PRAC 6531 – PRIMARY CARE OF ADULTS ACROSS THE LIFESPAN PRACTICUM
(QUARTER 5:11 WEEKS) EXAM BANK
1. Preventive Health & Health Maintenance (1–30)
2. Common Acute Conditions (31–60)
3. Chronic Disease Management (61–110)
4. Geriatric Syndromes & Special Populations (111–140)
5. Pharmacology & Prescribing (141–160)
6. Professional Issues & Clinical Reasoning (161–180)
1. A 55-year-old asymptomatic man with no cardiac history presents for a physical
exam. His blood pressure is 128/82 mm Hg. According to USPSTF guidelines, when
should you next screen him for hypertension?
a) In 1 year
b) In 2 years
c) In 3 years
d) In 5 years
Answer: b) In 2 years
*Rationale: The USPSTF recommends annual screening for adults ≥40 years or those at
increased risk, but if BP is <130/85, screening every 2 years is acceptable. This patient is
55 with BP 128/82 (elevated but not hypertensive).*
2. A 68-year-old woman with a 30-pack-year smoking history quit 10 years ago. She has
no respiratory symptoms. When should you next screen for lung cancer with low-dose
CT?
a) Not needed because she quit >5 years ago
b) Annually until age 75
,c) One-time screen at age 70
d) Every 2 years until age 80
Answer: b) Annually until age 75
*Rationale: USPSTF recommends annual LDCT for adults aged 50–80 with a 20+ pack-
year history who currently smoke or quit within the past 15 years. She quit within 15
years, so continue annual screening until age 75.*
3. Which immunization is universally recommended for all adults aged 65 years and
older regardless of prior vaccination status?
a) Pneumococcal polysaccharide vaccine (PPSV23) only
b) Pneumococcal conjugate vaccine (PCV20) as a single dose
c) Both PCV13 and PPSV23 one year apart
d) PCV13 followed by PPSV23 at least 8 weeks apart
Answer: b) Pneumococcal conjugate vaccine (PCV20) as a single dose
Rationale: ACIP now recommends either PCV20 alone or PCV15 followed by PPSV23 for
all adults ≥65. A single dose of PCV20 is the preferred simplified schedule.
4. A 72-year-old male with osteoporosis and no prior fractures asks about calcium
supplementation. What is the current recommendation?
a) Avoid calcium entirely due to cardiovascular risk
b) Aim for 1200 mg/day from diet and supplements combined
c) Supplement 1500 mg/day regardless of diet
d) Only vitamin D is needed after age 70
Answer: b) Aim for 1200 mg/day from diet and supplements combined
*Rationale: The NIH recommends 1200 mg/day of calcium for women >50 and men
>70. Diet is preferred, but supplements can fill gaps. High-dose supplements (>1500
mg) may increase kidney stone and possibly CVD risk.*
5. What is the preferred screening test for colorectal cancer in an average-risk 58-year-
old patient who declines colonoscopy?
,a) Flexible sigmoidoscopy every 10 years
b) Fecal immunochemical test (FIT) annually
c) CT colonography every 3 years
d) Carcinoembryonic antigen (CEA) blood test yearly
Answer: b) Fecal immunochemical test (FIT) annually
Rationale: FIT annually is an acceptable alternative to colonoscopy. Sigmoidoscopy is
every 5 years, not 10. CEA is not a screening test. CT colonography every 5 years is
another option but less accessible.
6. A 45-year-old woman has a 10-year ASCVD risk of 12%. Her LDL is 135 mg/dL.
According to ACC/AHA guidelines, what is the next appropriate step?
a) Start high-intensity statin
b) Start moderate-intensity statin
c) Recommend lifestyle changes only
d) Order coronary artery calcium (CAC) score
Answer: b) Start moderate-intensity statin
*Rationale: For primary prevention with LDL 70–189 and 10-year risk ≥7.5%, a
moderate-intensity statin is recommended. High-intensity statin is for risk ≥20% or
established CVD. CAC scoring is for risk-based decision uncertainty (e.g., borderline 5–
7.5%).*
7. A 66-year-old woman had a DEXA scan with T-score -2.8 at the femoral neck. She has
no prior fractures. What is the most appropriate pharmacologic treatment?
a) Calcium and vitamin D alone
b) Raloxifene
c) Alendronate
d) Teriparatide
Answer: c) Alendronate
*Rationale: T-score ≤ -2.5 meets criteria for osteoporosis. First-line therapy is a
, bisphosphonate (alendronate, risedronate, or zoledronic acid). Teriparatide is for severe
cases or bisphosphonate failure. Raloxifene is second-line.*
8. When should screening for abdominal aortic aneurysm (AAA) with ultrasound be
performed in a 68-year-old man who has never smoked?
a) Not indicated because he never smoked
b) One-time screen between 65–75 if ever smoked
c) One-time screen at age 68 regardless of smoking history
d) Every 5 years from age 65 onward
Answer: a) Not indicated because he never smoked
*Rationale: USPSTF recommends one-time AAA screening in men aged 65–75 with a
smoking history. Never-smokers have an extremely low incidence and do not need
routine screening.*
9. A 60-year-old female with hypertension and no CVD has an ankle-brachial index (ABI)
of 0.9. What is the most appropriate next step?
a) Repeat ABI in 2 years
b) Start aspirin and statin
c) Order lower extremity angiography
d) Refer for vascular surgery
Answer: b) Start aspirin and statin
Rationale: ABI 0.9 indicates borderline PAD. Even asymptomatic, this confers increased
CVD risk. Guidelines recommend antiplatelet therapy (aspirin) and statin for
cardiovascular risk reduction.
10. Which one-time screening is recommended by the USPSTF for hepatitis C in adults?
a) All adults aged 18–79 regardless of risk
b) Only those with known risk factors (IV drug use, transfusion before 1992)
c) All adults aged 50 and older
d) Only those born between 1945–1965
(QUARTER 5:11 WEEKS) EXAM BANK
1. Preventive Health & Health Maintenance (1–30)
2. Common Acute Conditions (31–60)
3. Chronic Disease Management (61–110)
4. Geriatric Syndromes & Special Populations (111–140)
5. Pharmacology & Prescribing (141–160)
6. Professional Issues & Clinical Reasoning (161–180)
1. A 55-year-old asymptomatic man with no cardiac history presents for a physical
exam. His blood pressure is 128/82 mm Hg. According to USPSTF guidelines, when
should you next screen him for hypertension?
a) In 1 year
b) In 2 years
c) In 3 years
d) In 5 years
Answer: b) In 2 years
*Rationale: The USPSTF recommends annual screening for adults ≥40 years or those at
increased risk, but if BP is <130/85, screening every 2 years is acceptable. This patient is
55 with BP 128/82 (elevated but not hypertensive).*
2. A 68-year-old woman with a 30-pack-year smoking history quit 10 years ago. She has
no respiratory symptoms. When should you next screen for lung cancer with low-dose
CT?
a) Not needed because she quit >5 years ago
b) Annually until age 75
,c) One-time screen at age 70
d) Every 2 years until age 80
Answer: b) Annually until age 75
*Rationale: USPSTF recommends annual LDCT for adults aged 50–80 with a 20+ pack-
year history who currently smoke or quit within the past 15 years. She quit within 15
years, so continue annual screening until age 75.*
3. Which immunization is universally recommended for all adults aged 65 years and
older regardless of prior vaccination status?
a) Pneumococcal polysaccharide vaccine (PPSV23) only
b) Pneumococcal conjugate vaccine (PCV20) as a single dose
c) Both PCV13 and PPSV23 one year apart
d) PCV13 followed by PPSV23 at least 8 weeks apart
Answer: b) Pneumococcal conjugate vaccine (PCV20) as a single dose
Rationale: ACIP now recommends either PCV20 alone or PCV15 followed by PPSV23 for
all adults ≥65. A single dose of PCV20 is the preferred simplified schedule.
4. A 72-year-old male with osteoporosis and no prior fractures asks about calcium
supplementation. What is the current recommendation?
a) Avoid calcium entirely due to cardiovascular risk
b) Aim for 1200 mg/day from diet and supplements combined
c) Supplement 1500 mg/day regardless of diet
d) Only vitamin D is needed after age 70
Answer: b) Aim for 1200 mg/day from diet and supplements combined
*Rationale: The NIH recommends 1200 mg/day of calcium for women >50 and men
>70. Diet is preferred, but supplements can fill gaps. High-dose supplements (>1500
mg) may increase kidney stone and possibly CVD risk.*
5. What is the preferred screening test for colorectal cancer in an average-risk 58-year-
old patient who declines colonoscopy?
,a) Flexible sigmoidoscopy every 10 years
b) Fecal immunochemical test (FIT) annually
c) CT colonography every 3 years
d) Carcinoembryonic antigen (CEA) blood test yearly
Answer: b) Fecal immunochemical test (FIT) annually
Rationale: FIT annually is an acceptable alternative to colonoscopy. Sigmoidoscopy is
every 5 years, not 10. CEA is not a screening test. CT colonography every 5 years is
another option but less accessible.
6. A 45-year-old woman has a 10-year ASCVD risk of 12%. Her LDL is 135 mg/dL.
According to ACC/AHA guidelines, what is the next appropriate step?
a) Start high-intensity statin
b) Start moderate-intensity statin
c) Recommend lifestyle changes only
d) Order coronary artery calcium (CAC) score
Answer: b) Start moderate-intensity statin
*Rationale: For primary prevention with LDL 70–189 and 10-year risk ≥7.5%, a
moderate-intensity statin is recommended. High-intensity statin is for risk ≥20% or
established CVD. CAC scoring is for risk-based decision uncertainty (e.g., borderline 5–
7.5%).*
7. A 66-year-old woman had a DEXA scan with T-score -2.8 at the femoral neck. She has
no prior fractures. What is the most appropriate pharmacologic treatment?
a) Calcium and vitamin D alone
b) Raloxifene
c) Alendronate
d) Teriparatide
Answer: c) Alendronate
*Rationale: T-score ≤ -2.5 meets criteria for osteoporosis. First-line therapy is a
, bisphosphonate (alendronate, risedronate, or zoledronic acid). Teriparatide is for severe
cases or bisphosphonate failure. Raloxifene is second-line.*
8. When should screening for abdominal aortic aneurysm (AAA) with ultrasound be
performed in a 68-year-old man who has never smoked?
a) Not indicated because he never smoked
b) One-time screen between 65–75 if ever smoked
c) One-time screen at age 68 regardless of smoking history
d) Every 5 years from age 65 onward
Answer: a) Not indicated because he never smoked
*Rationale: USPSTF recommends one-time AAA screening in men aged 65–75 with a
smoking history. Never-smokers have an extremely low incidence and do not need
routine screening.*
9. A 60-year-old female with hypertension and no CVD has an ankle-brachial index (ABI)
of 0.9. What is the most appropriate next step?
a) Repeat ABI in 2 years
b) Start aspirin and statin
c) Order lower extremity angiography
d) Refer for vascular surgery
Answer: b) Start aspirin and statin
Rationale: ABI 0.9 indicates borderline PAD. Even asymptomatic, this confers increased
CVD risk. Guidelines recommend antiplatelet therapy (aspirin) and statin for
cardiovascular risk reduction.
10. Which one-time screening is recommended by the USPSTF for hepatitis C in adults?
a) All adults aged 18–79 regardless of risk
b) Only those with known risk factors (IV drug use, transfusion before 1992)
c) All adults aged 50 and older
d) Only those born between 1945–1965
