FNP EXAM PREP QUESTIONS WITH
ANSWERS AND EXPLANATIONS
1. A 32-year-old has weight loss, heat intolerance, tremor, palpitations, diffuse goiter, and eye irritation.
Which follow-up measure best assesses treatment response or safety?
A. Monitor blood pressure, glucose, bone health, infection risk, and recurrence after treatment
B. Monitor symptoms, blood pressure, sodium, potassium, renin as appropriate, and adequacy of stress dosing
C. Monitor free T4/T3, TSH over time, blood counts if fever/sore throat occurs, and liver symptoms
D. Recheck A1c about every 3 months until stable and monitor renal, retinal, neurologic, and cardiovascular risk
Correct Answer: C. Monitor free T4/T3, TSH over time, blood counts if fever/sore throat occurs, and liver
symptoms
Explanation: Monitor free T4/T3, TSH over time, blood counts if fever/sore throat occurs, and liver symptoms
most directly evaluates response, safety, or progression for Graves hyperthyroidism. Graves disease is a common
cause of hyperthyroidism; methimazole is usually preferred except in selected pregnancy situations or thyroid
storm.
2. A clinic employee asks to view a neighbor's chart out of curiosity even though the employee is not
involved in the person's care. Which clinical interpretation is most accurate?
A. Informed consent and capacity
B. Mandatory reporting of suspected child abuse
C. Screening-test sensitivity and specificity
D. HIPAA minimum necessary principle
Correct Answer: D. HIPAA minimum necessary principle
Explanation: The overall pattern is most consistent with HIPAA minimum necessary principle. HIPAA does not
allow record access merely because a person works in the health system; access must be tied to an authorized
purpose.
3. Based on this presentation, which action should be implemented first? A 48-year-old has a rapidly
enlarging warm tender erythematous area on the lower leg without fluctuance or drainage.
A. Use an oral beta-lactam active against streptococci for mild uncomplicated nonpurulent cellulitis
B. Use an age-appropriate topical corticosteroid for flares, with steroid-sparing agents for selected areas or
chronic use
C. Use topical corticosteroid plus or minus vitamin D analog for limited plaque disease
D. Arrange prompt dermatology or surgical evaluation for complete diagnostic excision
Correct Answer: A. Use an oral beta-lactam active against streptococci for mild uncomplicated nonpurulent
cellulitis
Explanation: Use an oral beta-lactam active against streptococci for mild uncomplicated nonpurulent cellulitis is
the best management action among these options for the described situation. Nonpurulent cellulitis is usually
caused by streptococci; purulence changes the likely pathogens and management.
4. At the next visit, which assessment should receive the greatest attention? A 74-year-old reports episodic
palpitations; the pulse is irregularly irregular at 118/min.
A. Escalate evaluation if symptoms become more frequent, occur at rest, or decrease the activity threshold
B. Repeat lipids after treatment initiation to assess adherence and LDL-C response
C. Follow weight, symptoms, blood pressure, renal function, potassium, and ejection fraction when clinically
indicated
D. Monitor heart rate, symptoms, bleeding risk, renal function, and anticoagulant adherence
Correct Answer: D. Monitor heart rate, symptoms, bleeding risk, renal function, and anticoagulant adherence
Explanation: Monitor heart rate, symptoms, bleeding risk, renal function, and anticoagulant adherence most
directly evaluates response, safety, or progression for Atrial fibrillation. Atrial fibrillation is confirmed by ECG;
stroke prevention is based on thromboembolic risk and DOACs are preferred for most eligible patients without
mechanical valves or moderate-to-severe rheumatic mitral stenosis.
5. A 5-month-old develops rhinorrhea followed by cough, tachypnea, wheeze, and diffuse crackles during
winter. Which additional finding would most strongly support the leading clinical impression?
A. No swelling or deformity with the child protecting a pronated arm after longitudinal traction
B. Infant with viral prodrome, wheeze or crackles, and increased work of breathing
C. Mild dehydration with slightly dry mucosa and preserved perfusion
D. Moderate-to-severe tympanic-membrane bulging with acute otalgia
,Correct Answer: B. Infant with viral prodrome, wheeze or crackles, and increased work of breathing
Explanation: Infant with viral prodrome, wheeze or crackles, and increased work of breathing is the finding that
most strongly fits Bronchiolitis in this presentation. Bronchiolitis management is mainly supportive; routine
bronchodilator or steroid treatment has not shown consistent benefit.
6. A 76-year-old has 2 years of progressive memory loss, medication errors, missed bills, and declining
independent function. The diagnosis is established. Which nonpharmacologic or care-planning step is most
appropriate now?
A. Use nonpharmacologic sleep strategies and shared deprescribing plans
B. Address driving, medication safety, caregiver support, advance care planning, and home risks
C. Correct infection, hypoxia, pain, dehydration, sensory deprivation, and medication triggers; use orientation and
mobility strategies
D. Begin bladder training, timed voiding, fluid management, and pelvic-floor exercises
Correct Answer: B. Address driving, medication safety, caregiver support, advance care planning, and home
risks
Explanation: Address driving, medication safety, caregiver support, advance care planning, and home risks is the
most appropriate care-planning approach for this presentation. Dementia is chronic and progressive; loss of
function distinguishes major neurocognitive disorder from isolated subjective memory complaints.
7. A 68-year-old develops asymmetric resting tremor, bradykinesia, rigidity, and a shuffling gait. Which
follow-up measure best assesses treatment response or safety?
A. Monitor motor fluctuations, dyskinesias, orthostatic hypotension, hallucinations, cognition, and falls
B. Reassess eye protection and facial recovery; atypical progression or poor recovery warrants further evaluation
C. Monitor neurologic status and complete secondary-prevention evaluation for atrial fibrillation, carotid disease,
lipids, and blood pressure
D. Track headache days, acute-medication use, disability, and any change in neurologic pattern
Correct Answer: A. Monitor motor fluctuations, dyskinesias, orthostatic hypotension, hallucinations, cognition,
and falls
Explanation: Monitor motor fluctuations, dyskinesias, orthostatic hypotension, hallucinations, cognition, and
falls most directly evaluates response, safety, or progression for Parkinson disease. Bradykinesia is essential to the
parkinsonian syndrome; levodopa remains the most effective symptomatic motor therapy.
8. A 35-year-old has excessive difficult-to-control worry about multiple areas of life on most days for 8
months. Which additional finding would most strongly support the leading clinical impression?
A. At least 2 weeks of depressed mood or anhedonia with a syndrome causing functional impairment
B. Distinct period of elevated or irritable mood with increased energy and severe functional change
C. Loss of control, craving, tolerance, withdrawal, or continued use despite harm
D. Chronic excessive worry with restlessness, muscle tension, sleep disturbance, or irritability
Correct Answer: D. Chronic excessive worry with restlessness, muscle tension, sleep disturbance, or irritability
Explanation: Chronic excessive worry with restlessness, muscle tension, sleep disturbance, or irritability is the
finding that most strongly fits Generalized anxiety disorder in this presentation. GAD is chronic and pervasive
rather than episodic; CBT and serotonergic medications have the strongest long-term role.
9. A 61-year-old current smoker has a 32 pack-year history and no symptoms of lung cancer. Which
management action or intervention is most appropriate?
A. Order annual low-dose CT after shared decision-making
B. Initiate colorectal cancer screening now
C. Perform cervical cytology every 3 years for this age group
D. Order one-time screening abdominal ultrasound
Correct Answer: A. Order annual low-dose CT after shared decision-making
Explanation: Order annual low-dose CT after shared decision-making is the best management action among
these options for the described situation. For eligible high-risk adults, annual low-dose CT reduces lung-cancer
mortality; chest radiography is not the screening test.
10. A 45-year-old develops low-back pain after lifting boxes, has normal strength and reflexes, and no
fever, cancer history, trauma, or bowel/bladder symptoms. The diagnosis is established. Which
nonpharmacologic or care-planning step is most appropriate now?
A. Stay active, use heat, and return gradually to normal activity rather than bed rest
B. Encourage smoking cessation, exercise, vaccination review, and joint protection
,C. Rest the joint, use ice, and address triggers after the acute attack
D. Activity modification and rotator-cuff/scapular physical therapy
Correct Answer: A. Stay active, use heat, and return gradually to normal activity rather than bed rest
Explanation: Stay active, use heat, and return gradually to normal activity rather than bed rest is the most
appropriate care-planning approach for this presentation. Most acute low-back pain is nonspecific and improves
without imaging; red flags drive urgent evaluation.
11. At the next visit, which assessment should receive the greatest attention? A 69-year-old man has
urinary hesitancy, weak stream, nocturia, and incomplete-emptying sensation without fever or hematuria.
A. Monitor eGFR, albuminuria, potassium, blood pressure, and medication safety
B. Confirm stone passage or resolution, especially if symptoms persist, and monitor for fever or obstruction
C. Monitor weight, proteinuria, kidney function, thrombosis risk, and infection risk
D. Monitor symptom score, orthostatic effects, urinary retention, and renal complications
Correct Answer: D. Monitor symptom score, orthostatic effects, urinary retention, and renal complications
Explanation: Monitor symptom score, orthostatic effects, urinary retention, and renal complications most
directly evaluates response, safety, or progression for Benign prostatic hyperplasia. BPH produces obstructive and
storage symptoms; alpha blockers improve flow quickly but can cause dizziness and orthostasis.
12. A 27-year-old with 7 weeks of amenorrhea has unilateral pelvic pain, spotting, and a positive pregnancy
test. Which management action or intervention is most appropriate?
A. Use a topical azole; in nonpregnant patients an oral azole may be appropriate for uncomplicated disease
B. Use methotrexate only for carefully selected stable unruptured ectopic pregnancy; surgical treatment is
required when unstable or ruptured
C. Use pregnancy-safe antihypertensive therapy for severe pressure and magnesium sulfate for seizure
prophylaxis when indicated under obstetric management
D. For persistent symptoms without contraindication, use low-dose local vaginal estrogen or another approved
local therapy
Correct Answer: B. Use methotrexate only for carefully selected stable unruptured ectopic pregnancy; surgical
treatment is required when unstable or ruptured
Explanation: Use methotrexate only for carefully selected stable unruptured ectopic pregnancy; surgical
treatment is required when unstable or ruptured is the best management action among these options for the
described situation. An ectopic pregnancy must be excluded in early pregnancy with pain and bleeding;
hemodynamic instability requires immediate surgical evaluation.
13. An 84-year-old with recurrent falls takes diphenhydramine nightly for sleep and diazepam most
evenings. Which condition or clinical interpretation is most likely?
A. Potentially inappropriate medication use
B. Urinary incontinence in older adults
C. Fall-risk reduction
D. Major neurocognitive disorder
Correct Answer: A. Potentially inappropriate medication use
Explanation: The overall pattern is most consistent with Potentially inappropriate medication use. Older adults
are more sensitive to anticholinergic and sedative effects; medication review is a high-yield way to reduce
preventable harm.
14. A 60-year-old smoked 1.5 packs of cigarettes per day for 24 years and quit 5 years ago. What is the
smoking exposure in pack-years?
A. 24 pack-years
B. 30 pack-years
C. 45 pack-years
D. 36 pack-years
Correct Answer: D. 36 pack-years
Explanation: Pack-years equal packs smoked per day multiplied by years smoked: 1.5 x 24 = 36 pack-years.
Time since quitting does not subtract from the cumulative pack-year exposure.
15. A clinician is choosing a first-line screening test for a serious disease where missing cases would be
especially harmful. Which management action or intervention is most appropriate?
A. Respect an informed voluntary refusal by a capacitated adult and document the discussion
, B. Make the required report to child-protection authorities based on reasonable suspicion rather than waiting for
certainty
C. Use a highly sensitive test for initial screening and confirm positive results with a more specific test when
appropriate
D. Do not permit curiosity-based access; follow privacy and institutional reporting procedures
Correct Answer: C. Use a highly sensitive test for initial screening and confirm positive results with a more
specific test when appropriate
Explanation: Use a highly sensitive test for initial screening and confirm positive results with a more specific test
when appropriate is the best management action among these options for the described situation. Sensitivity
describes detection among people who truly have disease; specificity describes correctly identifying those without
disease.
16. A 29-year-old has episodic wheeze, chest tightness, and nocturnal cough that vary week to week. Which
assessment feature carries the greatest diagnostic weight in this presentation?
A. Large neck circumference and crowded upper airway with daytime somnolence
B. Tachycardia, unexplained hypoxemia, and recent immobilization or surgery
C. Variable expiratory wheeze with symptom triggers and periods of normal breathing
D. Dullness to percussion with decreased tactile fremitus over the effusion
Correct Answer: C. Variable expiratory wheeze with symptom triggers and periods of normal breathing
Explanation: Variable expiratory wheeze with symptom triggers and periods of normal breathing is the finding
that most strongly fits Asthma in this presentation. GINA 2026 continues to emphasize ICS-containing treatment
because SABA-only treatment does not address airway inflammation or exacerbation risk.
17. A 50-year-old reports drinking 6 to 8 drinks nightly, unsuccessful attempts to cut down, and continued
use despite family problems. Which clinical interpretation is most accurate?
A. Alcohol use disorder
B. Generalized anxiety disorder
C. Bipolar I disorder
D. Major depressive disorder
Correct Answer: A. Alcohol use disorder
Explanation: The overall pattern is most consistent with Alcohol use disorder. Alcohol use disorder is treatable
with behavioral and medication approaches; withdrawal risk should be assessed before outpatient reduction plans.
18. At the next visit, which assessment should receive the greatest attention? A 29-year-old plans pregnancy
within the next year and has no prior pregnancy affected by a neural-tube defect.
A. Advise pregnancy testing if menses is delayed and arrange ongoing contraception
B. Confirm adherence and optimize chronic disease, medication safety, and prenatal care once pregnant
C. Reassess glucose throughout pregnancy and perform postpartum diabetes testing 4 to 12 weeks after delivery
D. Reevaluate persistent or recurrent symptoms; routine test of cure is not needed after uncomplicated response
Correct Answer: B. Confirm adherence and optimize chronic disease, medication safety, and prenatal care once
pregnant
Explanation: Confirm adherence and optimize chronic disease, medication safety, and prenatal care once
pregnant most directly evaluates response, safety, or progression for Preconception folic acid. Adequate folic acid
before conception and in early pregnancy reduces neural-tube defects; higher-dose regimens are reserved for
specific high-risk histories.
19. Based on this presentation, which action should be implemented first? A 42-year-old has sudden severe
colicky flank pain radiating to the groin with microscopic hematuria.
A. Use an alpha-1 blocker for bothersome symptoms when appropriate
B. Use an NSAID for renal colic when not contraindicated; medical expulsive therapy may help selected distal
ureteral stones
C. Refer to nephrology for cause-specific therapy; use diuretics cautiously for symptomatic edema
D. Use a first-line agent such as nitrofurantoin for 5 days when appropriate
Correct Answer: B. Use an NSAID for renal colic when not contraindicated; medical expulsive therapy may
help selected distal ureteral stones
Explanation: Use an NSAID for renal colic when not contraindicated; medical expulsive therapy may help
selected distal ureteral stones is the best management action among these options for the described situation.
Renal colic plus hematuria is typical of ureteral stones; infection with obstruction is an emergency.
ANSWERS AND EXPLANATIONS
1. A 32-year-old has weight loss, heat intolerance, tremor, palpitations, diffuse goiter, and eye irritation.
Which follow-up measure best assesses treatment response or safety?
A. Monitor blood pressure, glucose, bone health, infection risk, and recurrence after treatment
B. Monitor symptoms, blood pressure, sodium, potassium, renin as appropriate, and adequacy of stress dosing
C. Monitor free T4/T3, TSH over time, blood counts if fever/sore throat occurs, and liver symptoms
D. Recheck A1c about every 3 months until stable and monitor renal, retinal, neurologic, and cardiovascular risk
Correct Answer: C. Monitor free T4/T3, TSH over time, blood counts if fever/sore throat occurs, and liver
symptoms
Explanation: Monitor free T4/T3, TSH over time, blood counts if fever/sore throat occurs, and liver symptoms
most directly evaluates response, safety, or progression for Graves hyperthyroidism. Graves disease is a common
cause of hyperthyroidism; methimazole is usually preferred except in selected pregnancy situations or thyroid
storm.
2. A clinic employee asks to view a neighbor's chart out of curiosity even though the employee is not
involved in the person's care. Which clinical interpretation is most accurate?
A. Informed consent and capacity
B. Mandatory reporting of suspected child abuse
C. Screening-test sensitivity and specificity
D. HIPAA minimum necessary principle
Correct Answer: D. HIPAA minimum necessary principle
Explanation: The overall pattern is most consistent with HIPAA minimum necessary principle. HIPAA does not
allow record access merely because a person works in the health system; access must be tied to an authorized
purpose.
3. Based on this presentation, which action should be implemented first? A 48-year-old has a rapidly
enlarging warm tender erythematous area on the lower leg without fluctuance or drainage.
A. Use an oral beta-lactam active against streptococci for mild uncomplicated nonpurulent cellulitis
B. Use an age-appropriate topical corticosteroid for flares, with steroid-sparing agents for selected areas or
chronic use
C. Use topical corticosteroid plus or minus vitamin D analog for limited plaque disease
D. Arrange prompt dermatology or surgical evaluation for complete diagnostic excision
Correct Answer: A. Use an oral beta-lactam active against streptococci for mild uncomplicated nonpurulent
cellulitis
Explanation: Use an oral beta-lactam active against streptococci for mild uncomplicated nonpurulent cellulitis is
the best management action among these options for the described situation. Nonpurulent cellulitis is usually
caused by streptococci; purulence changes the likely pathogens and management.
4. At the next visit, which assessment should receive the greatest attention? A 74-year-old reports episodic
palpitations; the pulse is irregularly irregular at 118/min.
A. Escalate evaluation if symptoms become more frequent, occur at rest, or decrease the activity threshold
B. Repeat lipids after treatment initiation to assess adherence and LDL-C response
C. Follow weight, symptoms, blood pressure, renal function, potassium, and ejection fraction when clinically
indicated
D. Monitor heart rate, symptoms, bleeding risk, renal function, and anticoagulant adherence
Correct Answer: D. Monitor heart rate, symptoms, bleeding risk, renal function, and anticoagulant adherence
Explanation: Monitor heart rate, symptoms, bleeding risk, renal function, and anticoagulant adherence most
directly evaluates response, safety, or progression for Atrial fibrillation. Atrial fibrillation is confirmed by ECG;
stroke prevention is based on thromboembolic risk and DOACs are preferred for most eligible patients without
mechanical valves or moderate-to-severe rheumatic mitral stenosis.
5. A 5-month-old develops rhinorrhea followed by cough, tachypnea, wheeze, and diffuse crackles during
winter. Which additional finding would most strongly support the leading clinical impression?
A. No swelling or deformity with the child protecting a pronated arm after longitudinal traction
B. Infant with viral prodrome, wheeze or crackles, and increased work of breathing
C. Mild dehydration with slightly dry mucosa and preserved perfusion
D. Moderate-to-severe tympanic-membrane bulging with acute otalgia
,Correct Answer: B. Infant with viral prodrome, wheeze or crackles, and increased work of breathing
Explanation: Infant with viral prodrome, wheeze or crackles, and increased work of breathing is the finding that
most strongly fits Bronchiolitis in this presentation. Bronchiolitis management is mainly supportive; routine
bronchodilator or steroid treatment has not shown consistent benefit.
6. A 76-year-old has 2 years of progressive memory loss, medication errors, missed bills, and declining
independent function. The diagnosis is established. Which nonpharmacologic or care-planning step is most
appropriate now?
A. Use nonpharmacologic sleep strategies and shared deprescribing plans
B. Address driving, medication safety, caregiver support, advance care planning, and home risks
C. Correct infection, hypoxia, pain, dehydration, sensory deprivation, and medication triggers; use orientation and
mobility strategies
D. Begin bladder training, timed voiding, fluid management, and pelvic-floor exercises
Correct Answer: B. Address driving, medication safety, caregiver support, advance care planning, and home
risks
Explanation: Address driving, medication safety, caregiver support, advance care planning, and home risks is the
most appropriate care-planning approach for this presentation. Dementia is chronic and progressive; loss of
function distinguishes major neurocognitive disorder from isolated subjective memory complaints.
7. A 68-year-old develops asymmetric resting tremor, bradykinesia, rigidity, and a shuffling gait. Which
follow-up measure best assesses treatment response or safety?
A. Monitor motor fluctuations, dyskinesias, orthostatic hypotension, hallucinations, cognition, and falls
B. Reassess eye protection and facial recovery; atypical progression or poor recovery warrants further evaluation
C. Monitor neurologic status and complete secondary-prevention evaluation for atrial fibrillation, carotid disease,
lipids, and blood pressure
D. Track headache days, acute-medication use, disability, and any change in neurologic pattern
Correct Answer: A. Monitor motor fluctuations, dyskinesias, orthostatic hypotension, hallucinations, cognition,
and falls
Explanation: Monitor motor fluctuations, dyskinesias, orthostatic hypotension, hallucinations, cognition, and
falls most directly evaluates response, safety, or progression for Parkinson disease. Bradykinesia is essential to the
parkinsonian syndrome; levodopa remains the most effective symptomatic motor therapy.
8. A 35-year-old has excessive difficult-to-control worry about multiple areas of life on most days for 8
months. Which additional finding would most strongly support the leading clinical impression?
A. At least 2 weeks of depressed mood or anhedonia with a syndrome causing functional impairment
B. Distinct period of elevated or irritable mood with increased energy and severe functional change
C. Loss of control, craving, tolerance, withdrawal, or continued use despite harm
D. Chronic excessive worry with restlessness, muscle tension, sleep disturbance, or irritability
Correct Answer: D. Chronic excessive worry with restlessness, muscle tension, sleep disturbance, or irritability
Explanation: Chronic excessive worry with restlessness, muscle tension, sleep disturbance, or irritability is the
finding that most strongly fits Generalized anxiety disorder in this presentation. GAD is chronic and pervasive
rather than episodic; CBT and serotonergic medications have the strongest long-term role.
9. A 61-year-old current smoker has a 32 pack-year history and no symptoms of lung cancer. Which
management action or intervention is most appropriate?
A. Order annual low-dose CT after shared decision-making
B. Initiate colorectal cancer screening now
C. Perform cervical cytology every 3 years for this age group
D. Order one-time screening abdominal ultrasound
Correct Answer: A. Order annual low-dose CT after shared decision-making
Explanation: Order annual low-dose CT after shared decision-making is the best management action among
these options for the described situation. For eligible high-risk adults, annual low-dose CT reduces lung-cancer
mortality; chest radiography is not the screening test.
10. A 45-year-old develops low-back pain after lifting boxes, has normal strength and reflexes, and no
fever, cancer history, trauma, or bowel/bladder symptoms. The diagnosis is established. Which
nonpharmacologic or care-planning step is most appropriate now?
A. Stay active, use heat, and return gradually to normal activity rather than bed rest
B. Encourage smoking cessation, exercise, vaccination review, and joint protection
,C. Rest the joint, use ice, and address triggers after the acute attack
D. Activity modification and rotator-cuff/scapular physical therapy
Correct Answer: A. Stay active, use heat, and return gradually to normal activity rather than bed rest
Explanation: Stay active, use heat, and return gradually to normal activity rather than bed rest is the most
appropriate care-planning approach for this presentation. Most acute low-back pain is nonspecific and improves
without imaging; red flags drive urgent evaluation.
11. At the next visit, which assessment should receive the greatest attention? A 69-year-old man has
urinary hesitancy, weak stream, nocturia, and incomplete-emptying sensation without fever or hematuria.
A. Monitor eGFR, albuminuria, potassium, blood pressure, and medication safety
B. Confirm stone passage or resolution, especially if symptoms persist, and monitor for fever or obstruction
C. Monitor weight, proteinuria, kidney function, thrombosis risk, and infection risk
D. Monitor symptom score, orthostatic effects, urinary retention, and renal complications
Correct Answer: D. Monitor symptom score, orthostatic effects, urinary retention, and renal complications
Explanation: Monitor symptom score, orthostatic effects, urinary retention, and renal complications most
directly evaluates response, safety, or progression for Benign prostatic hyperplasia. BPH produces obstructive and
storage symptoms; alpha blockers improve flow quickly but can cause dizziness and orthostasis.
12. A 27-year-old with 7 weeks of amenorrhea has unilateral pelvic pain, spotting, and a positive pregnancy
test. Which management action or intervention is most appropriate?
A. Use a topical azole; in nonpregnant patients an oral azole may be appropriate for uncomplicated disease
B. Use methotrexate only for carefully selected stable unruptured ectopic pregnancy; surgical treatment is
required when unstable or ruptured
C. Use pregnancy-safe antihypertensive therapy for severe pressure and magnesium sulfate for seizure
prophylaxis when indicated under obstetric management
D. For persistent symptoms without contraindication, use low-dose local vaginal estrogen or another approved
local therapy
Correct Answer: B. Use methotrexate only for carefully selected stable unruptured ectopic pregnancy; surgical
treatment is required when unstable or ruptured
Explanation: Use methotrexate only for carefully selected stable unruptured ectopic pregnancy; surgical
treatment is required when unstable or ruptured is the best management action among these options for the
described situation. An ectopic pregnancy must be excluded in early pregnancy with pain and bleeding;
hemodynamic instability requires immediate surgical evaluation.
13. An 84-year-old with recurrent falls takes diphenhydramine nightly for sleep and diazepam most
evenings. Which condition or clinical interpretation is most likely?
A. Potentially inappropriate medication use
B. Urinary incontinence in older adults
C. Fall-risk reduction
D. Major neurocognitive disorder
Correct Answer: A. Potentially inappropriate medication use
Explanation: The overall pattern is most consistent with Potentially inappropriate medication use. Older adults
are more sensitive to anticholinergic and sedative effects; medication review is a high-yield way to reduce
preventable harm.
14. A 60-year-old smoked 1.5 packs of cigarettes per day for 24 years and quit 5 years ago. What is the
smoking exposure in pack-years?
A. 24 pack-years
B. 30 pack-years
C. 45 pack-years
D. 36 pack-years
Correct Answer: D. 36 pack-years
Explanation: Pack-years equal packs smoked per day multiplied by years smoked: 1.5 x 24 = 36 pack-years.
Time since quitting does not subtract from the cumulative pack-year exposure.
15. A clinician is choosing a first-line screening test for a serious disease where missing cases would be
especially harmful. Which management action or intervention is most appropriate?
A. Respect an informed voluntary refusal by a capacitated adult and document the discussion
, B. Make the required report to child-protection authorities based on reasonable suspicion rather than waiting for
certainty
C. Use a highly sensitive test for initial screening and confirm positive results with a more specific test when
appropriate
D. Do not permit curiosity-based access; follow privacy and institutional reporting procedures
Correct Answer: C. Use a highly sensitive test for initial screening and confirm positive results with a more
specific test when appropriate
Explanation: Use a highly sensitive test for initial screening and confirm positive results with a more specific test
when appropriate is the best management action among these options for the described situation. Sensitivity
describes detection among people who truly have disease; specificity describes correctly identifying those without
disease.
16. A 29-year-old has episodic wheeze, chest tightness, and nocturnal cough that vary week to week. Which
assessment feature carries the greatest diagnostic weight in this presentation?
A. Large neck circumference and crowded upper airway with daytime somnolence
B. Tachycardia, unexplained hypoxemia, and recent immobilization or surgery
C. Variable expiratory wheeze with symptom triggers and periods of normal breathing
D. Dullness to percussion with decreased tactile fremitus over the effusion
Correct Answer: C. Variable expiratory wheeze with symptom triggers and periods of normal breathing
Explanation: Variable expiratory wheeze with symptom triggers and periods of normal breathing is the finding
that most strongly fits Asthma in this presentation. GINA 2026 continues to emphasize ICS-containing treatment
because SABA-only treatment does not address airway inflammation or exacerbation risk.
17. A 50-year-old reports drinking 6 to 8 drinks nightly, unsuccessful attempts to cut down, and continued
use despite family problems. Which clinical interpretation is most accurate?
A. Alcohol use disorder
B. Generalized anxiety disorder
C. Bipolar I disorder
D. Major depressive disorder
Correct Answer: A. Alcohol use disorder
Explanation: The overall pattern is most consistent with Alcohol use disorder. Alcohol use disorder is treatable
with behavioral and medication approaches; withdrawal risk should be assessed before outpatient reduction plans.
18. At the next visit, which assessment should receive the greatest attention? A 29-year-old plans pregnancy
within the next year and has no prior pregnancy affected by a neural-tube defect.
A. Advise pregnancy testing if menses is delayed and arrange ongoing contraception
B. Confirm adherence and optimize chronic disease, medication safety, and prenatal care once pregnant
C. Reassess glucose throughout pregnancy and perform postpartum diabetes testing 4 to 12 weeks after delivery
D. Reevaluate persistent or recurrent symptoms; routine test of cure is not needed after uncomplicated response
Correct Answer: B. Confirm adherence and optimize chronic disease, medication safety, and prenatal care once
pregnant
Explanation: Confirm adherence and optimize chronic disease, medication safety, and prenatal care once
pregnant most directly evaluates response, safety, or progression for Preconception folic acid. Adequate folic acid
before conception and in early pregnancy reduces neural-tube defects; higher-dose regimens are reserved for
specific high-risk histories.
19. Based on this presentation, which action should be implemented first? A 42-year-old has sudden severe
colicky flank pain radiating to the groin with microscopic hematuria.
A. Use an alpha-1 blocker for bothersome symptoms when appropriate
B. Use an NSAID for renal colic when not contraindicated; medical expulsive therapy may help selected distal
ureteral stones
C. Refer to nephrology for cause-specific therapy; use diuretics cautiously for symptomatic edema
D. Use a first-line agent such as nitrofurantoin for 5 days when appropriate
Correct Answer: B. Use an NSAID for renal colic when not contraindicated; medical expulsive therapy may
help selected distal ureteral stones
Explanation: Use an NSAID for renal colic when not contraindicated; medical expulsive therapy may help
selected distal ureteral stones is the best management action among these options for the described situation.
Renal colic plus hematuria is typical of ureteral stones; infection with obstruction is an emergency.
