Barkley AGPCNP Diagnostic Readiness Test (DRT) | 100
Actual Practice Questions and Answers
SECTION 1: ASSESSMENT & DIAGNOSIS (Questions 1-25)
Question 1
A 65-year-old male with a 40-pack-year smoking history presents with a persistent
cough and unintentional weight loss. Which of the following is the most appropriate
initial screening test for lung cancer?
A) Annual chest X-ray
B) Sputum cytology
C) Low-dose CT (LDCT) of the chest
D) CT pulmonary angiography
Answer: C) Low-dose CT (LDCT) of the chest
Rationale: The USPSTF recommends annual LDCT for adults aged 50-80 years with a
≥20 pack-year smoking history who currently smoke or have quit within the past 15
years. LDCT reduces lung-cancer mortality, while chest X-ray is not recommended for
screening .
Question 2
A 58-year-old female reports "skipped heartbeats" and occasional dizziness. Her only
medication is hydrochlorothiazide. ECG shows sinus rhythm with frequent premature
atrial contractions (PACs). What is the most appropriate next step?
A) Check serum potassium level
B) Start a beta-blocker
,C) Refer for electrophysiology study
D) Order a Holter monitor
Answer: A) Check serum potassium level
Rationale: Hypokalemia (a common adverse effect of thiazide diuretics) can increase
cardiac ectopy. Before initiating antiarrhythmic therapy, electrolyte imbalances should
be corrected .
Question 3
A 72-year-old man with a history of hypertension and osteoarthritis presents with acute
knee swelling, erythema, and pain. Joint aspiration reveals 20,000 WBCs/μL (80%
neutrophils). What is the most appropriate next step?
A) Apply a compression wrap and prescribe ibuprofen
B) Obtain Gram stain and culture of the aspirate
C) Inject intra-articular corticosteroid
D) Prescribe colchicine for suspected gout
Answer: B) Obtain Gram stain and culture of the aspirate
Rationale: The synovial fluid findings are inflammatory and could indicate septic
arthritis, which is a medical emergency. Gram stain and culture are essential to rule out
infection before empiric treatment .
Question 4
An asymptomatic 68-year-old female has a blood pressure of 154/92 mmHg on three
,separate occasions. She has no diabetes or known cardiovascular disease. According to
the 2017 ACC/AHA guideline, what is her stage of hypertension?
A) Elevated
B) Stage 1
C) Stage 2
D) Hypertensive crisis
Answer: C) Stage 2
Rationale: Stage 2 hypertension is defined as systolic BP ≥140 or diastolic ≥90 mmHg.
Her BP falls into Stage 2, which should be managed with lifestyle modifications and
pharmacologic therapy. Stage 1 is 130-139/80-89 mmHg .
Question 5
A 50-year-old male presents with nocturia, weak stream, and post-void dribbling. Digital
rectal exam reveals a symmetrically enlarged, smooth prostate. What is the most likely
diagnosis?
A) Prostate cancer
B) Acute prostatitis
C) Benign prostatic hyperplasia (BPH)
D) Chronic pelvic pain syndrome
Answer: C) Benign prostatic hyperplasia (BPH)
Rationale: BPH is a non-malignant enlargement of the prostate that causes obstructive
lower urinary tract symptoms. The prostate is smooth and symmetric; cancer typically
presents as a hard, irregular nodule .
, Question 6
A 75-year-old female with a history of atrial fibrillation is on warfarin and has an INR of
4.5 without bleeding. What is the most appropriate management?
A) Administer vitamin K 10 mg IV
B) Hold warfarin and recheck INR in 1-2 days
C) Give fresh frozen plasma
D) Increase warfarin dose
Answer: B) Hold warfarin and recheck INR in 1-2 days
Rationale: For an INR of 4.5 without bleeding, the standard approach is to withhold
warfarin and repeat the INR in 24-48 hours. Vitamin K is reserved for INR >10 or for
patients with bleeding .
Question 7
A 65-year-old male presents with a 3-week history of left leg swelling and discomfort.
He is a current smoker with a history of DVT. What is the most appropriate initial
imaging study?
A) Venous duplex ultrasound
B) CT venography
C) MRI venography
D) D-dimer assay
Answer: A) Venous duplex ultrasound
Rationale: Venous duplex ultrasound is the initial imaging study of choice for suspected
DVT. It is non-invasive, widely available, and highly accurate for detecting proximal vein
thrombosis. D-dimer is a screening test, not diagnostic imaging .
Actual Practice Questions and Answers
SECTION 1: ASSESSMENT & DIAGNOSIS (Questions 1-25)
Question 1
A 65-year-old male with a 40-pack-year smoking history presents with a persistent
cough and unintentional weight loss. Which of the following is the most appropriate
initial screening test for lung cancer?
A) Annual chest X-ray
B) Sputum cytology
C) Low-dose CT (LDCT) of the chest
D) CT pulmonary angiography
Answer: C) Low-dose CT (LDCT) of the chest
Rationale: The USPSTF recommends annual LDCT for adults aged 50-80 years with a
≥20 pack-year smoking history who currently smoke or have quit within the past 15
years. LDCT reduces lung-cancer mortality, while chest X-ray is not recommended for
screening .
Question 2
A 58-year-old female reports "skipped heartbeats" and occasional dizziness. Her only
medication is hydrochlorothiazide. ECG shows sinus rhythm with frequent premature
atrial contractions (PACs). What is the most appropriate next step?
A) Check serum potassium level
B) Start a beta-blocker
,C) Refer for electrophysiology study
D) Order a Holter monitor
Answer: A) Check serum potassium level
Rationale: Hypokalemia (a common adverse effect of thiazide diuretics) can increase
cardiac ectopy. Before initiating antiarrhythmic therapy, electrolyte imbalances should
be corrected .
Question 3
A 72-year-old man with a history of hypertension and osteoarthritis presents with acute
knee swelling, erythema, and pain. Joint aspiration reveals 20,000 WBCs/μL (80%
neutrophils). What is the most appropriate next step?
A) Apply a compression wrap and prescribe ibuprofen
B) Obtain Gram stain and culture of the aspirate
C) Inject intra-articular corticosteroid
D) Prescribe colchicine for suspected gout
Answer: B) Obtain Gram stain and culture of the aspirate
Rationale: The synovial fluid findings are inflammatory and could indicate septic
arthritis, which is a medical emergency. Gram stain and culture are essential to rule out
infection before empiric treatment .
Question 4
An asymptomatic 68-year-old female has a blood pressure of 154/92 mmHg on three
,separate occasions. She has no diabetes or known cardiovascular disease. According to
the 2017 ACC/AHA guideline, what is her stage of hypertension?
A) Elevated
B) Stage 1
C) Stage 2
D) Hypertensive crisis
Answer: C) Stage 2
Rationale: Stage 2 hypertension is defined as systolic BP ≥140 or diastolic ≥90 mmHg.
Her BP falls into Stage 2, which should be managed with lifestyle modifications and
pharmacologic therapy. Stage 1 is 130-139/80-89 mmHg .
Question 5
A 50-year-old male presents with nocturia, weak stream, and post-void dribbling. Digital
rectal exam reveals a symmetrically enlarged, smooth prostate. What is the most likely
diagnosis?
A) Prostate cancer
B) Acute prostatitis
C) Benign prostatic hyperplasia (BPH)
D) Chronic pelvic pain syndrome
Answer: C) Benign prostatic hyperplasia (BPH)
Rationale: BPH is a non-malignant enlargement of the prostate that causes obstructive
lower urinary tract symptoms. The prostate is smooth and symmetric; cancer typically
presents as a hard, irregular nodule .
, Question 6
A 75-year-old female with a history of atrial fibrillation is on warfarin and has an INR of
4.5 without bleeding. What is the most appropriate management?
A) Administer vitamin K 10 mg IV
B) Hold warfarin and recheck INR in 1-2 days
C) Give fresh frozen plasma
D) Increase warfarin dose
Answer: B) Hold warfarin and recheck INR in 1-2 days
Rationale: For an INR of 4.5 without bleeding, the standard approach is to withhold
warfarin and repeat the INR in 24-48 hours. Vitamin K is reserved for INR >10 or for
patients with bleeding .
Question 7
A 65-year-old male presents with a 3-week history of left leg swelling and discomfort.
He is a current smoker with a history of DVT. What is the most appropriate initial
imaging study?
A) Venous duplex ultrasound
B) CT venography
C) MRI venography
D) D-dimer assay
Answer: A) Venous duplex ultrasound
Rationale: Venous duplex ultrasound is the initial imaging study of choice for suspected
DVT. It is non-invasive, widely available, and highly accurate for detecting proximal vein
thrombosis. D-dimer is a screening test, not diagnostic imaging .
