LEIK FNP COMPREHENSIVE EXAM
PREP 2026/2027 QUESTIONS AND
ANSWERS
1. A 65-year-old male presents with a new-onset harsh, crescendo-decrescendo systolic
murmur heard best at the second right intercostal space that radiates to the carotid arteries.
What is the most likely diagnosis?
A. Mitral Regurgitation
B. Mitral Stenosis
C. Aortic Regurgitation
D. Aortic Stenosis
Answer: D
Conceptual Explanation: Aortic stenosis is characterized by a harsh systolic crescendo-
decrescendo murmur at the right upper sternal border radiating to the carotids.
2. A patient’s lab results show a TSH of 12.5 mIU/L and a low Free T4. Which of the following
is the most appropriate initial management?
A. Order an ultrasound of the thyroid
,B. Start Methimazole 10 mg daily
C. Recheck labs in 6 months
D. Start Levothyroxine 25-50 mcg daily
Answer: D
Conceptual Explanation: High TSH and low Free T4 indicate primary hypothyroidism,
requiring thyroid hormone replacement like Levothyroxine.
3. According to the GINA guidelines, what is the preferred rescue medication for a patient
with intermittent asthma?
A. Low-dose ICS-formoterol as needed
B. Albuterol (SABA) alone
C. Salmeterol (LABA) alone
D. Oral prednisone
Answer: A
Conceptual Explanation: Current GINA guidelines prefer low-dose ICS-formoterol as the
reliever for all asthma stages to reduce exacerbation risk.
4. A 4-year-old child is brought in for a well-child visit. Which vaccine is typically administered
at this age?
A. Hepatitis B
B. Rotavirus
, C. HPV
D. MMR and Varicella
Answer: D
Conceptual Explanation: The second dose of MMR and Varicella is routinely given
between ages 4 and 6 years.
5. Which physical exam finding is most consistent with a diagnosis of Iron Deficiency Anemia?
A. Koilonychia
B. Loss of vibratory sense
C. Jaundice
D. Splenomegaly
Answer: A
Conceptual Explanation: Koilonychia (spoon-shaped nails) is a classic sign of chronic iron
deficiency anemia.
6. An 80-year-old patient presents with sudden vision loss in one eye described as a ‘curtain
coming down.’ This is most likely:
A. Retinal Detachment
B. Macular Degeneration
C. Cataracts
PREP 2026/2027 QUESTIONS AND
ANSWERS
1. A 65-year-old male presents with a new-onset harsh, crescendo-decrescendo systolic
murmur heard best at the second right intercostal space that radiates to the carotid arteries.
What is the most likely diagnosis?
A. Mitral Regurgitation
B. Mitral Stenosis
C. Aortic Regurgitation
D. Aortic Stenosis
Answer: D
Conceptual Explanation: Aortic stenosis is characterized by a harsh systolic crescendo-
decrescendo murmur at the right upper sternal border radiating to the carotids.
2. A patient’s lab results show a TSH of 12.5 mIU/L and a low Free T4. Which of the following
is the most appropriate initial management?
A. Order an ultrasound of the thyroid
,B. Start Methimazole 10 mg daily
C. Recheck labs in 6 months
D. Start Levothyroxine 25-50 mcg daily
Answer: D
Conceptual Explanation: High TSH and low Free T4 indicate primary hypothyroidism,
requiring thyroid hormone replacement like Levothyroxine.
3. According to the GINA guidelines, what is the preferred rescue medication for a patient
with intermittent asthma?
A. Low-dose ICS-formoterol as needed
B. Albuterol (SABA) alone
C. Salmeterol (LABA) alone
D. Oral prednisone
Answer: A
Conceptual Explanation: Current GINA guidelines prefer low-dose ICS-formoterol as the
reliever for all asthma stages to reduce exacerbation risk.
4. A 4-year-old child is brought in for a well-child visit. Which vaccine is typically administered
at this age?
A. Hepatitis B
B. Rotavirus
, C. HPV
D. MMR and Varicella
Answer: D
Conceptual Explanation: The second dose of MMR and Varicella is routinely given
between ages 4 and 6 years.
5. Which physical exam finding is most consistent with a diagnosis of Iron Deficiency Anemia?
A. Koilonychia
B. Loss of vibratory sense
C. Jaundice
D. Splenomegaly
Answer: A
Conceptual Explanation: Koilonychia (spoon-shaped nails) is a classic sign of chronic iron
deficiency anemia.
6. An 80-year-old patient presents with sudden vision loss in one eye described as a ‘curtain
coming down.’ This is most likely:
A. Retinal Detachment
B. Macular Degeneration
C. Cataracts
