AANP FNP BOARD
CERTIFICATION EXAM 2026–2027
QUESTIONS AND ANSWERS
WITH RATIONALES/GRADED
A+/2026 UPDATE/100% CORRECT
/INSTANT DOWNLOAD
Cardiovascular
1. A 58-year-old male with hypertension and DM type 2 has a BP of 142/90
mmHg despite lifestyle changes. Which is the preferred initial antihypertensive?
a) Hydrochlorothiazide
b) Lisinopril
c) Amlodipine
d) Lisinopril
*Rationale: ACE inhibitors (lisinopril) are first-line in patients with DM and HTN due
to renoprotective effects (ADA 2026).*
2. Which ECG finding is most consistent with a prior inferior wall MI?
a) ST elevation in leads V1-V4
b) Pathologic Q waves in leads II, III, aVF
c) Tall R wave in V1
d) Prolonged QT interval
Rationale: Pathologic Q waves in inferior leads (II, III, aVF) indicate prior inferior MI.
3. A 72-year-old with sudden onset of severe tearing chest pain radiating to the
back has a BP of 100/60 and a widened mediastinum on CXR. Most likely
diagnosis?
a) Acute MI
b) Pulmonary embolism
c) Aortic dissection
, d) Pericarditis
Rationale: Tearing pain radiating to back + widened mediastinum = aortic dissection
until proven otherwise.
Pulmonary
4. A 65-year-old former smoker with progressive dyspnea and chronic cough
has FEV1/FVC < 0.70 post-bronchodilator. Which medication reduces
exacerbations and mortality in this setting?
a) Albuterol PRN
b) Long-acting muscarinic antagonist (LAMA)
c) Oral prednisone daily
d) Azithromycin prophylaxis
Rationale: LAMA (e.g., tiotropium) reduces exacerbations and improves mortality in
COPD (GOLD 2026).
5. A patient with asthma using albuterol daily and waking at night 3x/week is
at which step?
a) Step 1
b) Step 2
c) Step 3
d) Step 4
*Rationale: Daily symptoms + nocturnal awakenings = Step 2: low-dose ICS (GINA
2026).*
6. Most sensitive test for PE in a hemodynamically stable patient with moderate
pretest probability?
a) D-dimer
b) CT pulmonary angiography
c) V/Q scan
d) Chest X-ray
Rationale: CTPA is gold standard for PE diagnosis in stable patients.
Endocrinology
7. A 45-year-old obese female with acanthosis nigricans, fasting glucose 126
mg/dL, and HbA1c 7.2% is diagnosed with T2DM. First-line pharmacotherapy?
a) Insulin glargine
CERTIFICATION EXAM 2026–2027
QUESTIONS AND ANSWERS
WITH RATIONALES/GRADED
A+/2026 UPDATE/100% CORRECT
/INSTANT DOWNLOAD
Cardiovascular
1. A 58-year-old male with hypertension and DM type 2 has a BP of 142/90
mmHg despite lifestyle changes. Which is the preferred initial antihypertensive?
a) Hydrochlorothiazide
b) Lisinopril
c) Amlodipine
d) Lisinopril
*Rationale: ACE inhibitors (lisinopril) are first-line in patients with DM and HTN due
to renoprotective effects (ADA 2026).*
2. Which ECG finding is most consistent with a prior inferior wall MI?
a) ST elevation in leads V1-V4
b) Pathologic Q waves in leads II, III, aVF
c) Tall R wave in V1
d) Prolonged QT interval
Rationale: Pathologic Q waves in inferior leads (II, III, aVF) indicate prior inferior MI.
3. A 72-year-old with sudden onset of severe tearing chest pain radiating to the
back has a BP of 100/60 and a widened mediastinum on CXR. Most likely
diagnosis?
a) Acute MI
b) Pulmonary embolism
c) Aortic dissection
, d) Pericarditis
Rationale: Tearing pain radiating to back + widened mediastinum = aortic dissection
until proven otherwise.
Pulmonary
4. A 65-year-old former smoker with progressive dyspnea and chronic cough
has FEV1/FVC < 0.70 post-bronchodilator. Which medication reduces
exacerbations and mortality in this setting?
a) Albuterol PRN
b) Long-acting muscarinic antagonist (LAMA)
c) Oral prednisone daily
d) Azithromycin prophylaxis
Rationale: LAMA (e.g., tiotropium) reduces exacerbations and improves mortality in
COPD (GOLD 2026).
5. A patient with asthma using albuterol daily and waking at night 3x/week is
at which step?
a) Step 1
b) Step 2
c) Step 3
d) Step 4
*Rationale: Daily symptoms + nocturnal awakenings = Step 2: low-dose ICS (GINA
2026).*
6. Most sensitive test for PE in a hemodynamically stable patient with moderate
pretest probability?
a) D-dimer
b) CT pulmonary angiography
c) V/Q scan
d) Chest X-ray
Rationale: CTPA is gold standard for PE diagnosis in stable patients.
Endocrinology
7. A 45-year-old obese female with acanthosis nigricans, fasting glucose 126
mg/dL, and HbA1c 7.2% is diagnosed with T2DM. First-line pharmacotherapy?
a) Insulin glargine
