2025 AGNP MIDTERM EXAM | 105
QUESTIONS | WITH ACTUAL SOLUTIONS
GRADED A+
An 84-year-old woman, lives independently, concerned about driving. On 2
occasions, she had minor collisions when she was backing up her car (she
dislodged rearview mirror and struck a fire hydrant, each time on the
passenger side).
• History: osteoarthritis of the cervical and lumbar spine and mild hearing
impairment
• Medications: acetaminophen and calcium plus vitamin D
• Functional assessment: intact cognition and vision, with near-visual acuity
20/30 in each eye. She fails the whisper test.
• Physical examination: Decreased range of motion in neck and back in all
planes (unchanged from previous findings); Diffuse osteoarthritic deformities in
the knees and hands; Decreased range of motion at the hips; Mild kyphosis;
Motor strength and deep tendon reflexes are symmetric and intact
Which one of the following is the most appropriate next step?
A. Obtain radiography of the cervical spine in 3 views.
B. Recomme Answer - E. Refer to occupational therapy.
An 80-year-old woman hospitalized after fall and hip fracture
• History: stable osteoarthritis of the knees, peripheral neuropathy
• Prior to fall, she lived alone and managed all instrumental activities of daily
living; occasionally used cane or walker for mild problems with balance
, • Current status, 4 days after surgery: Needs assistance of 2 persons for
transfer; Frequently incontinent of urine; Eating very little
Which one of the following is the most likely outcome for this patient 6 months
after the fracture?
A. Continued slow functional decline
B. Recovery to her pre-fracture level of function
C. Partial recovery of function
D. Stability at the level of function on hospital discharge
E. Death Answer - B. Recovery to her pre-fracture level of function
An 85-year-old man with 2 episodes of low-volume urinary incontinence in the
last year, when he "waited too long"
• Functional assessment: Near-visual acuity of 20/50 on the right and 20/60 on
the left with correction; Fails whisper test in right ear ; Gait speed at usual pace
is 0.9 m/sec ; Mini-Cog screen: 2 of 3 items on recall, completes an accurate
clock 36 CASE 3 (2 of 3)
Which one of the following is the most appropriate next step for evaluation of
functional disability? A. Refer to audiology.
B. Refer to ophthalmology.
C. Refer to physical therapy.
D. Complete additional cognitive testing.
E. Complete an incontinence evaluation. Answer - B. Refer to ophthalmology.
A 68-year-old woman describes vision problems.
• Progressive blurring of distance vision
• Increased difficulty with nighttime driving, which she attributes to worsening
glare and haloes around lights
,• She no longer needs glasses for reading.
• History: hypertension, hypercholesterolemia
Which one of the following is the most likely cause of the changes in her
vision?
A. Uncontrolled hypertension
B. Poorly controlled blood glucose C. Choroidal neovascularization
D. Cataract progression
E. Increased intraocular pressure Answer - D. Cataract progression
A 72-year-old black man has right shoulder trauma after he fell in a parking lot.
He states that he was walking to his car when he suddenly tripped and fell
forward onto his arm. He subsequently learned that he had tripped over a
curb.
• History: hypertension, high cholesterol, glaucoma
Which one of the following most likely contributed to his fall?
A. Acute glaucoma
B. Failure to use glaucoma drops that morning
C. Poor peripheral vision
D. Retinal embolus from a carotid plaque Answer - C. Poor peripheral vision
An 88-year-old woman comes to the office for an urgent visit because, when
she awoke this morning, she found that she could no longer see to read. She
depends on her left eye for vision because she lost her right eye in an accident
when she was a child.
• On examination, vision is 20/400 in the left eye. She does not perceive light
in the right eye. She is referred emergently to an ophthalmologist, who
diagnoses neovascular age-related macular degeneration.
, Which one of the following is the most appropriate therapy?
A. Topical prostaglandin analog
B. Phacoemulsification with intraocular lens implantation
C. Intravitreal vascular endothelial growth factor inhibitor
D. Glasses with updated refraction E. Oral lutein, zeaxanthin, and omega-3 eye
nutrients Answer - C. Intravitreal vascular endothelial growth factor inhibitor
An 80-year-old woman comes to the office with her daughter. The daughter is
concerned that her mother has recently begun to withdraw from former
activities (attending book clubs, lectures).
• Patient's self-reported health status has changed from "excellent" last year
to "average" today.
• During the appointment she misunderstands some questions, and she
appears to struggle to understand some of what is said. Her memory does not
seem as keen as on previous visits.
• In response to direct questions, she states that over the past 2 weeks she has
felt a little down.
• She says that if people would include her in conversation, she would
probably feel better and be more inclined to engage in the activities she
previously enjoyed.
• Medications: daily multivitamin, daily aspirin
• Physical examination: Normal blood pressure and EKG; MMSE score is 26 of
30; Findings from routine laboratory tests are normal.
Which one Answer - D. Administer in-office hearing screen.
A 75-year-old man has age-related hearing loss, diagnosed by an audiologist.
The patient requests advice regarding hearing interventions.
QUESTIONS | WITH ACTUAL SOLUTIONS
GRADED A+
An 84-year-old woman, lives independently, concerned about driving. On 2
occasions, she had minor collisions when she was backing up her car (she
dislodged rearview mirror and struck a fire hydrant, each time on the
passenger side).
• History: osteoarthritis of the cervical and lumbar spine and mild hearing
impairment
• Medications: acetaminophen and calcium plus vitamin D
• Functional assessment: intact cognition and vision, with near-visual acuity
20/30 in each eye. She fails the whisper test.
• Physical examination: Decreased range of motion in neck and back in all
planes (unchanged from previous findings); Diffuse osteoarthritic deformities in
the knees and hands; Decreased range of motion at the hips; Mild kyphosis;
Motor strength and deep tendon reflexes are symmetric and intact
Which one of the following is the most appropriate next step?
A. Obtain radiography of the cervical spine in 3 views.
B. Recomme Answer - E. Refer to occupational therapy.
An 80-year-old woman hospitalized after fall and hip fracture
• History: stable osteoarthritis of the knees, peripheral neuropathy
• Prior to fall, she lived alone and managed all instrumental activities of daily
living; occasionally used cane or walker for mild problems with balance
, • Current status, 4 days after surgery: Needs assistance of 2 persons for
transfer; Frequently incontinent of urine; Eating very little
Which one of the following is the most likely outcome for this patient 6 months
after the fracture?
A. Continued slow functional decline
B. Recovery to her pre-fracture level of function
C. Partial recovery of function
D. Stability at the level of function on hospital discharge
E. Death Answer - B. Recovery to her pre-fracture level of function
An 85-year-old man with 2 episodes of low-volume urinary incontinence in the
last year, when he "waited too long"
• Functional assessment: Near-visual acuity of 20/50 on the right and 20/60 on
the left with correction; Fails whisper test in right ear ; Gait speed at usual pace
is 0.9 m/sec ; Mini-Cog screen: 2 of 3 items on recall, completes an accurate
clock 36 CASE 3 (2 of 3)
Which one of the following is the most appropriate next step for evaluation of
functional disability? A. Refer to audiology.
B. Refer to ophthalmology.
C. Refer to physical therapy.
D. Complete additional cognitive testing.
E. Complete an incontinence evaluation. Answer - B. Refer to ophthalmology.
A 68-year-old woman describes vision problems.
• Progressive blurring of distance vision
• Increased difficulty with nighttime driving, which she attributes to worsening
glare and haloes around lights
,• She no longer needs glasses for reading.
• History: hypertension, hypercholesterolemia
Which one of the following is the most likely cause of the changes in her
vision?
A. Uncontrolled hypertension
B. Poorly controlled blood glucose C. Choroidal neovascularization
D. Cataract progression
E. Increased intraocular pressure Answer - D. Cataract progression
A 72-year-old black man has right shoulder trauma after he fell in a parking lot.
He states that he was walking to his car when he suddenly tripped and fell
forward onto his arm. He subsequently learned that he had tripped over a
curb.
• History: hypertension, high cholesterol, glaucoma
Which one of the following most likely contributed to his fall?
A. Acute glaucoma
B. Failure to use glaucoma drops that morning
C. Poor peripheral vision
D. Retinal embolus from a carotid plaque Answer - C. Poor peripheral vision
An 88-year-old woman comes to the office for an urgent visit because, when
she awoke this morning, she found that she could no longer see to read. She
depends on her left eye for vision because she lost her right eye in an accident
when she was a child.
• On examination, vision is 20/400 in the left eye. She does not perceive light
in the right eye. She is referred emergently to an ophthalmologist, who
diagnoses neovascular age-related macular degeneration.
, Which one of the following is the most appropriate therapy?
A. Topical prostaglandin analog
B. Phacoemulsification with intraocular lens implantation
C. Intravitreal vascular endothelial growth factor inhibitor
D. Glasses with updated refraction E. Oral lutein, zeaxanthin, and omega-3 eye
nutrients Answer - C. Intravitreal vascular endothelial growth factor inhibitor
An 80-year-old woman comes to the office with her daughter. The daughter is
concerned that her mother has recently begun to withdraw from former
activities (attending book clubs, lectures).
• Patient's self-reported health status has changed from "excellent" last year
to "average" today.
• During the appointment she misunderstands some questions, and she
appears to struggle to understand some of what is said. Her memory does not
seem as keen as on previous visits.
• In response to direct questions, she states that over the past 2 weeks she has
felt a little down.
• She says that if people would include her in conversation, she would
probably feel better and be more inclined to engage in the activities she
previously enjoyed.
• Medications: daily multivitamin, daily aspirin
• Physical examination: Normal blood pressure and EKG; MMSE score is 26 of
30; Findings from routine laboratory tests are normal.
Which one Answer - D. Administer in-office hearing screen.
A 75-year-old man has age-related hearing loss, diagnosed by an audiologist.
The patient requests advice regarding hearing interventions.
