Barkley Geriatrics Practice ACTUAL EXAM ALL
QUESTIONS AND ANSWERS ALREADY GRADED
A+. 100% VERIFIED SOLUTIONS | UPDATED PER
LATEST GUIDELINES | GRADED A+
Geriatric Syndromes & Age-Related Changes (Questions 1-20)
Question 1
A 78-year-old man presents with acute confusion, disorientation, and hallucinations that
developed over 2 days. He has a history of Parkinson disease. Which condition is most likely?
A. Delirium
B. Dementia progression
C. Parkinson disease psychosis
D. Depression with psychotic features
Correct Answer: A
Rationale: The acute onset (over 2 days) with fluctuating course suggests delirium, which is a
medical emergency. Delirium in older adults is often caused by infections (UTI most common),
medications, metabolic disturbances, or dehydration. While Parkinson disease can cause
psychosis, the acute change and confusion are more consistent with delirium. Dementia
progression is typically gradual .
Question 2
Which of the following best represents the Beers Criteria recommendation regarding
benzodiazepine use in older adults?
A. Preferred for insomnia in adults over 65
B. Avoid due to increased risk of falls and cognitive impairment
C. Safe at low doses for short-term use only
D. First-line for anxiety in geriatric patients
,Correct Answer: B
Rationale: The Beers Criteria explicitly recommends avoiding benzodiazepines in older adults
due to heightened sensitivity, increased risk of falls, fractures, cognitive impairment, and
delirium. Non-benzodiazepine alternatives are preferred for anxiety and insomnia in geriatric
patients .
Question 3
According to geriatric screening guidelines, which screening test is recommended annually for
all adults aged 65 and older?
A. Hearing screening
B. Abdominal aortic aneurysm ultrasound
C. Falls risk assessment
D. Thyroid-stimulating hormone
Correct Answer: C
Rationale: Annual falls risk assessment is recommended for all older adults by the USPSTF and
geriatric guidelines. Falls are a leading cause of injury in older adults, and assessment allows for
targeted interventions such as medication review, gait and balance evaluation, and home safety
modifications .
Question 4
A 78-year-old woman with osteoporosis on alendronate develops severe, diffuse bone and
muscle pain after starting the medication. Which adverse effect should be suspected?
A. Hypocalcemia
B. Atypical femoral fracture
C. Esophageal ulceration
D. Severe musculoskeletal pain (acute phase reaction)
Correct Answer: D
Rationale: Intravenous bisphosphonates (and less commonly oral) can cause severe
musculoskeletal pain, sometimes within days of initiation of therapy. This is known as an acute
phase reaction. Hypocalcemia is typically asymptomatic or presents as paresthesias. Esophageal
ulceration causes odynophagia (painful swallowing), not diffuse pain. Atypical femoral fracture
occurs after long-term use .
,Question 5
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 now due to the availability and sensitivity of CT .
Question 6
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 (mild) is FEV1 ≥80%; GOLD 3 (severe) is 30-49%; GOLD 4 (very
severe) is <30% .
Question 7
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, indicating the stroke is more likely ischemic .
Question 8
A 72-year-old man with a history of COPD presents with confusion, asterixis, and
hyperammonemia. He has a history of chronic liver disease. What is the most appropriate
management?
A. Lactulose
B. Rifaximin
C. Both lactulose and rifaximin
D. Neomycin
Correct Answer: C
Rationale: Hepatic encephalopathy is treated with lactulose (acidifies the gut, traps ammonia)
and rifaximin (reduces ammonia-producing gut bacteria). Lactulose is first-line; rifaximin is
added for recurrent or refractory cases.
Question 9
A 68-year-old woman with type 2 diabetes and hypertension has an LDL-C of 140 mg/dL. She is
already on atorvastatin 40 mg. What is the next step according to the 2018 AHA/ACC cholesterol
guidelines?
A. Add ezetimibe
B. Increase atorvastatin to 80 mg
C. Start a PCSK9 inhibitor
D. No change; LDL-C is at goal
Correct Answer: A
QUESTIONS AND ANSWERS ALREADY GRADED
A+. 100% VERIFIED SOLUTIONS | UPDATED PER
LATEST GUIDELINES | GRADED A+
Geriatric Syndromes & Age-Related Changes (Questions 1-20)
Question 1
A 78-year-old man presents with acute confusion, disorientation, and hallucinations that
developed over 2 days. He has a history of Parkinson disease. Which condition is most likely?
A. Delirium
B. Dementia progression
C. Parkinson disease psychosis
D. Depression with psychotic features
Correct Answer: A
Rationale: The acute onset (over 2 days) with fluctuating course suggests delirium, which is a
medical emergency. Delirium in older adults is often caused by infections (UTI most common),
medications, metabolic disturbances, or dehydration. While Parkinson disease can cause
psychosis, the acute change and confusion are more consistent with delirium. Dementia
progression is typically gradual .
Question 2
Which of the following best represents the Beers Criteria recommendation regarding
benzodiazepine use in older adults?
A. Preferred for insomnia in adults over 65
B. Avoid due to increased risk of falls and cognitive impairment
C. Safe at low doses for short-term use only
D. First-line for anxiety in geriatric patients
,Correct Answer: B
Rationale: The Beers Criteria explicitly recommends avoiding benzodiazepines in older adults
due to heightened sensitivity, increased risk of falls, fractures, cognitive impairment, and
delirium. Non-benzodiazepine alternatives are preferred for anxiety and insomnia in geriatric
patients .
Question 3
According to geriatric screening guidelines, which screening test is recommended annually for
all adults aged 65 and older?
A. Hearing screening
B. Abdominal aortic aneurysm ultrasound
C. Falls risk assessment
D. Thyroid-stimulating hormone
Correct Answer: C
Rationale: Annual falls risk assessment is recommended for all older adults by the USPSTF and
geriatric guidelines. Falls are a leading cause of injury in older adults, and assessment allows for
targeted interventions such as medication review, gait and balance evaluation, and home safety
modifications .
Question 4
A 78-year-old woman with osteoporosis on alendronate develops severe, diffuse bone and
muscle pain after starting the medication. Which adverse effect should be suspected?
A. Hypocalcemia
B. Atypical femoral fracture
C. Esophageal ulceration
D. Severe musculoskeletal pain (acute phase reaction)
Correct Answer: D
Rationale: Intravenous bisphosphonates (and less commonly oral) can cause severe
musculoskeletal pain, sometimes within days of initiation of therapy. This is known as an acute
phase reaction. Hypocalcemia is typically asymptomatic or presents as paresthesias. Esophageal
ulceration causes odynophagia (painful swallowing), not diffuse pain. Atypical femoral fracture
occurs after long-term use .
,Question 5
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 now due to the availability and sensitivity of CT .
Question 6
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 (mild) is FEV1 ≥80%; GOLD 3 (severe) is 30-49%; GOLD 4 (very
severe) is <30% .
Question 7
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, indicating the stroke is more likely ischemic .
Question 8
A 72-year-old man with a history of COPD presents with confusion, asterixis, and
hyperammonemia. He has a history of chronic liver disease. What is the most appropriate
management?
A. Lactulose
B. Rifaximin
C. Both lactulose and rifaximin
D. Neomycin
Correct Answer: C
Rationale: Hepatic encephalopathy is treated with lactulose (acidifies the gut, traps ammonia)
and rifaximin (reduces ammonia-producing gut bacteria). Lactulose is first-line; rifaximin is
added for recurrent or refractory cases.
Question 9
A 68-year-old woman with type 2 diabetes and hypertension has an LDL-C of 140 mg/dL. She is
already on atorvastatin 40 mg. What is the next step according to the 2018 AHA/ACC cholesterol
guidelines?
A. Add ezetimibe
B. Increase atorvastatin to 80 mg
C. Start a PCSK9 inhibitor
D. No change; LDL-C is at goal
Correct Answer: A
