Sarah Michelle Live Review (Complete) |
2025/2026 Edition | Real Exam-Aligned Content,
Clinical Pearls & Tested Concepts
FNP & AGNP Live Review Content | Differential Diagnosis, Management, Clinical Guidelines,
and High-Yield Topics | Based on Current Exam Trends | Expert-Curated | Rationalized &
Exam-Ready
Introduction
This complete collection is based on the full Sarah Michelle Live Review (2025/2026
Edition), capturing the most commonly tested concepts, high-yield review content,
clinical mnemonics, and exam strategies used by thousands of successful NP candidates.
Covering Family Nurse Practitioner (FNP) and Adult-Gerontology Primary Care (AGNP) board
prep, this content is derived directly from live sessions, quizzes, and expert guidance focused on
diagnosis, treatment, guideline-based management, and exam-critical decision-making skills.
Answer Format
All correct responses and key concepts are highlighted in bold and green for fast retention and
focused review. Rationales are included where applicable to support clinical reasoning and
board readiness.
Section 1: High-Yield Differential Diagnosis
Question 1
A 60-year-old male presents with sudden chest pain, shortness of breath, and a history of
smoking. What is the top differential?
A) Pneumonia
B) Pulmonary embolism (PE)
C) Costochondritis
D) GERD
Rationale: Sudden chest pain and dyspnea in a smoker suggest PE, a life-threatening
condition requiring immediate D-dimer and CT pulmonary angiography.
Question 2
A 40-year-old female reports amenorrhea, galactorrhea, and headaches. What is the most likely
diagnosis?
A) Polycystic ovary syndrome (PCOS)
B) Prolactinoma
C) Hypothyroidism
D) Pregnancy
,Rationale: Amenorrhea, galactorrhea, and headaches point to a prolactinoma, confirmed by
elevated prolactin levels.
Question 3
A 5-year-old presents with fever, sore throat, and a sandpaper-like rash. What is the top
differential?
A) Measles
B) Scarlet fever
C) Roseola
D) Rubella
Rationale: Fever, sore throat, and a sandpaper rash suggest scarlet fever, requiring
antibiotics for Streptococcus pyogenes.
Question 4
A 25-year-old male presents with testicular pain and swelling after trauma. What is the most
likely diagnosis?
A) Epididymitis
B) Testicular torsion
C) Hydrocele
D) Varicocele
Rationale: Acute testicular pain post-trauma suggests torsion, a surgical emergency needing
urgent ultrasound.
Question 5
An elderly patient presents with confusion, ataxia, and ophthalmoplegia. What is the likely
diagnosis?
A) Stroke
B) Wernicke’s encephalopathy
C) Parkinson’s disease
D) Delirium
Rationale: The triad in a malnourished patient suggests Wernicke’s, linked to thiamine
deficiency, requiring immediate treatment.
Question 6
A 35-year-old female presents with pelvic pain, dysmenorrhea, and dyspareunia. What is the
most likely diagnosis?
A) Ovarian cyst
B) Endometriosis
C) PID
D) Uterine fibroids
Rationale: Pelvic pain with dysmenorrhea and dyspareunia suggests endometriosis, often
confirmed by laparoscopy.
Question 7
A 50-year-old male reports fatigue, polyuria, and polydipsia. What is the top differential?
A) Hypothyroidism
B) Diabetes mellitus
,C) Chronic kidney disease
D) Hyperaldosteronism
Rationale: Polyuria and polydipsia with fatigue suggest diabetes, confirmed by elevated blood
glucose.
Question 8
A child presents with a high fever, rash, and conjunctivitis. What is the likely diagnosis?
A) Measles
B) Kawasaki disease
C) Scarlet fever
D) Fifth disease
Rationale: Fever, rash, and conjunctivitis suggest Kawasaki disease, a pediatric emergency
needing IVIG.
Question 9
A 70-year-old presents with memory loss, agitation, and wandering. What is the most likely
diagnosis?
A) Depression
B) Alzheimer’s disease
C) Vascular dementia
D) Delirium
Rationale: Progressive memory loss and behavioral changes in the elderly suggest
Alzheimer’s, needing cognitive testing.
Question 10
A 30-year-old male presents with fever, rash, and joint pain after a camping trip. What is the top
differential?
A) Rheumatoid arthritis
B) Lyme disease
C) Gout
D) Systemic lupus erythematosus
Rationale: Fever, rash, and joint pain post-tick exposure suggest Lyme disease, confirmed by
ELISA and Western blot.
Section 2: Management and Clinical Guidelines
Question 11
What is the first-line treatment for a patient with mild persistent asthma?
A) Oral corticosteroids
B) Low-dose inhaled corticosteroids
C) Leukotriene modifiers
D) Long-acting beta-agonists
Rationale: NAEPP guidelines recommend low-dose inhaled corticosteroids for mild persistent
asthma control.
Question 12
A patient with type 1 diabetes has a blood glucose of 50 mg/dL. What is the initial treatment?
, A) Regular insulin
B) 15-20 g oral glucose or glucagon if unconscious
C) Metformin
D) IV fluids
Rationale: Oral glucose or glucagon corrects hypoglycemia rapidly in type 1 diabetes.
Question 13
What is the recommended screening for breast cancer in a 50-year-old woman with no risk
factors?
A) Annual MRI
B) Annual mammogram
C) Biennial ultrasound
D) Clinical breast exam only
Rationale: USPSTF recommends annual mammograms starting at age 50 for average-risk
women.
Question 14
A patient with hypertension (150/95 mmHg) and no comorbidities should start which
medication if lifestyle changes fail?
A) Beta-blockers
B) Thiazide diuretics
C) ACE inhibitors
D) Calcium channel blockers
Rationale: JNC-8 guidelines recommend thiazide diuretics as first-line for uncomplicated
hypertension.
Question 15
What is the initial management for a patient with suspected community-acquired pneumonia?
A) IV antibiotics
B) Oral amoxicillin or macrolide
C) Oxygen therapy alone
D) Corticosteroids
Rationale: IDSA/ATS guidelines recommend oral antibiotics for outpatient mild CAP.
Question 16
What is the first-line treatment for a patient with acute gout attack?
A) Allopurinol
B) Colchicine or NSAIDs
C) Corticosteroids
D) Acetaminophen
Rationale: Colchicine or NSAIDs are first-line for acute gout to reduce inflammation, per ACR
guidelines.
Question 17
A patient with type 2 diabetes and A1c 8.5% should start which medication?
A) Insulin
B) Metformin
2025/2026 Edition | Real Exam-Aligned Content,
Clinical Pearls & Tested Concepts
FNP & AGNP Live Review Content | Differential Diagnosis, Management, Clinical Guidelines,
and High-Yield Topics | Based on Current Exam Trends | Expert-Curated | Rationalized &
Exam-Ready
Introduction
This complete collection is based on the full Sarah Michelle Live Review (2025/2026
Edition), capturing the most commonly tested concepts, high-yield review content,
clinical mnemonics, and exam strategies used by thousands of successful NP candidates.
Covering Family Nurse Practitioner (FNP) and Adult-Gerontology Primary Care (AGNP) board
prep, this content is derived directly from live sessions, quizzes, and expert guidance focused on
diagnosis, treatment, guideline-based management, and exam-critical decision-making skills.
Answer Format
All correct responses and key concepts are highlighted in bold and green for fast retention and
focused review. Rationales are included where applicable to support clinical reasoning and
board readiness.
Section 1: High-Yield Differential Diagnosis
Question 1
A 60-year-old male presents with sudden chest pain, shortness of breath, and a history of
smoking. What is the top differential?
A) Pneumonia
B) Pulmonary embolism (PE)
C) Costochondritis
D) GERD
Rationale: Sudden chest pain and dyspnea in a smoker suggest PE, a life-threatening
condition requiring immediate D-dimer and CT pulmonary angiography.
Question 2
A 40-year-old female reports amenorrhea, galactorrhea, and headaches. What is the most likely
diagnosis?
A) Polycystic ovary syndrome (PCOS)
B) Prolactinoma
C) Hypothyroidism
D) Pregnancy
,Rationale: Amenorrhea, galactorrhea, and headaches point to a prolactinoma, confirmed by
elevated prolactin levels.
Question 3
A 5-year-old presents with fever, sore throat, and a sandpaper-like rash. What is the top
differential?
A) Measles
B) Scarlet fever
C) Roseola
D) Rubella
Rationale: Fever, sore throat, and a sandpaper rash suggest scarlet fever, requiring
antibiotics for Streptococcus pyogenes.
Question 4
A 25-year-old male presents with testicular pain and swelling after trauma. What is the most
likely diagnosis?
A) Epididymitis
B) Testicular torsion
C) Hydrocele
D) Varicocele
Rationale: Acute testicular pain post-trauma suggests torsion, a surgical emergency needing
urgent ultrasound.
Question 5
An elderly patient presents with confusion, ataxia, and ophthalmoplegia. What is the likely
diagnosis?
A) Stroke
B) Wernicke’s encephalopathy
C) Parkinson’s disease
D) Delirium
Rationale: The triad in a malnourished patient suggests Wernicke’s, linked to thiamine
deficiency, requiring immediate treatment.
Question 6
A 35-year-old female presents with pelvic pain, dysmenorrhea, and dyspareunia. What is the
most likely diagnosis?
A) Ovarian cyst
B) Endometriosis
C) PID
D) Uterine fibroids
Rationale: Pelvic pain with dysmenorrhea and dyspareunia suggests endometriosis, often
confirmed by laparoscopy.
Question 7
A 50-year-old male reports fatigue, polyuria, and polydipsia. What is the top differential?
A) Hypothyroidism
B) Diabetes mellitus
,C) Chronic kidney disease
D) Hyperaldosteronism
Rationale: Polyuria and polydipsia with fatigue suggest diabetes, confirmed by elevated blood
glucose.
Question 8
A child presents with a high fever, rash, and conjunctivitis. What is the likely diagnosis?
A) Measles
B) Kawasaki disease
C) Scarlet fever
D) Fifth disease
Rationale: Fever, rash, and conjunctivitis suggest Kawasaki disease, a pediatric emergency
needing IVIG.
Question 9
A 70-year-old presents with memory loss, agitation, and wandering. What is the most likely
diagnosis?
A) Depression
B) Alzheimer’s disease
C) Vascular dementia
D) Delirium
Rationale: Progressive memory loss and behavioral changes in the elderly suggest
Alzheimer’s, needing cognitive testing.
Question 10
A 30-year-old male presents with fever, rash, and joint pain after a camping trip. What is the top
differential?
A) Rheumatoid arthritis
B) Lyme disease
C) Gout
D) Systemic lupus erythematosus
Rationale: Fever, rash, and joint pain post-tick exposure suggest Lyme disease, confirmed by
ELISA and Western blot.
Section 2: Management and Clinical Guidelines
Question 11
What is the first-line treatment for a patient with mild persistent asthma?
A) Oral corticosteroids
B) Low-dose inhaled corticosteroids
C) Leukotriene modifiers
D) Long-acting beta-agonists
Rationale: NAEPP guidelines recommend low-dose inhaled corticosteroids for mild persistent
asthma control.
Question 12
A patient with type 1 diabetes has a blood glucose of 50 mg/dL. What is the initial treatment?
, A) Regular insulin
B) 15-20 g oral glucose or glucagon if unconscious
C) Metformin
D) IV fluids
Rationale: Oral glucose or glucagon corrects hypoglycemia rapidly in type 1 diabetes.
Question 13
What is the recommended screening for breast cancer in a 50-year-old woman with no risk
factors?
A) Annual MRI
B) Annual mammogram
C) Biennial ultrasound
D) Clinical breast exam only
Rationale: USPSTF recommends annual mammograms starting at age 50 for average-risk
women.
Question 14
A patient with hypertension (150/95 mmHg) and no comorbidities should start which
medication if lifestyle changes fail?
A) Beta-blockers
B) Thiazide diuretics
C) ACE inhibitors
D) Calcium channel blockers
Rationale: JNC-8 guidelines recommend thiazide diuretics as first-line for uncomplicated
hypertension.
Question 15
What is the initial management for a patient with suspected community-acquired pneumonia?
A) IV antibiotics
B) Oral amoxicillin or macrolide
C) Oxygen therapy alone
D) Corticosteroids
Rationale: IDSA/ATS guidelines recommend oral antibiotics for outpatient mild CAP.
Question 16
What is the first-line treatment for a patient with acute gout attack?
A) Allopurinol
B) Colchicine or NSAIDs
C) Corticosteroids
D) Acetaminophen
Rationale: Colchicine or NSAIDs are first-line for acute gout to reduce inflammation, per ACR
guidelines.
Question 17
A patient with type 2 diabetes and A1c 8.5% should start which medication?
A) Insulin
B) Metformin
