AANP FNP 2025-2026 Questions And
Answers
Koplik Spots - >>They are small, white spots (often on a reddened
ANSWER
background) that occur on the inside of the cheeks early in the course of *measles*.
Salter-Harris Fractures - ANSWER>>Fractures through a growth plate; therefore, they
are unique to pediatric patients. These fractures are categorized according to the
involvement of the physis, metaphysis, and epiphysis. The classification of the injuries
is important, because it affects patient treatment and provides clues to possible long-
term complications.
Pernicious Anemia (B12 Deficiency) - ANSWER>>A. Symptoms:
1. Initial: Generalized Weakness, Paresthesias
2. Next: Leg Stiffness, Ataxia
3. Late: Memory Impairment, Personality Change, Depressed Mood
B. Signs: (Mnemonic: "The 5 P's")
1. Pancytopenia (decrease in all blood cell lines)
2. Peripheral Neuropathy
3. Posterior Spinal Column Neuropathy (Dorsal Column Degeneration, Decreased
proprioception, Decreased Vibration Sense, Ataxia, Hyporeflexia {e.g. Decreased
Ankle Jerk})
4. Pyramidal Tract Signs
5. Papillary Atrophy of Tongue (Atrophic Glossitis) *red, beefy tongue*
C. Labs:
1. CBC
a. MCV >100 (macrocytic)
b. Leukopenia (decreased white blood cells)
c. Thrombocytopenia (decreased platelets)
D. Risk Factors:
1. Strict Vegetarian
2. History of Gastrectomy (Gastric Bypass Surgery)
3. Recent History of Malabsorption (Diarrhea)
E. B12 Food Sources 1.
Organ Meat
a. Liver 2. Dairy
Products
,2. Serum B12
a. Megaloblastosis (oval macrocytes)
3. Fortified Cereal
4. Shellfish a. Clam
Iron Deficiency Anemia - ANSWER>>A. Symptoms:
1. Fatigue
2. Generalized Weakness
3. Dyspnea on Exertion
4. Lightheadedness
B. Signs:
1. Pale Conjunctiva or Mucous Membranes
2. Pallor at Nail Beds
3. Tachycardia
4. Melena (dark, tarry stool)
5. Hematochezia (grossly bloody stool)
C. Labs:
1. CBC
a. MCV <75 (microcytic)
2. Iron Studies
a. Serum Ferritin
b. TIBC
c. Serum Iron
D. Risk Factors:
1. Vegetarian
2. Gastrointestinal Disease
E. Iron Food Sources:
1. Red Meat
2. Green Leafy Veggies
3. Dried Fruit
4. Nuts
5. Iron-Fortified Cereal
F. Associated Symptoms:
1. Generalized Pruritis (itching)
2. Restless Leg Syndrome (crawling feeling in legs)
3. Glossitis (inflammation of tongue)
4. Angular Cheilitis (cracking at corners of mouth)
G. Treatment:
1. Iron Supplement
a. Iron absorption decreased 40% when taken with meals - *do not take with meals*
b. Antacids or proton-pump inhibitor use will decrease iron absorption
c. *Vitamin C aids in the absorption of iron - orange juice*
,McMurray's Test - ANSWER>>I. Indication
A. Evaluation for *Knee Meniscus* Injury
II. Interpretation: Positive Test Suggests Meniscal Injury
A. *"Click" heard or palpated on above maneuvers*. B.
Joint line tenderness on palpation.
Lachman's Test - ANSWER>>I. Indications
A. Assessment for *Anterior Cruciate Ligament (ACL)* Rupture
II. Interpretation: Positive Test for ACL Rupture
A. Lax endpoints on anterior translation
Rotator Cuff Injury - >>I.
ANSWERSymptoms
A. Characteristics
1. Lateral arm without radiation beyond elbow
2. *Associated with arm weakness*
B. Timing
1. *Night pain interferes with sleep*
C. Provocative
1. Exacerbated by throwing motion
2. Overhead work
II. Initial Visit
A. Evaluation
1. Shoulder Exam
2. *Shoulder Xray*
B. Conservative Therapy
1. Modify Activity
2. Start Physical Therapy and Encourage Early Shoulder Mobilization
3. NSAIDS
Pancreatitis - ANSWER>>I. Causes
A. Adult common causes
1. Alcohol Abuse (35% of cases)
2. Cholelithiasis (40% of cases)
II. Symptoms
A. Abdominal Pain
1. Pancreatitis may be painful in some cases
2. Mid-Epigastric Pain, Left Upper Quadrant Abdominal
3. Pain or Periumbilical Abdominal Pain
4. Radiation into the chest or mid-back
5. Worse with eating and drinking (especially fatty foods) and in supine position
6. Boring pain that starts episodically and advances to become constant
III. Signs
A. General
1. Low Grade Fever
, B. Abdominal
1. Abdominal tenderness and guarding in the upper quadrants
2. Peritoneal signs may be present (e.g. abdominal rigidity or Rebound Tenderness)
3. Bowel sounds decreased
4. Palpable upper abdominal mass
5. Cullen's Sign (periumbilical discoloration with subcutaneous Ecchymosis and edema)
6. Grey Turner's Sign (flank discoloration with Ecchymosis)
IV. Labs
A. Approach
1. Consider obtaining Serum Amylase and serum Lipase simultaneously on initial
evaluation
a. *Expect Serum Amylase and Lipase to be increased in Pancreatitis* (question
diagnosis if only 1 increased)
b. Serum Lipase to amylase ratio >4 (and especially >5) strongly suggests Alcoholic
Pancreatitis
B. Fasting Triglycerides
1. *Hypertriglyceridemia (>1500)*
Cullen's Sign - >>Blue discoloration from subcutaneous *ecchymosis and
ANSWER
edema in periumbilical area*.
Grey Turner's Sign - >>Discoloration at the *flank with blue-red-purple or
ANSWER
green-brown ecchymosis*. Results from tissue catabolism of hemoglobin.
Subungual Hematoma - ANSWER >>I.
Causes
A. Crush injury to nail
II. Symptoms
A. Severe, throbbing digital pain
III. Signs
A. Discoloration of nail
B. Tip of digit swollen and tender
IV. Management: *Drainage (Nail Trephination)*
A. Contraindications
1. Phalanx Fracture
2. Nail Bed Laceration
3. Large Subungual Hematomas (>50% of nail)
a. Requires Nail Bed Laceration suturing
B. Technique
1. *Gently drill 2-3 small holes into nail*
a. Number 11 blade or
b. Spin 18 gauge needle between fingers or
Answers
Koplik Spots - >>They are small, white spots (often on a reddened
ANSWER
background) that occur on the inside of the cheeks early in the course of *measles*.
Salter-Harris Fractures - ANSWER>>Fractures through a growth plate; therefore, they
are unique to pediatric patients. These fractures are categorized according to the
involvement of the physis, metaphysis, and epiphysis. The classification of the injuries
is important, because it affects patient treatment and provides clues to possible long-
term complications.
Pernicious Anemia (B12 Deficiency) - ANSWER>>A. Symptoms:
1. Initial: Generalized Weakness, Paresthesias
2. Next: Leg Stiffness, Ataxia
3. Late: Memory Impairment, Personality Change, Depressed Mood
B. Signs: (Mnemonic: "The 5 P's")
1. Pancytopenia (decrease in all blood cell lines)
2. Peripheral Neuropathy
3. Posterior Spinal Column Neuropathy (Dorsal Column Degeneration, Decreased
proprioception, Decreased Vibration Sense, Ataxia, Hyporeflexia {e.g. Decreased
Ankle Jerk})
4. Pyramidal Tract Signs
5. Papillary Atrophy of Tongue (Atrophic Glossitis) *red, beefy tongue*
C. Labs:
1. CBC
a. MCV >100 (macrocytic)
b. Leukopenia (decreased white blood cells)
c. Thrombocytopenia (decreased platelets)
D. Risk Factors:
1. Strict Vegetarian
2. History of Gastrectomy (Gastric Bypass Surgery)
3. Recent History of Malabsorption (Diarrhea)
E. B12 Food Sources 1.
Organ Meat
a. Liver 2. Dairy
Products
,2. Serum B12
a. Megaloblastosis (oval macrocytes)
3. Fortified Cereal
4. Shellfish a. Clam
Iron Deficiency Anemia - ANSWER>>A. Symptoms:
1. Fatigue
2. Generalized Weakness
3. Dyspnea on Exertion
4. Lightheadedness
B. Signs:
1. Pale Conjunctiva or Mucous Membranes
2. Pallor at Nail Beds
3. Tachycardia
4. Melena (dark, tarry stool)
5. Hematochezia (grossly bloody stool)
C. Labs:
1. CBC
a. MCV <75 (microcytic)
2. Iron Studies
a. Serum Ferritin
b. TIBC
c. Serum Iron
D. Risk Factors:
1. Vegetarian
2. Gastrointestinal Disease
E. Iron Food Sources:
1. Red Meat
2. Green Leafy Veggies
3. Dried Fruit
4. Nuts
5. Iron-Fortified Cereal
F. Associated Symptoms:
1. Generalized Pruritis (itching)
2. Restless Leg Syndrome (crawling feeling in legs)
3. Glossitis (inflammation of tongue)
4. Angular Cheilitis (cracking at corners of mouth)
G. Treatment:
1. Iron Supplement
a. Iron absorption decreased 40% when taken with meals - *do not take with meals*
b. Antacids or proton-pump inhibitor use will decrease iron absorption
c. *Vitamin C aids in the absorption of iron - orange juice*
,McMurray's Test - ANSWER>>I. Indication
A. Evaluation for *Knee Meniscus* Injury
II. Interpretation: Positive Test Suggests Meniscal Injury
A. *"Click" heard or palpated on above maneuvers*. B.
Joint line tenderness on palpation.
Lachman's Test - ANSWER>>I. Indications
A. Assessment for *Anterior Cruciate Ligament (ACL)* Rupture
II. Interpretation: Positive Test for ACL Rupture
A. Lax endpoints on anterior translation
Rotator Cuff Injury - >>I.
ANSWERSymptoms
A. Characteristics
1. Lateral arm without radiation beyond elbow
2. *Associated with arm weakness*
B. Timing
1. *Night pain interferes with sleep*
C. Provocative
1. Exacerbated by throwing motion
2. Overhead work
II. Initial Visit
A. Evaluation
1. Shoulder Exam
2. *Shoulder Xray*
B. Conservative Therapy
1. Modify Activity
2. Start Physical Therapy and Encourage Early Shoulder Mobilization
3. NSAIDS
Pancreatitis - ANSWER>>I. Causes
A. Adult common causes
1. Alcohol Abuse (35% of cases)
2. Cholelithiasis (40% of cases)
II. Symptoms
A. Abdominal Pain
1. Pancreatitis may be painful in some cases
2. Mid-Epigastric Pain, Left Upper Quadrant Abdominal
3. Pain or Periumbilical Abdominal Pain
4. Radiation into the chest or mid-back
5. Worse with eating and drinking (especially fatty foods) and in supine position
6. Boring pain that starts episodically and advances to become constant
III. Signs
A. General
1. Low Grade Fever
, B. Abdominal
1. Abdominal tenderness and guarding in the upper quadrants
2. Peritoneal signs may be present (e.g. abdominal rigidity or Rebound Tenderness)
3. Bowel sounds decreased
4. Palpable upper abdominal mass
5. Cullen's Sign (periumbilical discoloration with subcutaneous Ecchymosis and edema)
6. Grey Turner's Sign (flank discoloration with Ecchymosis)
IV. Labs
A. Approach
1. Consider obtaining Serum Amylase and serum Lipase simultaneously on initial
evaluation
a. *Expect Serum Amylase and Lipase to be increased in Pancreatitis* (question
diagnosis if only 1 increased)
b. Serum Lipase to amylase ratio >4 (and especially >5) strongly suggests Alcoholic
Pancreatitis
B. Fasting Triglycerides
1. *Hypertriglyceridemia (>1500)*
Cullen's Sign - >>Blue discoloration from subcutaneous *ecchymosis and
ANSWER
edema in periumbilical area*.
Grey Turner's Sign - >>Discoloration at the *flank with blue-red-purple or
ANSWER
green-brown ecchymosis*. Results from tissue catabolism of hemoglobin.
Subungual Hematoma - ANSWER >>I.
Causes
A. Crush injury to nail
II. Symptoms
A. Severe, throbbing digital pain
III. Signs
A. Discoloration of nail
B. Tip of digit swollen and tender
IV. Management: *Drainage (Nail Trephination)*
A. Contraindications
1. Phalanx Fracture
2. Nail Bed Laceration
3. Large Subungual Hematomas (>50% of nail)
a. Requires Nail Bed Laceration suturing
B. Technique
1. *Gently drill 2-3 small holes into nail*
a. Number 11 blade or
b. Spin 18 gauge needle between fingers or
