AGPCNP-BC (ANCC) Practice Exam

This AGPCNP practice questions bank is a comprehensive, clinician-crafted study resource designed specifically for nurse practitioners preparing for the ANCC AGPCNP-BC certification. It contains hundreds of realistic multiple-choice items (with clear answer keys and in-depth explanations) that mirror the scope, depth, and style of the actual exam. Each question is written to test knowledge, clinical reasoning, and decision-making across the full adult-gerontology primary care spectrum. If you want targeted practice that translates into real exam performance, this collection delivers focused, evidence-aligned preparation.

What you’ll get

• Large set of ancc agpcnp practice questions spanning basic science through complex clinical management.
• Four-option MCQs (A–D) with the correct answer and a clinician-level explanation ≥200 characters for every item.
• Questions reflect current 2025 practice: pharmacology, diagnostics, procedural triage, comorbidity management, and guideline-aligned treatment decisions.
• Coverage includes primary care, urgent care, inpatient crossover scenarios, and high-risk special populations.
• Practical test items designed for timed practice, self-assessment, and identifying knowledge gaps.

Complete topics covered

This bank intentionally covers the most high-yield and frequently tested domains on the AGPCNP exam, including (but not limited to):

• Cardiology: HFpEF/HFrEF management, ACS, arrhythmias, valve disease, device therapy.
• Pulmonary: COPD, acute respiratory failure, pulmonary embolism, pneumothorax, pulmonary rehab.
• Endocrinology: Diabetes (pharmacotherapy + SGLT2/GLP-1), thyroid disorders, adrenal dysfunction.
• Infectious Disease: Sepsis, C. difficile, tropical infections, antimicrobial stewardship.
• Neurology: Stroke (tPA/thrombectomy windows), dementia types, neuropathies, NPH.
• Geriatrics: Polypharmacy, delirium, falls, goals-of-care and palliative scenarios.
• Women’s Health & OB considerations: contraception in special populations, menopausal care, obstetric triage essentials.
• Oncology & Onco-toxicity: immunotherapy adverse events, chemo cardiotoxicity, cancer palliation.
• Renal: CKD management, electrolyte emergencies, dialysis considerations.
• Emergency & Procedural: airway emergencies, acute abdomen, trauma, toxicology basics.
• Pharmacology & Interactions: anticoagulation, antibiotics, psychotropics, immunosuppressants.
• Dermatology, ENT/airway, ophthalmology, transplant medicine, sexual health, travel medicine, vaccine guidance, rheumatology, hepatology, ethics, occupational exposures — all represented with focused clinical vignettes.

Each question is mapped implicitly to one or more of the above domains so your practice is broad and realistic.

Who can take this exam bank

• AGPCNP candidates preparing for the ANCC AGPCNP-BC certification exam.
• Recent graduates and advanced practice providers wanting to validate clinical readiness for adult-gerontology primary care roles.
• Clinical instructors and program directors looking for vetted practice items for classroom use.
• NPs preparing for hospital privileges or interviews that require broad adult-geriatrics knowledge.

Useful for

• Reinforcing clinical reasoning under time pressure.
• Identifying weak content areas and tailoring study plans.
• Practicing exam-style single best-answer selection with evidence-based rationales.
• Building confidence with scenario-based questions similar to the ANCC format.
• Creating timed mock exams for real-world rehearsal.

Eligibility & prerequisites

There are no strict prerequisites to use this question bank; however, best results occur when you:

• Have completed graduate-level adult/gerontology coursework or clinical rotations.
• Are familiar with primary care fundamentals (history, exam, common labs, diagnostic testing).
• Are actively preparing for the ANCC AGPCNP-BC exam or seeking to refresh broad adult-geriatrics knowledge.

How this bank is different

• Real-world clinical voice: questions are written in a human clinician tone—clear, practical, and purposely unsensational.
• Explanations that teach, not just tell: each answer includes a short teaching point that explains why an option is correct and why others are not.
• Coverage balance: acute care + ambulatory continuity, chronic disease complexity, and geriatric nuance.
• Up-to-date 2025 relevance: pharmacology interactions, newer therapy classes, and modern procedural/triage concepts are reflected.

Study tips — how to use this bank effectively

1. Create a baseline practice test. Take a timed 60–90 minute set of mixed items to simulate exam conditions. Note score and time per question.
2. Identify patterns in missed items. Tag weak domains (e.g., cardiology, infectious disease) and make a focused review plan.
3. Use spaced repetition. Revisit missed questions after 3 days, 1 week, and 3 weeks to convert short-term recall into long-term retention.
4. Master the explanations. When reviewing a question, read the rationale fully and summarize the teaching point in your own words.
5. Practice under time pressure. Build pacing—aim for steady progress rather than rushing.
6. Form study groups. Discuss tricky cases aloud; teaching a concept improves recall.
7. Integrate guidelines. Cross-reference explanations with primary guidelines (cardiology, diabetes, COPD, sepsis) for deeper context.
8. Mock exams. Periodically take full 150–200 question mocks to simulate the testing day stamina requirement.
9. Address test-taking skills. Eliminate distractors, focus on stem clues (severity, risk factors, time windows), and prioritize safety-first answers in emergencies.
10. Self-care. Sleep, nutrition, and short exercise breaks accelerate consolidation during intense study phases.

Recommendations

If you’re preparing for the ANCC AGPCNP exam, consistent, deliberate practice with high-quality, clinically realistic questions is the single most reliable strategy to improve scores and patient-care readiness. Use this agpcnp practice questions bank to close knowledge gaps, sharpen test strategy, and build the confidence you need to sit and pass the certification.

Sample Questions and Answers

A 68-year-old man with hypertension and type 2 diabetes presents for medication review. His current BP average is 138/82 mmHg. He is on lisinopril 20 mg daily. Which statement about his BP goal is MOST appropriate for primary care management in an otherwise healthy older adult?

A. Target <120/80 mmHg for all adults >65.
B. Target <140/90 mmHg, individualized based on comorbidities and frailty.
C. Stop ACE inhibitor because benefit is minimal at age >65.
D. Increase lisinopril to 40 mg to achieve systolic <130 mmHg.

Answer: B

Explanation: BP targets in older adults should be individualized. While intensive targets (eg, <130/80) may benefit some, frailty, orthostatic risk, and comorbidities often warrant a more conservative target such as <140/90. Blanket aggressive lowering in all >65 can increase adverse events (falls, AKI). Continue ACE inhibitor and tailor therapy rather than automatic escalation or cessation.

A 55-year-old woman with smoker history of 30 pack-years asks about lung cancer screening. She quit smoking 6 years ago. Which patient meets typical low-dose CT screening criteria?

A. Current smoker, 20 pack-years, age 55.
B. Former smoker, 30 pack-years, quit 6 years ago, age 55.
C. Never smoker, age 55, occupational asbestos exposure.
D. Former smoker, 10 pack-years, quit 2 years ago, age 68.

Answer: B

Explanation: Low-dose CT screening typically targets older adults with significant smoking history (eg, 20–30 pack-years depending on guideline) and recent quit within ~15 years. A former smoker with 30 pack-years who quit 6 years ago and is age 55 fits screening criteria. Screening isn’t for low pack-years or never-smokers, and prior asbestos exposure may alter risk but doesn’t alone meet standard criteria.

A 72-year-old woman with osteoarthritis has chronic knee pain poorly controlled with acetaminophen. She has stage 3 CKD (eGFR 45). Which analgesic is the SAFEST next choice for chronic pain management?

A. Ibuprofen 400 mg TID PRN nightly.
B. Naproxen 500 mg BID daily.
C. Tramadol at lowest effective dose with monitoring.
D. High-dose opioid (eg, oxycodone) scheduled daily.

Answer: C

Explanation: In CKD stage 3, NSAIDs increase risk of renal impairment and should be avoided or used sparingly. Opioids have increased risks and are not first-line for chronic OA. Tramadol, used cautiously at lowest effective dose with monitoring for side effects and interactions, is often considered when acetaminophen inadequate and NSAIDs are contraindicated. Nonpharmacologic therapies must be optimized.

A 60-year-old man with known coronary artery disease presents with LDL cholesterol of 132 mg/dL on no statin therapy. He asks whether to start a statin. What is the best recommendation?

A. Start a high-intensity statin because he has established ASCVD.
B. No statin needed; aim for lifestyle changes only.
C. Start low-intensity statin; high intensity increases risk too much.
D. Use ezetimibe monotherapy instead of statin.

Answer: A

Explanation: In patients with established atherosclerotic cardiovascular disease (ASCVD), high-intensity statin therapy is recommended to reduce LDL and secondary events unless contraindications exist. Lifestyle alone is insufficient. Ezetimibe is adjunctive when statin tolerance or goal unmet; it is not first-line monotherapy for secondary prevention.

A 45-year-old woman complains of fatigue, weight gain, and constipation. Lab shows TSH 8.2 mIU/L (elevated) and free T4 low. She is otherwise healthy. First-line management?

A. Start levothyroxine with weight-based dosing and recheck TSH in 6–8 weeks.
B. Prescribe liothyronine (T3) alone for immediate symptom relief.
C. Refer to endocrinology before initiating therapy.
D. Reassure and repeat labs in 6 months without therapy.

Answer: A

Explanation: Overt hypothyroidism (elevated TSH with low free T4) is treated with levothyroxine replacement, typically weight-based dosing (eg, ~1.6 mcg/kg in younger healthy adults; lower in older/cardiac disease) and TSH reassessment in 6–8 weeks. T3 monotherapy is not recommended. Referral reserved for complex or refractory cases.

A 34-year-old woman with newly diagnosed type 2 diabetes has A1c 7.2% and is overweight. Which initial pharmacotherapy is guideline-recommended for most patients?

A. Start metformin unless contraindicated.
B. Begin insulin immediately to normalize glucose.
C. Use sulfonylurea monotherapy first.
D. Start GLP-1 receptor agonist as first-line for everyone.

Answer: A

Explanation: Metformin is the usual first-line pharmacotherapy for type 2 diabetes in absence of contraindications due to efficacy, safety, weight neutrality or modest loss, and low cost. Insulin is reserved for very high A1c, symptomatic hyperglycemia, or specific circumstances. GLP-1 agonists and SGLT2 inhibitors have important roles (esp. for weight, CV/renal benefits) but are not universal first-line due to cost/coverage issues.

A 70-year-old patient with atrial fibrillation (nonvalvular) and CHA₂DS₂-VASc score of 3 is being counseled. Which is the best stroke prevention strategy?

A. No anticoagulation; use aspirin daily.
B. Start DOAC at appropriate dose unless contraindicated.
C. Warfarin only if patient refuses DOACs.
D. Only rate control; anticoagulation optional.

Answer: B

Explanation: For nonvalvular AF with CHA₂DS₂-VASc ≥2 in men (or ≥3 in women depending on scoring specifics), anticoagulation with a DOAC (direct oral anticoagulant) is preferred over warfarin in most patients for stroke prevention due to similar or better efficacy and lower intracranial hemorrhage risk. Aspirin alone is inadequate for stroke prevention in these patients.

A 28-year-old female presents with bacterial vaginosis symptoms. Which regimen is first-line and recommended?

A. Metronidazole 500 mg orally twice daily for 7 days.
B. Single dose ceftriaxone IM.
C. Oral fluconazole single dose.
D. Topical clotrimazole 7 days.

Answer: A

Explanation: Bacterial vaginosis is typically treated with oral metronidazole 500 mg twice daily for 7 days (or topical metronidazole gel). Ceftriaxone is for gonorrhea; fluconazole for vulvovaginal candidiasis; clotrimazole is antifungal — not appropriate for BV.

A 66-year-old man with long-standing COPD presents with increased dyspnea and productive cough. Pulse ox 90% on room air. Which management step is MOST appropriate initially?

A. Start oral prednisone and a short acting bronchodilator; consider antibiotics if increased sputum purulence.
B. Immediately intubate and transfer to ICU.
C. Start inhaled corticosteroid monotherapy only.
D. Prescribe long-term oxygen without addressing exacerbation pharmacotherapy.

Answer: A

Explanation: Acute COPD exacerbations are commonly managed with short-acting bronchodilators (SABA±SAMA), systemic corticosteroids (eg, prednisone 40 mg daily for 5 days), and antibiotics if increased sputum purulence or other signs of infection. Oxygen support is tailored. Intubation reserved for respiratory failure. Inhaled corticosteroid alone is insufficient for acute exacerbation.

A 78-year-old with mild dementia and creatinine clearance 25 mL/min needs a UTI treated. Which antibiotic is LEAST appropriate because of renal dosing concerns and CNS side effects in the elderly?

A. Nitrofurantoin.
B. Trimethoprim-sulfamethoxazole (TMP-SMX).
C. Amoxicillin-clavulanate.
D. Fosfomycin single dose.

Answer: A

Explanation: Nitrofurantoin is contraindicated or not recommended when creatinine clearance is below certain thresholds (often <30–60 mL/min depending on guideline) due to poor efficacy and potential toxicity. It is also less suitable in older adults with renal impairment. TMP-SMX and amoxicillin-clavulanate require dosing adjustments but are used with caution; fosfomycin can be used for uncomplicated cystitis.

A 50-year-old woman with recurrent migraines is interested in preventive therapy. She has uncontrolled hypertension currently. Which class should generally be avoided as first choice for migraine prevention until BP is controlled?

A. Beta-blockers (eg, propranolol).
B. Topiramate.
C. Tricyclic antidepressants (eg, amitriptyline).
D. CGRP monoclonal antibodies.

Answer: A

Explanation: Beta-blockers can be effective for migraine prevention but may interact with hypotension/bradycardia and are not ideal if cardiovascular instability exists. However, with uncontrolled hypertension beta-blockers could actually help; nuance matters. Topiramate and TCAs are effective alternatives; CGRP monoclonal antibodies are options especially when other therapies fail. Selection must consider comorbidities and side effects.

A 65-year-old man with intermittent claudication has a resting ABI of 0.65. What is the best initial management approach?

A. Recommend supervised exercise program, smoking cessation, and statin therapy.
B. Immediate peripheral angioplasty.
C. Prescribe dual antiplatelet therapy indefinitely.
D. No treatment necessary for ABI >0.5.

Answer: A

Explanation: For peripheral arterial disease with ABI 0.41–0.90 and intermittent claudication, first-line management includes supervised exercise therapy, smoking cessation, optimization of diabetes/hypertension, statin therapy, and antiplatelet therapy (usually single antiplatelet). Revascularization reserved for lifestyle-limiting symptoms despite optimal medical therapy.

A 42-year-old woman presents with new onset unilateral breast mass, nonmobile, irregular. Next best step in evaluation?

A. Diagnostic mammography and targeted breast ultrasound.
B. Reassure and repeat exam in 6 months.
C. Start empiric antibiotics for mastitis.
D. Order MRI immediately.

Answer: A

Explanation: A new suspicious breast mass warrants prompt diagnostic imaging—diagnostic mammography plus targeted ultrasound—to characterize the lesion. MRI is reserved for specific indications. Empiric antibiotics only for classic infectious signs; waiting is unsafe for solid suspicious mass.

A patient on metformin reports fatigue and mild dyspnea. Labs show MCV 96 fL, Hgb 10.2 g/dL, low vitamin B12. Which is most likely cause and management?

A. Metformin can cause B12 deficiency; discontinue metformin and start B12 replacement.
B. B12 deficiency associated with metformin; continue metformin and start B12 supplementation.
C. Switch to insulin because oral agents cause anemia.
D. Iron deficiency is more likely; start oral iron.

Answer: B

Explanation: Long-term metformin use is associated with reduced B12 absorption and may cause macrocytic anemia and neuropathy. The correct approach is to continue metformin when benefits outweigh risks and treat B12 deficiency with replacement while monitoring. Discontinuing metformin is not usually necessary solely for B12 deficiency.

A 30-year-old sexually active woman seeks contraception and has migraine with aura. Which contraceptive is CONTRAINDICATED?

A. Combined estrogen-progestin oral contraceptive pill.
B. Progestin-only pill.
C. Levonorgestrel IUD.
D. Copper IUD.

Answer: A

Explanation: Migraine with aura increases stroke risk and is a contraindication to combined estrogen–progestin contraceptives due to added thrombotic risk. Progestin-only methods and IUDs (levonorgestrel and copper) are safer alternatives. Patient counseling should include risks/benefits and individual factors.

A 79-year-old with advanced dementia and dysphagia is having difficulty swallowing pills. Family asks about medication simplification. Which approach is most appropriate?

A. Conduct a medication review to deprescribe nonessential meds and switch to liquid or transdermal forms as needed.
B. Continue all current meds to avoid destabilization.
C. Convert all meds to crushing tablets without checking formulation.
D. Stop all cardiovascular medications immediately.

Answer: A

Explanation: In advanced dementia with dysphagia, a careful medication reconciliation and deprescribing of nonessential medications is indicated, prioritizing symptomatic control and comfort. Switching to liquid or transdermal formulations where appropriate and checking whether tablets are crushable is necessary. Avoid abrupt cessation of essential meds without review.

A 58-year-old man with chronic hepatitis C achieves sustained virologic response after antiviral therapy. What screening should continue?

A. Ongoing hepatocellular carcinoma surveillance if advanced fibrosis or cirrhosis was present prior to cure.
B. No further surveillance needed for any patient after cure.
C. Stop all liver labs and imaging indefinitely.
D. Only screen if symptoms develop.

Answer: A

Explanation: Patients who had advanced fibrosis or cirrhosis prior to successful hepatitis C treatment remain at risk for hepatocellular carcinoma and should continue surveillance (eg, liver ultrasound ± AFP every 6 months). Those without advanced fibrosis generally do not require continued HCC surveillance after cure. Ongoing monitoring should be individualized.

A 24-hour urine collection shows suspected nephrotic range proteinuria. Which feature is CLASSIC for nephrotic syndrome?

A. Hypoalbuminemia, hyperlipidemia, and peripheral edema.
B. Hematuria as main finding with no edema.
C. Low urine protein excretion <150 mg/day.
D. Hyponatremia without proteinuria.

Answer: A

Explanation: Nephrotic syndrome classically presents with heavy proteinuria (>3.5 g/day), hypoalbuminemia, hyperlipidemia, and peripheral edema. Hematuria is more typical of nephritic syndromes. Recognition prompts evaluation for underlying causes and management of edema, proteinuria, thrombosis risk, and hyperlipidemia.

A patient is prescribed warfarin and asks about dietary interactions. Which statement is accurate?

A. Consistent intake of vitamin K–rich foods is important; avoid dramatic fluctuations.
B. Any green vegetable must be completely avoided.
C. Vitamin K has no effect on warfarin.
D. Large doses of vitamin C will reliably reverse warfarin.

Answer: A

Explanation: For patients on warfarin, maintaining a consistent intake of vitamin K–rich foods (eg, leafy greens) is important; sudden increases or decreases can alter INR. Complete avoidance is unnecessary and can cause instability. Vitamin K reverses warfarin effects when needed but vitamin C does not reliably reverse anticoagulation.

A 67-year-old male with uncontrolled type 2 diabetes presents with a foot ulcer. Which finding increases immediate concern for osteomyelitis?

A. Exposed bone at base of ulcer or positive probe-to-bone test.
B. Mild callus without drainage.
C. Ulcer less than 0.5 cm superficial.
D. Intact pedal pulses and no erythema.

Answer: A

Explanation: Exposure of bone or a positive probe-to-bone test are worrisome for underlying osteomyelitis and require prompt imaging (eg, MRI) and specialist involvement. Superficial small ulcers without signs of infection are lower risk. Peripheral vascular status and depth/size matter but exposed bone is high suspicion.

A 70-year-old woman has chronic insomnia; she asks for a sleep medication. Which agent is preferred for older adults to minimize cognitive and fall risk?

A. Start with cognitive behavioral therapy for insomnia (CBT-I) before pharmacotherapy; if medication needed, consider short-term use of safer hypnotics.
B. Prescribe benzodiazepines long term for immediate efficacy.
C. Use diphenhydramine nightly as over-the-counter option.
D. Start high-dose trazodone nightly indefinitely.

Answer: A

Explanation: CBT-I is first-line for chronic insomnia and preferred in older adults. Pharmacotherapy carries risks (falls, cognitive impairment); benzodiazepines and sedative antihistamines like diphenhydramine are generally discouraged long-term. If meds are necessary, use short courses and choose agents with favorable safety profiles while monitoring.

A 48-year-old man presents with suspected acute diverticulitis — localized left lower quadrant pain, fever, leukocytosis. CT shows uncomplicated diverticulitis. Best outpatient management?

A. Outpatient oral antibiotics, clear liquids/advance as tolerated, outpatient follow-up if stable.
B. Immediate hospital admission for IV antibiotics and surgery.
C. Prescribe laxatives and no antibiotics.
D. Urgent colon resection.

Answer: A

Explanation: Many cases of uncomplicated diverticulitis can be managed outpatient with oral antibiotics (depending on evolving evidence some guidelines allow selective non-antibiotic management), bowel rest/clear liquids then advance diet, and close follow-up. Hospitalization and surgery reserved for complicated disease (abscess, perforation, sepsis).

A 56-year-old woman with chronic GERD on PPI therapy still has nighttime symptoms despite adherence. She asks for further evaluation. Which is the most appropriate next step?

A. Evaluate adherence and lifestyle triggers; consider ambulatory pH monitoring or upper endoscopy if alarm features or refractory symptoms.
B. Increase PPI dose without further evaluation.
C. Stop PPI and start H2 blocker only.
D. Immediate referral for anti-reflux surgery.

Answer: A

Explanation: For refractory GERD, first reassess adherence and behaviors. If persistent symptoms despite appropriate therapy — especially with alarm features (dysphagia, weight loss, GI bleeding) — further evaluation with endoscopy or pH/impedance testing is appropriate prior to escalating therapy or surgery. Empiric dose increase without evaluation may miss complications.

A 62-year-old man with chronic atrial fibrillation is to begin a DOAC. Which laboratory is most important before starting a DOAC?

A. Renal function (creatinine/eGFR) to dose appropriately.
B. CBC only.
C. LFTs only.
D. Blood type.

Answer: A

Explanation: Renal function is critical to determine appropriate DOAC dosing and contraindications; many DOACs require dose adjustments or avoidance at low eGFR. CBC and LFTs are useful baseline tests but renal function directly impacts dosing and safety. Blood type is irrelevant.

A 33-year-old woman at 12 weeks pregnancy needs treatment for asymptomatic bacteriuria. Which antibiotic is appropriate?

A. Nitrofurantoin in pregnancy is acceptable in second and third trimesters and often used in pregnancy with caution; avoid in first trimester if possible.
B. Fluoroquinolones are first-line in pregnancy.
C. Tetracyclines are safe in pregnancy.
D. No treatment necessary for asymptomatic bacteriuria in pregnancy.

Answer: A (with nuance)

Explanation: Asymptomatic bacteriuria in pregnancy should be treated because of risk of pyelonephritis. Nitrofurantoin and certain beta-lactams are commonly used; nitrofurantoin is generally avoided at term and used cautiously in first trimester depending on guideline and risk assessment. Fluoroquinolones and tetracyclines are contraindicated. Always choose pregnancy-safe options.

A 59-year-old man with chronic back pain is on long-term opioid therapy. Which strategy reduces opioid-related harms?

A. Implement opioid risk-reduction: regular PDMP checks, urine drug screening, treatment agreements, and consider opioid tapering or multimodal pain management.
B. Double the dose to achieve pain control.
C. Stop opioids immediately without plan.
D. Add benzodiazepines for sleep.

Answer: A

Explanation: Reducing opioid harm includes structured strategies: regular prescription drug monitoring program checks, urine drug testing, treatment agreements, naloxone prescribing when appropriate, and multimodal nonopioid therapies; gradual tapering when indicated. Abrupt cessation, dose escalation, or adding benzodiazepines increases risk.

A 70-year-old with frailty wants influenza vaccination. Which approach is best?

A. Offer a high-dose or adjuvanted influenza vaccine formulation appropriate for older adults if available.
B. Avoid influenza vaccine due to age.
C. Give live attenuated intranasal vaccine.
D. Vaccination is not effective in frail elders.

Answer: A

Explanation: Older adults, especially those ≥65, are recommended to receive age-appropriate influenza vaccines, such as high-dose or adjuvanted formulations, which may provide better immunogenicity in older immune systems. Live intranasal vaccine is typically not recommended for older adults. Vaccination remains beneficial even in frailty.

A patient with suspected polymyalgia rheumatica (PMR) has proximal morning stiffness and elevated ESR/CRP. What is the initial diagnostic and therapeutic approach?

A. Start low-dose prednisone promptly and arrange evaluation for giant cell arteritis symptoms; follow inflammatory markers and clinical response.
B. Wait for biopsy confirmation before treatment.
C. NSAIDs are sufficient and steroids contraindicated.
D. Start methotrexate immediately without steroids.

Answer: A

Explanation: PMR often responds rapidly to low-dose glucocorticoids; early treatment is appropriate when clinical suspicion is high. Because of association with giant cell arteritis, patients should be monitored for headache, visual changes — high suspicion prompts urgent evaluation. Biopsy is for suspected GCA, not required before PMR therapy.

A 25-year-old man presents after sexual assault within 48 hours. Which is appropriate immediate management in primary care/ER?

A. Provide emergency contraception, offer HIV PEP evaluation, give STI prophylaxis per protocol, collect forensic evidence as appropriate, and provide psychosocial support/referral.
B. Only treat visible wounds; defer all testing.
C. Prescribe long-term antibiotics without counseling.
D. Refuse to collect forensic evidence.

Answer: A

Explanation: Comprehensive care after sexual assault includes ensuring safety, offering emergency contraception, evaluating for and initiating HIV postexposure prophylaxis when indicated (ideally within 72 hours), providing STI prophylaxis per local protocols, collecting forensic evidence if the patient consents, and offering mental health resources and follow-up. Consent and trauma-informed care are essential.

A 66-year-old patient with chronic insomnia is on multiple medications. You want to assess fall risk and deprescribe where possible. Which tool or approach is most practical in primary care for identifying potentially inappropriate medications in older adults?

A. Use criteria such as the Beers Criteria to review medications and prioritize deprescribing.
B. Continue all meds because the patient tolerates them.
C. Stop all antihypertensives at once to reduce falls.
D. Use only patient preference without clinical review.

Answer: A

Explanation: The Beers Criteria and similar lists are practical tools to identify potentially inappropriate medications in older adults and guide deprescribing discussions. Medication review should be systematic and individualized; abrupt cessation of essential meds risks harm. Shared decision-making and stepwise deprescribing are best.