Facts read from aanpcert.org and 2 more · last checked Nov 7, 2026
Assess is 32% of the scored exam, 43 of 135 items, and the 2024 blueprint enlarged it. Its questions stop short of the diagnosis: which question to ask, which maneuver to perform, which test to order first.
Practice questions
60 questions written to the FNP-C outline; each choice is explained once you pick.
Gather the subjective data: chief complaint, history of present illness, past, family and social history, medications, review of systems.
Examine: choose between a focused and a complete exam, and pick the maneuver that separates two causes.
Test: order, perform or interpret screening and diagnostic tests, including what a result means for this patient.
Typical stems: “Which history detail is most important”, “Which finding best supports”, “Which test is most appropriate first”.
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18 Assess questions from several systems
0 / 18 answered18 questions
Tap an option: why each one is right or wrong appears under it.
Assess · 32%
A 64-year-old man has 6 months of neck stiffness, clumsy hands with trouble buttoning shirts, and an unsteady gait. Examination shows brisk biceps and patellar reflexes, a positive Hoffmann sign, and bilateral upgoing plantar responses. Which is the most appropriate next step?
Hand clumsiness, gait imbalance, hyperreflexia, Hoffmann sign, and Babinski signs are upper motor neuron findings at the cervical cord level; MRI of the cervical spine is the study for suspected cervical myelopathy.
Nerve conduction studies assess peripheral nerves; they will not show cord compression, and the findings here are upper, not lower, motor neuron signs.
Arm findings and a positive Hoffmann sign place the lesion above the lumbar spine; imaging the lumbar spine misses the level.
Progressive myelopathy can worsen with delay and manipulation; starting therapy before imaging defines the compression is the wrong order.
A 50-year-old with a heart rate of 110/min is having a focused cardiac examination. At this rate the two heart sounds are hard to tell apart by rhythm alone. Which technique best identifies S1?
Breath-holding quiets breath sounds but does not tell S1 from S2.
The bell picks up low-pitched sounds such as S3, S4, and the rumble of mitral stenosis; the base is where S2 is louder, so listening there does not label which sound is S1.
S1 occurs at the start of systole, so the sound that coincides with the carotid upstroke is S1; this works even when tachycardia shortens diastole and erases the usual long and short pauses.
Squat-to-stand changes preload and is used to bring out the murmur of hypertrophic cardiomyopathy or mitral valve prolapse, not to identify S1.
A 58-year-old has a pigmented skin lesion being followed over time. Which measurement technique is most accurate?
A ruler measurement of the greatest diameter, recorded at each visit, gives an objective baseline for detecting the evolution that the E of ABCDE refers to.
Visual estimates vary between examiners and visits, so small but important growth is easy to miss.
Comparing a lesion with a coin or pencil eraser is imprecise and cannot document a millimeter change in diameter.
Photographs without a ruler or scale cannot show a true change in size, because distance and zoom vary from one image to the next.
A 60-year-old reports difficulty swallowing. Which test best evaluates cranial nerves IX and X together?
The gag reflex has a glossopharyngeal sensory limb and a vagal motor limb, and palatal elevation with 'ah' tests vagal motor function, so together they test IX and X.
Taste on the anterior two-thirds of the tongue is carried by the facial nerve (CN VII); the glossopharyngeal nerve carries taste from the posterior third.
Shoulder shrug tests the spinal accessory nerve (CN XI), the neighbor most often confused with IX and X.
Tongue protrusion tests the hypoglossal nerve (CN XII); the tongue deviates toward the side of a lesion.
A 40-year-old man reports several relatives with early heart disease. Which format provides the most comprehensive family history?
Limiting the history to living relatives omits deceased family members, whose age and cause of death are often the key to inherited cardiovascular risk.
A list of conditions without who had them and at what age cannot show premature onset (men under 55, women under 65) or an inheritance pattern.
A three-generation pedigree records relatives, ages at onset, and causes of death, which shows inheritance patterns and premature disease.
First-degree relatives alone miss patterns in grandparents, aunts, uncles, and cousins that suggest familial hypercholesterolemia or inherited cardiomyopathy.
A 60-year-old man with obesity has a suspected early diastolic murmur of aortic regurgitation. Which maneuver best accentuates this murmur during auscultation?
Supine positioning moves the heart away from the anterior chest wall and makes a soft basal diastolic murmur harder to hear.
The bell at the apex in the left lateral position brings out mitral stenosis, a low-pitched rumble, not the high-pitched murmur of aortic regurgitation.
Standing after squatting lowers preload and softens regurgitant murmurs; it is used for hypertrophic cardiomyopathy and mitral prolapse.
Sitting up, leaning forward, and holding the breath after exhaling bring the aortic root close to the chest wall, so the faint high-pitched decrescendo murmur of AR is heard with the diaphragm at the left sternal border.
A 24-year-old man reports a heavy feeling in his scrotum. Which examination finding is most concerning for testicular cancer?
Transillumination indicates fluid, as in a hydrocele; a solid tumor does not transilluminate, though a hydrocele can hide one, so the testis still needs examination.
A soft cyst above and behind the testis is a spermatocele in the epididymis, separate from the testis and benign.
A 'bag of worms' that grows on standing is a varicocele, a venous dilation of the pampiniform plexus, not a testicular tumor.
A firm, painless mass that cannot be separated from the testis is cancer until proven otherwise and needs scrotal ultrasound.
A 65-year-old man has a painful vesicular rash in the V1 (ophthalmic) distribution on one side of his forehead. Which examination finding most strongly predicts ocular involvement?
Shallow oral ulcers suggest aphthous ulcers or herpes simplex stomatitis; they do not predict ophthalmic involvement in V1 zoster.
Zoster respects the midline; bilateral facial vesicles suggest another process, such as disseminated infection or a different blistering disorder.
Vesicles on the nasal tip mean the nasociliary branch of V1 is involved; that branch also supplies the eye, so Hutchinson sign predicts ocular zoster and calls for urgent eye evaluation.
A thoracic dermatomal rash is the most common zoster site but says nothing about the eye; it is a different dermatome.
A 38-year-old man has recurrent attacks of severe unilateral orbital pain lasting about an hour, occurring at the same time each night. Which associated feature is most characteristic of the likely diagnosis?
Preferring to lie still in a dark, quiet room is typical of migraine; cluster patients are restless during an attack.
Cluster headache produces strictly one-sided orbital pain with same-side tearing, conjunctival injection, and nasal congestion, and patients pace or rock during attacks.
A visual aura that precedes the headache is a feature of migraine with aura, not of cluster headache.
A 70-year-old man with a long smoking history reports vague abdominal fullness. On examination you palpate a pulsatile mass just left of midline above the umbilicus that expands laterally with each pulse. Which finding does this most suggest?
A pulsatile mass that widens laterally with each beat, in an older man with a smoking history, suggests an abdominal aortic aneurysm, which is confirmed by ultrasound.
A nodular liver edge lies in the right upper quadrant and does not expand laterally with each heartbeat.
A normal aorta in a thin person pulses forward (upward), not side to side; lateral expansion is what separates an aneurysm from transmitted pulsation.
A distended bladder is a midline suprapubic, dull mass, not a pulsatile one above the umbilicus.
A 78-year-old man with several days of poor oral intake has a BUN of 60 mg/dL and creatinine of 2.0 mg/dL, giving a BUN-to-creatinine ratio of 30. How should this pattern be interpreted?
Established acute tubular necrosis usually has a ratio of 10 to 15 and muddy brown casts, because damaged tubules no longer reabsorb urea efficiently.
Aging lowers GFR gradually but does not raise creatinine to 2.0 mg/dL with a high ratio over a few days of poor intake.
A BUN-to-creatinine ratio above 20 after days of poor intake fits prerenal azotemia: urea is reabsorbed along with sodium and water when renal perfusion falls.
Postrenal obstruction can raise the ratio, but nothing in the history (retention, a palpable bladder, hydronephrosis) points to an outlet problem.
A 40-year-old man has 2 days of fever and malaise and you are deciding whether this is a mild self-limited illness or a serious systemic infection. Which reported feature is most concerning for a severe systemic infection?
A dry cough without measured fever points to a mild viral or upper respiratory process, not systemic infection.
Shaking chills (true rigors) with high fever suggest bacteremia and raise the probability of a serious systemic infection that needs urgent evaluation.
Mild myalgia that improves with rest is typical of a self-limited viral illness.
Night or daytime sweats without chills are nonspecific and do not by themselves signal bacteremia.
A 30-year-old is evaluated after a first witnessed generalized convulsion. Which history element is most critical to obtain first?
Caffeine is a minor trigger at most; it does not change how a first seizure is evaluated.
An aura or focal features at onset (one-sided jerking, a rising epigastric sensation) mean focal-onset seizure with spread, which points to a structural brain lesion and shapes the urgency of imaging.
Sleep deprivation can lower the seizure threshold, but it does not identify a structural cause the way a focal onset does.
Family history is useful later in classifying an epilepsy syndrome, but it does not decide the urgent workup of a first convulsion.
A 55-year-old man reports one episode of painless visible hematuria that has now resolved. Which history detail is most important to obtain?
Tobacco and occupational aromatic amines (dye, rubber, leather, and paint work) are the main risk factors for urothelial cancer, the diagnosis that painless visible hematuria in an older adult must exclude.
Exercise and minor trauma can cause transient hematuria, but blaming them in a 55-year-old risks missing a bladder tumor.
Stones usually cause colicky pain; a past stone does not explain painless hematuria or remove the need for a cancer workup.
Dysuria and frequency suggest infection, but visible hematuria in a 55-year-old needs urologic evaluation even if a UTI is found.
A 46-year-old man had a brief loss of consciousness while mowing the lawn. He recovered fully within a minute. Which feature of the history most strongly suggests a cardiac cause of his syncope?
Syncope while urinating is situational reflex syncope, a benign mechanism, especially after alcohol.
Warmth, nausea, and sweating beforehand are the vasovagal prodrome, the hallmark of a reflex (benign) faint.
Fainting after standing still for a long time is classic for vasovagal syncope from venous pooling.
Syncope during exertion without warning suggests an arrhythmia or structural heart disease, such as aortic stenosis or hypertrophic cardiomyopathy, and needs urgent cardiac evaluation.
A 55-year-old man has an acutely swollen, red, exquisitely tender first metatarsophalangeal joint. Which test is most appropriate to confirm the diagnosis?
Punched-out erosions appear only after years of recurrent gout; a first attack usually has a normal radiograph.
Monosodium urate crystals (needle-shaped, negatively birefringent) in joint fluid confirm gout, and the same aspirate excludes septic arthritis.
ESR is elevated in any inflammatory or infected joint and cannot identify the cause.
Serum urate can be normal during an acute gout flare and high in people who never have gout, so it neither confirms nor excludes the diagnosis.
A 72-year-old man has lost 6% of his body weight over 6 months without trying. He reports mild fatigue. Examination is unremarkable, and he is up to date on colorectal cancer screening. Which initial evaluation is most appropriate?
Endoscopy is guided by GI symptoms, anemia, or abnormal tests; he is up to date on colorectal screening and has no GI findings.
PET-CT is not an initial test; it adds cost and false positives when basic tests and the history have not pointed to a cancer.
Tumor markers lack the sensitivity and specificity for screening and are used to follow known cancers, not to find the cause of weight loss.
Unintentional loss of more than 5% of body weight in 6 months starts with a history, an exam, and basic tests (CBC, metabolic panel, TSH, and chest radiograph), which find most causes.
A running total sits here; it fills in after your last pick.
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One patient, step one: what to collect
The patient: a 58-year-old woman started lisinopril for hypertension four months ago. She now reports a dry, tickling cough of six weeks that keeps her awake. The same case runs through all four task pages.
History first: when the cough began relative to the first lisinopril dose, whether it is productive, smoking, reflux symptoms, postnasal drip, wheeze, recent viral illness.
Red flags to ask about: hemoptysis, weight loss, fever or night sweats, dyspnea. Any of them changes the workup.
Examination: vital signs and oxygen saturation, nose and pharynx, lungs for wheeze or crackles.
Tests: none are needed yet if the history fits a drug effect and there are no red flags; a chest radiograph comes in when red flags are present or the cough outlasts the expected course.
Naming the disease. If the stem asks what to assess, a correct diagnosis is still the wrong kind of answer.
The definitive test first. “Initial” usually means the quick, low-risk test; the gold standard is often a distractor.
A test when a maneuver answers it. Bedside exam steps are tested for their own sake; ordering imaging first skips them.
Screening logic for a symptomatic patient. Symptoms call for diagnostic testing, not the screening interval (screening rules).
Sensitivity and specificity reversed. A highly sensitive test that is negative rules a condition out; a highly specific test that is positive rules it in.
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Skin, kidney and EENT findings
Dermatology, renal and genitourinary, and eye, ear, nose and throat items have no page of their own here. Their history and examination questions are part of this page's quiz and the practice test. Children's ear and skin problems are covered on CPNP-PC ENT and allergy and CPNP-PC dermatology.