ELITE TEST BANK:
Ham’s Primary Care
Geriatrics (7th Ed.) &
Clinical Standards
PART 0: THE NAVIGATOR
● PART I: THE PRIMER
○ Welcome to the Big Leagues
○ The 2026/2027 Critical Action Cheat Sheet
● PART II: THE ELITE TEST BANK
○ Questions 1–28: Foundational Syntax & Application (The Hard Deck)
○ Questions 29–58: Professional Simulation (Immediate Action Drills)
○ Questions 59–88: Grandmaster Synthesis (Crisis & Complexity)
PART I: THE PRIMER
Welcome to the Big Leagues. Using this test bank will directly intercept fatal professional errors
before they reach a patient. You are moving beyond academic memorization; this gauntlet
builds the clinical intuition required to navigate high-stakes, multi-morbid geriatric care under the
rigorous 2026/2027 standards of UT Texas Dell Medical School and the American Geriatrics
Society.
The 2026/2027 Critical Action Cheat Sheet
Clinical Domain 2026/2027 Standard / Guideline Critical Application Directive
Assessment The Geriatric 5Ms Every clinical decision must
filter through Mind, Mobility,
Medications, Multicomplexity,
and Matters Most.
Pharmacology 2026 AGS Beers Criteria Apixaban is the DOAC of
choice. Never use Z-drugs for
insomnia without exhausting
CBT-I. Avoid Bactrim with
ACEi/ARBs in CKD due to
lethal hyperkalemia.
Cardiology 2025/2026 AHA/ACC HTN Universal target is <130/80 mm
,Clinical Domain 2026/2027 Standard / Guideline Critical Application Directive
Hg for adults to prevent
cognitive decline, utilizing the
PREVENT equation for risk
stratification.
Endocrinology 2026 ADA Standards Minimum protein intake is
0.8-1.5 g/kg/day to prevent
sarcopenia. CGM is universally
recommended for older adults
on insulin.
Neurology Anti-Amyloid Therapeutics Lecanemab/Donanemab
require APOE ε4 genotyping
and strict MRI monitoring
(baseline, prior to 5th, 7th, 14th
infusions) for ARIA.
Billing/Ops 2026 Medicare PFS G0511/G0512 are sunsetted.
FQHCs/RHCs must report
individual CPTs or APCM
add-on codes for care
coordination.
PART II: THE ELITE TEST BANK
Questions 1–28: Foundational Syntax & Application
Q1: A 78-year-old with chronic kidney disease (CKD) and hypertension is prescribed
trimethoprim-sulfamethoxazole for a UTI. The patient takes lisinopril. What severe interaction
must be monitored per the 2026 AGS Beers Criteria? A) Severe hypocalcemia B)
Life-threatening hyperkalemia C) Acute liver failure D) Hemolytic anemia
● The Answer: B (Life-threatening hyperkalemia)
● Distractor Analysis: A, C, and D are incorrect: The lethal interaction between ACE
inhibitors and trimethoprim in CKD strictly involves the blockade of potassium excretion.
The Mentor's Analysis: Trimethoprim acts as a potassium-sparing diuretic in the distal tubule.
Combined with an ACE inhibitor and an aging kidney, potassium rapidly elevates, inducing fatal
arrhythmias. Professional Intuition: Always check the BMP before adding an antibiotic that
manipulates renal ion channels.
Q2: Under the 2026 ADA Standards, the use of Continuous Glucose Monitoring (CGM) in an
82-year-old with Type 2 diabetes on basal insulin is: A) Contraindicated due to technological
complexity. B) Recommended to improve glycemic outcomes and prevent silent hypoglycemia.
C) Strictly reserved for Type 1 diabetics. D) Limited to inpatient hospital management.
● The Answer: B (Recommended to improve glycemic outcomes and prevent silent
hypoglycemia.)
● Distractor Analysis: A, C, and D are incorrect: 2026 guidelines explicitly mandate CGM
for older adults with Type 2 diabetes on insulin to reduce treatment burden and intercept
silent hypoglycemia.
The Mentor's Analysis: Hypoglycemia in the elderly presents as falls and silent cardiac
ischemia. CGM provides real-time telemetry. Professional Intuition: Fingersticks are
snapshots; CGM is a continuous security camera.
, Q3: According to the 2025/2026 AHA/ACC Hypertension Guidelines, the overarching blood
pressure treatment target for an independent 75-year-old to mitigate cardiovascular and
cognitive risk is: A) <150/90 mm Hg B) <140/90 mm Hg C) <130/80 mm Hg D) <120/70 mm Hg
● The Answer: C (<130/80 mm Hg)
● Distractor Analysis: A and B are incorrect: These represent outdated legacy targets that
tolerate excessive vascular shear stress. D is incorrect: This target risks severe
orthostatic hypotension in geriatrics.
The Mentor's Analysis: The 2026 standard aggressively targets <130/80 mm Hg to preserve
both myocardial function and cerebral microvasculature, provided it is safely tolerated.
Professional Intuition: Protect the brain by protecting the vessels.
Q4: A patient initiating lecanemab for mild Alzheimer's disease must undergo protocolized MRI
monitoring to detect Amyloid-Related Imaging Abnormalities (ARIA). When are the mandatory
routine MRIs scheduled? A) Only if the patient becomes symptomatic. B) Baseline, and prior to
the 5th, 7th, and 14th infusions. C) Every 30 days for the first year. D) Baseline and at 12
months.
● The Answer: B (Baseline, and prior to the 5th, 7th, and 14th infusions.)
● Distractor Analysis: A, C, and D are incorrect: ARIA is largely asymptomatic. Routine,
protocolized imaging at weeks 16, 24, and 52 is legally and clinically mandated.
The Mentor's Analysis: ARIA-E (edema) and ARIA-H (hemorrhage) peak early in treatment.
You cannot wait for clinical symptoms; by then, the neurological damage is severe.
Professional Intuition: In anti-amyloid therapy, the MRI is your primary clinical exam.
Q5: To prevent sarcopenia in an 80-year-old patient, the 2026 ADA Standards and geriatric
nutritional guidelines recommend a daily protein intake of: A) 0.4 - 0.6 g/kg/day B) 0.8 - 1.5
g/kg/day C) 2.0 - 2.5 g/kg/day D) Protein restriction is required to protect renal function
regardless of CKD stage.
● The Answer: B (0.8 - 1.5 g/kg/day)
● Distractor Analysis: A is incorrect: This induces rapid muscle wasting. C is incorrect:
This strains renal clearance. D is incorrect: Blanket restriction accelerates frailty.
The Mentor's Analysis: Sarcopenia is the gateway to the geriatric cascade (falls, fractures,
death). Protein is the physiological anchor of independence. Professional Intuition: Prioritize
lean mass preservation as aggressively as glycemic control.
Q6: A core concept of the Geriatric 5Ms is Matters Most. In clinical practice, this requires the
practitioner to FIRST: A) Ensure the patient adheres strictly to all prescribed medications. B)
Align medical treatments with the patient's specific health outcome goals and care preferences.
C) Maximize lifespan at all costs. D) Defer all clinical decisions to the patient's next of kin.
● The Answer: B (Align medical treatments with the patient's specific health outcome goals
and care preferences.)
● Distractor Analysis: A, C, and D are incorrect: These violate patient-centered care.
Matters Most dictates that the patient's personal goals (e.g., quality of life vs. longevity)
drive the intervention.
The Mentor's Analysis: If a treatment extends life by six months but destroys the patient's
ability to remain at home, and the patient's primary goal is independence, the treatment is a
failure. Professional Intuition: The medical objective must serve the human objective.
Q7: Per the 2026 Medicare Physician Fee Schedule (PFS) for Rural Health Clinics (RHCs), how
should Psychiatric Collaborative Care Model (CoCM) services be billed? A) Using the legacy
G0511 wrapper code. B) Using the legacy G0512 wrapper code. C) Reporting the individual
CPT/HCPCS codes that previously comprised G0512. D) CoCM services are no longer
reimbursable.
Ham’s Primary Care
Geriatrics (7th Ed.) &
Clinical Standards
PART 0: THE NAVIGATOR
● PART I: THE PRIMER
○ Welcome to the Big Leagues
○ The 2026/2027 Critical Action Cheat Sheet
● PART II: THE ELITE TEST BANK
○ Questions 1–28: Foundational Syntax & Application (The Hard Deck)
○ Questions 29–58: Professional Simulation (Immediate Action Drills)
○ Questions 59–88: Grandmaster Synthesis (Crisis & Complexity)
PART I: THE PRIMER
Welcome to the Big Leagues. Using this test bank will directly intercept fatal professional errors
before they reach a patient. You are moving beyond academic memorization; this gauntlet
builds the clinical intuition required to navigate high-stakes, multi-morbid geriatric care under the
rigorous 2026/2027 standards of UT Texas Dell Medical School and the American Geriatrics
Society.
The 2026/2027 Critical Action Cheat Sheet
Clinical Domain 2026/2027 Standard / Guideline Critical Application Directive
Assessment The Geriatric 5Ms Every clinical decision must
filter through Mind, Mobility,
Medications, Multicomplexity,
and Matters Most.
Pharmacology 2026 AGS Beers Criteria Apixaban is the DOAC of
choice. Never use Z-drugs for
insomnia without exhausting
CBT-I. Avoid Bactrim with
ACEi/ARBs in CKD due to
lethal hyperkalemia.
Cardiology 2025/2026 AHA/ACC HTN Universal target is <130/80 mm
,Clinical Domain 2026/2027 Standard / Guideline Critical Application Directive
Hg for adults to prevent
cognitive decline, utilizing the
PREVENT equation for risk
stratification.
Endocrinology 2026 ADA Standards Minimum protein intake is
0.8-1.5 g/kg/day to prevent
sarcopenia. CGM is universally
recommended for older adults
on insulin.
Neurology Anti-Amyloid Therapeutics Lecanemab/Donanemab
require APOE ε4 genotyping
and strict MRI monitoring
(baseline, prior to 5th, 7th, 14th
infusions) for ARIA.
Billing/Ops 2026 Medicare PFS G0511/G0512 are sunsetted.
FQHCs/RHCs must report
individual CPTs or APCM
add-on codes for care
coordination.
PART II: THE ELITE TEST BANK
Questions 1–28: Foundational Syntax & Application
Q1: A 78-year-old with chronic kidney disease (CKD) and hypertension is prescribed
trimethoprim-sulfamethoxazole for a UTI. The patient takes lisinopril. What severe interaction
must be monitored per the 2026 AGS Beers Criteria? A) Severe hypocalcemia B)
Life-threatening hyperkalemia C) Acute liver failure D) Hemolytic anemia
● The Answer: B (Life-threatening hyperkalemia)
● Distractor Analysis: A, C, and D are incorrect: The lethal interaction between ACE
inhibitors and trimethoprim in CKD strictly involves the blockade of potassium excretion.
The Mentor's Analysis: Trimethoprim acts as a potassium-sparing diuretic in the distal tubule.
Combined with an ACE inhibitor and an aging kidney, potassium rapidly elevates, inducing fatal
arrhythmias. Professional Intuition: Always check the BMP before adding an antibiotic that
manipulates renal ion channels.
Q2: Under the 2026 ADA Standards, the use of Continuous Glucose Monitoring (CGM) in an
82-year-old with Type 2 diabetes on basal insulin is: A) Contraindicated due to technological
complexity. B) Recommended to improve glycemic outcomes and prevent silent hypoglycemia.
C) Strictly reserved for Type 1 diabetics. D) Limited to inpatient hospital management.
● The Answer: B (Recommended to improve glycemic outcomes and prevent silent
hypoglycemia.)
● Distractor Analysis: A, C, and D are incorrect: 2026 guidelines explicitly mandate CGM
for older adults with Type 2 diabetes on insulin to reduce treatment burden and intercept
silent hypoglycemia.
The Mentor's Analysis: Hypoglycemia in the elderly presents as falls and silent cardiac
ischemia. CGM provides real-time telemetry. Professional Intuition: Fingersticks are
snapshots; CGM is a continuous security camera.
, Q3: According to the 2025/2026 AHA/ACC Hypertension Guidelines, the overarching blood
pressure treatment target for an independent 75-year-old to mitigate cardiovascular and
cognitive risk is: A) <150/90 mm Hg B) <140/90 mm Hg C) <130/80 mm Hg D) <120/70 mm Hg
● The Answer: C (<130/80 mm Hg)
● Distractor Analysis: A and B are incorrect: These represent outdated legacy targets that
tolerate excessive vascular shear stress. D is incorrect: This target risks severe
orthostatic hypotension in geriatrics.
The Mentor's Analysis: The 2026 standard aggressively targets <130/80 mm Hg to preserve
both myocardial function and cerebral microvasculature, provided it is safely tolerated.
Professional Intuition: Protect the brain by protecting the vessels.
Q4: A patient initiating lecanemab for mild Alzheimer's disease must undergo protocolized MRI
monitoring to detect Amyloid-Related Imaging Abnormalities (ARIA). When are the mandatory
routine MRIs scheduled? A) Only if the patient becomes symptomatic. B) Baseline, and prior to
the 5th, 7th, and 14th infusions. C) Every 30 days for the first year. D) Baseline and at 12
months.
● The Answer: B (Baseline, and prior to the 5th, 7th, and 14th infusions.)
● Distractor Analysis: A, C, and D are incorrect: ARIA is largely asymptomatic. Routine,
protocolized imaging at weeks 16, 24, and 52 is legally and clinically mandated.
The Mentor's Analysis: ARIA-E (edema) and ARIA-H (hemorrhage) peak early in treatment.
You cannot wait for clinical symptoms; by then, the neurological damage is severe.
Professional Intuition: In anti-amyloid therapy, the MRI is your primary clinical exam.
Q5: To prevent sarcopenia in an 80-year-old patient, the 2026 ADA Standards and geriatric
nutritional guidelines recommend a daily protein intake of: A) 0.4 - 0.6 g/kg/day B) 0.8 - 1.5
g/kg/day C) 2.0 - 2.5 g/kg/day D) Protein restriction is required to protect renal function
regardless of CKD stage.
● The Answer: B (0.8 - 1.5 g/kg/day)
● Distractor Analysis: A is incorrect: This induces rapid muscle wasting. C is incorrect:
This strains renal clearance. D is incorrect: Blanket restriction accelerates frailty.
The Mentor's Analysis: Sarcopenia is the gateway to the geriatric cascade (falls, fractures,
death). Protein is the physiological anchor of independence. Professional Intuition: Prioritize
lean mass preservation as aggressively as glycemic control.
Q6: A core concept of the Geriatric 5Ms is Matters Most. In clinical practice, this requires the
practitioner to FIRST: A) Ensure the patient adheres strictly to all prescribed medications. B)
Align medical treatments with the patient's specific health outcome goals and care preferences.
C) Maximize lifespan at all costs. D) Defer all clinical decisions to the patient's next of kin.
● The Answer: B (Align medical treatments with the patient's specific health outcome goals
and care preferences.)
● Distractor Analysis: A, C, and D are incorrect: These violate patient-centered care.
Matters Most dictates that the patient's personal goals (e.g., quality of life vs. longevity)
drive the intervention.
The Mentor's Analysis: If a treatment extends life by six months but destroys the patient's
ability to remain at home, and the patient's primary goal is independence, the treatment is a
failure. Professional Intuition: The medical objective must serve the human objective.
Q7: Per the 2026 Medicare Physician Fee Schedule (PFS) for Rural Health Clinics (RHCs), how
should Psychiatric Collaborative Care Model (CoCM) services be billed? A) Using the legacy
G0511 wrapper code. B) Using the legacy G0512 wrapper code. C) Reporting the individual
CPT/HCPCS codes that previously comprised G0512. D) CoCM services are no longer
reimbursable.
