AGNP Midterm Exam Questions and answers New!!
2025/2026 RATED A+
An 84-year-old woman, lives independently, concerned about driving. On 2 occasions, she had
Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il`
minor collisions when she was backing up her car (she dislodged rearview mirror and struck a fire
Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il`
hydrant, each time on the passenger side).
Il` Il` Il` Il` Il` Il` Il`
• History: osteoarthritis of the cervical and lumbar spine and mild hearing impairment
Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il`
• Medications: acetaminophen and calcium plus vitamin D
Il` Il` Il` Il` Il` Il` Il`
• Functional assessment: intact cognition and vision, with near-visual acuity 20/30 in each eye.
Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il`
She fails the whisper test.
Il` Il` Il` Il` Il`
• Physical examination: Decreased range of motion in neck and back in all planes (unchanged from
Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il`
previous findings); Diffuse osteoarthritic deformities in the knees and hands; Decreased range of
Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il`
motion at the hips; Mild kyphosis; Motor strength and deep tendon reflexes are symmetric and
Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il`
intact
Il`
Which one of the following is the most appropriate next step?
Il` Il` Il` Il` Il` Il` Il` Il` Il` Il`
A. Obtain radiography of the cervical spine in 3 views.
Il` Il` Il` Il` Il` Il` Il` Il` Il`
B. Recommend that she no longer drive.
Il` Il` Il` Il` Il` Il`
C. Refer to physical therapy.
Il` Il` Il` Il`
D. Refer to audiology.
Il` Il` Il`
E. Refer to occupational therapy.
Il` Il` Il` Il`
E. Refer to occupational therapy.
Il` Il` Il` Il`
An 80-year-old woman hospitalized after fall and hip fracture
Il` Il` Il` Il` Il` Il` Il` Il`
• History: stable osteoarthritis of the knees, peripheral neuropathy
Il` Il` Il` Il` Il` Il` Il` Il`
• Prior to fall, she lived alone and managed all instrumental activities of daily living; occasionally
Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il`
used cane or walker for mild problems with balance
Il` Il` Il` Il` Il` Il` Il` Il` Il`
• Current status, 4 days after surgery: Needs assistance of 2 persons for transfer; Frequently
Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il`
incontinent of urine; Eating very little
Il` Il` Il` Il` Il` Il`
Which one of the following is the most likely outcome for this patient 6 months after the fracture?
Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il`
A. Continued slow functional decline
Il` Il` Il` Il`
B. Recovery to her pre-fracture level of function
Il` Il` Il` Il` Il` Il` Il`
C. Partial recovery of function
Il` Il` Il` Il`
D. Stability at the level of function on hospital discharge
Il` Il` Il` Il` Il` Il` Il` Il` Il`
E. Death Il`
B. Recovery to her pre-fracture level of function
Il` Il` Il` Il` Il` Il` Il`
,AD
An 85-year-old man with 2 episodes of low-volume urinary incontinence in the last year, when he
Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il`
"waited too long"
Il` Il` Il`
• Functional assessment: Near-visual acuity of 20/50 on the right and 20/60 on the left with
Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il`
correction; Fails whisper test in right ear ; Gait speed at usual pace is 0.9 m/sec ; Mini-Cog screen:
Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il`
2 of 3 items on recall, completes an accurate clock 36 CASE 3 (2 of 3)
Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il`
Which one of the following is the most appropriate next step for evaluation of functional
Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il`
disability? A. Refer to audiology.
Il` Il` Il` Il` Il`
B. Refer to ophthalmology.
Il` Il` Il`
C. Refer to physical therapy.
Il` Il` Il` Il`
D. Complete additional cognitive testing.
Il` Il` Il` Il`
E. Complete an incontinence evaluation.
Il` Il` Il` Il`
B. Refer to ophthalmology.
Il` Il` Il`
A 68-year-old woman describes vision problems.
Il` Il` Il` Il` Il`
• Progressive blurring of distance vision
Il` Il` Il` Il` Il`
• Increased difficulty with nighttime driving, which she attributes to worsening glare and haloes
Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il`
around lights
Il` Il`
• She no longer needs glasses for reading.
Il` Il` Il` Il` Il` Il` Il`
• History: hypertension, hypercholesterolemia
Il` Il` Il`
Which one of the following is the most likely cause of the changes in her vision?
Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il`
A. Uncontrolled hypertension
Il` Il`
B. Poorly controlled blood glucose C. Choroidal neovascularization
Il` Il` Il` Il` Il` Il` Il`
D. Cataract progression
Il` Il`
E. Increased intraocular pressure
Il` Il` Il`
D. Cataract progression
Il` Il`
A 72-year-old black man has right shoulder trauma after he fell in a parking lot. He states that he
Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il`
was walking to his car when he suddenly tripped and fell forward onto his arm. He subsequently
Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il`
learned that he had tripped over a curb.
Il` Il` Il` Il` Il` Il` Il` Il`
• History: hypertension, high cholesterol, glaucoma
Il` Il` Il` Il` Il`
Which one of the following most likely contributed to his fall?
Il` Il` Il` Il` Il` Il` Il` Il` Il` Il`
A. Acute glaucoma Il` Il`
B. Failure to use glaucoma drops that morning
Il` Il` Il` Il` Il` Il` Il`
,C. Poor peripheral vision
Il` Il` Il`
D. Retinal embolus from a carotid plaque
Il` Il` Il` Il` Il` Il`
C. Poor peripheral vision
Il` Il` Il`
An 88-year-old woman comes to the office for an urgent visit because, when she awoke this
Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il`
morning, she found that she could no longer see to read. She depends on her left eye for vision
Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il`
because she lost her right eye in an accident when she was a child.
Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il`
• On examination, vision is 20/400 in the left eye. She does not perceive light in the right eye. She
Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il`
is referred emergently to an ophthalmologist, who diagnoses neovascular age-related macular
Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il`
degeneration.
Il`
Which one of the following is the most appropriate therapy?
Il` Il` Il` Il` Il` Il` Il` Il` Il`
A. Topical prostaglandin analog
Il` Il` Il`
B. Phacoemulsification with intraocular lens implantation
Il` Il` Il` Il` Il`
C. Intravitreal vascular endothelial growth factor inhibitor
Il` Il` Il` Il` Il` Il`
D. Glasses with updated refraction E. Oral lutein, zeaxanthin, and omega-3 eye nutrients
Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il`
C. Intravitreal vascular endothelial growth factor inhibitor
Il` Il` Il` Il` Il` Il`
An 80-year-old woman comes to the office with her daughter. The daughter is concerned that her
Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il`
mother has recently begun to withdraw from former activities (attending book clubs, lectures).
Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il`
• Patient's self-reported health status has changed from "excellent" last year to "average" today.
Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il`
• During the appointment she misunderstands some questions, and she appears to struggle to
Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il`
understand some of what is said. Her memory does not seem as keen as on previous visits.
Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il`
• In response to direct questions, she states that over the past 2 weeks she has felt a little down.
Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il`
• She says that if people would include her in conversation, she would probably feel better and be
Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il`
more inclined to engage in the activities she previously enjoyed.
Il` Il` Il` Il` Il` Il` Il` Il` Il` Il`
• Medications: daily multivitamin, daily aspirin
Il` Il` Il` Il` Il`
• Physical examination: Normal blood pressure and EKG; MMSE score is 26 of 30; Findings from
Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il`
routine laboratory tests are normal.
Il` Il` Il` Il` Il`
Which one of the following is the most appropriate next step?
Il` Il` Il` Il` Il` Il` Il` Il` Il` Il`
A. Begin antidepressant therapy.
Il` Il` Il`
B. Refer for psychiatry consultation. C. Refer for neurologic evaluation. D. Administer in-office
Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il`
hearing screen.
Il` Il`
D. Administer in-office hearing screen.
Il` Il` Il` Il`
A 75-year-old man has age-related hearing loss, diagnosed by an audiologist. The patient requests
Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il`
advice regarding hearing interventions.
Il` Il` Il` Il`
, • He has difficulty understanding speech at meetings and in restaurants; he describes "hearing
Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il`
people talk but not making out the words."
Il` Il` Il` Il` Il` Il` Il` Il`
• Score on the Hearing Handicap Inventory for the Elderly (short form) is 25, consistent with
Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il`
significant self-reported handicap. (HHIE-S is a self-reported questionnaire that quantifies the
Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il`
handicapping effects of hearing loss.)
Il` Il` Il` Il` Il`
• Pure-tone test indicates a mild sloping to moderate sensorineural hearing loss most pronounced
Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il`
in high frequencies.
Il` Il` Il`
• Speech understanding in quiet environment is excellent, but decreases to fair in a noisy
Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il`
environment.
Il`
Which one of the following is the most suitable intervention for this patient?
Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il`
A. Cochlear implant
Il` Il`
B. Bone-anchored hearing aid
Il` Il` Il`
C. Environmental modifications
Il` Il`
D. Hearing aid and counseling on communication strategies
Il` Il` Il` Il` Il` Il` Il`
D. Hearing aid and counseling on communication strategies
Il` Il` Il` Il` Il` Il` Il`
A 65-year-old male presents to the outpatient office for a routine health evaluation.
Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il`
The patient has a history of hypertension (HTN), for which he takes medications.
Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il`
He has no concerns and his physical examination is unremarkable. During the evaluation, the
Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il`
patient requests an electrocardiogram (ECG) to ensure that his heart is functioning "okay." The
Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il`
United States Preventive Services Task Force (USPSTF) lists obtaining an electrocardiogram in this
Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il`
clinical situation as a Grade D recommendation.
Il` Il` Il` Il` Il` Il` Il`
Which standard for guideline development does using Grade A - D recommendations follow as per
Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il`
the Health and Medicine Division (formerly the Institute of Medicine [IOM])?
Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il`
Choose the single best answer. Il` Il` Il` Il`
A. Articulation of recommendations
Il` Il` Il`
B. Establishing evidence foundations for and rating strength of recommendations
Il` Il` Il` Il` Il` Il` Il` Il` Il`
C. Establishing transparency
Il` Il`
D. Guideline development group composition
Il` Il` Il` Il`
E. Management of conflict of interest
Il` Il` Il` Il` Il`
B. Establishing evidence foundations for and rating strength of recommendations
Il` Il` Il` Il` Il` Il` Il` Il` Il`
The USPSTF grades its recommendations based on the amount and quality of evidence supporting
Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il`
each intervention. This meets Standard 5, establishing the evidence foundations for and rating
Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il`
the strength of recommendations. Standard 1, establishing transparency, requires that the
Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il`
2025/2026 RATED A+
An 84-year-old woman, lives independently, concerned about driving. On 2 occasions, she had
Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il`
minor collisions when she was backing up her car (she dislodged rearview mirror and struck a fire
Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il`
hydrant, each time on the passenger side).
Il` Il` Il` Il` Il` Il` Il`
• History: osteoarthritis of the cervical and lumbar spine and mild hearing impairment
Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il`
• Medications: acetaminophen and calcium plus vitamin D
Il` Il` Il` Il` Il` Il` Il`
• Functional assessment: intact cognition and vision, with near-visual acuity 20/30 in each eye.
Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il`
She fails the whisper test.
Il` Il` Il` Il` Il`
• Physical examination: Decreased range of motion in neck and back in all planes (unchanged from
Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il`
previous findings); Diffuse osteoarthritic deformities in the knees and hands; Decreased range of
Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il`
motion at the hips; Mild kyphosis; Motor strength and deep tendon reflexes are symmetric and
Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il`
intact
Il`
Which one of the following is the most appropriate next step?
Il` Il` Il` Il` Il` Il` Il` Il` Il` Il`
A. Obtain radiography of the cervical spine in 3 views.
Il` Il` Il` Il` Il` Il` Il` Il` Il`
B. Recommend that she no longer drive.
Il` Il` Il` Il` Il` Il`
C. Refer to physical therapy.
Il` Il` Il` Il`
D. Refer to audiology.
Il` Il` Il`
E. Refer to occupational therapy.
Il` Il` Il` Il`
E. Refer to occupational therapy.
Il` Il` Il` Il`
An 80-year-old woman hospitalized after fall and hip fracture
Il` Il` Il` Il` Il` Il` Il` Il`
• History: stable osteoarthritis of the knees, peripheral neuropathy
Il` Il` Il` Il` Il` Il` Il` Il`
• Prior to fall, she lived alone and managed all instrumental activities of daily living; occasionally
Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il`
used cane or walker for mild problems with balance
Il` Il` Il` Il` Il` Il` Il` Il` Il`
• Current status, 4 days after surgery: Needs assistance of 2 persons for transfer; Frequently
Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il`
incontinent of urine; Eating very little
Il` Il` Il` Il` Il` Il`
Which one of the following is the most likely outcome for this patient 6 months after the fracture?
Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il`
A. Continued slow functional decline
Il` Il` Il` Il`
B. Recovery to her pre-fracture level of function
Il` Il` Il` Il` Il` Il` Il`
C. Partial recovery of function
Il` Il` Il` Il`
D. Stability at the level of function on hospital discharge
Il` Il` Il` Il` Il` Il` Il` Il` Il`
E. Death Il`
B. Recovery to her pre-fracture level of function
Il` Il` Il` Il` Il` Il` Il`
,AD
An 85-year-old man with 2 episodes of low-volume urinary incontinence in the last year, when he
Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il`
"waited too long"
Il` Il` Il`
• Functional assessment: Near-visual acuity of 20/50 on the right and 20/60 on the left with
Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il`
correction; Fails whisper test in right ear ; Gait speed at usual pace is 0.9 m/sec ; Mini-Cog screen:
Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il`
2 of 3 items on recall, completes an accurate clock 36 CASE 3 (2 of 3)
Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il`
Which one of the following is the most appropriate next step for evaluation of functional
Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il`
disability? A. Refer to audiology.
Il` Il` Il` Il` Il`
B. Refer to ophthalmology.
Il` Il` Il`
C. Refer to physical therapy.
Il` Il` Il` Il`
D. Complete additional cognitive testing.
Il` Il` Il` Il`
E. Complete an incontinence evaluation.
Il` Il` Il` Il`
B. Refer to ophthalmology.
Il` Il` Il`
A 68-year-old woman describes vision problems.
Il` Il` Il` Il` Il`
• Progressive blurring of distance vision
Il` Il` Il` Il` Il`
• Increased difficulty with nighttime driving, which she attributes to worsening glare and haloes
Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il`
around lights
Il` Il`
• She no longer needs glasses for reading.
Il` Il` Il` Il` Il` Il` Il`
• History: hypertension, hypercholesterolemia
Il` Il` Il`
Which one of the following is the most likely cause of the changes in her vision?
Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il`
A. Uncontrolled hypertension
Il` Il`
B. Poorly controlled blood glucose C. Choroidal neovascularization
Il` Il` Il` Il` Il` Il` Il`
D. Cataract progression
Il` Il`
E. Increased intraocular pressure
Il` Il` Il`
D. Cataract progression
Il` Il`
A 72-year-old black man has right shoulder trauma after he fell in a parking lot. He states that he
Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il`
was walking to his car when he suddenly tripped and fell forward onto his arm. He subsequently
Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il`
learned that he had tripped over a curb.
Il` Il` Il` Il` Il` Il` Il` Il`
• History: hypertension, high cholesterol, glaucoma
Il` Il` Il` Il` Il`
Which one of the following most likely contributed to his fall?
Il` Il` Il` Il` Il` Il` Il` Il` Il` Il`
A. Acute glaucoma Il` Il`
B. Failure to use glaucoma drops that morning
Il` Il` Il` Il` Il` Il` Il`
,C. Poor peripheral vision
Il` Il` Il`
D. Retinal embolus from a carotid plaque
Il` Il` Il` Il` Il` Il`
C. Poor peripheral vision
Il` Il` Il`
An 88-year-old woman comes to the office for an urgent visit because, when she awoke this
Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il`
morning, she found that she could no longer see to read. She depends on her left eye for vision
Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il`
because she lost her right eye in an accident when she was a child.
Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il`
• On examination, vision is 20/400 in the left eye. She does not perceive light in the right eye. She
Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il`
is referred emergently to an ophthalmologist, who diagnoses neovascular age-related macular
Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il`
degeneration.
Il`
Which one of the following is the most appropriate therapy?
Il` Il` Il` Il` Il` Il` Il` Il` Il`
A. Topical prostaglandin analog
Il` Il` Il`
B. Phacoemulsification with intraocular lens implantation
Il` Il` Il` Il` Il`
C. Intravitreal vascular endothelial growth factor inhibitor
Il` Il` Il` Il` Il` Il`
D. Glasses with updated refraction E. Oral lutein, zeaxanthin, and omega-3 eye nutrients
Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il`
C. Intravitreal vascular endothelial growth factor inhibitor
Il` Il` Il` Il` Il` Il`
An 80-year-old woman comes to the office with her daughter. The daughter is concerned that her
Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il`
mother has recently begun to withdraw from former activities (attending book clubs, lectures).
Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il`
• Patient's self-reported health status has changed from "excellent" last year to "average" today.
Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il`
• During the appointment she misunderstands some questions, and she appears to struggle to
Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il`
understand some of what is said. Her memory does not seem as keen as on previous visits.
Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il`
• In response to direct questions, she states that over the past 2 weeks she has felt a little down.
Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il`
• She says that if people would include her in conversation, she would probably feel better and be
Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il`
more inclined to engage in the activities she previously enjoyed.
Il` Il` Il` Il` Il` Il` Il` Il` Il` Il`
• Medications: daily multivitamin, daily aspirin
Il` Il` Il` Il` Il`
• Physical examination: Normal blood pressure and EKG; MMSE score is 26 of 30; Findings from
Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il`
routine laboratory tests are normal.
Il` Il` Il` Il` Il`
Which one of the following is the most appropriate next step?
Il` Il` Il` Il` Il` Il` Il` Il` Il` Il`
A. Begin antidepressant therapy.
Il` Il` Il`
B. Refer for psychiatry consultation. C. Refer for neurologic evaluation. D. Administer in-office
Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il`
hearing screen.
Il` Il`
D. Administer in-office hearing screen.
Il` Il` Il` Il`
A 75-year-old man has age-related hearing loss, diagnosed by an audiologist. The patient requests
Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il`
advice regarding hearing interventions.
Il` Il` Il` Il`
, • He has difficulty understanding speech at meetings and in restaurants; he describes "hearing
Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il`
people talk but not making out the words."
Il` Il` Il` Il` Il` Il` Il` Il`
• Score on the Hearing Handicap Inventory for the Elderly (short form) is 25, consistent with
Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il`
significant self-reported handicap. (HHIE-S is a self-reported questionnaire that quantifies the
Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il`
handicapping effects of hearing loss.)
Il` Il` Il` Il` Il`
• Pure-tone test indicates a mild sloping to moderate sensorineural hearing loss most pronounced
Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il`
in high frequencies.
Il` Il` Il`
• Speech understanding in quiet environment is excellent, but decreases to fair in a noisy
Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il`
environment.
Il`
Which one of the following is the most suitable intervention for this patient?
Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il`
A. Cochlear implant
Il` Il`
B. Bone-anchored hearing aid
Il` Il` Il`
C. Environmental modifications
Il` Il`
D. Hearing aid and counseling on communication strategies
Il` Il` Il` Il` Il` Il` Il`
D. Hearing aid and counseling on communication strategies
Il` Il` Il` Il` Il` Il` Il`
A 65-year-old male presents to the outpatient office for a routine health evaluation.
Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il`
The patient has a history of hypertension (HTN), for which he takes medications.
Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il`
He has no concerns and his physical examination is unremarkable. During the evaluation, the
Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il`
patient requests an electrocardiogram (ECG) to ensure that his heart is functioning "okay." The
Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il`
United States Preventive Services Task Force (USPSTF) lists obtaining an electrocardiogram in this
Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il`
clinical situation as a Grade D recommendation.
Il` Il` Il` Il` Il` Il` Il`
Which standard for guideline development does using Grade A - D recommendations follow as per
Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il`
the Health and Medicine Division (formerly the Institute of Medicine [IOM])?
Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il`
Choose the single best answer. Il` Il` Il` Il`
A. Articulation of recommendations
Il` Il` Il`
B. Establishing evidence foundations for and rating strength of recommendations
Il` Il` Il` Il` Il` Il` Il` Il` Il`
C. Establishing transparency
Il` Il`
D. Guideline development group composition
Il` Il` Il` Il`
E. Management of conflict of interest
Il` Il` Il` Il` Il`
B. Establishing evidence foundations for and rating strength of recommendations
Il` Il` Il` Il` Il` Il` Il` Il` Il`
The USPSTF grades its recommendations based on the amount and quality of evidence supporting
Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il`
each intervention. This meets Standard 5, establishing the evidence foundations for and rating
Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il`
the strength of recommendations. Standard 1, establishing transparency, requires that the
Il` Il` Il` Il` Il` Il` Il` Il` Il` Il` Il`
