology of Delirium (DELIRIUMS): R - correct answer>>RETENTION/REDUCED SENSORY INPUT. Urinary/fecal retention. Reduced sensory input including lack of eye glasses, hearing aids, etc. Etiology of Delirium (DELIRIUMS): I #2 - correct answer>>ICTAL/POST ICTAL STATE. Alcohol withdrawal is a common cause of an isolated seizure in older adults. Etiology of Delirium (DELIRIUMS): U - correct answer>>UNDERNUTRITION. Protein/calorie malnutrition, vitamin B12 or folate deficiency, dehydration. Etiology of Delirium (DELIRIUMS): M - correct answer>>METABOLIC/MYOCARDIAL PROBLEMS. Poorly controlled diabetes, poorly controlled hypo or hyperthyroidism. Myocardial problems, including MI/ACS, HF, dysrhythmia. Etiology of Delirium (DELIRIUMS): S - correct answer>>SUBDURAL HEMATOMA. Can be a result of minor head trauma, due to combination of brain atrophy and fragile blood vessels. Elder brains are smaller and easier to "shake loose." Medications to slow decline in Alzheimers Dementia - correct answer>>Vitamin E 1, IU BID or Selegiline (MAOI) 5 mg BID. Medications to use in mild-to-moderate dementia - correct answer>>Mainstay of treatment: Cholinesterase inhibitors (Donepezil (Aricept), Rivastigmine (Exelon), Galantamine (Razayne) have minor and time limited benefits by increasing acetylcholine. Medications to use in moderate to severe alzheimer dementia - correct answer>>The NMDA receptor antagonist memantine (Namenda). Medication may work by affecting Glutamate. Better to use in early stage disease. Medications to use in agitation/depression in dementia - correct answer>>Escitalopram. Standard antidepressant therapy. Depression common in AD. Medication for agitation/psychosis in AD - correct answer>>Second generation antipsychotics like Risperidone. However - increase insulin resistance, increase CV risk, increase risk of thrombotic event. Risks of Amitriptyline (Elavil) in older adults - correct answer>>Significant risk of orthostatic hypotension
Giant Cell Arteritis clinical presentation - correct answer>>Tender or nodular pulseless vessel (usually temporal). Severe unilateral HA. 50% will have visual impairment. Giant Cell Arteritis diagnosis - correct answer>>CRP and ESR markedly elevated. Definitive diagnosis involves superficial temporal artery biopsy. Color duplex ultrasonography can be used instead of or in addition to biopsy. Giant Cell Arteritis intervention - correct answer>>Reduce pain. Minimize risk of blindness. High dose corticosteroid therapy (1-2 mg/kg per day prednisone until stabalized). Slowly reduce dose over 6 mo to 2 years. ASA can be used to reduce stroke risk. GI protection (PPI or misoprosol). Bone protection (bisphosphonate). Macule - correct answer>>Single flat non palpable area of discoloration, irregularly shaped, and 0.5 cm at the widest diameter Papule - correct answer>>Single, uniformly brown colored slightly raised, irregularly shaped with defined boarders, 6 mm in diameter Papule pops up Fissure - correct answer>>Linear like cleavage with sharp walls through the epidermis Cyst - correct answer>>Single, firm, smooth, raised, dome shaped, fluid filled, flesh colored encapsulated lesion of 1.5 cm in diameter. Wheal - correct answer>>Clustered smooth, slightly raised, circumscribed, pruritic skin colored lesions of various sizes up to 2 cm surrounded by area of erythema Purpura - correct answer>>Flat, non blanchable, confluent purple colored irregularly shaped lesions on skin ranging 2-20 mm in size. Petechiae are small purpura. Basal Cell Carcinoma common areas - correct answer>>Sun exposed areas Basal Cell Carcinoma development - correct answer>>Arises de novo (from nothing to a lesion). More common than SCC. Basal Cell Carcinoma appearance - correct answer>>Papule, nodule with or without central erosion. Pearly or waxy appearance, usually relatively distinct boarders with or without telangiectasia (less ulcerated)
Basal Cell Carcinoma metastasis risk - correct answer>>Low risk. Significant tissue destruction risk without treatment. Can lead to an open wound. Squamous Cell Carcinoma areas - correct answer>>Sun exposed areas Squamous Cell Carcinoma development - correct answer>>De novo development or from actinic keratoses. Less common than BCC. Squamous Cell Carcinoma appearance - correct answer>>Red conical hard lesions with or without ulceration (irritated). Less distinct boarders than BCC. Squamous Cell Carcinoma metastatic risk - correct answer>> 3 - 7% (more than BCC). Significant tissue destruction risk without treatment. Greatest metastatic risk if located on lip, oral cavity, or genitalia. First line HTN meds - correct answer>>1) Thiazide diuretic
- Calcium channel blocker
- ACE inhibitor or ARB Black adults: Thiazide diuretic or CCB Primary HTN: Initial diagnostics - correct answer>>Fasting blood glucose (DM). CBC with lipid profile (atherosclerosis). Serum creatinine + eGFR (renal failure). Serum Na, K+, Ca2+ (help to choose meds). TSH (rule out hyperthyroidism). UA (renal failure, proteinuria). ECG (LVH). portwine stain (infants): pathophysiology - correct answer>>Disorder of dermal capillaries and post capillary venules. Occasionally associated with other congenital or genetic syndromes (sturge-weber or AV malformation syndrome) portwine stain (infants): presentation - correct answer>>Presents at birth. Blanchable from red to dark pink and grows proportionally with child. Will darken and often become nodular as child grows and does not regress. Lesions on face tend to follow branches of trigeminal nerve. Consider sturge weber syndrome especially if face or eyelids involved. Port wine stain (infant): management - correct answer>>Pulse dye laser therapy is standard (lightens but does not remove). Refer to opthalmology for eyelids due to association with glaucoma. Refer to neurology if facial lesions due to association with seizures.
