Barkley DRT 1 - Barkley Post Test -
Practice Exam Newest Version 100%
Actual Test Review Solution
Question 1: A 62-year-old male comes to your office with concerns about a
general feeling of dizziness and lightheadedness. He states that he has been feeling
a pulsating pain right below the base of his skull; this pain often occurs early in the
morning and resolves throughout the day. If the patient’s condition is
cardiovascular in nature, his findings would be indicative of which of the following
conditions?
A. Aortic Stenosis
B. Hypertension
C. Angina
D. Myocardial Infarction
Rationale: Morning occipital headaches that are pulsating and improve during the
day are a classic (though not sensitive) sign of hypertension. Elevated blood
pressure in the early morning due to circadian rhythm can cause these headaches.
Question 2: Under which of the following circumstances can a nurse practitioner
seek the full physician fee when filing reimbursement under Medicare?
A. The physician is across town at a meeting but gives the nurse practitioner verbal
permission over the phone to initiate services.
B. With the physician’s direct oversight, the nurse practitioner administers
and reads an EKG for a patient with heart failure, a service that is normally
part of the physician’s bill for similar services.
C. After the presiding physician initiates services, the nurse practitioner continues
care for the patient and files for reimbursement under his own provider.
D. The nurse practitioner is in the same hospital as the presiding physician when
providing physician services to the patient.
,Rationale: For a service to be billed under the full physician fee, it must be
performed under direct supervision, meaning the physician is present in the same
office suite and immediately available. Option B describes direct oversight.
Question 3: A 55-year-old female presents with progressive shortness of breath on
exertion, fatigue, and a systolic ejection murmur at the right upper sternal border
that radiates to the carotids. Her pulse is slow-rising. What is the most likely
diagnosis?
A. Mitral regurgitation
B. Aortic stenosis
C. Hypertrophic cardiomyopathy
D. Pulmonary stenosis
Rationale: The classic triad of aortic stenosis is syncope, angina, and dyspnea.
Physical exam shows a late-peaking systolic murmur, slow-rising carotid upstroke
(pulsus parvus et tardus), and often a sustained apical impulse.
Question 4: A 45-year-old man with hypertension and diabetes has a blood
pressure of 148/92 mmHg in the clinic despite taking lisinopril 20 mg daily. His
home readings average 135/85. Which of the following is the best next step?
A. Double the lisinopril dose
B. Add amlodipine 5 mg daily
C. Switch to losartan
D. Order a 24-hour ambulatory blood pressure monitor
Rationale: For patients with diabetes and hypertension, target BP <130/80.
Adding a calcium channel blocker (amlodipine) is an appropriate second agent.
Home readings confirm true hypertension. A 24-hour monitor could be considered
but adding medication is reasonable.
Question 5: A 30-year-old woman presents with fatigue, arthralgias, malar rash,
and oral ulcers. Laboratory tests show ANA positive, anti-dsDNA positive, and
low C3. What is the most appropriate initial treatment for her arthritis and rash?
,A. Methotrexate
B. Hydroxychloroquine
C. Prednisone 60 mg daily
D. Cyclophosphamide
Rationale: Hydroxychloroquine is first-line for mild to moderate systemic lupus
erythematosus, especially for skin and joint manifestations. High-dose steroids or
immunosuppressants are reserved for organ-threatening disease.
Question 6: A 68-year-old male with COPD presents with increased dyspnea,
purulent sputum, and fever. Chest X-ray shows no infiltrate. He has no history of
heart failure. His oxygen saturation is 88% on room air. What is the most
appropriate next step?
A. Oral levofloxacin and discharge
B. Inhaled bronchodilators, systemic corticosteroids, antibiotics, and
supplemental oxygen
C. Only increase his home bronchodilators
D. Hospitalize for intravenous antibiotics and BiPAP
Rationale: Acute exacerbation of COPD with hypoxemia (SaO2 <90%) and
purulent sputum requires bronchodilators, systemic corticosteroids (e.g.,
prednisone), antibiotics (based on local resistance), and oxygen. Hospitalization is
indicated if severe or fails outpatient treatment.
Question 7: A 72-year-old woman with osteoporosis presents with acute onset of
severe low back pain after lifting a grocery bag. She is unable to stand. On exam,
there is midline tenderness over L1. Her neurologic exam is normal. What is the
most appropriate initial imaging study?
A. MRI lumbar spine without contrast
B. X-ray of the lumbar spine
C. CT lumbar spine
D. Bone scan
, Rationale: Plain x-ray is the first-line imaging for suspected vertebral compression
fracture in the elderly. It can confirm fracture and guide management. MRI is
indicated if neurologic deficits or suspected infection/malignancy.
Question 8: A 50-year-old male with type 2 diabetes on metformin has a GFR of
35 mL/min/1.73m². His HbA1c is 8.5%. Which medication should be avoided or
used with caution?
A. Sitagliptin
B. Metformin (contraindicated if GFR <30; use with caution if 30-45)
C. Glipizide
D. Liraglutide
Rationale: Metformin is contraindicated when eGFR <30 mL/min due to risk of
lactic acidosis. At eGFR 30-45, metformin should be used with caution and at
reduced dose. The other options are safer in advanced CKD.
Question 9: A 28-year-old healthy female presents with a chief complaint of “my
arm goes numb when I sleep on it.” She has no weakness, pain, or other symptoms.
Neurologic exam is normal. What is the most appropriate management?
A. MRI cervical spine
B. Reassurance and advice to avoid positional pressure
C. Referral to neurology
D. Nerve conduction studies
Rationale: This is a classic description of transient nerve compression due to
positioning (e.g., sleeping on the arm). In the absence of persistent or progressive
symptoms, reassurance is appropriate.
Question 10: A 65-year-old smoker presents with a chronic cough that has
changed in character, becoming more frequent and associated with hemoptysis.
Chest X-ray shows a hilar mass. What is the most appropriate next step?
A. PET scan
B. CT of the chest
Practice Exam Newest Version 100%
Actual Test Review Solution
Question 1: A 62-year-old male comes to your office with concerns about a
general feeling of dizziness and lightheadedness. He states that he has been feeling
a pulsating pain right below the base of his skull; this pain often occurs early in the
morning and resolves throughout the day. If the patient’s condition is
cardiovascular in nature, his findings would be indicative of which of the following
conditions?
A. Aortic Stenosis
B. Hypertension
C. Angina
D. Myocardial Infarction
Rationale: Morning occipital headaches that are pulsating and improve during the
day are a classic (though not sensitive) sign of hypertension. Elevated blood
pressure in the early morning due to circadian rhythm can cause these headaches.
Question 2: Under which of the following circumstances can a nurse practitioner
seek the full physician fee when filing reimbursement under Medicare?
A. The physician is across town at a meeting but gives the nurse practitioner verbal
permission over the phone to initiate services.
B. With the physician’s direct oversight, the nurse practitioner administers
and reads an EKG for a patient with heart failure, a service that is normally
part of the physician’s bill for similar services.
C. After the presiding physician initiates services, the nurse practitioner continues
care for the patient and files for reimbursement under his own provider.
D. The nurse practitioner is in the same hospital as the presiding physician when
providing physician services to the patient.
,Rationale: For a service to be billed under the full physician fee, it must be
performed under direct supervision, meaning the physician is present in the same
office suite and immediately available. Option B describes direct oversight.
Question 3: A 55-year-old female presents with progressive shortness of breath on
exertion, fatigue, and a systolic ejection murmur at the right upper sternal border
that radiates to the carotids. Her pulse is slow-rising. What is the most likely
diagnosis?
A. Mitral regurgitation
B. Aortic stenosis
C. Hypertrophic cardiomyopathy
D. Pulmonary stenosis
Rationale: The classic triad of aortic stenosis is syncope, angina, and dyspnea.
Physical exam shows a late-peaking systolic murmur, slow-rising carotid upstroke
(pulsus parvus et tardus), and often a sustained apical impulse.
Question 4: A 45-year-old man with hypertension and diabetes has a blood
pressure of 148/92 mmHg in the clinic despite taking lisinopril 20 mg daily. His
home readings average 135/85. Which of the following is the best next step?
A. Double the lisinopril dose
B. Add amlodipine 5 mg daily
C. Switch to losartan
D. Order a 24-hour ambulatory blood pressure monitor
Rationale: For patients with diabetes and hypertension, target BP <130/80.
Adding a calcium channel blocker (amlodipine) is an appropriate second agent.
Home readings confirm true hypertension. A 24-hour monitor could be considered
but adding medication is reasonable.
Question 5: A 30-year-old woman presents with fatigue, arthralgias, malar rash,
and oral ulcers. Laboratory tests show ANA positive, anti-dsDNA positive, and
low C3. What is the most appropriate initial treatment for her arthritis and rash?
,A. Methotrexate
B. Hydroxychloroquine
C. Prednisone 60 mg daily
D. Cyclophosphamide
Rationale: Hydroxychloroquine is first-line for mild to moderate systemic lupus
erythematosus, especially for skin and joint manifestations. High-dose steroids or
immunosuppressants are reserved for organ-threatening disease.
Question 6: A 68-year-old male with COPD presents with increased dyspnea,
purulent sputum, and fever. Chest X-ray shows no infiltrate. He has no history of
heart failure. His oxygen saturation is 88% on room air. What is the most
appropriate next step?
A. Oral levofloxacin and discharge
B. Inhaled bronchodilators, systemic corticosteroids, antibiotics, and
supplemental oxygen
C. Only increase his home bronchodilators
D. Hospitalize for intravenous antibiotics and BiPAP
Rationale: Acute exacerbation of COPD with hypoxemia (SaO2 <90%) and
purulent sputum requires bronchodilators, systemic corticosteroids (e.g.,
prednisone), antibiotics (based on local resistance), and oxygen. Hospitalization is
indicated if severe or fails outpatient treatment.
Question 7: A 72-year-old woman with osteoporosis presents with acute onset of
severe low back pain after lifting a grocery bag. She is unable to stand. On exam,
there is midline tenderness over L1. Her neurologic exam is normal. What is the
most appropriate initial imaging study?
A. MRI lumbar spine without contrast
B. X-ray of the lumbar spine
C. CT lumbar spine
D. Bone scan
, Rationale: Plain x-ray is the first-line imaging for suspected vertebral compression
fracture in the elderly. It can confirm fracture and guide management. MRI is
indicated if neurologic deficits or suspected infection/malignancy.
Question 8: A 50-year-old male with type 2 diabetes on metformin has a GFR of
35 mL/min/1.73m². His HbA1c is 8.5%. Which medication should be avoided or
used with caution?
A. Sitagliptin
B. Metformin (contraindicated if GFR <30; use with caution if 30-45)
C. Glipizide
D. Liraglutide
Rationale: Metformin is contraindicated when eGFR <30 mL/min due to risk of
lactic acidosis. At eGFR 30-45, metformin should be used with caution and at
reduced dose. The other options are safer in advanced CKD.
Question 9: A 28-year-old healthy female presents with a chief complaint of “my
arm goes numb when I sleep on it.” She has no weakness, pain, or other symptoms.
Neurologic exam is normal. What is the most appropriate management?
A. MRI cervical spine
B. Reassurance and advice to avoid positional pressure
C. Referral to neurology
D. Nerve conduction studies
Rationale: This is a classic description of transient nerve compression due to
positioning (e.g., sleeping on the arm). In the absence of persistent or progressive
symptoms, reassurance is appropriate.
Question 10: A 65-year-old smoker presents with a chronic cough that has
changed in character, becoming more frequent and associated with hemoptysis.
Chest X-ray shows a hilar mass. What is the most appropriate next step?
A. PET scan
B. CT of the chest
