Master AAP Exam Preparation: Notes, Guides &
Practice Materials
Question 1: A 45-year-old male presents with a blood pressure of 142/92 mmHg on two separate
visits. He has no history of cardiovascular disease. According to current guidelines, what is the most
appropriate initial pharmacologic management?
A. Start a beta-blocker
B. Start a thiazide diuretic or ACE inhibitor
C. Start a loop diuretic
D. Start an alpha-blocker
CORRECT ANSWER: B. Start a thiazide diuretic or ACE inhibitor
RATIONALE: For non-black patients with hypertension and no compelling indications, initial therapy
should include a thiazide diuretic, calcium channel blocker, ACE inhibitor, or ARB.
Question 2: Which of the following is the most sensitive screening test for primary hypothyroidism?
A. Free T4
B. Total T3
C. Thyroid Stimulating Hormone (TSH)
D. Thyroid Peroxidase Antibodies
CORRECT ANSWER: C. Thyroid Stimulating Hormone (TSH)
RATIONALE: TSH is the most sensitive and specific initial screening test for thyroid dysfunction; it rises
early in primary hypothyroidism before T4 levels drop.
Question 3: A 65-year-old female with type 2 diabetes has an HbA1c of 8.5% despite maximal
metformin therapy. She has established atherosclerotic cardiovascular disease. Which medication
class should be added next?
A. Sulfonylurea
B. GLP-1 receptor agonist
C. DPP-4 inhibitor
D. Thiazolidinedione
CORRECT ANSWER: B. GLP-1 receptor agonist
RATIONALE: In patients with T2DM and established ASCVD, guidelines recommend adding a GLP-1 RA
or SGLT2 inhibitor with proven cardiovascular benefit.
Question 4: What is the first-line treatment for acute otitis media in a child with no drug allergies?
A. Azithromycin
B. Amoxicillin
C. Cefdinir
D. Observation only
CORRECT ANSWER: B. Amoxicillin
,RATIONALE: High-dose amoxicillin is the first-line antibiotic for acute otitis media in children without
penicillin allergy due to its efficacy against S. pneumoniae.
Question 5: A patient presents with unilateral leg swelling, warmth, and pain. Wells Criteria score is 3.
What is the next best diagnostic step?
A. D-dimer test
B. CT Pulmonary Angiography
C. Compression Ultrasonography
D. Venography
CORRECT ANSWER: C. Compression Ultrasonography
RATIONALE: With a moderate to high pre-test probability (Wells >2), compression ultrasonography is
the diagnostic test of choice for suspected DVT.
Question 6: Which vaccine is contraindicated in a pregnant woman?
A. Tdap
B. Influenza (inactivated)
C. MMR
D. Hepatitis B
CORRECT ANSWER: C. MMR
RATIONALE: MMR is a live attenuated vaccine and is contraindicated during pregnancy due to
theoretical risk of fetal infection.
Question 7: A 30-year-old female presents with fatigue, hair loss, and a malar rash. ANA is positive.
What is the most specific confirmatory test?
A. Anti-dsDNA
B. Anti-Smith
C. Complement levels
D. ESR
CORRECT ANSWER: B. Anti-Smith
RATIONALE: While anti-dsDNA is specific, Anti-Smith antibodies are highly specific for Systemic Lupus
Erythematosus (SLE), though less sensitive.
Question 8: What is the recommended frequency for cervical cancer screening in a woman aged 30-65
using HPV testing alone?
A. Every year
B. Every 3 years
C. Every 5 years
D. Every 10 years
CORRECT ANSWER: C. Every 5 years
,RATIONALE: USPSTF guidelines recommend primary HPV testing every 5 years for women aged 30-65
as a preferred screening strategy.
Question 9: A patient with COPD presents with increased dyspnea and purulent sputum. What is the
most appropriate initial management?
A. Oral corticosteroids and antibiotics
B. Increase bronchodilator frequency only
C. Immediate intubation
D. Chest physiotherapy alone
CORRECT ANSWER: A. Oral corticosteroids and antibiotics
RATIONALE: Acute exacerbations of COPD characterized by increased dyspnea, sputum volume, and
purulence require systemic steroids and antibiotics.
Question 10: Which medication is known to cause gingival hyperplasia?
A. Lisinopril
B. Phenytoin
C. Metformin
D. Atorvastatin
CORRECT ANSWER: B. Phenytoin
RATIONALE: Phenytoin, along with calcium channel blockers and cyclosporine, is a well-known cause of
drug-induced gingival hyperplasia.
Question 11: A 50-year-old male presents with hematochezia. He has no family history of colon
cancer. What is the gold standard diagnostic test?
A. Fecal occult blood test
B. Flexible sigmoidoscopy
C. Colonoscopy
D. CT Colonography
CORRECT ANSWER: C. Colonoscopy
RATIONALE: Colonoscopy is the gold standard for evaluating hematochezia as it allows for visualization
of the entire colon and biopsy/polypectomy.
Question 12: What is the target LDL cholesterol level for a patient with very high-risk ASCVD?
A. <130 mg/dL
B. <100 mg/dL
C. <70 mg/dL
D. <50 mg/dL
CORRECT ANSWER: C. <70 mg/dL
, RATIONALE: Current ACC/AHA guidelines suggest an LDL threshold of <70 mg/dL for patients with very
high-risk ASCVD on maximally tolerated statin therapy.
Question 13: A child presents with a "slapped cheek" rash. What is the causative organism?
A. Varicella zoster
B. Parvovirus B19
C. Coxsackievirus
D. Measles virus
CORRECT ANSWER: B. Parvovirus B19
RATIONALE: Erythema infectiosum (Fifth disease), characterized by a slapped cheek rash, is caused by
Parvovirus B19.
Question 14: Which finding is most consistent with bacterial vaginosis?
A. Curdy white discharge
B. pH > 4.5 and clue cells
C. Strawberry cervix
D. pH < 4.0
CORRECT ANSWER: B. pH > 4.5 and clue cells
RATIONALE: Bacterial vaginosis is diagnosed by Amsel criteria, including vaginal pH >4.5, clue cells on
microscopy, and a positive whiff test.
Question 15: What is the first-line treatment for uncomplicated cystitis in a non-pregnant woman?
A. Ciprofloxacin for 7 days
B. Nitrofurantoin for 5 days
C. Amoxicillin for 3 days
D. Levofloxacin for 10 days
CORRECT ANSWER: B. Nitrofurantoin for 5 days
RATIONALE: Nitrofurantoin, TMP-SMX, or Fosfomycin are first-line agents for uncomplicated cystitis;
fluoroquinolones are reserved for resistant cases.
Question 16: A patient presents with sudden onset severe headache described as "worst of life."
What is the initial diagnostic test?
A. MRI Brain
B. Non-contrast CT Head
C. Lumbar Puncture
D. EEG
CORRECT ANSWER: B. Non-contrast CT Head
RATIONALE: A non-contrast CT is the initial test of choice to rule out subarachnoid hemorrhage in
patients with a thunderclap headache.
Practice Materials
Question 1: A 45-year-old male presents with a blood pressure of 142/92 mmHg on two separate
visits. He has no history of cardiovascular disease. According to current guidelines, what is the most
appropriate initial pharmacologic management?
A. Start a beta-blocker
B. Start a thiazide diuretic or ACE inhibitor
C. Start a loop diuretic
D. Start an alpha-blocker
CORRECT ANSWER: B. Start a thiazide diuretic or ACE inhibitor
RATIONALE: For non-black patients with hypertension and no compelling indications, initial therapy
should include a thiazide diuretic, calcium channel blocker, ACE inhibitor, or ARB.
Question 2: Which of the following is the most sensitive screening test for primary hypothyroidism?
A. Free T4
B. Total T3
C. Thyroid Stimulating Hormone (TSH)
D. Thyroid Peroxidase Antibodies
CORRECT ANSWER: C. Thyroid Stimulating Hormone (TSH)
RATIONALE: TSH is the most sensitive and specific initial screening test for thyroid dysfunction; it rises
early in primary hypothyroidism before T4 levels drop.
Question 3: A 65-year-old female with type 2 diabetes has an HbA1c of 8.5% despite maximal
metformin therapy. She has established atherosclerotic cardiovascular disease. Which medication
class should be added next?
A. Sulfonylurea
B. GLP-1 receptor agonist
C. DPP-4 inhibitor
D. Thiazolidinedione
CORRECT ANSWER: B. GLP-1 receptor agonist
RATIONALE: In patients with T2DM and established ASCVD, guidelines recommend adding a GLP-1 RA
or SGLT2 inhibitor with proven cardiovascular benefit.
Question 4: What is the first-line treatment for acute otitis media in a child with no drug allergies?
A. Azithromycin
B. Amoxicillin
C. Cefdinir
D. Observation only
CORRECT ANSWER: B. Amoxicillin
,RATIONALE: High-dose amoxicillin is the first-line antibiotic for acute otitis media in children without
penicillin allergy due to its efficacy against S. pneumoniae.
Question 5: A patient presents with unilateral leg swelling, warmth, and pain. Wells Criteria score is 3.
What is the next best diagnostic step?
A. D-dimer test
B. CT Pulmonary Angiography
C. Compression Ultrasonography
D. Venography
CORRECT ANSWER: C. Compression Ultrasonography
RATIONALE: With a moderate to high pre-test probability (Wells >2), compression ultrasonography is
the diagnostic test of choice for suspected DVT.
Question 6: Which vaccine is contraindicated in a pregnant woman?
A. Tdap
B. Influenza (inactivated)
C. MMR
D. Hepatitis B
CORRECT ANSWER: C. MMR
RATIONALE: MMR is a live attenuated vaccine and is contraindicated during pregnancy due to
theoretical risk of fetal infection.
Question 7: A 30-year-old female presents with fatigue, hair loss, and a malar rash. ANA is positive.
What is the most specific confirmatory test?
A. Anti-dsDNA
B. Anti-Smith
C. Complement levels
D. ESR
CORRECT ANSWER: B. Anti-Smith
RATIONALE: While anti-dsDNA is specific, Anti-Smith antibodies are highly specific for Systemic Lupus
Erythematosus (SLE), though less sensitive.
Question 8: What is the recommended frequency for cervical cancer screening in a woman aged 30-65
using HPV testing alone?
A. Every year
B. Every 3 years
C. Every 5 years
D. Every 10 years
CORRECT ANSWER: C. Every 5 years
,RATIONALE: USPSTF guidelines recommend primary HPV testing every 5 years for women aged 30-65
as a preferred screening strategy.
Question 9: A patient with COPD presents with increased dyspnea and purulent sputum. What is the
most appropriate initial management?
A. Oral corticosteroids and antibiotics
B. Increase bronchodilator frequency only
C. Immediate intubation
D. Chest physiotherapy alone
CORRECT ANSWER: A. Oral corticosteroids and antibiotics
RATIONALE: Acute exacerbations of COPD characterized by increased dyspnea, sputum volume, and
purulence require systemic steroids and antibiotics.
Question 10: Which medication is known to cause gingival hyperplasia?
A. Lisinopril
B. Phenytoin
C. Metformin
D. Atorvastatin
CORRECT ANSWER: B. Phenytoin
RATIONALE: Phenytoin, along with calcium channel blockers and cyclosporine, is a well-known cause of
drug-induced gingival hyperplasia.
Question 11: A 50-year-old male presents with hematochezia. He has no family history of colon
cancer. What is the gold standard diagnostic test?
A. Fecal occult blood test
B. Flexible sigmoidoscopy
C. Colonoscopy
D. CT Colonography
CORRECT ANSWER: C. Colonoscopy
RATIONALE: Colonoscopy is the gold standard for evaluating hematochezia as it allows for visualization
of the entire colon and biopsy/polypectomy.
Question 12: What is the target LDL cholesterol level for a patient with very high-risk ASCVD?
A. <130 mg/dL
B. <100 mg/dL
C. <70 mg/dL
D. <50 mg/dL
CORRECT ANSWER: C. <70 mg/dL
, RATIONALE: Current ACC/AHA guidelines suggest an LDL threshold of <70 mg/dL for patients with very
high-risk ASCVD on maximally tolerated statin therapy.
Question 13: A child presents with a "slapped cheek" rash. What is the causative organism?
A. Varicella zoster
B. Parvovirus B19
C. Coxsackievirus
D. Measles virus
CORRECT ANSWER: B. Parvovirus B19
RATIONALE: Erythema infectiosum (Fifth disease), characterized by a slapped cheek rash, is caused by
Parvovirus B19.
Question 14: Which finding is most consistent with bacterial vaginosis?
A. Curdy white discharge
B. pH > 4.5 and clue cells
C. Strawberry cervix
D. pH < 4.0
CORRECT ANSWER: B. pH > 4.5 and clue cells
RATIONALE: Bacterial vaginosis is diagnosed by Amsel criteria, including vaginal pH >4.5, clue cells on
microscopy, and a positive whiff test.
Question 15: What is the first-line treatment for uncomplicated cystitis in a non-pregnant woman?
A. Ciprofloxacin for 7 days
B. Nitrofurantoin for 5 days
C. Amoxicillin for 3 days
D. Levofloxacin for 10 days
CORRECT ANSWER: B. Nitrofurantoin for 5 days
RATIONALE: Nitrofurantoin, TMP-SMX, or Fosfomycin are first-line agents for uncomplicated cystitis;
fluoroquinolones are reserved for resistant cases.
Question 16: A patient presents with sudden onset severe headache described as "worst of life."
What is the initial diagnostic test?
A. MRI Brain
B. Non-contrast CT Head
C. Lumbar Puncture
D. EEG
CORRECT ANSWER: B. Non-contrast CT Head
RATIONALE: A non-contrast CT is the initial test of choice to rule out subarachnoid hemorrhage in
patients with a thunderclap headache.
