AANP FNP ACTUAL EXAM – QUESTIONS
AND ANSWERS | VERIFIED AND WELL
DETAILED ANSWERS | PLUS RATIONALES
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UPDATE 2026/2027
DOMAIN 1: ASSESS (32%)
Question 1
A 68-year-old male with a 40-pack-year smoking history presents with a new-onset
cough, hemoptysis, and 15-lb unintentional weight loss over 3 months. Chest X-ray
shows a right hilar mass. Which of the following is the most
appropriate initial diagnostic step?
A) CT scan of the chest with contrast
B) PET/CT scan
C) Sputum cytology × 3
D) Bronchoscopy with biopsy
,Rationale: Sputum cytology is the least invasive initial diagnostic test for a suspected
central lung mass. CT and PET/CT are staging tools, not diagnostic. Bronchoscopy is
indicated if sputum cytology is negative or nondiagnostic. The key is "initial" step—begin
with the least invasive approach.
Question 2
A 45-year-old woman presents with fatigue, cold intolerance, weight gain, and dry skin.
TSH is 8.5 mIU/L (normal 0.4–4.0), free T4 is 0.6 ng/dL (normal 0.8–1.8). What is the most
appropriate management?
A) Levothyroxine 25–50 mcg daily, recheck TSH in 6–8 weeks
B) Levothyroxine 100 mcg daily, recheck in 4 weeks
C) Observe and recheck TSH in 3 months
D) Refer to endocrinology for radioactive iodine uptake scan
Rationale: This is overt primary hypothyroidism (elevated TSH + low free T4). Start low-
dose levothyroxine (25–50 mcg) in older adults or mild cases; 100 mcg is too high and
may cause palpitations/arrhythmias. Observation is for subclinical hypothyroidism (TSH <
10 with normal T4). RAIU is for hyperthyroidism workup.
Question 3
A 32-year-old G1P0 at 28 weeks gestation complains of painless, bright red vaginal
bleeding. Vital signs: HR 110, BP 100/70. Fetal heart rate is 150. What is the most likely
diagnosis and next step?
A) Placental abruption – immediate cesarean
, B) Placenta previa – bedside ultrasound and admit
C) Cervical polyp – speculum exam
D) Labor – tocolytics
Rationale: Painless third-trimester bleeding = placenta previa until proven
otherwise. Never perform a digital vaginal exam if previa is suspected (can cause
catastrophic hemorrhage). Bedside ultrasound is the correct next step, followed by
admission. Abruption is painful with a rigid abdomen. Cervical polyps are less common
and less emergent.
Question 4
A 55-year-old male with HTN and DM type 2 presents with a 2-day history of severe,
tearing chest pain radiating to the back. BP is 190/110 in right arm, 100/60 in left arm.
ECG shows no ischemic changes. What is the most appropriate next imaging study?
A) Chest X-ray
B) Transthoracic echocardiogram
C) CT angiography of the chest
D) MRI of the aorta
Rationale: Classic presentation of aortic dissection—tearing pain with pulse/blood
pressure differential between arms. CT angiography is the gold-standard first-line imaging
in emergencies due to speed and accuracy. CXR may show widened mediastinum but is
not diagnostic. MRI takes too long. TTE is not sensitive for ascending aortic dissection.
Question 5
AND ANSWERS | VERIFIED AND WELL
DETAILED ANSWERS | PLUS RATIONALES
| DOWNLOAD AND PASS | LATEST EXAM
UPDATE 2026/2027
DOMAIN 1: ASSESS (32%)
Question 1
A 68-year-old male with a 40-pack-year smoking history presents with a new-onset
cough, hemoptysis, and 15-lb unintentional weight loss over 3 months. Chest X-ray
shows a right hilar mass. Which of the following is the most
appropriate initial diagnostic step?
A) CT scan of the chest with contrast
B) PET/CT scan
C) Sputum cytology × 3
D) Bronchoscopy with biopsy
,Rationale: Sputum cytology is the least invasive initial diagnostic test for a suspected
central lung mass. CT and PET/CT are staging tools, not diagnostic. Bronchoscopy is
indicated if sputum cytology is negative or nondiagnostic. The key is "initial" step—begin
with the least invasive approach.
Question 2
A 45-year-old woman presents with fatigue, cold intolerance, weight gain, and dry skin.
TSH is 8.5 mIU/L (normal 0.4–4.0), free T4 is 0.6 ng/dL (normal 0.8–1.8). What is the most
appropriate management?
A) Levothyroxine 25–50 mcg daily, recheck TSH in 6–8 weeks
B) Levothyroxine 100 mcg daily, recheck in 4 weeks
C) Observe and recheck TSH in 3 months
D) Refer to endocrinology for radioactive iodine uptake scan
Rationale: This is overt primary hypothyroidism (elevated TSH + low free T4). Start low-
dose levothyroxine (25–50 mcg) in older adults or mild cases; 100 mcg is too high and
may cause palpitations/arrhythmias. Observation is for subclinical hypothyroidism (TSH <
10 with normal T4). RAIU is for hyperthyroidism workup.
Question 3
A 32-year-old G1P0 at 28 weeks gestation complains of painless, bright red vaginal
bleeding. Vital signs: HR 110, BP 100/70. Fetal heart rate is 150. What is the most likely
diagnosis and next step?
A) Placental abruption – immediate cesarean
, B) Placenta previa – bedside ultrasound and admit
C) Cervical polyp – speculum exam
D) Labor – tocolytics
Rationale: Painless third-trimester bleeding = placenta previa until proven
otherwise. Never perform a digital vaginal exam if previa is suspected (can cause
catastrophic hemorrhage). Bedside ultrasound is the correct next step, followed by
admission. Abruption is painful with a rigid abdomen. Cervical polyps are less common
and less emergent.
Question 4
A 55-year-old male with HTN and DM type 2 presents with a 2-day history of severe,
tearing chest pain radiating to the back. BP is 190/110 in right arm, 100/60 in left arm.
ECG shows no ischemic changes. What is the most appropriate next imaging study?
A) Chest X-ray
B) Transthoracic echocardiogram
C) CT angiography of the chest
D) MRI of the aorta
Rationale: Classic presentation of aortic dissection—tearing pain with pulse/blood
pressure differential between arms. CT angiography is the gold-standard first-line imaging
in emergencies due to speed and accuracy. CXR may show widened mediastinum but is
not diagnostic. MRI takes too long. TTE is not sensitive for ascending aortic dissection.
Question 5
