AANP FNP DIFFERENT VERSION EXAM IN 2025
QUESTIONS WITH COMPLETE SOLUTIONS
GUARANTEED PASS
Basal Cell Carcinoma
-painless, pearly, ulcerated nodule with overlying telangiectasis
-found on sun areas
Actinic Keratoses
-slightly rough, pink or flesh-colored lesion in sun-exposed area
-pharmacological treatment: 5-fluorouracil (topical chemotherapy)
-non-pharmacological treatment: chemical peel, cryotherapy,
laser resurfacing Tuberculosis
I. Transmission
A. Mycobacterium tuberculosis carried in airborne droplets
B. Active Pulmonary or Laryngeal Tuberculosis transmitted
1. Sneeze, cough, speak, or sing
II. Symptoms
A. Latent Tuberculosis is asymptomatic
B. Active Tuberculosis presentation often mimics cancer
presentation
1. Non-specific presentation (most common)
a. Fatigue
b. Weight loss
c. Cachexia
d. Night Sweats
C. Pulmonary Tuberculosis symptoms
1. Productive cough (typically 2-3 weeks)
2. Hemoptysis (uncommon)
,3. Pleuritic Chest Pain
4. Dyspnea
III. Signs
A. Sites of Involvement
1. Primary infection: lung involvement
B. Disseminated Disease
IV. Management
A. Latent Tuberculosis
1. Positive PPD without signs of Active Tb
2. Treatment indicated if risk of Tb Progression from latent to
active disease B. Active Tuberculosis
Gout
I. Pathophysiology
A. Gout occurs when Uric Acid levels exceed solubility limits
1. Monosodium urate crystals deposit in joints, Kidney, and soft
tissues
2. Crystal deposition triggers a inflammatory response from
cytokines and Neutrophils
3. Joint space is irreversibly injured with ongoing attacks
II. Risk Factors
A. Most common
1. Obesity
2. Alcohol use (especially beer)
3. High purine diet (red meats, turkey and wild game, organ
meats, seafood)
4. Drinks sweetened with high fructose corn syrup
5. Diuretic therapy including Thiazide Diuretics
,6. Other risks
a. Diabetes Mellitus
b. Hyperlipidemia
c. Hypertension
d. Atherosclerosis
e. Renal Insufficiency
f. Myeloproliferative disease
III. Symptoms
A. Associated Symptoms
1. Chills
2. Fever as high as 104 F (40 C) 3. Severity: Very
severe pain
a. Unable to bear weight
b. Too painful to put on socks
c. Intollerant to light touch from blankets
B. Regions Lower extremities
1. First Metatarsophalangeal joint of great toe (most common)
a. Known as Podagra
i. Affected in 50% of first gout attacks
Mid-tarsal joints
2. Ankle Joints
3. Knee Joints
C. Regions upper extremities
1. Fingers
2. Wrists
3. Elbows
D. Characteristics: Joint Pain
1. Excruciating, crushing type pain
2. Timing: Joint Pain
, 3. Acute onset of lower extremity Joint Pain
4. Wakens patient from sleep
IV. Signs
A. Acute
1. Joint Inflammation
2. Erythema, tenderness and swelling at affected joint
a. Pain extends well beyond joint
b. Entire foot involved in some cases
3. Asymmetric joint involvement
a. May only involve one side with the first attack
4. Skin over joint is tense and shiny
B. Chronic
1. Gouty Tophi (develop after 10 years)
a. Subcutaneous Nodules of monosodium urate crystals and
lipids, proteins and mucopolysaccharides
C. Chronic Arthritis
1. Chronic deposition occurs with recurrent attacks
Dix-Hallpike Maneuver Central Vertigo
I. Findings: Suggestive of central causes
A. Nystagmus
1. Vertical or torsional Nystagmus (pure Horizontal Nystagmus
may occur with either peripheral or central cause) 2. No
Nystagmus on Horizontal Head Impulse Test
3. Persists <6 seconds after Dix-Hallpike Maneuver
4. Fixation of eyes on object does not inhibit Nystagmus
5. Requires weeks to months to resolve
B. Episodes last hours to days
C. Severe imbalance impairs standing and walking
D. No Hearing Loss or Tinnitus in most central cases
QUESTIONS WITH COMPLETE SOLUTIONS
GUARANTEED PASS
Basal Cell Carcinoma
-painless, pearly, ulcerated nodule with overlying telangiectasis
-found on sun areas
Actinic Keratoses
-slightly rough, pink or flesh-colored lesion in sun-exposed area
-pharmacological treatment: 5-fluorouracil (topical chemotherapy)
-non-pharmacological treatment: chemical peel, cryotherapy,
laser resurfacing Tuberculosis
I. Transmission
A. Mycobacterium tuberculosis carried in airborne droplets
B. Active Pulmonary or Laryngeal Tuberculosis transmitted
1. Sneeze, cough, speak, or sing
II. Symptoms
A. Latent Tuberculosis is asymptomatic
B. Active Tuberculosis presentation often mimics cancer
presentation
1. Non-specific presentation (most common)
a. Fatigue
b. Weight loss
c. Cachexia
d. Night Sweats
C. Pulmonary Tuberculosis symptoms
1. Productive cough (typically 2-3 weeks)
2. Hemoptysis (uncommon)
,3. Pleuritic Chest Pain
4. Dyspnea
III. Signs
A. Sites of Involvement
1. Primary infection: lung involvement
B. Disseminated Disease
IV. Management
A. Latent Tuberculosis
1. Positive PPD without signs of Active Tb
2. Treatment indicated if risk of Tb Progression from latent to
active disease B. Active Tuberculosis
Gout
I. Pathophysiology
A. Gout occurs when Uric Acid levels exceed solubility limits
1. Monosodium urate crystals deposit in joints, Kidney, and soft
tissues
2. Crystal deposition triggers a inflammatory response from
cytokines and Neutrophils
3. Joint space is irreversibly injured with ongoing attacks
II. Risk Factors
A. Most common
1. Obesity
2. Alcohol use (especially beer)
3. High purine diet (red meats, turkey and wild game, organ
meats, seafood)
4. Drinks sweetened with high fructose corn syrup
5. Diuretic therapy including Thiazide Diuretics
,6. Other risks
a. Diabetes Mellitus
b. Hyperlipidemia
c. Hypertension
d. Atherosclerosis
e. Renal Insufficiency
f. Myeloproliferative disease
III. Symptoms
A. Associated Symptoms
1. Chills
2. Fever as high as 104 F (40 C) 3. Severity: Very
severe pain
a. Unable to bear weight
b. Too painful to put on socks
c. Intollerant to light touch from blankets
B. Regions Lower extremities
1. First Metatarsophalangeal joint of great toe (most common)
a. Known as Podagra
i. Affected in 50% of first gout attacks
Mid-tarsal joints
2. Ankle Joints
3. Knee Joints
C. Regions upper extremities
1. Fingers
2. Wrists
3. Elbows
D. Characteristics: Joint Pain
1. Excruciating, crushing type pain
2. Timing: Joint Pain
, 3. Acute onset of lower extremity Joint Pain
4. Wakens patient from sleep
IV. Signs
A. Acute
1. Joint Inflammation
2. Erythema, tenderness and swelling at affected joint
a. Pain extends well beyond joint
b. Entire foot involved in some cases
3. Asymmetric joint involvement
a. May only involve one side with the first attack
4. Skin over joint is tense and shiny
B. Chronic
1. Gouty Tophi (develop after 10 years)
a. Subcutaneous Nodules of monosodium urate crystals and
lipids, proteins and mucopolysaccharides
C. Chronic Arthritis
1. Chronic deposition occurs with recurrent attacks
Dix-Hallpike Maneuver Central Vertigo
I. Findings: Suggestive of central causes
A. Nystagmus
1. Vertical or torsional Nystagmus (pure Horizontal Nystagmus
may occur with either peripheral or central cause) 2. No
Nystagmus on Horizontal Head Impulse Test
3. Persists <6 seconds after Dix-Hallpike Maneuver
4. Fixation of eyes on object does not inhibit Nystagmus
5. Requires weeks to months to resolve
B. Episodes last hours to days
C. Severe imbalance impairs standing and walking
D. No Hearing Loss or Tinnitus in most central cases
