Barkley AGPCNP Predictor/Readiness FLORIDA
STATE FIRE INSTRUCTOR 3 ACTUAL EXAM ALL
QUESTIONS AND ANSWERS ALREADY GRADED A+.
100% VERIFIED SOLUTIONS | UPDATED PER LATEST
GUIDELINES | GRADED A+
Domain 1: Assessment & Diagnosis (Questions 1-20)
Question 1
A 72-year-old woman with a 50-pack-year smoking history presents with dyspnea and a chronic
cough. Pulmonary function tests show FEV1/FVC <0.70 and an FEV1 of 55% predicted without
significant reversibility. What is the correct GOLD classification?
A. GOLD 1 (mild)
B. GOLD 2 (moderate)
C. GOLD 3 (severe)
D. GOLD 4 (very severe)
Correct Answer: B
Rationale: GOLD 2 (moderate) is defined as FEV1 50-79% predicted after bronchodilator use,
with FEV1/FVC <0.70. GOLD 1 is FEV1 ≥80%, GOLD 3 is 30-49%, and GOLD 4 is <30% .
Question 2
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
Correct Answer: C
,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 3
An 85-year-old man with BPH and hypertension presents with acute onset of urinary retention,
severe flank pain, and hematuria. What is the most appropriate initial diagnostic test?
A. Abdominal ultrasound
B. Intravenous pyelogram
C. CT scan of the abdomen and pelvis without contrast
D. Plain abdominal X-ray
Correct Answer: C
Rationale: CT scan without contrast is the gold standard for diagnosing renal calculi, which is
suspected given acute flank pain and hematuria. Ultrasound may miss small stones. IVP is less
commonly used. CT is rapid, sensitive, and specific .
Question 4
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
Correct Answer: A
Rationale: Hypokalemia (a common adverse effect of thiazide diuretics) can increase cardiac
ectopy. Before initiating antiarrhythmic therapy, electrolyte imbalances should be corrected .
Question 5
A 75-year-old male with long-standing hypertension and atrial fibrillation on warfarin presents
with acute-onset confusion, right-sided weakness, and aphasia. CT head is negative for
hemorrhage. What is the most likely diagnosis?
,A. Transient ischemic attack
B. Ischemic stroke
C. Subdural hematoma
D. Cerebral amyloid angiopathy
Correct Answer: B
Rationale: Sudden focal neurological deficits with negative CT (but MRI would show infarction)
is classic for ischemic stroke. TIA lasts <24 hours and typically resolves without permanent
deficit. Subdural hematoma may have gradual onset. Warfarin increases risk of hemorrhagic
stroke, but CT is negative .
Question 6
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
Correct Answer: B
Rationale: Stage 1 hypertension is defined as systolic BP 130-139 or diastolic 80-89 mmHg. Her
BP of 154/92 falls into Stage 1, which should be managed with lifestyle modifications and a 10-
year ASCVD risk assessment .
Question 7
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
Correct Answer: C
, Rationale: BPH is a non-malignant enlargement of the prostate that causes obstructive LUTS.
The prostate is smooth and symmetric; cancer typically presents as a hard, irregular nodule .
Question 8
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
Correct Answer: B
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 9
A 65-year-old male presents with 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 only
Correct Answer: A
Rationale: Venous duplex ultrasound is the initial imaging study of choice for suspected DVT. It
is non-invasive, widely available, and highly sensitive for proximal DVT. D-dimer alone is not
diagnostic .
Question 10
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?
STATE FIRE INSTRUCTOR 3 ACTUAL EXAM ALL
QUESTIONS AND ANSWERS ALREADY GRADED A+.
100% VERIFIED SOLUTIONS | UPDATED PER LATEST
GUIDELINES | GRADED A+
Domain 1: Assessment & Diagnosis (Questions 1-20)
Question 1
A 72-year-old woman with a 50-pack-year smoking history presents with dyspnea and a chronic
cough. Pulmonary function tests show FEV1/FVC <0.70 and an FEV1 of 55% predicted without
significant reversibility. What is the correct GOLD classification?
A. GOLD 1 (mild)
B. GOLD 2 (moderate)
C. GOLD 3 (severe)
D. GOLD 4 (very severe)
Correct Answer: B
Rationale: GOLD 2 (moderate) is defined as FEV1 50-79% predicted after bronchodilator use,
with FEV1/FVC <0.70. GOLD 1 is FEV1 ≥80%, GOLD 3 is 30-49%, and GOLD 4 is <30% .
Question 2
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
Correct Answer: C
,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 3
An 85-year-old man with BPH and hypertension presents with acute onset of urinary retention,
severe flank pain, and hematuria. What is the most appropriate initial diagnostic test?
A. Abdominal ultrasound
B. Intravenous pyelogram
C. CT scan of the abdomen and pelvis without contrast
D. Plain abdominal X-ray
Correct Answer: C
Rationale: CT scan without contrast is the gold standard for diagnosing renal calculi, which is
suspected given acute flank pain and hematuria. Ultrasound may miss small stones. IVP is less
commonly used. CT is rapid, sensitive, and specific .
Question 4
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
Correct Answer: A
Rationale: Hypokalemia (a common adverse effect of thiazide diuretics) can increase cardiac
ectopy. Before initiating antiarrhythmic therapy, electrolyte imbalances should be corrected .
Question 5
A 75-year-old male with long-standing hypertension and atrial fibrillation on warfarin presents
with acute-onset confusion, right-sided weakness, and aphasia. CT head is negative for
hemorrhage. What is the most likely diagnosis?
,A. Transient ischemic attack
B. Ischemic stroke
C. Subdural hematoma
D. Cerebral amyloid angiopathy
Correct Answer: B
Rationale: Sudden focal neurological deficits with negative CT (but MRI would show infarction)
is classic for ischemic stroke. TIA lasts <24 hours and typically resolves without permanent
deficit. Subdural hematoma may have gradual onset. Warfarin increases risk of hemorrhagic
stroke, but CT is negative .
Question 6
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
Correct Answer: B
Rationale: Stage 1 hypertension is defined as systolic BP 130-139 or diastolic 80-89 mmHg. Her
BP of 154/92 falls into Stage 1, which should be managed with lifestyle modifications and a 10-
year ASCVD risk assessment .
Question 7
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
Correct Answer: C
, Rationale: BPH is a non-malignant enlargement of the prostate that causes obstructive LUTS.
The prostate is smooth and symmetric; cancer typically presents as a hard, irregular nodule .
Question 8
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
Correct Answer: B
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 9
A 65-year-old male presents with 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 only
Correct Answer: A
Rationale: Venous duplex ultrasound is the initial imaging study of choice for suspected DVT. It
is non-invasive, widely available, and highly sensitive for proximal DVT. D-dimer alone is not
diagnostic .
Question 10
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?
