SMNP-APPROVED CLINICAL
REASONING: HIGH-YIELD AANP
BOARD QUESTIONS WITH
COMPREHENSIVE RATIONALES
1. A 34-year-old pregnant patient presents to the emergency room
with sudden onset of abdominal pain and vaginal bleeding. Which
condition is most likely?
A) Placenta previa
B) Ectopic pregnancy
C) Miscarriage
D) Placental abruption
Correct Answer: D) Placental abruption
Rationale: Placental abruption is the premature separation of the placenta
from the uterine wall and is a serious complication of the second half of
pregnancy. It typically presents with sudden-onset abdominal pain and
vaginal bleeding.
2. A patient on phenytoin therapy presents with new-onset
bradycardia. What should you suspect?
A) Headache
B) Gingival hyperplasia
C) Alopecia
D) Phenytoin toxicity
,Correct Answer: D) Phenytoin toxicity
Rationale: Phenytoin is an antiepileptic drug that blocks voltage-gated
sodium channels. In toxic doses, it can also block depolarization of cardiac
myocytes, resulting in bradycardia.
3. Which of the following ECG findings is most characteristic of acute
pericarditis?
A) ST elevation in all leads except aVR and V1
B) ST depression in V2-V4
C) Pathologic Q waves
D) Peaked T waves
Correct Answer: A) ST elevation in all leads except aVR and V1
Rationale: Acute pericarditis causes diffuse ST elevation with PR
depression. ST depression in V2-V4 suggests ischemia. Pathologic Q waves
indicate prior MI, and peaked T waves are characteristic of hyperkalemia.
4. For which side effect should you monitor a patient who has been
started on an ACE inhibitor like lisinopril?
A) Hyperkalemia
B) Hypokalemia
C) Tachycardia
D) Edema
Correct Answer: A) Hyperkalemia
Rationale: ACE inhibitors can cause hyperkalemia by reducing aldosterone
secretion, which decreases potassium excretion.
5. What is the first-line rate control agent for a stable patient with
atrial fibrillation and heart failure with reduced ejection fraction
(HFrEF)?
A) Digoxin
B) Diltiazem
,C) Metoprolol tartrate
D) Amiodarone
Correct Answer: C) Metoprolol tartrate
Rationale: Beta-blockers (metoprolol tartrate, atenolol) are first-line for
rate control in atrial fibrillation with HFrEF. Non-dihydropyridine calcium
channel blockers (diltiazem) are contraindicated in HFrEF.
6. A patient with a history of panic disorder is likely to present with all
of the following EXCEPT:
A) Report of chest pain during panic attack
B) Concomitant thought disorder
C) History of agoraphobia
D) Peak symptoms approximately 10 minutes into panic attack
Correct Answer: B) Concomitant thought disorder
Rationale: Panic disorder has a distinct clinical presentation characterized
by chest pain and symptom peak approximately 10 minutes after the attack
begins. There is frequently a history of agoraphobia, but it is not associated
with a thought disorder.
7. What is the most concerning ECG finding in a patient with
hyperkalemia?
A) Peaked T waves
B) U waves
C) Prolonged QT interval
D) ST elevation
Correct Answer: A) Peaked T waves
Rationale: Peaked or "tented" T waves are an early and classic ECG finding
in hyperkalemia.
, 8. A patient presents with rest angina, ST depression on ECG, and an
elevated troponin. What is the most likely diagnosis?
A) Unstable angina
B) Prinzmetal's angina
C) NSTEMI
D) STEMI
Correct Answer: C) NSTEMI
Rationale: Rest angina + ECG changes (ST depression) + elevated troponin
= Non-ST-Elevation Myocardial Infarction (NSTEMI). Unstable angina has
no troponin rise.
9. A 25-year-old graduate student is prescribed an SSRI for depression.
How long should the pharmacologic intervention continue after
remission is achieved?
A) 1-2 months
B) 4-6 months
C) At least 6 months
D) Indefinitely
Correct Answer: C) At least 6 months
Rationale: Depression is a chronic disorder. Once a therapeutic goal is
achieved, treatment should continue at least 6 months; then it is
appropriate to reevaluate the clinical scenario.
10. A patient with peripheral artery disease (PAD) asks about reducing
cardiovascular events. Which medication is recommended first for this
purpose?
A) Aspirin
B) Atorvastatin
C) Cilostazol
D) Clopidogrel
REASONING: HIGH-YIELD AANP
BOARD QUESTIONS WITH
COMPREHENSIVE RATIONALES
1. A 34-year-old pregnant patient presents to the emergency room
with sudden onset of abdominal pain and vaginal bleeding. Which
condition is most likely?
A) Placenta previa
B) Ectopic pregnancy
C) Miscarriage
D) Placental abruption
Correct Answer: D) Placental abruption
Rationale: Placental abruption is the premature separation of the placenta
from the uterine wall and is a serious complication of the second half of
pregnancy. It typically presents with sudden-onset abdominal pain and
vaginal bleeding.
2. A patient on phenytoin therapy presents with new-onset
bradycardia. What should you suspect?
A) Headache
B) Gingival hyperplasia
C) Alopecia
D) Phenytoin toxicity
,Correct Answer: D) Phenytoin toxicity
Rationale: Phenytoin is an antiepileptic drug that blocks voltage-gated
sodium channels. In toxic doses, it can also block depolarization of cardiac
myocytes, resulting in bradycardia.
3. Which of the following ECG findings is most characteristic of acute
pericarditis?
A) ST elevation in all leads except aVR and V1
B) ST depression in V2-V4
C) Pathologic Q waves
D) Peaked T waves
Correct Answer: A) ST elevation in all leads except aVR and V1
Rationale: Acute pericarditis causes diffuse ST elevation with PR
depression. ST depression in V2-V4 suggests ischemia. Pathologic Q waves
indicate prior MI, and peaked T waves are characteristic of hyperkalemia.
4. For which side effect should you monitor a patient who has been
started on an ACE inhibitor like lisinopril?
A) Hyperkalemia
B) Hypokalemia
C) Tachycardia
D) Edema
Correct Answer: A) Hyperkalemia
Rationale: ACE inhibitors can cause hyperkalemia by reducing aldosterone
secretion, which decreases potassium excretion.
5. What is the first-line rate control agent for a stable patient with
atrial fibrillation and heart failure with reduced ejection fraction
(HFrEF)?
A) Digoxin
B) Diltiazem
,C) Metoprolol tartrate
D) Amiodarone
Correct Answer: C) Metoprolol tartrate
Rationale: Beta-blockers (metoprolol tartrate, atenolol) are first-line for
rate control in atrial fibrillation with HFrEF. Non-dihydropyridine calcium
channel blockers (diltiazem) are contraindicated in HFrEF.
6. A patient with a history of panic disorder is likely to present with all
of the following EXCEPT:
A) Report of chest pain during panic attack
B) Concomitant thought disorder
C) History of agoraphobia
D) Peak symptoms approximately 10 minutes into panic attack
Correct Answer: B) Concomitant thought disorder
Rationale: Panic disorder has a distinct clinical presentation characterized
by chest pain and symptom peak approximately 10 minutes after the attack
begins. There is frequently a history of agoraphobia, but it is not associated
with a thought disorder.
7. What is the most concerning ECG finding in a patient with
hyperkalemia?
A) Peaked T waves
B) U waves
C) Prolonged QT interval
D) ST elevation
Correct Answer: A) Peaked T waves
Rationale: Peaked or "tented" T waves are an early and classic ECG finding
in hyperkalemia.
, 8. A patient presents with rest angina, ST depression on ECG, and an
elevated troponin. What is the most likely diagnosis?
A) Unstable angina
B) Prinzmetal's angina
C) NSTEMI
D) STEMI
Correct Answer: C) NSTEMI
Rationale: Rest angina + ECG changes (ST depression) + elevated troponin
= Non-ST-Elevation Myocardial Infarction (NSTEMI). Unstable angina has
no troponin rise.
9. A 25-year-old graduate student is prescribed an SSRI for depression.
How long should the pharmacologic intervention continue after
remission is achieved?
A) 1-2 months
B) 4-6 months
C) At least 6 months
D) Indefinitely
Correct Answer: C) At least 6 months
Rationale: Depression is a chronic disorder. Once a therapeutic goal is
achieved, treatment should continue at least 6 months; then it is
appropriate to reevaluate the clinical scenario.
10. A patient with peripheral artery disease (PAD) asks about reducing
cardiovascular events. Which medication is recommended first for this
purpose?
A) Aspirin
B) Atorvastatin
C) Cilostazol
D) Clopidogrel
