Barkley FNP / FLORIDA STATE FIRE INSTRUCTOR 3
ACTUAL EXAM ALL QUESTIONS AND ANSWERS
ALREADY GRADED A+. 100% VERIFIED SOLUTIONS |
UPDATED PER LATEST GUIDELINES | GRADED A+.
Domain Percentage
Advanced Physical Assessment 25%
Pharmacotherapeutics 25%
Pathophysiology 20%
Differential Diagnosis 20%
Professional & Legal Issues 10%
A passing threshold of ≥70% is generally recommended for readiness .
SECTION 1: ADVANCED PHYSICAL ASSESSMENT &
DIAGNOSIS (Questions 1-50)
Question 1
A 62-year-old man with a history of hypertension and a 40-pack-year smoking history
presents with a 2-week history of a pulsatile, tender mass in the right popliteal fossa. He
denies trauma. On physical exam, a palpable, pulsatile mass is noted behind the right
knee. What is the most likely diagnosis and the greatest risk associated with this
condition?
,A) Popliteal artery aneurysm; rupture and acute limb ischemia
B) Baker's cyst; rupture and pseudothrombophlebitis
C) Femoral artery aneurysm; distal embolization
D) Deep vein thrombosis; pulmonary embolism
Answer: A) Popliteal artery aneurysm; rupture and acute limb ischemia
Rationale: A popliteal artery aneurysm (PAA) is defined as a focal dilation of the
popliteal artery >1.5 cm. It is strongly associated with other aneurysms (especially
abdominal aortic aneurysm) and atherosclerotic disease. The classic presentation is a
pulsatile popliteal mass. The most serious complications are thrombosis or distal
embolization leading to acute limb ischemia (limb-threatening), and rupture (less
common). Baker's cyst is a fluid-filled synovial sac that is non-pulsatile. DVT causes calf
tenderness, warmth, and edema, not a pulsatile mass .
Question 2
A 54-year-old woman with a history of atrial fibrillation (not on anticoagulation)
presents with acute onset of severe, diffuse abdominal pain. She is diaphoretic and
hypotensive. The abdomen is soft with mild tenderness, no rebound, no guarding.
Lactate is 6.2 mmol/L. ECG shows atrial fibrillation with rapid ventricular response. What
is the most likely diagnosis?
A) Acute pancreatitis
B) Mesenteric ischemia
C) Ruptured abdominal aortic aneurysm
D) Diverticulitis with perforation
Answer: B) Mesenteric ischemia
,Rationale: The combination of atrial fibrillation (a source for emboli), severe abdominal
pain out of proportion to physical exam findings (pain disproportionate to tenderness),
and elevated lactate strongly suggests acute mesenteric ischemia (AMI). AMI can be
embolic (often from AF) or thrombotic. CT angiography of the abdomen is the
diagnostic test of choice. Pancreatitis would have epigastric pain radiating to the back
and elevated lipase. Ruptured AAA would present with back/flank pain, hypotension,
and a pulsatile abdominal mass .
Question 3
A 38-year-old woman with no significant medical history presents with palpitations,
dyspnea on exertion, and a systolic murmur best heard at the left upper sternal border
that increases with inspiration. The murmur is harsh, crescendo-decrescendo, and
radiates to the back. Which valvular abnormality is most consistent with these findings?
A) Mitral valve prolapse
B) Tricuspid regurgitation
C) Pulmonic stenosis
D) Aortic stenosis
Answer: C) Pulmonic stenosis
Rationale: Pulmonic stenosis is a congenital heart defect that often presents in
adulthood with a harsh, crescendo-decrescendo systolic murmur best heard at the left
upper sternal border (pulmonic area). The murmur increases with inspiration (Carvallo
sign for right-sided murmurs) and may radiate to the back or left shoulder. Mitral valve
prolapse gives a mid-systolic click at the apex. Tricuspid regurgitation is holosystolic at
the left lower sternal border. Aortic stenosis is heard at the right upper sternal border
and radiates to the carotids .
, Question 4
A 58-year-old male with type 2 diabetes reports burning foot pain worse at night. Exam
shows diminished pinprick sensation distal to the ankles and absent Achilles reflexes.
What is the most likely diagnosis?
A) Peripheral artery disease
B) Lumbar radiculopathy
C) Diabetic peripheral neuropathy
D) Vitamin B12 deficiency
Answer: C) Diabetic peripheral neuropathy
Rationale: Distal symmetric polyneuropathy in diabetes presents with burning pain,
nocturnal exacerbation, loss of sensation (stocking-glove distribution), and areflexia.
PAD would show diminished pulses and cool extremities; lumbar radiculopathy would
have a dermatomal pattern; B12 deficiency can cause neuropathy but diabetes is the
more likely cause given the history .
Question 5
A 70-year-old woman reports progressive forgetfulness over 2 years. Exam reveals
difficulty with word finding, apraxia, and agnosia. MMSE is 22/30. There is no fluctuation
in cognition. What is the most likely diagnosis?
A) Alzheimer's disease
B) Lewy body dementia
C) Frontotemporal dementia
D) Vascular dementia
ACTUAL EXAM ALL QUESTIONS AND ANSWERS
ALREADY GRADED A+. 100% VERIFIED SOLUTIONS |
UPDATED PER LATEST GUIDELINES | GRADED A+.
Domain Percentage
Advanced Physical Assessment 25%
Pharmacotherapeutics 25%
Pathophysiology 20%
Differential Diagnosis 20%
Professional & Legal Issues 10%
A passing threshold of ≥70% is generally recommended for readiness .
SECTION 1: ADVANCED PHYSICAL ASSESSMENT &
DIAGNOSIS (Questions 1-50)
Question 1
A 62-year-old man with a history of hypertension and a 40-pack-year smoking history
presents with a 2-week history of a pulsatile, tender mass in the right popliteal fossa. He
denies trauma. On physical exam, a palpable, pulsatile mass is noted behind the right
knee. What is the most likely diagnosis and the greatest risk associated with this
condition?
,A) Popliteal artery aneurysm; rupture and acute limb ischemia
B) Baker's cyst; rupture and pseudothrombophlebitis
C) Femoral artery aneurysm; distal embolization
D) Deep vein thrombosis; pulmonary embolism
Answer: A) Popliteal artery aneurysm; rupture and acute limb ischemia
Rationale: A popliteal artery aneurysm (PAA) is defined as a focal dilation of the
popliteal artery >1.5 cm. It is strongly associated with other aneurysms (especially
abdominal aortic aneurysm) and atherosclerotic disease. The classic presentation is a
pulsatile popliteal mass. The most serious complications are thrombosis or distal
embolization leading to acute limb ischemia (limb-threatening), and rupture (less
common). Baker's cyst is a fluid-filled synovial sac that is non-pulsatile. DVT causes calf
tenderness, warmth, and edema, not a pulsatile mass .
Question 2
A 54-year-old woman with a history of atrial fibrillation (not on anticoagulation)
presents with acute onset of severe, diffuse abdominal pain. She is diaphoretic and
hypotensive. The abdomen is soft with mild tenderness, no rebound, no guarding.
Lactate is 6.2 mmol/L. ECG shows atrial fibrillation with rapid ventricular response. What
is the most likely diagnosis?
A) Acute pancreatitis
B) Mesenteric ischemia
C) Ruptured abdominal aortic aneurysm
D) Diverticulitis with perforation
Answer: B) Mesenteric ischemia
,Rationale: The combination of atrial fibrillation (a source for emboli), severe abdominal
pain out of proportion to physical exam findings (pain disproportionate to tenderness),
and elevated lactate strongly suggests acute mesenteric ischemia (AMI). AMI can be
embolic (often from AF) or thrombotic. CT angiography of the abdomen is the
diagnostic test of choice. Pancreatitis would have epigastric pain radiating to the back
and elevated lipase. Ruptured AAA would present with back/flank pain, hypotension,
and a pulsatile abdominal mass .
Question 3
A 38-year-old woman with no significant medical history presents with palpitations,
dyspnea on exertion, and a systolic murmur best heard at the left upper sternal border
that increases with inspiration. The murmur is harsh, crescendo-decrescendo, and
radiates to the back. Which valvular abnormality is most consistent with these findings?
A) Mitral valve prolapse
B) Tricuspid regurgitation
C) Pulmonic stenosis
D) Aortic stenosis
Answer: C) Pulmonic stenosis
Rationale: Pulmonic stenosis is a congenital heart defect that often presents in
adulthood with a harsh, crescendo-decrescendo systolic murmur best heard at the left
upper sternal border (pulmonic area). The murmur increases with inspiration (Carvallo
sign for right-sided murmurs) and may radiate to the back or left shoulder. Mitral valve
prolapse gives a mid-systolic click at the apex. Tricuspid regurgitation is holosystolic at
the left lower sternal border. Aortic stenosis is heard at the right upper sternal border
and radiates to the carotids .
, Question 4
A 58-year-old male with type 2 diabetes reports burning foot pain worse at night. Exam
shows diminished pinprick sensation distal to the ankles and absent Achilles reflexes.
What is the most likely diagnosis?
A) Peripheral artery disease
B) Lumbar radiculopathy
C) Diabetic peripheral neuropathy
D) Vitamin B12 deficiency
Answer: C) Diabetic peripheral neuropathy
Rationale: Distal symmetric polyneuropathy in diabetes presents with burning pain,
nocturnal exacerbation, loss of sensation (stocking-glove distribution), and areflexia.
PAD would show diminished pulses and cool extremities; lumbar radiculopathy would
have a dermatomal pattern; B12 deficiency can cause neuropathy but diabetes is the
more likely cause given the history .
Question 5
A 70-year-old woman reports progressive forgetfulness over 2 years. Exam reveals
difficulty with word finding, apraxia, and agnosia. MMSE is 22/30. There is no fluctuation
in cognition. What is the most likely diagnosis?
A) Alzheimer's disease
B) Lewy body dementia
C) Frontotemporal dementia
D) Vascular dementia
