AGNP Midterm|| GRADED A+|| LATEST
UPDATE 2025/26
An 84-year-old woman, lives independently, concerned about driving. On 2
occasions, she had minor collisions when she was backing up her car (she
dislodged rearview mirror and struck a fire hydrant, each time on the passenger
side).
• History: osteoarthritis of the cervical and lumbar spine and mild hearing
impairment
• Medications: acetaminophen and calcium plus vitamin D
• Functional assessment: intact cognition and vision, with near-visual acuity
20/30 in each eye. She fails the whisper test.
• Physical examination: Decreased range of motion in neck and back in all planes
(unchanged from previous findings); Diffuse osteoarthritic deformities in the
knees and hands; Decreased range of motion at the hips; Mild kyphosis; Motor
strength and deep tendon reflexes are symmetric and intact
Which one of the following is the most appropriate next step?
A. Obtain radiography of the cervical spine in 3 views.
B. Recommend that she no longer drive.
C. Refer to physical therapy.
D. Refer to audiology.
E. Refer to occupational therapy.
,E. Refer to occupational therapy.
An 80-year-old woman hospitalized after fall and hip fracture
• History: stable osteoarthritis of the knees, peripheral neuropathy
• Prior to fall, she lived alone and managed all instrumental activities of daily
living; occasionally used cane or walker for mild problems with balance
• Current status, 4 days after surgery: Needs assistance of 2 persons for transfer;
Frequently incontinent of urine; Eating very little
Which one of the following is the most likely outcome for this patient 6 months
after the fracture?
A. Continued slow functional decline
B. Recovery to her pre-fracture level of function
C. Partial recovery of function
D. Stability at the level of function on hospital discharge
E. Death
B. Recovery to her pre-fracture level of function
An 85-year-old man with 2 episodes of low-volume urinary incontinence in the
last year, when he "waited too long"
• Functional assessment: Near-visual acuity of 20/50 on the right and 20/60 on the
left with correction; Fails whisper test in right ear ; Gait speed at usual pace is 0.9
m/sec ; Mini-Cog screen: 2 of 3 items on recall, completes an accurate clock 36
CASE 3 (2 of 3)
,Which one of the following is the most appropriate next step for evaluation of
functional disability? A. Refer to audiology.
B. Refer to ophthalmology.
C. Refer to physical therapy.
D. Complete additional cognitive testing.
E. Complete an incontinence evaluation.
B. Refer to ophthalmology.
A 68-year-old woman describes vision problems.
• Progressive blurring of distance vision
• Increased difficulty with nighttime driving, which she attributes to worsening
glare and haloes around lights
• She no longer needs glasses for reading.
• History: hypertension, hypercholesterolemia
Which one of the following is the most likely cause of the changes in her vision?
A. Uncontrolled hypertension
B. Poorly controlled blood glucose C. Choroidal neovascularization
D. Cataract progression
E. Increased intraocular pressure
D. Cataract progression
A 72-year-old black man has right shoulder trauma after he fell in a parking lot. He
states that he was walking to his car when he suddenly tripped and fell forward
onto his arm. He subsequently learned that he had tripped over a curb.
, • History: hypertension, high cholesterol, glaucoma
Which one of the following most likely contributed to his fall?
A. Acute glaucoma
B. Failure to use glaucoma drops that morning
C. Poor peripheral vision
D. Retinal embolus from a carotid plaque
C. Poor peripheral vision
An 88-year-old woman comes to the office for an urgent visit because, when she
awoke this morning, she found that she could no longer see to read. She depends
on her left eye for vision because she lost her right eye in an accident when she
was a child.
• On examination, vision is 20/400 in the left eye. She does not perceive light in
the right eye. She is referred emergently to an ophthalmologist, who diagnoses
neovascular age-related macular degeneration.
Which one of the following is the most appropriate therapy?
A. Topical prostaglandin analog
B. Phacoemulsification with intraocular lens implantation
C. Intravitreal vascular endothelial growth factor inhibitor
D. Glasses with updated refraction E. Oral lutein, zeaxanthin, and omega-3 eye
nutrients
C. Intravitreal vascular endothelial growth factor inhibitor
UPDATE 2025/26
An 84-year-old woman, lives independently, concerned about driving. On 2
occasions, she had minor collisions when she was backing up her car (she
dislodged rearview mirror and struck a fire hydrant, each time on the passenger
side).
• History: osteoarthritis of the cervical and lumbar spine and mild hearing
impairment
• Medications: acetaminophen and calcium plus vitamin D
• Functional assessment: intact cognition and vision, with near-visual acuity
20/30 in each eye. She fails the whisper test.
• Physical examination: Decreased range of motion in neck and back in all planes
(unchanged from previous findings); Diffuse osteoarthritic deformities in the
knees and hands; Decreased range of motion at the hips; Mild kyphosis; Motor
strength and deep tendon reflexes are symmetric and intact
Which one of the following is the most appropriate next step?
A. Obtain radiography of the cervical spine in 3 views.
B. Recommend that she no longer drive.
C. Refer to physical therapy.
D. Refer to audiology.
E. Refer to occupational therapy.
,E. Refer to occupational therapy.
An 80-year-old woman hospitalized after fall and hip fracture
• History: stable osteoarthritis of the knees, peripheral neuropathy
• Prior to fall, she lived alone and managed all instrumental activities of daily
living; occasionally used cane or walker for mild problems with balance
• Current status, 4 days after surgery: Needs assistance of 2 persons for transfer;
Frequently incontinent of urine; Eating very little
Which one of the following is the most likely outcome for this patient 6 months
after the fracture?
A. Continued slow functional decline
B. Recovery to her pre-fracture level of function
C. Partial recovery of function
D. Stability at the level of function on hospital discharge
E. Death
B. Recovery to her pre-fracture level of function
An 85-year-old man with 2 episodes of low-volume urinary incontinence in the
last year, when he "waited too long"
• Functional assessment: Near-visual acuity of 20/50 on the right and 20/60 on the
left with correction; Fails whisper test in right ear ; Gait speed at usual pace is 0.9
m/sec ; Mini-Cog screen: 2 of 3 items on recall, completes an accurate clock 36
CASE 3 (2 of 3)
,Which one of the following is the most appropriate next step for evaluation of
functional disability? A. Refer to audiology.
B. Refer to ophthalmology.
C. Refer to physical therapy.
D. Complete additional cognitive testing.
E. Complete an incontinence evaluation.
B. Refer to ophthalmology.
A 68-year-old woman describes vision problems.
• Progressive blurring of distance vision
• Increased difficulty with nighttime driving, which she attributes to worsening
glare and haloes around lights
• She no longer needs glasses for reading.
• History: hypertension, hypercholesterolemia
Which one of the following is the most likely cause of the changes in her vision?
A. Uncontrolled hypertension
B. Poorly controlled blood glucose C. Choroidal neovascularization
D. Cataract progression
E. Increased intraocular pressure
D. Cataract progression
A 72-year-old black man has right shoulder trauma after he fell in a parking lot. He
states that he was walking to his car when he suddenly tripped and fell forward
onto his arm. He subsequently learned that he had tripped over a curb.
, • History: hypertension, high cholesterol, glaucoma
Which one of the following most likely contributed to his fall?
A. Acute glaucoma
B. Failure to use glaucoma drops that morning
C. Poor peripheral vision
D. Retinal embolus from a carotid plaque
C. Poor peripheral vision
An 88-year-old woman comes to the office for an urgent visit because, when she
awoke this morning, she found that she could no longer see to read. She depends
on her left eye for vision because she lost her right eye in an accident when she
was a child.
• On examination, vision is 20/400 in the left eye. She does not perceive light in
the right eye. She is referred emergently to an ophthalmologist, who diagnoses
neovascular age-related macular degeneration.
Which one of the following is the most appropriate therapy?
A. Topical prostaglandin analog
B. Phacoemulsification with intraocular lens implantation
C. Intravitreal vascular endothelial growth factor inhibitor
D. Glasses with updated refraction E. Oral lutein, zeaxanthin, and omega-3 eye
nutrients
C. Intravitreal vascular endothelial growth factor inhibitor
