AANP BOARD FINAL EXAM 2024/2025 QUESTIONS AND
VERIFIED CORRECT ANSWERS/ ALREADY GRADED A++
Pernicious anemia - ANSWER macrocytic, normochromic anemia due to
deficiency in intrinsic factor which results in malabsorption of B12
S/s: weakness, GLOSSITIS, palpitations, dizziness, anorexia, NEURO
SIGNS (paresthesia, loss of vibratory sense, loss of fine motor control,
positive romberg, positive babinski)
Labs: mcv elevated, serum b12 decreased
Management: b12 (cyanocobalamin) 100 IM daily x1 week, maintenance
treatment requires lifelong monthly administration
myasthenia gravis - ANSWER autoimmune disorder resulting in the
reduction of the number of acetylcholine receptor sites at the
neuromuscular junction.
weakness typically worse after exercise and better after rest
occurs more commonly in women
s/s: PTOSIS (1 droopy eyelid), diplopia, dysarthria, dysphagia, extremity
weakness, fatigue, respiratory difficulty, sensory modalities and DTR
normal
labs: antibodies to acetylcholine receptors, edrophonium (tension) test may
be used to differentiate a myasthenia vs. cholinergic crisis
management: neurology referral, anti cholinesterase drugs block hydrolysis
of acetylcholine, immunosuppressives, plasmapheresis, ventilator support
during crisis
Multiple Sclerosis (MS) - ANSWER body's immune system attacks myelin
affects white women of western european descent
,s/s: weakness, numbness, tingling, unsteadiness in a limb, spastic
paraparesis, diplopia, disequilibrium, urinary urgency/hesitancy, optic
atrophy, nystagmus
dx: definitive dx can never be solely based off of labs, mild lymphocytosis
common, slightly elevated protein in CSF, elevated CSF gig, MRI of brain
tx: antispasmodics, INTERFERON THERAPY, immunosuppressive
therapy, plasmapheresis
Bell's Palsy - ANSWER inflammatory reaction involving facial nerve
usually affects right side of face
relationship to reactivation of herpes simplex
s/s: abrupt onset of facial paresis, pain about the eye, face feels stiff and
pulled to one side (can't move forehead)
tx: prednisone 60 mg divided in 4-5 doses/day and tapered over 7-10 days,
acyclovir, lubricating eye drops & patch at night, neurology referral as
needed
trigeminal neuralgia - ANSWER a nerve disorder that causes a stabbing or
electric-shock-like pain in parts of the face.
may accompany MS, pressure on trigeminal nerve from swollen blood
vessel/tumor
s/s: painful spasms that last a few seconds-minutes, pain usually localized
to one side of face
dx: neuro exam, MRI, trigeminal reflex testing
tx: anti-seizure drugs (carbamazepine),, muscle relaxants, tricyclic anti-
depressants
Gerontology neuro considerations - ANSWER decreased number of
neurons & neurotransmitters, modifications in cerebral dendrites, glial
,support cells, synapses, compromised thermoregulation, decreased sense
of touch, increase in pain tolerance, blunter or absent fever response
Peptic Ulcer Disease (PUD) - ANSWER causes:
-H. Pylori present in >90% of duodenal ulcers and >75% of gastric ulcers
- meds like NSAIDS, ASA, glucocorticoids
more common in men
duodenal ulcers: between ages of 30-55
gastric ulcers: ages 55-65
more common in 1/2 PPD smokers
alcohol and dietary factors
role of stress
s/s: GNAWING epigastric pain
- relief of pain with eating (duodenal)
- pain worsens with eating (gastric)
- bleeding (20%), perforation (5-10%)
perforation s/s: severe epigastric pain, board like abdomen, quiet bowel
sounds, RIGIDITY
outpatient management:
-H2 receptor antagonists- cimetidine (tagamet), ranitidine (zantac),
famotidine (pepcid) HS
-PPI (30 minutes before meals)
-mucosal protective agents- Bismuth Subsalicylate (Pepto-bismol),
misoprostol (cytotec) for NSAID induced ulcer prophylaxis
-antacids- mylanta, maalox, MOM
H. Pylori Eradication therapy - ANSWER MOC
Metronicazole (Flagyl) 500 bid with meals, Omeprazole (prilosec) bid b4
meal and clarithromycin (biaxin) 500 bid with meals for 7 days
AOC
Amox. (Amoxil)1 g bid with meals, omeprazole 20 bed b4 meals and
clarithromycin (biaxin) 500 bid with meals x 7 days
MOA
, Metronidazole (Flagyl) 500 bid with meals, omeprozole (prilosec) 20 bid b4
meals and amox (amoxil) 1 g bid with meals x 7 days
anti ulcer therapy is recommended following the previous regimens for 3-7
weeks prilosec for duodenal, H2 blockers
irritable bowel syndrome (IBS) - ANSWER stress theory, affects women
more
s/s: abdominal cramping, abdominal pain, rectal tenses, patient pre-
occupied with bowel symptoms, changes in stool consistency and or
pattern, dyspepsia, fatigue, anxiety/depression
dx: sigmoidoscopy, barium studies, rectal exam
tx: emotional support, high fiber diet, SSRI for those depressed,
anticholinergics/antidiarrheals for severe
Cholecystitis - ANSWER Inflammation of gallbladder, associated with
gallstones in >90% of cases
often precipitated by fatty meal
RUQ tenderness to palpation
muscle guarding/rebound pain
fever
**Murphy's sign: deep pain on inspiration while fingers are placed under
right rib cage
U/S gold standard, WBC, bilirubin, AST, ALT, LDH, amylase may all be
elevated
pain management,
for acutely ill: NGT for decompression, IV crystalloids, broad spectrum abx,
GI/Sugical content
Bowel Obstruction - ANSWER Blockage of the intestinal lumen impending
passage of bowel contents, usually caused from tumor in the colon
(colorectal cancer)
VERIFIED CORRECT ANSWERS/ ALREADY GRADED A++
Pernicious anemia - ANSWER macrocytic, normochromic anemia due to
deficiency in intrinsic factor which results in malabsorption of B12
S/s: weakness, GLOSSITIS, palpitations, dizziness, anorexia, NEURO
SIGNS (paresthesia, loss of vibratory sense, loss of fine motor control,
positive romberg, positive babinski)
Labs: mcv elevated, serum b12 decreased
Management: b12 (cyanocobalamin) 100 IM daily x1 week, maintenance
treatment requires lifelong monthly administration
myasthenia gravis - ANSWER autoimmune disorder resulting in the
reduction of the number of acetylcholine receptor sites at the
neuromuscular junction.
weakness typically worse after exercise and better after rest
occurs more commonly in women
s/s: PTOSIS (1 droopy eyelid), diplopia, dysarthria, dysphagia, extremity
weakness, fatigue, respiratory difficulty, sensory modalities and DTR
normal
labs: antibodies to acetylcholine receptors, edrophonium (tension) test may
be used to differentiate a myasthenia vs. cholinergic crisis
management: neurology referral, anti cholinesterase drugs block hydrolysis
of acetylcholine, immunosuppressives, plasmapheresis, ventilator support
during crisis
Multiple Sclerosis (MS) - ANSWER body's immune system attacks myelin
affects white women of western european descent
,s/s: weakness, numbness, tingling, unsteadiness in a limb, spastic
paraparesis, diplopia, disequilibrium, urinary urgency/hesitancy, optic
atrophy, nystagmus
dx: definitive dx can never be solely based off of labs, mild lymphocytosis
common, slightly elevated protein in CSF, elevated CSF gig, MRI of brain
tx: antispasmodics, INTERFERON THERAPY, immunosuppressive
therapy, plasmapheresis
Bell's Palsy - ANSWER inflammatory reaction involving facial nerve
usually affects right side of face
relationship to reactivation of herpes simplex
s/s: abrupt onset of facial paresis, pain about the eye, face feels stiff and
pulled to one side (can't move forehead)
tx: prednisone 60 mg divided in 4-5 doses/day and tapered over 7-10 days,
acyclovir, lubricating eye drops & patch at night, neurology referral as
needed
trigeminal neuralgia - ANSWER a nerve disorder that causes a stabbing or
electric-shock-like pain in parts of the face.
may accompany MS, pressure on trigeminal nerve from swollen blood
vessel/tumor
s/s: painful spasms that last a few seconds-minutes, pain usually localized
to one side of face
dx: neuro exam, MRI, trigeminal reflex testing
tx: anti-seizure drugs (carbamazepine),, muscle relaxants, tricyclic anti-
depressants
Gerontology neuro considerations - ANSWER decreased number of
neurons & neurotransmitters, modifications in cerebral dendrites, glial
,support cells, synapses, compromised thermoregulation, decreased sense
of touch, increase in pain tolerance, blunter or absent fever response
Peptic Ulcer Disease (PUD) - ANSWER causes:
-H. Pylori present in >90% of duodenal ulcers and >75% of gastric ulcers
- meds like NSAIDS, ASA, glucocorticoids
more common in men
duodenal ulcers: between ages of 30-55
gastric ulcers: ages 55-65
more common in 1/2 PPD smokers
alcohol and dietary factors
role of stress
s/s: GNAWING epigastric pain
- relief of pain with eating (duodenal)
- pain worsens with eating (gastric)
- bleeding (20%), perforation (5-10%)
perforation s/s: severe epigastric pain, board like abdomen, quiet bowel
sounds, RIGIDITY
outpatient management:
-H2 receptor antagonists- cimetidine (tagamet), ranitidine (zantac),
famotidine (pepcid) HS
-PPI (30 minutes before meals)
-mucosal protective agents- Bismuth Subsalicylate (Pepto-bismol),
misoprostol (cytotec) for NSAID induced ulcer prophylaxis
-antacids- mylanta, maalox, MOM
H. Pylori Eradication therapy - ANSWER MOC
Metronicazole (Flagyl) 500 bid with meals, Omeprazole (prilosec) bid b4
meal and clarithromycin (biaxin) 500 bid with meals for 7 days
AOC
Amox. (Amoxil)1 g bid with meals, omeprazole 20 bed b4 meals and
clarithromycin (biaxin) 500 bid with meals x 7 days
MOA
, Metronidazole (Flagyl) 500 bid with meals, omeprozole (prilosec) 20 bid b4
meals and amox (amoxil) 1 g bid with meals x 7 days
anti ulcer therapy is recommended following the previous regimens for 3-7
weeks prilosec for duodenal, H2 blockers
irritable bowel syndrome (IBS) - ANSWER stress theory, affects women
more
s/s: abdominal cramping, abdominal pain, rectal tenses, patient pre-
occupied with bowel symptoms, changes in stool consistency and or
pattern, dyspepsia, fatigue, anxiety/depression
dx: sigmoidoscopy, barium studies, rectal exam
tx: emotional support, high fiber diet, SSRI for those depressed,
anticholinergics/antidiarrheals for severe
Cholecystitis - ANSWER Inflammation of gallbladder, associated with
gallstones in >90% of cases
often precipitated by fatty meal
RUQ tenderness to palpation
muscle guarding/rebound pain
fever
**Murphy's sign: deep pain on inspiration while fingers are placed under
right rib cage
U/S gold standard, WBC, bilirubin, AST, ALT, LDH, amylase may all be
elevated
pain management,
for acutely ill: NGT for decompression, IV crystalloids, broad spectrum abx,
GI/Sugical content
Bowel Obstruction - ANSWER Blockage of the intestinal lumen impending
passage of bowel contents, usually caused from tumor in the colon
(colorectal cancer)
