FNP Mnemonics: 12 Memory Tricks for the AANP and ANCC Exams

History of present illness

“OLDCARTS”

1. OOnset: when and how it started (sudden or gradual)
2. LLocation (and radiation)
3. DDuration: how long, constant or episodic
4. CCharacteristics: quality (sharp, burning, pressure)
5. AAggravating factors
6. RRelieving factors (including what has been tried)
7. TTiming: frequency, time of day, pattern
8. SSeverity (0-10 scale, effect on function)

Use it when: When an item asks which history question to ask next, or which missing detail would most change the differential.

Careful: OLDCARTS has no slot for associated symptoms, and that is often the detail that separates the diagnoses (fever with headache, dyspnea with chest pain), so add it every time. OPQRST is an equivalent list; the exam does not care which one you use.

Valve murmurs by timing

“MR. AS is systolic; MS. AR is diastolic”

1. MRMitral regurgitation: holosystolic at the apex, radiates to the axilla
2. ASAortic stenosis: crescendo-decrescendo at the right upper sternal border, radiates to the carotids
3. MSMitral stenosis: low-pitched diastolic rumble at the apex, often with an opening snap
4. ARAortic regurgitation: high-pitched, blowing early diastolic decrescendo at the left sternal border

Use it when: When a stem describes a murmur's timing, location and radiation and asks for the valve lesion, or for the next step.

Careful: Other lesions are also systolic (VSD, pulmonic stenosis, hypertrophic cardiomyopathy), so check location and maneuvers: an HCM murmur gets louder with Valsalva or standing, while an AS murmur gets softer. Any diastolic murmur is pathologic and needs an echocardiogram.

Adult preventive screening start ages (USPSTF)

“Breasts at 40, colon at 45, lungs at 50, bones and belly at 65”

1. 40Breast: mammography every 2 years, ages 40-74 (2024)
2. 45Colorectal: ages 45-75 (2021)
3. 50Lung: annual low-dose CT, ages 50-80 with a 20 pack-year history who smoke now or quit within 15 years
4. 65Bones and belly: osteoporosis screening for women 65 and older (and younger postmenopausal women at increased risk); one-time AAA ultrasound for men 65-75 who ever smoked

Use it when: When a vignette describes a patient's age, sex and history and asks which screening test is due, or which one is not indicated.

Careful: Answer with USPSTF unless the item names another body; ACS, ACOG and specialty societies differ. Cervical screening (final 2018 USPSTF) is cytology every 3 years at 21-29, then cytology every 3 years, primary hrHPV every 5 years or cotesting every 5 years at 30-65; a 2024 draft adds self-collected HPV. Prostate PSA at 55-69 is an individual decision, not routine.

Building a differential

“VINDICATE”

1. VVascular
2. IInfectious and inflammatory
3. NNeoplastic
4. DDegenerative and drug-induced
5. IIatrogenic, idiopathic, intoxication
6. CCongenital
7. AAutoimmune and allergic
8. TTrauma
9. EEndocrine and metabolic

Use it when: When a presentation fits nothing obvious and you need to generate possibilities, or when an item asks which diagnosis has not been considered.

Careful: VINDICATE widens the list; the exam rewards narrowing it. Rank by most likely for this patient's age and history, then rule out the can't-miss diagnoses first. 'Drug-induced' is the category candidates forget, and FNP items often hinge on a medication side effect.

Headache red flags

“SNOOP”

1. SSystemic symptoms or signs (fever, weight loss) or secondary risk factors (cancer, HIV, immunosuppression, pregnancy)
2. NNeurologic symptoms or signs (focal deficit, confusion, seizure)
3. OOnset sudden: thunderclap, worst headache of life, peak within a minute
4. OOlder age: new headache after 50
5. PPattern change or progression, positional, papilledema, precipitated by Valsalva or exertion

Use it when: When an item asks which headache needs urgent imaging or referral, versus which can be treated as migraine or tension-type.

Careful: A new headache after 50 with jaw claudication or scalp tenderness is giant cell arteritis until proven otherwise: check ESR/CRP and start steroids quickly to protect vision. Thunderclap headache with a normal CT may still need further work-up for subarachnoid hemorrhage.

Strep pharyngitis (Centor with McIsaac age modifier)

“CENTOR”

1. CCough absent: +1
2. EExudate or swelling of the tonsils: +1
3. NNodes: tender, swollen anterior cervical nodes: +1
4. TTemperature above 38 C (100.4 F): +1
5. OROld or young: age 3-14 +1, 15-44 0, 45 and older -1

Use it when: When an item asks whether to test, treat or reassure a patient with sore throat.

Careful: The score decides who to test, not who to treat: a score of 0-1 needs no test; higher scores get a rapid antigen test. IDSA advises a backup throat culture after a negative rapid test in children and adolescents, but not routinely in adults. Treat confirmed strep with penicillin or amoxicillin.

Diabetes diagnostic thresholds (ADA)

“6.5, 126, 200 for diabetes; 5.7, 100, 140 for prediabetes”

Diabetes: A1C 6.5% or higher, fasting plasma glucose 126 mg/dL or higher, 2-hour glucose 200 mg/dL or higher on a 75-g OGTT, or a random glucose of 200 or higher with classic symptoms. Prediabetes starts at A1C 5.7%, fasting glucose 100 mg/dL and 2-hour glucose 140 mg/dL (up to 6.4%, 125 and 199).

Use it when: When a stem gives one or two lab values and asks whether the patient has diabetes, prediabetes, or needs a repeat test.

Careful: Without unequivocal hyperglycemia, the diagnosis needs two abnormal results, from the same sample or two separate samples. A1C is unreliable with anemia, hemoglobinopathies, recent transfusion or pregnancy. ADA screens all adults from 35; USPSTF screens adults 35-70 with overweight or obesity.

First-line antihypertensives (2025 AHA/ACC)

“A, C or D”

1. AACE inhibitor or ARB (never both together)
2. CCalcium channel blocker, long-acting dihydropyridine (amlodipine)
3. DDiuretic, thiazide-type (chlorthalidone, hydrochlorothiazide, indapamide)

Use it when: When an item asks which drug to start for a new hypertensive patient, or which choice suits a comorbidity.

Careful: Beta-blockers are not first line unless there is another indication (heart failure, post-MI, rate control). CKD with albuminuria or diabetes with albuminuria points to an ACE inhibitor or ARB; ACE inhibitors and ARBs are contraindicated in pregnancy. For stage 2 (140/90 or higher) start two first-line drugs, preferably as a single-pill combination. The 2025 guideline uses PREVENT risk with a 7.5% threshold.

ACE inhibitor adverse effects

“CAPTOPRIL”

1. CCough (dry, bradykinin-mediated)
2. AAngioedema
3. PPotassium excess (hyperkalemia)
4. TTaste changes
5. OhypOtension, especially first dose or volume depletion
6. PPregnancy: contraindicated (fetal renal toxicity)
7. RRash
8. IIncreased renin
9. LLower angiotensin II

Use it when: When an item asks which side effect to counsel about, why a patient stopped an ACE inhibitor, or what to switch to.

Careful: For cough, switch to an ARB. Angioedema is a lifelong contraindication to ACE inhibitors and can still occur on an ARB, though less often. Check potassium and creatinine after starting; a creatinine rise of up to about 30% is expected and is not by itself a reason to stop.

Stroke risk in atrial fibrillation

“CHA2DS2-VASc”

1. CCongestive heart failure: 1
2. HHypertension: 1
3. A2Age 75 or older: 2
4. DDiabetes: 1
5. S2Stroke, TIA or thromboembolism history: 2
6. VVascular disease (prior MI, peripheral artery disease, aortic plaque): 1
7. AAge 65-74: 1
8. ScSex category female: 1

Use it when: When an AF patient's history is given and the item asks whether to start anticoagulation and with what.

Careful: The 2023 ACC/AHA AF guideline recommends anticoagulation at a score of 2 or more in men or 3 or more in women; female sex alone is a risk modifier, not a reason to treat. Prefer a DOAC over warfarin except with a mechanical heart valve or moderate-to-severe mitral stenosis. Aspirin is not an alternative for stroke prevention.

When to recheck after a change

“6-8 for thyroid, 3 for sugar, 4-12 for lipids, monthly for pressure”

Recheck TSH 6-8 weeks after starting or changing levothyroxine. Recheck A1C about every 3 months after a therapy change or when not at goal, and at least twice a year when stable at goal. Recheck a lipid panel 4-12 weeks after starting or changing a statin. See a patient with hypertension about monthly after starting or adjusting medication until blood pressure is at goal.

Use it when: When a follow-up item asks when to repeat a lab or visit, or why a result taken too early is misleading.

Careful: Checking too soon is the classic trap: a TSH 2 weeks after a dose change has not reached steady state. Also check potassium and creatinine within a few weeks of starting an ACE inhibitor, ARB or diuretic.

Treatment failure checklist

“The four Ws”

1. WWrong diagnosis: does the picture still fit, or did something new appear?
2. WWrong drug: resistance, wrong spectrum, or a better guideline choice
3. WWrong dose or duration: under-dosed, wrong frequency, stopped early
4. WWon't take it: adherence, cost, side effects, technique (inhalers, insulin)

Use it when: When the patient returns not better and the item asks for the most appropriate next step before escalating therapy.

Careful: The exam usually wants adherence and technique checked before adding a second drug, for example inhaler technique before stepping up asthma therapy, or home blood pressure readings before labeling hypertension resistant. Red-flag worsening needs re-evaluation or referral, not another antibiotic.