Assess
32%of exam
History and PhysicalScreening GuidelinesGrowth MilestonesMental Health Screens
Diagnose
26-27%of exam
HTN CategoriesDiabetes CriteriaInfection CluesLab Interpretation
Plan
26-27%of exam
Treatment TargetsFirst-Line DrugsImmunization ScheduleAntibiotic Selection
Evaluate
15%of exam
Follow-Up IntervalsResponse SignalsReferral TriggersSafety Monitoring
Quick Facts
- Exam
- AANPCB FNP-C
- Credential
- Family Nurse Practitioner
- Questions
- 150 total, 135 scored
- Time
- 3 hours
- Pass Score
- 500 scaled, 200-800 range
- Format
- Computer-based, Prometric centers
- Level
- Graduate NP certification
- Blueprint Date
- January 2, 2024
Depression Screen Mnemonic
SIGECAPS: sleep, interest, guilt, energy, concentration, appetite, psychomotor, suicidality
Sleep changesInterest lossGuilt feelingsEnergy lossConcentration problemsAppetite changePsychomotor changesSuicidal ideation
Preventive Screening Start Ages
- Average-risk colon cancer→Start screening at 45
- Average-risk breast cancer→Start mammography at 40
- Cervical cancer screening→Start at age 21
- Heavy smoker, ages 50-80→Annual low-dose CT
- Postmenopausal woman, 65 plus→Order DEXA scan
- Overweight adult, ages 35-70→Screen for diabetes
Pediatric Developmental Milestones
- 2 months
- Social smile appears
- 4 months
- Rolls over, laughs
- 6 months
- Sits unsupported, babbles
- 9 months
- Pulls to stand
- 12 months
- First words, walks alone
- 18 months
- Runs, 10-25 word vocabulary
Melanoma ABCDE Mnemonic
ABCDE: asymmetry, border, color, diameter, evolution
Asymmetry irregular shapeBorder ragged edgesColor varies withinDiameter over 6mmEvolution over time
USPSTF Screening Guidelines
- Colorectal cancer
- Screening starts age 45USPSTF
- Breast mammography
- Biennial, ages 40-74
- Cervical cancer
- Screening starts age 21
- Lung cancer LDCT
- Ages 50-80, 20 pack-years
- AAA screening
- Men 65-75 who smoked
- Diabetes screening
- Overweight adults ages 35-70
- Depression screening
- All adults, use PHQ-9
Focused History Mnemonic
SAMPLE: symptoms, allergies, meds, past history, last meal, events
Symptoms onsetAllergies knownMedications currentPast historyLast oral intakeEvents leading up
Mental Health Screening Tools
- PHQ-9
- Depression severity screen
- GAD-7
- Anxiety severity screen
- CAGE
- Alcohol use screening tool
- Edinburgh scale
- Postpartum depression screening tool
Type 1 vs Type 2 Diabetes
Type 1
- Autoimmune beta-cell destruction
- Always needs insulin
- Often younger onset
Type 2
- Insulin resistance dominant
- Oral agents first-line
- Often adult onset
Absolute vs relative insulin
HTN Diagnostic Categories
- Normal
- <120/80 mmHgACC/AHA 2017
- Elevated
- 120-129/<80 mmHg
- Stage 1
- 130-139/80-89 mmHg
- Stage 2
- ≥140/90 mmHg
- HTN crisis
- >180/120 mmHg
IFG vs IGT Prediabetes
IFG
- Fasting glucose 100-125
- Uses fasting glucose test
IGT
- 2-hour OGTT 140-199
- Uses post-load glucose test
Fasting vs post-load test
Diabetes Diagnostic Criteria
- A1C diabetes
- ≥6.5% confirms diagnosisADA 2026
- Fasting glucose
- ≥126 mg/dL fasting
- 2-hr OGTT
- ≥200 mg/dL diabetes
- Random glucose
- ≥200 plus classic symptoms
- Prediabetes A1C
- 5.7-6.4% range
- IFG
- Fasting 100-125 mg/dL
Cystitis vs Pyelonephritis
Cystitis
- Dysuria and frequency only
- No fever or flank pain
- Oral outpatient therapy
Pyelonephritis
- Fever and flank pain
- Systemic illness signs
- May need IV therapy
Local vs systemic infection
Infection Diagnostic Clues
- Centor criteria
- Predicts bacterial strep pharyngitis
- UTI dipstick
- Nitrites plus leukocyte esterase
- Pyelonephritis sign
- Fever plus flank pain
- Pneumonia sign
- Focal crackles, consolidation
- Mono triad
- Fever, pharyngitis, adenopathy
Primary vs Subclinical Hypothyroidism
Primary hypothyroid
- TSH is high
- Free T4 is low
Subclinical hypothyroid
- TSH is high
- Free T4 is normal
Free T4 level decides
Acute Injury Care Mnemonic
RICE: rest, ice, compression, elevation
Rest the jointIce 20 minutesCompress with wrapElevate the limb
JNC8 vs ACC/AHA HTN Targets
JNC8 (2014)
- Goal under 60 is 140/90
- Goal 60 plus is 150/90
ACC/AHA (2017)
- Goal is under 130/80
- Redefines stage 1 at 130/80
Older vs newer thresholds
HTN Drug Selection Picker
- Black patient, no CKD→Thiazide or CCB
- CKD, any race→ACEi or ARB preferred
- Diabetes plus albuminuria→ACEi or ARB
- Pregnant and hypertensive→Labetalol or nifedipine
- Stage 2 hypertension→Start two-drug combo
- Resistant hypertension→Add spironolactone
HTN Treatment Targets
- ACC/AHA goal
- <130/80 for most adults
- JNC8, age under 60
- <140/90 goal
- JNC8, age 60 plus
- <150/90 goal
- Diabetes plus HTN
- <130/80 per ADA
- CKD plus HTN
- ACEi or ARB preferred
Purulent vs Non-Purulent Cellulitis
Non-purulent
- No abscess or drainage
- Likely strep cause
- Cephalexin first-line
Purulent
- Abscess or drainage present
- Likely MRSA cause
- TMP-SMX or doxycycline
Drainage presence changes coverage
Antibiotic Selection Picker
- Uncomplicated cystitis→Nitrofurantoin, 5 days
- UTI, pregnant, near term→Avoid nitrofurantoin
- Strep-positive pharyngitis→Penicillin or amoxicillin
- Penicillin allergy→Cephalexin or azithromycin
- Acute bacterial sinusitis→Amoxicillin-clavulanate
- Purulent cellulitis, MRSA risk→TMP-SMX or doxycycline
HTN First-Line Drug Classes
- Black patients, no CKD
- Thiazide or CCB first
- CKD, any race
- ACEi or ARB first
- Diabetes plus albuminuria
- ACEi or ARB preferred
- ACEi suffix
- Drug names ending -pril
- ARB suffix
- Drug names ending -sartan
Pap Alone vs Co-Testing Schedule
Ages 21 to 29
- Cytology alone accepted
- Repeat every 3 years
Ages 30 to 65
- Cytology plus HPV co-test
- Repeat every 5 years
Age adds HPV co-testing
Diabetes Management (ADA)
- First-line drug
- Metformin, unless contraindicated
- A1C goal, most adults
- <7% target
- A1C goal, low risk
- <6.5% may be appropriate
- ASCVD or CKD
- Add GLP-1 RA or SGLT2i
- Statin start age
- 40 to 75 years
- BP goal with diabetes
- <130/80 per ADA 2026
Childhood Immunization Schedule
- Birth dose
- Hepatitis B vaccine
- 2, 4, 6 months
- DTaP, IPV, Hib, PCV
- 12-15 months
- MMR, Varicella, Hepatitis A
- 4-6 years
- DTaP, IPV, MMR boosters
- 11-12 years
- Tdap, HPV, MenACWY
- RSV prevention
- Nirsevimab for eligible infants
Adult and Pregnancy Immunizations
- Td/Tdap booster
- Every 10 years
- Shingles vaccine
- Age 50 plus, 2 doses
- Pneumococcal vaccine
- All adults 50+, or risk
- Pregnancy Tdap
- Give 27 to 36 weeks
Women's Health Screening and Care
- Pap alone, ages 21-29
- Every 3 years
- Co-testing, ages 30-65
- Every 5 years
- Stop screening
- Age 65 with adequate history
- Chlamydia screening
- Sexually active women under 25
- First prenatal visit
- 6 to 8 weeks
- GDM screening
- 24 to 28 weeks gestation
First-Line Antibiotic Choices
- Uncomplicated cystitis
- Nitrofurantoin for 5 days
- Strep pharyngitis
- Penicillin or amoxicillin, 10 days
- Acute otitis media
- High-dose amoxicillin first
- Bacterial sinusitis
- Amoxicillin-clavulanate first line
- Non-purulent cellulitis
- Cephalexin first-line choice
- MRSA-risk cellulitis
- TMP-SMX or doxycycline
Pregnancy Drug Safety
- Avoid, cardiac drugs
- ACE inhibitors, ARBs, statins
- Avoid, antibiotics
- Tetracyclines, fluoroquinolones
- Safe UTI drug
- Nitrofurantoin, avoid near term
- Safe HTN drugs
- Labetalol, nifedipine, methyldopa
Follow-Up and Monitoring Intervals
- New antihypertensive
- Recheck in 2-4 weeks
- A1C monitoring
- Every 3 months, uncontrolled
- Stable diabetes
- A1C every 6 months
- Statin therapy
- Lipid panel in 4-12 weeks
- Antibiotic failure
- Reassess at 48 to 72 hours
Treatment Response Red Flags
- BP still uncontrolled
- Add a second agent
- Persistent proteinuria
- Refer to nephrology
- Growth faltering
- Refer to pediatric specialist
- No improvement, 72 hours
- Reassess or broaden antibiotic
- Worsening dyspnea
- Escalate care urgently
Common Traps
JNC8 goal ≠ ACC/AHA goal
JNC8 allows 150/90 after 60 ≠ ACC/AHA targets under 130/80
Pretest questions ≠ scored questions
15 pretest items unscored ≠ 135 scored items count
Type 1 DM ≠ Type 2 DM
Type 1 always needs insulin ≠ Type 2 starts oral agents
Cystitis ≠ pyelonephritis
Cystitis has no fever ≠ Pyelonephritis has flank pain
IFG ≠ IGT prediabetes
IFG uses fasting glucose ≠ IGT uses 2-hour OGTT
Nitrofurantoin ≠ safe near term
Avoid after 36 weeks ≠ Risk of hemolytic anemia
AANPCB domains ≠ ANCC domains
AANPCB uses four domains ≠ ANCC uses five domains
Last Minute
- 1.150 questions, 135 scored
- 2.3 hours, pass score 500
- 3.Assess 32%, Diagnose 26.5%
- 4.Plan 26.5%, Evaluate 15%
- 5.ACC/AHA goal: under 130/80
- 6.Metformin first-line for diabetes
- 7.Colon cancer screening starts 45
- 8.Nitrofurantoin treats uncomplicated UTI
- 9.Pap co-testing starts age 30
- 10.HPV vaccine given ages 11-12
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