ELITE TEST BANK:
HAM’S PRIMARY CARE
GERIATRICS (v9.0)
PART 0: THE NAVIGATOR
● PART I: THE PRIMER
○ The "Welcome to the Big Leagues" Hook
○ The "Critical Action" Cheat Sheet
● PART II: THE ELITE TEST BANK
○ Section 1: Foundational Syntax & Application (Questions 1–28)
■ Focus: 2026 AGS Beers Criteria, ADA 2026 Updates, GOLD 2026
Guidelines, AHA PREVENT Equation, Alzheimer's 2026 Protocols,
Foundational Geriatric Syndromes.
○ Section 2: Professional Simulation (Questions 29–58)
■ Focus: Ham’s Case Studies (Delirium, Dementia, Palliative Care), G2211
Billing Protocols, UT Health Houston 4Ms Protocols, Geriatric Emergency
Triage.
○ Section 3: Grandmaster Synthesis (Questions 59–88)
■ Focus: Complex Multimorbidity, Prescribing Cascades, High-Stakes
Diagnostic Triage, End-of-Life Ethical Frameworks.
PART I: THE PRIMER
The "Welcome to the Big Leagues" Hook Novice practitioners memorize isolated facts; elite
geriatric primary care providers recognize complex, overlapping patterns of physiological
decline. This test bank intercepts high-stakes errors—such as misinterpreting the 2026 AGS
Beers Criteria Alternatives List or failing to apply the updated AHA PREVENT equation—forging
you into a practitioner whose clinical intuition extends life, preserves cognition, and protects
vulnerable patients from iatrogenic harm.
The "Critical Action" Cheat Sheet
● The 2026 Beers Mandate: Never stop at "Do Not Prescribe." You must implement the
Alternatives List (e.g., Cognitive Behavioral Therapy for Insomnia over zolpidem;
Apixaban over Warfarin).
● The PREVENT Paradigm: The Pooled Cohort Equations (PCE) are obsolete. Calculate
ASCVD risk using the AHA PREVENT equation, integrating eGFR, UACR, and the Social
Deprivation Index (SDI). Race is mathematically eliminated.
● The G2211 Home Field Advantage: As of 2026, append the G2211 complexity add-on
code to home/residence E/M codes (99341–99350) for longitudinal geriatric care.
, ● The Alzheimer's MRI Rule: For patients on Lecanemab, the 2026 FDA protocol
mandates safety MRIs prior to infusions 3, 5, 7, and 14 to monitor for ARIA.
Clinical Framework 2026/2027 Elite Standard Foundational Logic
AHA PREVENT Risk Integrates eGFR, UACR, SDI. Removes structural racial bias;
accurately assesses 10/30-year
risk.
ADA Diabetes Care Target <140/90 mmHg for frail Prevents fatal orthostatic
elders. hypotension and falls.
AGS Beers Criteria Focus on "Alternatives List". Provides actionable,
non-pharmacological
scaffolding before
deprescribing.
Medicare G2211 Add-on for longitudinal home Compensates for the heavy
care. cognitive burden of complex
geriatric management.
UT Houston 4Ms Mentation, Mobility, Medication, Aligns evidence-based geriatric
What Matters. care with the patient's ultimate
life goals.
PART II: THE ELITE TEST BANK
Section 1: Foundational Syntax & Application
Q1: An 81-year-old client reports chronic primary insomnia. According to the 2026 AGS Beers
Criteria Alternatives List, which intervention is the FIRST appropriate action? A) Prescribe
zolpidem 5mg PO at bedtime. B) Initiate Cognitive Behavioral Therapy for Insomnia (CBT-I). C)
Recommend over-the-counter diphenhydramine 25mg. D) Prescribe lorazepam 0.5mg PO at
bedtime.
● The Answer: B (Initiate Cognitive Behavioral Therapy for Insomnia.)
● Distractor Analysis:
○ A, C, and D are incorrect: The 2026 Beers Criteria shifted from simply avoiding
"Z-drugs," antihistamines, and benzodiazepines to mandating actionable
non-pharmacologic scaffolding first. These distractors dramatically increase delirium
and fall risk.
The Mentor's Analysis: Sleep architecture degrades with age. Masking this with sedatives
guarantees a hip fracture. The 2026 standard replaces chemical suppression with behavioral
realignment. Always build the behavioral scaffold before writing the prescription.
Q2: A 76-year-old patient with atrial fibrillation requires anticoagulation. Based on the 2026 AGS
Beers Criteria, which medication is the MOST APPROPRIATE choice? A) Warfarin, titrated to
an INR of 2.0-3.0. B) Rivaroxaban 20mg daily. C) Apixaban 5mg twice daily. D) Clopidogrel
75mg daily.
● The Answer: C (Apixaban 5mg twice daily.)
● Distractor Analysis:
○ A and B are incorrect: The 2026 guidelines explicitly prefer DOACs—specifically
apixaban—over warfarin and rivaroxaban due to a significantly lower risk of major
bleeding in older adults.
○ D is incorrect: Clopidogrel is an antiplatelet, insufficient for AFib stroke prevention.
The Mentor's Analysis: The geriatric vascular system is fragile. Warfarin requires impossible
, dietary consistency, and rivaroxaban has unfavorable bleeding profiles in the elderly. Apixaban
represents the pinnacle of current risk-to-benefit ratios in geriatric cardiology.
Q3: You are assessing a 72-year-old client’s 10-year ASCVD risk. Under 2026 standards, which
variables MUST be included in the AHA PREVENT equation? A) Race, total cholesterol, and
age. B) Social Deprivation Index (SDI), eGFR, and Urine Albumin-to-Creatinine Ratio (UACR).
C) BMI, race, and serum creatinine. D) Fasting glucose, race, and family history.
● The Answer: B (Social Deprivation Index, eGFR, and Urine Albumin-to-Creatinine Ratio.)
● Distractor Analysis:
○ A, C, and D are incorrect: The 2026 PREVENT equation strictly removes
race-based coefficients to eliminate structural bias, replacing them with precise
renal metrics (eGFR/UACR) and socioeconomic data (SDI).
The Mentor's Analysis: Cardiovascular risk is not just about lipids; it is about end-organ
microvascular health and zip codes. The inclusion of SDI and UACR forces the clinician to treat
the social determinants of health alongside the kidneys.
Q4: A frail 84-year-old patient with type 2 diabetes has a blood pressure of 138/88 mmHg.
According to the 2026 ADA Standards of Care, what is the MOST APPROPRIATE action? A)
Immediately initiate a thiazide diuretic to achieve a target of <120/80 mmHg. B) Maintain current
therapy, as the target for highly frail older adults is <140/90 mmHg. C) Add a beta-blocker to
reduce systolic pressure below 110 mmHg. D) Restrict dietary sodium to 1000mg daily.
● The Answer: B (Maintain current therapy, as the target for highly frail older adults is
<140/90 mmHg.)
● Distractor Analysis:
○ A and C are incorrect: While the 2026 ADA guidelines push for <130/80 mmHg in
healthy older adults, they explicitly state that a looser target of <140/90 mmHg is
required for individuals with poor health or limited life expectancy to prevent
orthostatic falls.
○ D is incorrect: Extreme sodium restriction in frail elders causes fatal hyponatremia.
The Mentor's Analysis: A "perfect" blood pressure reading means nothing if the patient falls
and shatters their pelvis due to orthostatic hypotension. In geriatrics, safety supersedes strict
physiological metrics.
Q5: According to the 2026 GOLD COPD Guidelines, an older adult who experiences exactly
one moderate exacerbation prior to initiating maintenance therapy should IMMEDIATELY be
considered for: A) Step-down therapy to Short-Acting Beta Agonists (SABA) only. B) Treatment
escalation to prevent subsequent events. C) Oral corticosteroid monotherapy. D) Palliative
hospice care.
● The Answer: B (Treatment escalation to prevent subsequent events.)
● Distractor Analysis:
○ A is incorrect: SABA monotherapy is obsolete in modern COPD management.
○ C is incorrect: Oral steroids are for acute rescue, not maintenance.
○ D is incorrect: One exacerbation does not equal terminal decline. The 2026 GOLD
update explicitly adjusted criteria so that a single moderate exacerbation triggers
escalation.
The Mentor's Analysis: We no longer wait for the patient's lungs to fail twice. The 2026 GOLD
updates reflect proactive defense. One strike means the airway is unstable; escalate the
bronchodilator therapy immediately.
Q6: A 68-year-old client with obesity and newly diagnosed Type 1 Diabetes asks about weight
loss management. Under the 2026 ADA Standards of Care, which is the MOST APPROPRIATE
initial consideration? A) Strict avoidance of all GLP-1 receptor agonists. B) Evaluation for GLP-1
HAM’S PRIMARY CARE
GERIATRICS (v9.0)
PART 0: THE NAVIGATOR
● PART I: THE PRIMER
○ The "Welcome to the Big Leagues" Hook
○ The "Critical Action" Cheat Sheet
● PART II: THE ELITE TEST BANK
○ Section 1: Foundational Syntax & Application (Questions 1–28)
■ Focus: 2026 AGS Beers Criteria, ADA 2026 Updates, GOLD 2026
Guidelines, AHA PREVENT Equation, Alzheimer's 2026 Protocols,
Foundational Geriatric Syndromes.
○ Section 2: Professional Simulation (Questions 29–58)
■ Focus: Ham’s Case Studies (Delirium, Dementia, Palliative Care), G2211
Billing Protocols, UT Health Houston 4Ms Protocols, Geriatric Emergency
Triage.
○ Section 3: Grandmaster Synthesis (Questions 59–88)
■ Focus: Complex Multimorbidity, Prescribing Cascades, High-Stakes
Diagnostic Triage, End-of-Life Ethical Frameworks.
PART I: THE PRIMER
The "Welcome to the Big Leagues" Hook Novice practitioners memorize isolated facts; elite
geriatric primary care providers recognize complex, overlapping patterns of physiological
decline. This test bank intercepts high-stakes errors—such as misinterpreting the 2026 AGS
Beers Criteria Alternatives List or failing to apply the updated AHA PREVENT equation—forging
you into a practitioner whose clinical intuition extends life, preserves cognition, and protects
vulnerable patients from iatrogenic harm.
The "Critical Action" Cheat Sheet
● The 2026 Beers Mandate: Never stop at "Do Not Prescribe." You must implement the
Alternatives List (e.g., Cognitive Behavioral Therapy for Insomnia over zolpidem;
Apixaban over Warfarin).
● The PREVENT Paradigm: The Pooled Cohort Equations (PCE) are obsolete. Calculate
ASCVD risk using the AHA PREVENT equation, integrating eGFR, UACR, and the Social
Deprivation Index (SDI). Race is mathematically eliminated.
● The G2211 Home Field Advantage: As of 2026, append the G2211 complexity add-on
code to home/residence E/M codes (99341–99350) for longitudinal geriatric care.
, ● The Alzheimer's MRI Rule: For patients on Lecanemab, the 2026 FDA protocol
mandates safety MRIs prior to infusions 3, 5, 7, and 14 to monitor for ARIA.
Clinical Framework 2026/2027 Elite Standard Foundational Logic
AHA PREVENT Risk Integrates eGFR, UACR, SDI. Removes structural racial bias;
accurately assesses 10/30-year
risk.
ADA Diabetes Care Target <140/90 mmHg for frail Prevents fatal orthostatic
elders. hypotension and falls.
AGS Beers Criteria Focus on "Alternatives List". Provides actionable,
non-pharmacological
scaffolding before
deprescribing.
Medicare G2211 Add-on for longitudinal home Compensates for the heavy
care. cognitive burden of complex
geriatric management.
UT Houston 4Ms Mentation, Mobility, Medication, Aligns evidence-based geriatric
What Matters. care with the patient's ultimate
life goals.
PART II: THE ELITE TEST BANK
Section 1: Foundational Syntax & Application
Q1: An 81-year-old client reports chronic primary insomnia. According to the 2026 AGS Beers
Criteria Alternatives List, which intervention is the FIRST appropriate action? A) Prescribe
zolpidem 5mg PO at bedtime. B) Initiate Cognitive Behavioral Therapy for Insomnia (CBT-I). C)
Recommend over-the-counter diphenhydramine 25mg. D) Prescribe lorazepam 0.5mg PO at
bedtime.
● The Answer: B (Initiate Cognitive Behavioral Therapy for Insomnia.)
● Distractor Analysis:
○ A, C, and D are incorrect: The 2026 Beers Criteria shifted from simply avoiding
"Z-drugs," antihistamines, and benzodiazepines to mandating actionable
non-pharmacologic scaffolding first. These distractors dramatically increase delirium
and fall risk.
The Mentor's Analysis: Sleep architecture degrades with age. Masking this with sedatives
guarantees a hip fracture. The 2026 standard replaces chemical suppression with behavioral
realignment. Always build the behavioral scaffold before writing the prescription.
Q2: A 76-year-old patient with atrial fibrillation requires anticoagulation. Based on the 2026 AGS
Beers Criteria, which medication is the MOST APPROPRIATE choice? A) Warfarin, titrated to
an INR of 2.0-3.0. B) Rivaroxaban 20mg daily. C) Apixaban 5mg twice daily. D) Clopidogrel
75mg daily.
● The Answer: C (Apixaban 5mg twice daily.)
● Distractor Analysis:
○ A and B are incorrect: The 2026 guidelines explicitly prefer DOACs—specifically
apixaban—over warfarin and rivaroxaban due to a significantly lower risk of major
bleeding in older adults.
○ D is incorrect: Clopidogrel is an antiplatelet, insufficient for AFib stroke prevention.
The Mentor's Analysis: The geriatric vascular system is fragile. Warfarin requires impossible
, dietary consistency, and rivaroxaban has unfavorable bleeding profiles in the elderly. Apixaban
represents the pinnacle of current risk-to-benefit ratios in geriatric cardiology.
Q3: You are assessing a 72-year-old client’s 10-year ASCVD risk. Under 2026 standards, which
variables MUST be included in the AHA PREVENT equation? A) Race, total cholesterol, and
age. B) Social Deprivation Index (SDI), eGFR, and Urine Albumin-to-Creatinine Ratio (UACR).
C) BMI, race, and serum creatinine. D) Fasting glucose, race, and family history.
● The Answer: B (Social Deprivation Index, eGFR, and Urine Albumin-to-Creatinine Ratio.)
● Distractor Analysis:
○ A, C, and D are incorrect: The 2026 PREVENT equation strictly removes
race-based coefficients to eliminate structural bias, replacing them with precise
renal metrics (eGFR/UACR) and socioeconomic data (SDI).
The Mentor's Analysis: Cardiovascular risk is not just about lipids; it is about end-organ
microvascular health and zip codes. The inclusion of SDI and UACR forces the clinician to treat
the social determinants of health alongside the kidneys.
Q4: A frail 84-year-old patient with type 2 diabetes has a blood pressure of 138/88 mmHg.
According to the 2026 ADA Standards of Care, what is the MOST APPROPRIATE action? A)
Immediately initiate a thiazide diuretic to achieve a target of <120/80 mmHg. B) Maintain current
therapy, as the target for highly frail older adults is <140/90 mmHg. C) Add a beta-blocker to
reduce systolic pressure below 110 mmHg. D) Restrict dietary sodium to 1000mg daily.
● The Answer: B (Maintain current therapy, as the target for highly frail older adults is
<140/90 mmHg.)
● Distractor Analysis:
○ A and C are incorrect: While the 2026 ADA guidelines push for <130/80 mmHg in
healthy older adults, they explicitly state that a looser target of <140/90 mmHg is
required for individuals with poor health or limited life expectancy to prevent
orthostatic falls.
○ D is incorrect: Extreme sodium restriction in frail elders causes fatal hyponatremia.
The Mentor's Analysis: A "perfect" blood pressure reading means nothing if the patient falls
and shatters their pelvis due to orthostatic hypotension. In geriatrics, safety supersedes strict
physiological metrics.
Q5: According to the 2026 GOLD COPD Guidelines, an older adult who experiences exactly
one moderate exacerbation prior to initiating maintenance therapy should IMMEDIATELY be
considered for: A) Step-down therapy to Short-Acting Beta Agonists (SABA) only. B) Treatment
escalation to prevent subsequent events. C) Oral corticosteroid monotherapy. D) Palliative
hospice care.
● The Answer: B (Treatment escalation to prevent subsequent events.)
● Distractor Analysis:
○ A is incorrect: SABA monotherapy is obsolete in modern COPD management.
○ C is incorrect: Oral steroids are for acute rescue, not maintenance.
○ D is incorrect: One exacerbation does not equal terminal decline. The 2026 GOLD
update explicitly adjusted criteria so that a single moderate exacerbation triggers
escalation.
The Mentor's Analysis: We no longer wait for the patient's lungs to fail twice. The 2026 GOLD
updates reflect proactive defense. One strike means the airway is unstable; escalate the
bronchodilator therapy immediately.
Q6: A 68-year-old client with obesity and newly diagnosed Type 1 Diabetes asks about weight
loss management. Under the 2026 ADA Standards of Care, which is the MOST APPROPRIATE
initial consideration? A) Strict avoidance of all GLP-1 receptor agonists. B) Evaluation for GLP-1
