Elite Test Bank: Ham’s Primary
Care Geriatrics (7th Edition)
2026/2027 Standards
PART 0: THE NAVIGATOR
● PART I: THE PRIMER
● PART II: THE ELITE TEST BANK
○ Section A: Foundational Syntax & Application (Questions 1–15) Focus: The
5Ms, 2026 Beers Criteria, Pharmacokinetics, and Medicare Frameworks.
○ Section B: Professional Simulation (Questions 16–40) Focus: Atypical
Presentations, ARIA Protocols, Fall Diagnostics, and Deprescribing.
○ Section C: Grandmaster Synthesis (Questions 41–66) Focus: Multi-System
Comorbidity, Prescribing Cascades, and High-Stakes Crisis Aversion.
PART I: THE PRIMER
Mastering the chaotic, high-stakes architecture of geriatric primary care is the definitive
monopoly moat dividing clinical architects from mere data-collectors. In the 2026 landscape of
physiological collapse and shifting Medicare mandates, professional intuition replaces academic
memorization to avert fatal errors.
The "Panic Button" Cheat Sheet
● The 5Ms Hard Deck: Mentation, Mobility, Medications, Multicomplexity, What Matters
Most.
● Renal Reality: The Cockcroft-Gault formula dictates drug dosing; indexed eGFR
(CKD-EPI) mathematically overestimates clearance in the sarcopenic elderly.
● Beers Baseline (2026): SGLT2 inhibitors and proton pump inhibitors (PPIs) carry strict
warnings; deprescribe before compounding the chemical burden.
● Anti-Amyloid Axiom: Monoclonal antibodies demand strict Amyloid-Related Imaging
Abnormalities (ARIA) MRI monitoring, with an additional scan now mandated prior to the
3rd infusion.
● G2211 Expansion: As of January 1, 2026, the G2211 complexity add-on code is fully
billable for longitudinal home/residence visits.
PART II: THE ELITE TEST BANK
Section A: Foundational Syntax & Application (Questions 1–15)
Q1: A primary care practice is transitioning to an Age-Friendly Health System designation under
the 2026 guidelines. The clinical director audits the electronic health records to ensure
compliance with the core framework. Which intervention represents the MOST ACCURATE
,application of the 4Ms/5Ms framework? A) Prioritizing the rapid correction of single-disease
biomarkers over functional capacity. B) Aligning all medication, mentation, and mobility
interventions strictly with the patient's documented "What Matters Most" goals. C) Automatically
referring all patients over 65 to physical therapy regardless of baseline mobility. D) Utilizing
isolated chronological age to determine the aggressiveness of chronic disease management.
● The Answer: B (Aligning all medication, mentation, and mobility interventions strictly with
the patient's documented "What Matters Most" goals.)
● Distractor Analysis:
○ A is incorrect: This violates the concept of "Multicomplexity." Treating single-disease
biomarkers often leads to prescribing cascades and ignores the holistic reality of
geriatric decline.
○ C is incorrect: Interventions must be individualized. Blanket referrals do not align
with the specific mobility goals or functional baseline of the individual patient.
○ D is incorrect: Chronological age alone is a poor predictor of physiological reserve.
Decisions must be based on frailty, multimorbidity, and patient priorities.
The Mentor's Analysis: The pinnacle of the Age-Friendly Health System is quality of life, which
is governed entirely by "What Matters." If an intervention optimizes mentation or mobility but
directly violates the patient's overarching life goals, it is clinically inappropriate. Professional
Intuition: The medical plan must serve the life plan, never the reverse.
Q2: An 89-year-old highly cachectic male weighing 42 kg requires renally dosed antibiotic
therapy. The laboratory reports an estimated Glomerular Filtration Rate (eGFR) via CKD-EPI of
72 mL/min/1.73m². Which action is the MOST APPROPRIATE INITIAL step for the practitioner?
A) Dose the medication based on the laboratory-reported CKD-EPI eGFR to ensure adequate
peak concentrations. B) Calculate the absolute creatinine clearance utilizing the Cockcroft-Gault
formula with the patient's actual body weight. C) Utilize ideal body weight in the MDRD equation
to prevent sub-therapeutic dosing. D) Withhold the antibiotic until a 24-hour urine creatinine
clearance is completed.
● The Answer: B (Calculate the absolute creatinine clearance utilizing the Cockcroft-Gault
formula with the patient's actual body weight.)
● Distractor Analysis:
○ A is incorrect: The CKD-EPI equation relies on serum creatinine. In cachectic
patients with profound sarcopenia, serum creatinine is artificially low, causing the
equation to drastically overestimate renal function, leading to toxic dosing.
○ C is incorrect: MDRD is outdated for geriatric drug dosing, and ideal body weight is
not the standard when actual body weight is significantly lower due to cachexia.
○ D is incorrect: A 24-hour collection is impractical in acute settings and delays
necessary treatment unnecessarily.
The Mentor's Analysis: In the extreme elderly, muscle mass vanishes. Low muscle mass
means low creatinine production. Therefore, a "normal" serum creatinine often masks severe
renal impairment. The Cockcroft-Gault formula remains the ironclad standard for
pharmacokinetic dosing because it was the formula used during the clinical trials of most legacy
drugs.
Q3: Under the updated 2026 AGS Beers Criteria, a practitioner is reviewing the medication list
of a 78-year-old female with a history of recurrent urinary tract infections and mild heart failure.
Which medication class now carries a strict 2026 warning requiring intense scrutiny and
potential deprescribing? A) Beta-blockers B) Sodium-glucose co-transporter 2 (SGLT2)
inhibitors C) Angiotensin-converting enzyme (ACE) inhibitors D) Calcium channel blockers
● The Answer: B (Sodium-glucose co-transporter 2 (SGLT2) inhibitors)
, ● Distractor Analysis:
○ A is incorrect: Beta-blockers are standard guideline-directed medical therapy for
heart failure and are not a new primary target for the Beers Criteria.
○ C is incorrect: ACE inhibitors are not newly restricted under the 2026 Beers
updates.
○ D is incorrect: While they have side effects, calcium channel blockers are not the
subject of the specific 2026 Beers warning highlighted for this demographic.
The Mentor's Analysis: While SGLT2 inhibitors offer immense cardiovascular and renal
benefits, they were newly added to the Beers list due to the high risk of genital mycotic
infections, volume depletion, and euglycemic diabetic ketoacidosis in frail older adults.
Professional Intuition: Always weigh the cardiovascular benefit against the immediate threat of
recurrent urogenital infections in the frail elderly.
Q4: A patient with mild cognitive impairment is initiating anti-amyloid monoclonal antibody
therapy (lecanemab). According to the 2026 FDA safety mandates regarding Amyloid-Related
Imaging Abnormalities (ARIA), when is the MOST CRITICAL newly added timepoint for an MRI
scan? A) Prior to the 1st infusion only. B) Between the 2nd and 3rd infusion. C) Immediately
following the 14th infusion. D) At the 52-week mark.
● The Answer: B (Between the 2nd and 3rd infusion.)
● Distractor Analysis:
○ A is incorrect: While a baseline scan is required, it is not the newly added safety
mandate.
○ C is incorrect: A scan before the 14th infusion was part of the original protocol, not
the new updated mandate.
○ D is incorrect: Week 52 is standard surveillance, but misses the acute window for
early ARIA-E onset.
The Mentor's Analysis: The FDA updated the prescribing information to require an MRI
between the 2nd and 3rd infusion because real-world data showed critical, asymptomatic brain
swelling (ARIA-E) developing early in the treatment course. Detecting this fluid buildup before
the 3rd dose prevents progression to fatal status epilepticus.
Q5: Effective January 1, 2026, a practitioner conducting a comprehensive, longitudinal
evaluation and management (E/M) visit for a homebound patient with multiple chronic conditions
wishes to capture the complexity of the visit. Which billing action is MOST APPROPRIATE? A)
Bill only the standard home E/M code (99341-99350) as add-on codes are restricted to
outpatient facilities. B) Append modifier -25 to the standard home E/M code. C) Report the
G2211 complexity add-on code alongside the appropriate home or residence E/M visit code. D)
Bill the Advanced Primary Care Management (APCM) code G0558 exclusively.
● The Answer: C (Report the G2211 complexity add-on code alongside the appropriate
home or residence E/M visit code.)
● Distractor Analysis:
○ A is incorrect: The 2026 Medicare Physician Fee Schedule explicitly expanded
G2211 to include home and residence visits to recognize the "invisible work" of
home-based care.
○ B is incorrect: Modifier -25 is used for a significant, separately identifiable E/M
service on the same day as a procedure, and generally prohibits the use of G2211.
○ D is incorrect: APCM codes (G0556-G0558) are monthly care management codes,
not add-on codes for face-to-face E/M visit complexity.
The Mentor's Analysis: The 2026 expansion of G2211 is a massive victory for geriatric home
care. It financially acknowledges the intense coordination required to manage complex patients
, outside the clinic. You must document the continuous, longitudinal relationship to justify the
code.
Q6: A clinical practice is utilizing the new 2026 Advanced Primary Care Management (APCM)
HCPCS codes. Which patient profile BEST meets the requirements for billing code G0557? A) A
patient with a single, acute respiratory infection expected to resolve in two weeks. B) A patient
with zero chronic conditions undergoing a routine annual wellness exam. C) A patient with two
or more chronic conditions expected to last at least 12 months, placing them at significant risk of
functional decline. D) A Qualified Medicare Beneficiary (QMB) requiring immediate surgical
intervention.
● The Answer: C (A patient with two or more chronic conditions expected to last at least 12
months, placing them at significant risk of functional decline.)
● Distractor Analysis:
○ A is incorrect: APCM requires conditions expected to last at least 12 months or until
death.
○ B is incorrect: Zero or one chronic condition corresponds to the lower-tier code
G0556.
○ D is incorrect: QMB patients with multiple chronic conditions are billed under the
highest tier code, G0558.
The Mentor's Analysis: APCM codes bundle Principal, Transitional, and Chronic Care
Management into a streamlined monthly billing process.
Code Target Demographic
G0556 One or zero chronic conditions
G0557 Two or more chronic conditions
G0558 Two or more conditions + QMB status
G0557 is the workhorse code for the standard multimorbid geriatric patient.
Q7: Under the revised Texas Advance Directives Act (TADA), if a hospital ethics committee
determines that requested life-sustaining treatment is medically futile, what is the EXACT
mandated timeframe the facility must provide the family to secure a transfer before treatment
can be legally withdrawn? A) 48 hours B) 10 days C) 14 days D) 25 days
● The Answer: D (25 days)
● Distractor Analysis:
○ A is incorrect: 48 hours was the old requirement for notifying the family of the ethics
committee meeting, which was updated to 7 days.
○ B is incorrect: This is the infamous legacy "10-Day Rule" that was heavily criticized
and subsequently abolished by H.B. 3162.
○ C is incorrect: 14 days is a fabricated timeframe in this legal context.
The Mentor's Analysis: The shift from 10 days to 25 days under H.B. 3162 represents a major
legal and ethical pivot in Texas end-of-life care. It balances the provider's duty of
non-maleficence against the family's right to seek alternative care. Always initiate transfer
protocols the absolute second the committee makes its ruling.
---
Q8: An 82-year-old patient is evaluated in the clinic. They ambulate slowly with a cane, require
help managing their finances, and complain of chronic exhaustion. According to the Clinical
Frailty Scale, how should this patient's status be BEST conceptualized? A) A normal, expected
manifestation of chronological aging. B) A distinct biologic syndrome of decreased physiological
reserve and extreme vulnerability to minor stressors. C) A temporary condition secondary to
acute dehydration. D) A psychological manifestation of undiagnosed depression.
Care Geriatrics (7th Edition)
2026/2027 Standards
PART 0: THE NAVIGATOR
● PART I: THE PRIMER
● PART II: THE ELITE TEST BANK
○ Section A: Foundational Syntax & Application (Questions 1–15) Focus: The
5Ms, 2026 Beers Criteria, Pharmacokinetics, and Medicare Frameworks.
○ Section B: Professional Simulation (Questions 16–40) Focus: Atypical
Presentations, ARIA Protocols, Fall Diagnostics, and Deprescribing.
○ Section C: Grandmaster Synthesis (Questions 41–66) Focus: Multi-System
Comorbidity, Prescribing Cascades, and High-Stakes Crisis Aversion.
PART I: THE PRIMER
Mastering the chaotic, high-stakes architecture of geriatric primary care is the definitive
monopoly moat dividing clinical architects from mere data-collectors. In the 2026 landscape of
physiological collapse and shifting Medicare mandates, professional intuition replaces academic
memorization to avert fatal errors.
The "Panic Button" Cheat Sheet
● The 5Ms Hard Deck: Mentation, Mobility, Medications, Multicomplexity, What Matters
Most.
● Renal Reality: The Cockcroft-Gault formula dictates drug dosing; indexed eGFR
(CKD-EPI) mathematically overestimates clearance in the sarcopenic elderly.
● Beers Baseline (2026): SGLT2 inhibitors and proton pump inhibitors (PPIs) carry strict
warnings; deprescribe before compounding the chemical burden.
● Anti-Amyloid Axiom: Monoclonal antibodies demand strict Amyloid-Related Imaging
Abnormalities (ARIA) MRI monitoring, with an additional scan now mandated prior to the
3rd infusion.
● G2211 Expansion: As of January 1, 2026, the G2211 complexity add-on code is fully
billable for longitudinal home/residence visits.
PART II: THE ELITE TEST BANK
Section A: Foundational Syntax & Application (Questions 1–15)
Q1: A primary care practice is transitioning to an Age-Friendly Health System designation under
the 2026 guidelines. The clinical director audits the electronic health records to ensure
compliance with the core framework. Which intervention represents the MOST ACCURATE
,application of the 4Ms/5Ms framework? A) Prioritizing the rapid correction of single-disease
biomarkers over functional capacity. B) Aligning all medication, mentation, and mobility
interventions strictly with the patient's documented "What Matters Most" goals. C) Automatically
referring all patients over 65 to physical therapy regardless of baseline mobility. D) Utilizing
isolated chronological age to determine the aggressiveness of chronic disease management.
● The Answer: B (Aligning all medication, mentation, and mobility interventions strictly with
the patient's documented "What Matters Most" goals.)
● Distractor Analysis:
○ A is incorrect: This violates the concept of "Multicomplexity." Treating single-disease
biomarkers often leads to prescribing cascades and ignores the holistic reality of
geriatric decline.
○ C is incorrect: Interventions must be individualized. Blanket referrals do not align
with the specific mobility goals or functional baseline of the individual patient.
○ D is incorrect: Chronological age alone is a poor predictor of physiological reserve.
Decisions must be based on frailty, multimorbidity, and patient priorities.
The Mentor's Analysis: The pinnacle of the Age-Friendly Health System is quality of life, which
is governed entirely by "What Matters." If an intervention optimizes mentation or mobility but
directly violates the patient's overarching life goals, it is clinically inappropriate. Professional
Intuition: The medical plan must serve the life plan, never the reverse.
Q2: An 89-year-old highly cachectic male weighing 42 kg requires renally dosed antibiotic
therapy. The laboratory reports an estimated Glomerular Filtration Rate (eGFR) via CKD-EPI of
72 mL/min/1.73m². Which action is the MOST APPROPRIATE INITIAL step for the practitioner?
A) Dose the medication based on the laboratory-reported CKD-EPI eGFR to ensure adequate
peak concentrations. B) Calculate the absolute creatinine clearance utilizing the Cockcroft-Gault
formula with the patient's actual body weight. C) Utilize ideal body weight in the MDRD equation
to prevent sub-therapeutic dosing. D) Withhold the antibiotic until a 24-hour urine creatinine
clearance is completed.
● The Answer: B (Calculate the absolute creatinine clearance utilizing the Cockcroft-Gault
formula with the patient's actual body weight.)
● Distractor Analysis:
○ A is incorrect: The CKD-EPI equation relies on serum creatinine. In cachectic
patients with profound sarcopenia, serum creatinine is artificially low, causing the
equation to drastically overestimate renal function, leading to toxic dosing.
○ C is incorrect: MDRD is outdated for geriatric drug dosing, and ideal body weight is
not the standard when actual body weight is significantly lower due to cachexia.
○ D is incorrect: A 24-hour collection is impractical in acute settings and delays
necessary treatment unnecessarily.
The Mentor's Analysis: In the extreme elderly, muscle mass vanishes. Low muscle mass
means low creatinine production. Therefore, a "normal" serum creatinine often masks severe
renal impairment. The Cockcroft-Gault formula remains the ironclad standard for
pharmacokinetic dosing because it was the formula used during the clinical trials of most legacy
drugs.
Q3: Under the updated 2026 AGS Beers Criteria, a practitioner is reviewing the medication list
of a 78-year-old female with a history of recurrent urinary tract infections and mild heart failure.
Which medication class now carries a strict 2026 warning requiring intense scrutiny and
potential deprescribing? A) Beta-blockers B) Sodium-glucose co-transporter 2 (SGLT2)
inhibitors C) Angiotensin-converting enzyme (ACE) inhibitors D) Calcium channel blockers
● The Answer: B (Sodium-glucose co-transporter 2 (SGLT2) inhibitors)
, ● Distractor Analysis:
○ A is incorrect: Beta-blockers are standard guideline-directed medical therapy for
heart failure and are not a new primary target for the Beers Criteria.
○ C is incorrect: ACE inhibitors are not newly restricted under the 2026 Beers
updates.
○ D is incorrect: While they have side effects, calcium channel blockers are not the
subject of the specific 2026 Beers warning highlighted for this demographic.
The Mentor's Analysis: While SGLT2 inhibitors offer immense cardiovascular and renal
benefits, they were newly added to the Beers list due to the high risk of genital mycotic
infections, volume depletion, and euglycemic diabetic ketoacidosis in frail older adults.
Professional Intuition: Always weigh the cardiovascular benefit against the immediate threat of
recurrent urogenital infections in the frail elderly.
Q4: A patient with mild cognitive impairment is initiating anti-amyloid monoclonal antibody
therapy (lecanemab). According to the 2026 FDA safety mandates regarding Amyloid-Related
Imaging Abnormalities (ARIA), when is the MOST CRITICAL newly added timepoint for an MRI
scan? A) Prior to the 1st infusion only. B) Between the 2nd and 3rd infusion. C) Immediately
following the 14th infusion. D) At the 52-week mark.
● The Answer: B (Between the 2nd and 3rd infusion.)
● Distractor Analysis:
○ A is incorrect: While a baseline scan is required, it is not the newly added safety
mandate.
○ C is incorrect: A scan before the 14th infusion was part of the original protocol, not
the new updated mandate.
○ D is incorrect: Week 52 is standard surveillance, but misses the acute window for
early ARIA-E onset.
The Mentor's Analysis: The FDA updated the prescribing information to require an MRI
between the 2nd and 3rd infusion because real-world data showed critical, asymptomatic brain
swelling (ARIA-E) developing early in the treatment course. Detecting this fluid buildup before
the 3rd dose prevents progression to fatal status epilepticus.
Q5: Effective January 1, 2026, a practitioner conducting a comprehensive, longitudinal
evaluation and management (E/M) visit for a homebound patient with multiple chronic conditions
wishes to capture the complexity of the visit. Which billing action is MOST APPROPRIATE? A)
Bill only the standard home E/M code (99341-99350) as add-on codes are restricted to
outpatient facilities. B) Append modifier -25 to the standard home E/M code. C) Report the
G2211 complexity add-on code alongside the appropriate home or residence E/M visit code. D)
Bill the Advanced Primary Care Management (APCM) code G0558 exclusively.
● The Answer: C (Report the G2211 complexity add-on code alongside the appropriate
home or residence E/M visit code.)
● Distractor Analysis:
○ A is incorrect: The 2026 Medicare Physician Fee Schedule explicitly expanded
G2211 to include home and residence visits to recognize the "invisible work" of
home-based care.
○ B is incorrect: Modifier -25 is used for a significant, separately identifiable E/M
service on the same day as a procedure, and generally prohibits the use of G2211.
○ D is incorrect: APCM codes (G0556-G0558) are monthly care management codes,
not add-on codes for face-to-face E/M visit complexity.
The Mentor's Analysis: The 2026 expansion of G2211 is a massive victory for geriatric home
care. It financially acknowledges the intense coordination required to manage complex patients
, outside the clinic. You must document the continuous, longitudinal relationship to justify the
code.
Q6: A clinical practice is utilizing the new 2026 Advanced Primary Care Management (APCM)
HCPCS codes. Which patient profile BEST meets the requirements for billing code G0557? A) A
patient with a single, acute respiratory infection expected to resolve in two weeks. B) A patient
with zero chronic conditions undergoing a routine annual wellness exam. C) A patient with two
or more chronic conditions expected to last at least 12 months, placing them at significant risk of
functional decline. D) A Qualified Medicare Beneficiary (QMB) requiring immediate surgical
intervention.
● The Answer: C (A patient with two or more chronic conditions expected to last at least 12
months, placing them at significant risk of functional decline.)
● Distractor Analysis:
○ A is incorrect: APCM requires conditions expected to last at least 12 months or until
death.
○ B is incorrect: Zero or one chronic condition corresponds to the lower-tier code
G0556.
○ D is incorrect: QMB patients with multiple chronic conditions are billed under the
highest tier code, G0558.
The Mentor's Analysis: APCM codes bundle Principal, Transitional, and Chronic Care
Management into a streamlined monthly billing process.
Code Target Demographic
G0556 One or zero chronic conditions
G0557 Two or more chronic conditions
G0558 Two or more conditions + QMB status
G0557 is the workhorse code for the standard multimorbid geriatric patient.
Q7: Under the revised Texas Advance Directives Act (TADA), if a hospital ethics committee
determines that requested life-sustaining treatment is medically futile, what is the EXACT
mandated timeframe the facility must provide the family to secure a transfer before treatment
can be legally withdrawn? A) 48 hours B) 10 days C) 14 days D) 25 days
● The Answer: D (25 days)
● Distractor Analysis:
○ A is incorrect: 48 hours was the old requirement for notifying the family of the ethics
committee meeting, which was updated to 7 days.
○ B is incorrect: This is the infamous legacy "10-Day Rule" that was heavily criticized
and subsequently abolished by H.B. 3162.
○ C is incorrect: 14 days is a fabricated timeframe in this legal context.
The Mentor's Analysis: The shift from 10 days to 25 days under H.B. 3162 represents a major
legal and ethical pivot in Texas end-of-life care. It balances the provider's duty of
non-maleficence against the family's right to seek alternative care. Always initiate transfer
protocols the absolute second the committee makes its ruling.
---
Q8: An 82-year-old patient is evaluated in the clinic. They ambulate slowly with a cane, require
help managing their finances, and complain of chronic exhaustion. According to the Clinical
Frailty Scale, how should this patient's status be BEST conceptualized? A) A normal, expected
manifestation of chronological aging. B) A distinct biologic syndrome of decreased physiological
reserve and extreme vulnerability to minor stressors. C) A temporary condition secondary to
acute dehydration. D) A psychological manifestation of undiagnosed depression.
