AANP FNP Actual Exam Questions and
Correct Answers 2023
Basal Cell Carcinoma - ANS--painless, pearly, ulcerated nodule with overlying
telangiectasis
-found on sun areas
Actinic Keratoses - ANS--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 - ANS-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 - ANS-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 - ANS-
Central Vertigo - ANS-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
E. Acute Vestibular Syndrome (Posterior Circulation in 25% of cases)
1. Rapid onset (<1 hour) of acute, persistent, continuous Vertigo or Dizziness
2. Associated with Nystagmus, Nausea or Vomiting, head motion intolerance, and gait
unsteadiness
F. Positive HiNTs Exam Criteria (at least 1 of 3 positive) are suggestive of cerebellar
CVA or Brainstem CVA (100% sensitive, 96% specific)
1. Normal Horizontal Head Impulse Test (no saccade/correction on head rotation) OR
2. Nystagmus that changes direction (or Vertical Nystagmus or torsional Nystagmus)
OR
3. Skew Deviation on Alternate Eye Cover Test in which uncovered eye demonstrates
quick vertical gaze corrections
III. Causes: Central Vertigo
A. Non-Vascular Central Causes of Vertigo (CN 8 or CNS)
1. Tumor
a. Acoustic Neuroma (Vestibular Schwannoma)
b. Infratentorial ependymoma
c. Brainstem glioma
d. Medulloblastoma
, e. Neurofibromatosis
2. Migraine Headache
3. Multiple Sclerosis
B. Vascular disease related transient cerebral anoxia
1. Specific anoxia to vertebrobasilar system
a. Vessel specific
i. Brainstem Infarct (associated with Hearing Loss)
1. Anterior Inferior Cerebellar Artery Infarction
2. Anterior Vestibular Artery Infarction
ii. Brainstem Infarct (no Hearing Loss)
1. Posterior Inferior Cerebellar Artery infarction
2. Labyrinthine Artery Infarction
b. Precipitating conditions
i. Arteriosclerosis
ii. Hypertension
iii. Anemia
iv. Atrial Fibrillation
C. Other Causes
1. Postural Hypotension
2. Syncope
Peripheral Vertigo - ANS-I. Findings: Suggestive of peripheral causes
A. Pathognomonic for peripheral cause
1. Sudden onset with brief episodes often on awakening
2. Rotary Illusion with Nausea, Vomiting
B. Nystagmus
1. Combined horizontal and torsional Nystagmus
2. Persists 5-20 seconds after Dix-Hallpike Maneuver
3. Fixation of eyes on object inhibits Nystagmus
C. Moderate imbalance
D. Nausea or Vomiting
E. Associated findings
1. Hearing Loss
2. Tinnitus
F. Tullio's Phenomenon
1. Nystagmus and Vertigo provoked by loud sounds
II. Causes: Common (Peripheral Vertigo)
A. Acute Vestibular Neuronitis
B. Benign Paroxysmal Positional Vertigo
C. Meniere's Disease
III. Causes: Other (Peripheral Vertigo)
A. Ear Infections
1. Serous Otitis Media
2. Chronic Otitis Media
Correct Answers 2023
Basal Cell Carcinoma - ANS--painless, pearly, ulcerated nodule with overlying
telangiectasis
-found on sun areas
Actinic Keratoses - ANS--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 - ANS-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 - ANS-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 - ANS-
Central Vertigo - ANS-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
E. Acute Vestibular Syndrome (Posterior Circulation in 25% of cases)
1. Rapid onset (<1 hour) of acute, persistent, continuous Vertigo or Dizziness
2. Associated with Nystagmus, Nausea or Vomiting, head motion intolerance, and gait
unsteadiness
F. Positive HiNTs Exam Criteria (at least 1 of 3 positive) are suggestive of cerebellar
CVA or Brainstem CVA (100% sensitive, 96% specific)
1. Normal Horizontal Head Impulse Test (no saccade/correction on head rotation) OR
2. Nystagmus that changes direction (or Vertical Nystagmus or torsional Nystagmus)
OR
3. Skew Deviation on Alternate Eye Cover Test in which uncovered eye demonstrates
quick vertical gaze corrections
III. Causes: Central Vertigo
A. Non-Vascular Central Causes of Vertigo (CN 8 or CNS)
1. Tumor
a. Acoustic Neuroma (Vestibular Schwannoma)
b. Infratentorial ependymoma
c. Brainstem glioma
d. Medulloblastoma
, e. Neurofibromatosis
2. Migraine Headache
3. Multiple Sclerosis
B. Vascular disease related transient cerebral anoxia
1. Specific anoxia to vertebrobasilar system
a. Vessel specific
i. Brainstem Infarct (associated with Hearing Loss)
1. Anterior Inferior Cerebellar Artery Infarction
2. Anterior Vestibular Artery Infarction
ii. Brainstem Infarct (no Hearing Loss)
1. Posterior Inferior Cerebellar Artery infarction
2. Labyrinthine Artery Infarction
b. Precipitating conditions
i. Arteriosclerosis
ii. Hypertension
iii. Anemia
iv. Atrial Fibrillation
C. Other Causes
1. Postural Hypotension
2. Syncope
Peripheral Vertigo - ANS-I. Findings: Suggestive of peripheral causes
A. Pathognomonic for peripheral cause
1. Sudden onset with brief episodes often on awakening
2. Rotary Illusion with Nausea, Vomiting
B. Nystagmus
1. Combined horizontal and torsional Nystagmus
2. Persists 5-20 seconds after Dix-Hallpike Maneuver
3. Fixation of eyes on object inhibits Nystagmus
C. Moderate imbalance
D. Nausea or Vomiting
E. Associated findings
1. Hearing Loss
2. Tinnitus
F. Tullio's Phenomenon
1. Nystagmus and Vertigo provoked by loud sounds
II. Causes: Common (Peripheral Vertigo)
A. Acute Vestibular Neuronitis
B. Benign Paroxysmal Positional Vertigo
C. Meniere's Disease
III. Causes: Other (Peripheral Vertigo)
A. Ear Infections
1. Serous Otitis Media
2. Chronic Otitis Media
