AANP EXAM ACTUAL EXAM QUESTIONS
AND VERIFIED CORRECT ANSWERS WITH
RATIONALES || ALREADY GRADED A+
<2024 UPDATED VERSION>
Sensitive screening test for HIV - ANSWER ✔ combo HIV1 and HIV2 antibody
immunoassay with p24 antigen
ELISA and Western Blot only test for HIV antibody
Macular degeneration - ANSWER ✔ thickening sclerotic changes in retinal
basement membrane complex. Causes painless changes in vision including
distortion of central vision. On fundo exam will see drusen (soft yellow deposits in
macular region). Risk factors are tobacco use, sun exposure. No treatment
available for dry form. Laser treatment or intraviteal injection of antivascular
growth factor for wet form
Treatment of suppurative (non gonococcal or chlamydial infection (s. aureas, s.
pneumo, H. influ) - ANSWER ✔ Primary: opthalmic with FQ ocular solution.
Secondary: opthalmic treatment with polymixin B with trimetroprim solution or
with azithromycin 1%.
Treatment of otitis externa (pseudomonas sp, proteus sp). Acute infection often S.
aureus. - ANSWER ✔ otic drops with ofloxacin or cipro with hydrocortisone or
polymixin B with neomycin and hydrocortisone. Cleaning of ear canal important.
Use 1:2 mix of white vinegar and rubbing alcohol after swimming. Do not use
neomycin if eardrum punctured.
Exudative pharyngitis - ANSWER ✔ Caused by A, C, G streptococcus, viral,
HHV-6, M. pneumo. 1st line therapy is PCN PO for 10 days or IM for 1 dose if
problems with adherence.
,2nd line: erythromycin for 10 days; 2nd generation cephalo for 4-6 days;
azithromycin for 5 days, or clarithomycin for 10 days.
If vesicular or ulcerative, usually viral.
Chicken pox - ANSWER ✔ 2-3 mm vesicles that start on trunk, appear on limbs
2-3 days later. Non clustered and at a variety of stages. Mild to moderately ill.
Small pox - ANSWER ✔ 2-3 mm vesicles with generalized distribution without a
pattern. All lesions at same stage. Severe systemic illness.
Actinic keratoses - ANSWER ✔ mostly on sunexposed areas. Red or brown,
scaly, often tender. Sometimes flesh colored. Can turn into SCC. Can remain
unchanged, spontaneously change or progress. Can treat with topical 5-FU, 5%
imiquimod cream, photodynamic therapy with topical acid. Can do cryosurgery,
laser resurfacing, chemical peel.
Basal Cell carcinoma - ANSWER ✔ more common,, sun exposed areas, arise de
novo, papule, nodule with or without central erosion, pearly or waxy appearance,
telangiectasia, low mets risk.
Squamous cell carcinoma - ANSWER ✔ less common, sun exposed areas, can
arise for actinic keratoses or de novo, red, conical hard lesions with or without
ulceration, less distince borders, more chance of mets especially if located on lip,
oral cavity, or genitalia.
psoriasis tx and location - ANSWER ✔ vitamin D derivative cream, anterior
surface of knees
scabies tx and location - ANSWER ✔ permetherin lotion, over waist band area
Verucca vulgaris treatment - ANSWER ✔ Imiquimod cream
Tinea pedis tx - ANSWER ✔ Topical ketoconazole
Rosacea tx - ANSWER ✔ Topical metronidazole
Keratosis pilaris tx - ANSWER ✔ ammonium lactate lotion
,Eczema location - ANSWER ✔ antecubital fossa
Pityriasis rosea location - ANSWER ✔ usually proceeded by a herald patch on the
trunk
Acanthosis Nigrans - ANSWER ✔ hyperpigmented plaques with a velvet like
appearance at the nape of the neck, axillary region, and groin. Check fasting BG.
Contact dermitis - ANSWER ✔ intensely pruiritic rash on both hands and right
cheek. Scattered vesicles, small areas of crusting.
Bactrim - ANSWER ✔ best choice in antimicrobial therapy for a skin and soft
tissue infection likely caused by MRSA.
Brown Recluse spider bites - ANSWER ✔ Central blistering with surrounding
gray to purple discoloration at bite site. Surrounded by ring of blanched skin
surrounded by large area of redness.
TSH - ANSWER ✔ normal level is 0.4-4.0. Reflects anterior pituitary lobe's
ability to detect amount of circulating free thyroxine.
Free T4 - ANSWER ✔ Normal level is 10-27. Unbound metabolically active
portion of thyroxine.
Total T4 - ANSWER ✔ Normal level is 4.5-12.0. Reflects the total fo protein
bound and free thyroxine.
Free T3 - ANSWER ✔ Normal level is 3.5 to 7.7. unbound metabolically active
portion of triiodothyronine (T3). Is about four times more metabolically active.
Total T3 - ANSWER ✔ Noraml is 95-190. Reflects the total of the protein bound
and free triiodothyronine.
Untreated hypothyroidism - ANSWER ✔ low free T4 and high TSH. Give
synthroid by dosing by weight, using ideal body wt in obesity, actual in
underweight. 1.6 mcg/kg/day in adults, 4.0 mcg/kg/day in kids, 1.0 mcg/kg/day in
elderly. 50% increase during pregnancy so send to high risk OB. Increase dose by
, 33% or more as soon as pregnancy is confirmed. Check TSH every 6-8 weeks or 8-
12 weeks.
Untreated hyperthyroidism - ANSWER ✔ High free T4 and low TSH. treat with
beta adrenergic antagonist with B1,B2 blockage such as propranolol to counteract
tachycardia and tremor. Use PTU or tapazole. Radiactive iodine tx.
Subclinical hypothyroidism - ANSWER ✔ High TSH, normal free T4.
Recommend tx of people with TSH more than 5 if the patient has goiter or if
thyroid antibodies present. Presence of sxs compatible iwth hypothyroidism,
infertility, pregnancy, or imminent pregnancy would favor tx.
Evaluation of thyroid nodule - ANSWER ✔ Risk of malignancy if 5%. Hx of head
or neck irradiation, localized pain, dysphonia, hemoptysis, regional
lymphadenopathy, or a hard, fixed mass should raise suspicion. Initial testing with
TSH measurement. A hot nodule has low risk of malignancy. Fine needle
aspiration advised regardess of TSH results.
Red flag onset of headache - ANSWER ✔ Sudden, abrupt, "thunderclap"
headache is suggestive of subarachnoid hemorrhage. Headache with exertion, sex,
coughing and sneezing is suggestive of increased cranial pressure.
Tension type headache - ANSWER ✔ last 30 minutes to 7 days but usually 1-24
hours; pressing, nonpulsatile pain, mild to moderate intensity, bilateral, Can have 1
of the following characteristics: nausea, photophobia, phonophobia.
Migraine without aura - ANSWER ✔ last 4 to 72 hours, unilateral, moderate to
severe with pulsating, aggravated by normal activity, nausea, ,vomiting,
photophobia, phonophobia,
Migraine with aura - ANSWER ✔ focal dysfunction of cerebral cortex of brain
stem causes more than 1 aura symptom; develop over 4 mins. Sxs include feeling
of dread or anxiety, unusual fatigue, nervousness, GI upset, visual or olfactory
alteration. Should not last more than 1 hour.
Migraine specific meds - ANSWER ✔ triptans, ergot deriviatives. Caution about
pregnancy, CVD, uncontrolled HTN due to vascular effects.
