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ANCC AGPCNP-BC study materials
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ANCC AGPCNP-BC practice questions

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Question 1Assessment

A 54-year-old man with no chronic conditions takes no medications. Averaged readings from two separate office visits are 134/86 mm Hg. Using the 2017 ACC/AHA classification, how should his blood pressure be categorized?

  1. Stage 1 hypertension Correct answer.
  2. Elevated blood pressure
  3. Normal blood pressure
  4. Stage 2 hypertension

Explanation

Stage 1 hypertension is defined as a systolic pressure of 130-139 mm Hg or a diastolic pressure of 80-89 mm Hg. Elevated blood pressure is 120-129/<80 mm Hg, and stage 2 begins at 140/90 mm Hg. The diagnosis requires averaged readings from two or more encounters.

Question 2Assessment

In a healthy adult, at which location is the first heart sound (S1) heard most clearly?

  1. Left second intercostal space
  2. Right second intercostal space
  3. Erb point, left third space
  4. Apex, at the mitral area Correct answer.

Explanation

S1 is produced by closure of the mitral and tricuspid valves and is best appreciated at the apex, over the mitral area. The right and left second intercostal spaces are where aortic and pulmonic events (S2 components) are best heard.

Question 3Assessment

Which breath sound is expected over the posterior lung bases of a healthy, resting adult?

  1. Fine crackles that clear with coughing
  2. Vesicular sounds, inspiration longer than expiration Correct answer.
  3. Bronchial sounds with a long expiratory phase
  4. A pleural friction rub

Explanation

Vesicular breath sounds are low-pitched and soft, with inspiration lasting longer than expiration over most of the lung fields. Bronchial sounds over peripheral lung tissue, crackles, and rubs are abnormal findings.

Question 4Assessment

A 45-year-old woman weighs 88 kg and is 1.68 m tall, giving a body mass index of 31.2 kg/m2. How should this be classified?

  1. Overweight
  2. Class II obesity
  3. Class I obesity Correct answer.
  4. Normal weight

Explanation

A BMI of 30.0-34.9 kg/m2 is class I obesity, 35.0-39.9 is class II, and 40 or greater is class III. Overweight spans 25.0-29.9 kg/m2, and normal weight is 18.5-24.9 kg/m2.

Question 5Assessment

Which resting oxygen saturation range is generally considered normal for a healthy adult breathing room air at sea level?

  1. 90% to 94%
  2. 95% to 100% Correct answer.
  3. 100% only
  4. 85% to 89%

Explanation

Pulse oximetry in a healthy adult at sea level typically reads 95% to 100%. Values below 90% represent hypoxemia and require prompt evaluation, and a reading of exactly 100% is not required for normality.

Question 6Assessment

At what age does the USPSTF recommend beginning colorectal cancer screening for average-risk adults?

  1. 50 years
  2. 40 years
  3. 45 years Correct answer.
  4. 60 years

Explanation

The USPSTF recommends starting colorectal cancer screening at age 45 in average-risk adults and continuing through age 75. Earlier initiation applies to people with a family history or other elevated risk.

Question 7Assessment

A 70-year-old high school graduate scores 22 out of 30 on the Mini-Mental State Examination. How should this result be interpreted?

  1. Consistent with acute delirium
  2. Diagnostic of Alzheimer disease
  3. Within normal limits for age and education
  4. Cognitive impairment warranting further evaluation Correct answer.

Explanation

Scores below 24 on the MMSE generally suggest cognitive impairment and should trigger a fuller evaluation, including functional assessment and laboratory testing. A screening score supports suspicion but does not by itself establish a specific dementia diagnosis.

Question 8Assessment

Which sequence is correct when performing an abdominal examination in an adult?

  1. Auscultation, inspection, palpation, percussion
  2. Palpation, percussion, auscultation, inspection
  3. Inspection, palpation, percussion, auscultation
  4. Inspection, auscultation, percussion, palpation Correct answer.

Explanation

Auscultation is performed before percussion and palpation because those maneuvers can alter bowel sound frequency and intensity. The examination therefore proceeds inspection, auscultation, percussion, then palpation.

Question 9Assessment

A 74-year-old man reports exertional syncope. He has a harsh crescendo-decrescendo systolic murmur at the right second intercostal space radiating to both carotids, with a delayed carotid upstroke. Which lesion do these findings suggest?

  1. Tricuspid regurgitation
  2. Ventricular septal defect
  3. Mitral regurgitation
  4. Aortic stenosis Correct answer.

Explanation

Aortic stenosis classically produces a crescendo-decrescendo systolic murmur at the right upper sternal border with radiation to the carotids and a parvus et tardus carotid upstroke. Exertional syncope is a cardinal symptom of severe disease.

Question 10Assessment

Which bedside finding best supports elevated right atrial pressure?

  1. A negative hepatojugular reflux
  2. Absent pulsation in the right internal jugular vein
  3. Jugular venous pulsation 4 cm above the sternal angle at 30 degrees Correct answer.
  4. Jugular venous pulsation seen only when the patient is supine

Explanation

With the patient at 30 to 45 degrees, a jugular venous column more than 3 cm above the sternal angle indicates elevated right atrial pressure. Sustained elevation during abdominal compression (positive hepatojugular reflux) further supports the finding.

Question 11Assessment

A 38-year-old woman completes the PHQ-2 and scores 4. What is the most appropriate next step?

  1. Administer the PHQ-9 to quantify severity Correct answer.
  2. Reassure her that the screen is negative
  3. Start an SSRI empirically
  4. Repeat the PHQ-2 in one year

Explanation

A PHQ-2 score of 3 or greater is a positive screen and should be followed by the PHQ-9 to grade severity and guide management. Treatment decisions follow the fuller assessment rather than the two-item screen.

Question 12Assessment

A 52-year-old man reports drinking 5 to 6 beers on weekends and has an AUDIT-C score of 6. How should this be interpreted?

  1. A negative screen, since he does not drink daily
  2. A positive screen warranting further assessment Correct answer.
  3. A score that is invalid in men
  4. A score indicating dependence requiring detoxification

Explanation

The AUDIT-C is positive at a score of 4 or greater in men and 3 or greater in women, regardless of whether drinking is daily. A positive result prompts a fuller assessment of consumption patterns and alcohol-related harm.

Question 13Assessment

Which test is used to screen an older adult's gait and balance and to estimate fall risk?

  1. Timed Up and Go test Correct answer.
  2. Mini-Cog
  3. Romberg test
  4. Babinski sign

Explanation

The Timed Up and Go test measures the time to rise, walk 3 meters, turn, and sit; a longer time indicates impaired mobility and increased fall risk. It is a practical, validated component of the geriatric fall assessment.

Question 14Assessment

During a routine examination of a 58-year-old, a firm 1.5 cm left supraclavicular lymph node is identified. What is the most appropriate interpretation?

  1. Concerning for malignancy; further evaluation needed Correct answer.
  2. Recheck only if it enlarges over the next year
  3. A normal finding at this age
  4. Most likely a recent upper respiratory infection

Explanation

A supraclavicular node, especially on the left (Virchow node), carries a high risk of intra-abdominal or thoracic malignancy and warrants prompt investigation. Firm, nontender, fixed nodes are more concerning than tender, mobile ones.

Question 15Assessment

An ECG shows an irregularly irregular rhythm at 110 beats/min with no discernible P waves and narrow QRS complexes. What is the most likely interpretation?

  1. Second-degree AV block, type I
  2. Ventricular tachycardia
  3. Sinus tachycardia with frequent premature beats
  4. Atrial fibrillation with rapid ventricular response Correct answer.

Explanation

An irregularly irregular rhythm with absent P waves and narrow complexes is the hallmark of atrial fibrillation. A rate above 100 beats/min defines the rapid ventricular response.

Question 16Assessment

A 68-year-old with calf pain on walking has an ankle-brachial index of 0.62 in the symptomatic leg. How should this be interpreted?

  1. Normal arterial perfusion
  2. Moderate peripheral artery disease Correct answer.
  3. Falsely elevated from arterial calcification
  4. Severe peripheral artery disease

Explanation

An ankle-brachial index of 0.90 or less is abnormal; values of 0.41 to 0.90 indicate mild to moderate peripheral artery disease, and 0.40 or less indicates severe disease. Values above 1.40 suggest falsely elevated results from noncompressible, calcified vessels.

Question 17Assessment

Spirometry in a 55-year-old former smoker shows an FEV1/FVC ratio of 0.58 and an FEV1 of 62% of predicted. What pattern does this represent?

  1. Restrictive ventilatory defect
  2. Mixed defect with a preserved ratio
  3. Obstructive ventilatory defect Correct answer.
  4. Normal spirometry

Explanation

An FEV1/FVC ratio below 0.70 after bronchodilator defines airflow obstruction, and the reduced FEV1 indicates its severity. Restrictive disease shows a preserved or increased ratio with reduced lung volumes.

Question 18Assessment

A patient with limited English proficiency needs a detailed medication history. What is the most appropriate approach?

  1. Defer the medication history to a later visit
  2. Ask the patient's adult cousin to interpret
  3. Use a trained medical interpreter, in person or by video Correct answer.
  4. Speak slowly and loudly and rely on gestures

Explanation

Trained medical interpreters improve accuracy and confidentiality and reduce errors compared with ad hoc interpreters. Family members should not be used for clinically complex or sensitive information.

Question 19Assessment

Which breast finding on physical examination is most suggestive of malignancy?

  1. A hard, fixed, irregular mass with skin dimpling Correct answer.
  2. A soft, mobile, rubbery mass that varies with menses
  3. Bilateral diffuse tenderness without a discrete mass
  4. Greenish nipple discharge from several ducts

Explanation

Malignant masses are typically hard, irregular, and fixed to surrounding tissue, and skin dimpling or nipple retraction raises concern. Fibrocystic changes more often produce soft, mobile, cyclic findings.

Question 20Assessment

Which activity is classified as an instrumental activity of daily living (IADL)?

  1. Toileting with continence
  2. Managing finances and medications Correct answer.
  3. Bathing and showering
  4. Transferring from bed to chair

Explanation

IADLs require higher-level cognitive and organizational skills and include managing money, medications, transportation, shopping, and meal preparation. Basic ADLs include bathing, dressing, toileting, transferring, and feeding.

Question 21Assessment

A 60-year-old man has an early diastolic decrescendo blowing murmur heard best at the left upper sternal border while sitting and leaning forward at end-expiration. Which lesion does this suggest?

  1. Mitral valve prolapse
  2. Mitral stenosis
  3. Aortic regurgitation Correct answer.
  4. Pulmonic stenosis

Explanation

Aortic regurgitation produces an early diastolic decrescendo murmur at the left sternal border that is accentuated by sitting forward in expiration. A wide pulse pressure and bounding pulses commonly accompany it.

Question 22Assessment

A 45-year-old with a large pericardial effusion has a systolic pressure that falls 18 mm Hg during inspiration. What does this finding represent?

  1. Pulsus bisferiens typical of aortic stenosis
  2. Pulsus paradoxus consistent with cardiac tamponade Correct answer.
  3. A normal respiratory variation of no clinical importance
  4. Pulsus alternans indicating left ventricular failure

Explanation

An inspiratory decline in systolic pressure greater than 10 mm Hg defines pulsus paradoxus, a classic sign of cardiac tamponade. Impaired right ventricular filling during inspiration reduces left ventricular output.

Question 23Assessment

A 62-year-old man smoked 1.5 packs per day for 30 years and quit 4 years ago. He has no respiratory symptoms. According to the USPSTF, which statement about lung cancer screening is correct?

  1. He meets criteria for annual low-dose CT screening Correct answer.
  2. He is ineligible until he reaches age 70
  3. He is ineligible because he no longer smokes
  4. He should have annual chest radiography instead

Explanation

The USPSTF recommends annual low-dose CT screening for adults aged 50 to 80 with at least a 20 pack-year history who currently smoke or quit within the past 15 years. This patient has 45 pack-years and quit 4 years ago, so he qualifies.

Question 24Assessment

An 82-year-old hospitalized patient develops confusion over 2 days with fluctuating attention and disorientation; he was independent at home before admission. Which diagnosis best fits?

  1. Vascular dementia
  2. Alzheimer disease
  3. Major depressive disorder with cognitive symptoms
  4. Delirium Correct answer.

Explanation

Acute onset, fluctuating course, and inattention in a hospitalized older adult are hallmarks of delirium, which the Confusion Assessment Method identifies. Dementia has an insidious, progressive course and does not itself produce acute fluctuation.

Question 25Assessment

A screening test has a sensitivity of 98% and a specificity of 60%. How is this test best used clinically?

  1. Primarily to rule out disease Correct answer.
  2. Only in patients with a very high pretest probability
  3. As a confirmatory test after another positive result
  4. Primarily to confirm disease when positive

Explanation

A highly sensitive test yields few false negatives, so a negative result makes disease unlikely and is useful for ruling out. High specificity, not high sensitivity, is what supports ruling in disease.

Question 26Assessment

A 78-year-old reports dizziness on standing. Which set of vital-sign changes confirms orthostatic hypotension?

  1. A fall in systolic pressure of 15 mm Hg after 1 minute of standing
  2. A fall in systolic pressure of 25 mm Hg after 3 minutes of standing Correct answer.
  3. A fall in heart rate of 15 beats/min after 3 minutes of standing
  4. A rise in diastolic pressure of 12 mm Hg after 2 minutes of standing

Explanation

Orthostatic hypotension is defined as a decrease of at least 20 mm Hg in systolic pressure or at least 10 mm Hg in diastolic pressure within 3 minutes of standing. A 25 mm Hg systolic drop meets this criterion. Heart-rate changes alone do not define the condition.

Question 27Assessment

Which stethoscope component is best for hearing low-pitched heart sounds such as an S3 or the rumble of mitral stenosis?

  1. The diaphragm pressed firmly against the chest
  2. The diaphragm applied lightly to the chest
  3. The bell pressed firmly against the chest
  4. The bell applied lightly to the chest Correct answer.

Explanation

The bell transmits low-frequency sounds when it is applied lightly, making it useful for S3, S4, and mitral stenosis. Pressing firmly on the bell stretches the skin and converts it functionally into a diaphragm. The diaphragm is better for higher-frequency sounds.

Question 28Assessment

In the ABCDE criteria for melanoma, what does the E represent?

  1. Enlargement of regional lymph nodes
  2. Evolution of the lesion over time Correct answer.
  3. Elevation above the surrounding skin
  4. Erythema surrounding the lesion

Explanation

The E in the ABCDE melanoma criteria stands for evolution, meaning a lesion changes in size, shape, color, or symptoms. Evolution is a particularly important warning sign. Elevation and erythema are not part of the mnemonic.

Question 29Assessment

Which item obtained during a health history is a subjective symptom rather than an objective sign?

  1. A brachial blood pressure of 150/90 mm Hg
  2. An apical systolic murmur heard on auscultation
  3. An oral temperature of 38.2°C
  4. Report of burning epigastric pain Correct answer.

Explanation

Subjective symptoms are reported by the patient, such as pain, nausea, or fatigue. Objective signs are directly observed or measured by the clinician. Temperature, murmurs, and blood pressure are objective findings.

Question 30Assessment

A 54-year-old woman reports fatigue, weight gain, and cold intolerance. Which physical examination finding most supports hypothyroidism?

  1. Delayed reflex relaxation Correct answer.
  2. Fine tremor of the outstretched hands
  3. Lid retraction with a staring gaze
  4. Hyperreflexia with sustained clonus

Explanation

Hypothyroidism slows the relaxation phase of deep tendon reflexes, producing the classic 'hung-up' reflex. Hyperreflexia, tremor, and lid retraction are associated with hyperthyroidism. These signs help distinguish the two thyroid states at the bedside.

Question 31Assessment

A patient with a distended abdomen is suspected of having ascites. Which percussion technique is used to detect free peritoneal fluid?

  1. Percuss for tympany over the gastric bubble after a meal
  2. Percuss the liver span along the midclavicular line during expiration
  3. Percuss over the lower sternum while the patient exhales fully
  4. Percuss from flank to umbilicus for loss of dullness Correct answer.

Explanation

Shifting dullness is demonstrated by percussing from the flank, where fluid collects, toward the umbilicus; the dull note gives way to tympany as the patient turns. This maneuver detects free peritoneal fluid. Liver span and gastric tympany assess different structures.

Question 32Assessment

A 60-year-old has fever, cough, and right lower lobe consolidation. How does tactile fremitus compare with the unaffected side?

  1. Decreased over the consolidation
  2. Absent over the consolidation
  3. Increased over the consolidation Correct answer.
  4. Unchanged from the unaffected side

Explanation

Consolidated lung tissue transmits sound more efficiently, so tactile fremitus increases over an area of pneumonia. Fremitus decreases with pleural effusion, pneumothorax, or bronchial obstruction. This distinction helps localize the abnormality.

Question 33Assessment

Which cranial nerve is assessed by asking the patient to shrug the shoulders against resistance and turn the head against resistance?

  1. Hypoglossal nerve (CN XII)
  2. Facial nerve (CN VII)
  3. Accessory nerve (CN XI) Correct answer.
  4. Glossopharyngeal nerve (CN IX)

Explanation

The spinal accessory nerve supplies the trapezius and sternocleidomastoid muscles, which mediate shoulder shrug and head turning. CN VII controls facial muscles, CN XII controls the tongue, and CN IX contributes to swallowing and gag.

Question 34Assessment

A 65-year-old has new unilateral left leg swelling and calf tenderness. Which feature most raises concern for deep vein thrombosis rather than chronic venous insufficiency?

  1. Bilateral ankle edema that worsens by the end of the day
  2. Unilateral calf tenderness and a girth difference Correct answer.
  3. Brownish pigmentation around the medial malleolus
  4. Varicose veins with chronic superficial skin changes

Explanation

Deep vein thrombosis typically produces unilateral swelling, calf tenderness, and a measurable difference in leg circumference. Chronic venous insufficiency usually causes bilateral dependent edema, stasis pigmentation, and varicosities. Unilateral findings warrant further evaluation for thrombosis.

Question 35Assessment

Which screening instrument is preferred over the MMSE for detecting mild cognitive impairment in a high-functioning older adult?

  1. Mini-Cog
  2. Functional Activities Questionnaire
  3. Montreal Cognitive Assessment Correct answer.
  4. Clock-drawing test alone

Explanation

The Montreal Cognitive Assessment is more sensitive than the MMSE for mild cognitive impairment, particularly in educated, high-functioning patients. The Mini-Cog is brief but less detailed, and the clock-drawing test alone is insufficient. The Functional Activities Questionnaire measures daily function rather than cognition.

Question 36Assessment

An 84-year-old with advanced dementia and limited verbal ability appears agitated during repositioning. Which approach best assesses pain?

  1. Ask the patient to rate pain from 0 to 10
  2. Use an observational tool such as PAINAD Correct answer.
  3. Rely on the family's estimate of pain
  4. Assume agitation is due to dementia and observe

Explanation

Patients with advanced dementia who cannot self-report pain should be assessed with a validated observational tool such as the PAINAD, which scores breathing, vocalization, facial expression, body language, and consolability. Agitation during movement may signal pain. Family input can supplement but not replace structured assessment.

Question 37Assessment

Which test best screens for loss of protective foot sensation in a patient with diabetes?

  1. Vibration sense with a 128-Hz tuning fork only
  2. Ankle reflex testing
  3. Capillary refill of the toes
  4. 10-g monofilament testing Correct answer.

Explanation

The 10-g monofilament assesses large-fiber protective sensation and predicts ulcer risk in diabetes. Vibration testing is useful but does not directly measure protective sensation. Ankle reflexes and capillary refill assess different aspects of neurologic and vascular status.

Question 38Assessment

A diagnostic test has a positive likelihood ratio of 10. How should this result be interpreted?

  1. Positive results are 10 times more likely with disease than without Correct answer.
  2. A positive result is 10 times more likely in patients without the disease
  3. The test changes pretest probability by 10 percentage points
  4. The test correctly identifies 10% of patients with the disease

Explanation

The positive likelihood ratio is sensitivity divided by (1 minus specificity). An LR+ of 10 means a positive result is 10 times more likely in a patient with the disease than in one without it, which substantially raises posttest probability. It is not a percentage or a fixed change in probability points.

Question 39Assessment

A screening program for a cancer appears to improve survival, but it preferentially detects slowly growing tumors. Which bias best explains this apparent benefit?

  1. Recall bias
  2. Length bias Correct answer.
  3. Observer bias
  4. Selection bias

Explanation

Length bias occurs because screening is more likely to detect slowly progressive disease, which has a longer detectable preclinical phase and generally better prognosis. This can make screening look beneficial even without changing the disease course. Recall and observer bias concern reporting and measurement, respectively.

Question 40Assessment

A screening test with fixed sensitivity and specificity is applied in a population with a much higher disease prevalence. What happens to the positive predictive value?

  1. It increases Correct answer.
  2. It remains unchanged
  3. It becomes equal to sensitivity
  4. It decreases

Explanation

Positive predictive value rises as disease prevalence increases because a larger proportion of positive results are true positives. Sensitivity and specificity are properties of the test and do not change with prevalence. Negative predictive value moves in the opposite direction.

Question 41Diagnosis

A 52-year-old man with a body mass index of 29 kg/m² has no symptoms but has a random screening hemoglobin A1c of 6.6%. He takes no medications and has no acute illness. Which diagnosis do these results support?

  1. Diabetes mellitus Correct answer.
  2. Impaired fasting glucose
  3. Prediabetes
  4. Normal glucose tolerance

Explanation

An A1c of 6.5% or greater meets the diagnostic threshold for diabetes mellitus; 5.7% to 6.4% defines prediabetes and below 5.7% is normal. In an asymptomatic adult the result should be confirmed with a second abnormal test, but the initial classification is diabetes.

Question 42Diagnosis

A 58-year-old woman has repeated office blood pressure readings averaging 148/94 mm Hg over three visits, with proper technique and an appropriately sized cuff. She has no symptoms and no evidence of end-organ damage. How should this be classified?

  1. Stage 2 hypertension Correct answer.
  2. Hypertensive urgency
  3. Elevated blood pressure
  4. Stage 1 hypertension

Explanation

Stage 2 hypertension is defined as a systolic pressure of 140 mm Hg or higher or a diastolic pressure of 90 mm Hg or higher, so both of her values fall in this category. Staging is based on the higher of the systolic or diastolic category.

Question 43Diagnosis

A 57-year-old man has acute monoarticular pain and swelling of the first metatarsophalangeal joint. Arthrocentesis yields cloudy fluid with needle-shaped crystals that are negatively birefringent under polarized light. Which diagnosis do these findings confirm?

  1. Gout Correct answer.
  2. Calcium pyrophosphate deposition disease
  3. Reactive arthritis
  4. Septic arthritis

Explanation

The presence of monosodium urate crystals, which are needle-shaped and negatively birefringent, is definitive for gout. Identifying organisms or a positive Gram stain would instead be required to diagnose septic arthritis.

Question 44Diagnosis

A 66-year-old man with diabetes and a 20-pack-year smoking history reports calf cramping after walking two blocks that resolves with rest. Ankle-brachial index testing yields a value of 0.72 in the symptomatic leg. How should this result be interpreted?

  1. Chronic limb-threatening ischemia
  2. Normal perfusion
  3. Borderline perfusion
  4. Mild-to-moderate PAD Correct answer.

Explanation

An ankle-brachial index of 0.90 or less is abnormal, and values of roughly 0.40 to 0.90 correspond to mild-to-moderate peripheral artery disease, typically with claudication. Values below 0.40 suggest severe disease and chronic limb-threatening ischemia.

Question 45Diagnosis

A 68-year-old postmenopausal woman with no prior fragility fracture undergoes dual-energy x-ray absorptiometry. Her lowest T-score is −2.7 at the femoral neck. What diagnosis do these results establish?

  1. Secondary osteoporosis
  2. Normal bone density
  3. Osteoporosis Correct answer.
  4. Osteopenia

Explanation

A T-score of −2.5 or lower at the hip, femoral neck, or lumbar spine establishes osteoporosis. A T-score between −1.0 and −2.5 defines osteopenia, and secondary osteoporosis is a causal designation rather than a density category.

Question 46Diagnosis

A 34-year-old woman presents with two months of low mood, anhedonia, poor sleep, and reduced concentration. She has no suicidal ideation and no history of mania. Which instrument is the preferred initial screening tool for her presentation?

  1. CAGE alcohol screen
  2. GAD-7 anxiety scale
  3. PHQ-9 depression scale Correct answer.
  4. Mini-Cog cognitive screen

Explanation

The nine-item Patient Health Questionnaire is the validated, widely recommended tool for depression screening in adults and also grades severity. The GAD-7 measures anxiety, the Mini-Cog assesses cognition, and the CAGE screens for unhealthy alcohol use.

Question 47Diagnosis

A 29-year-old woman develops flushing, throat tightness, and diffuse hives minutes after eating shellfish. Which single finding is sufficient to establish a diagnosis of anaphylaxis without additional organ involvement?

  1. Sudden hypotension after a known allergen exposure Correct answer.
  2. Nausea and vomiting alone after a large meal
  3. Isolated hives that resolve with an oral antihistamine
  4. Wheezing alone that improves with a bronchodilator

Explanation

Anaphylaxis is diagnosed when acute hypotension, bronchospasm, or laryngeal edema occurs after exposure to a likely allergen, even without a second organ system involved. Otherwise, involvement of two or more organ systems after exposure is required.

Question 48Diagnosis

A 55-year-old man has a body mass index of 36 kg/m², a neck circumference of 43 cm, hypertension, and nightly snoring witnessed by his partner. His STOP-BANG score is 5. How should this score be interpreted?

  1. Low risk for moderate-to-severe OSA
  2. Diagnostic of severe OSA without a sleep study
  3. High risk for moderate-to-severe OSA Correct answer.
  4. Moderate risk requiring no further testing

Explanation

A STOP-BANG score of 5 or higher identifies high risk for moderate-to-severe obstructive sleep apnea and warrants referral for diagnostic testing. Scores of 0 to 2 indicate low risk and 3 to 4 indicate intermediate risk.

Question 49Diagnosis

A 72-year-old man is evaluated for community-acquired pneumonia. He is alert and oriented with a respiratory rate of 24 breaths/min, blood pressure 105/65 mm Hg, blood urea nitrogen 22 mg/dL, and temperature 38.4°C. What is his CURB-65 score?

  1. CURB-65 score of 3
  2. CURB-65 score of 4
  3. CURB-65 score of 2 Correct answer.
  4. CURB-65 score of 1

Explanation

CURB-65 assigns one point each for confusion, urea above 7 mmol/L (blood urea nitrogen roughly above 19 mg/dL), respiratory rate of 30 or more, systolic pressure below 90 or diastolic 60 or less, and age 65 or older. This patient earns points only for the elevated urea and his age, giving a score of 2.

Question 50Diagnosis

A 44-year-old woman has fatigue and exertional dyspnea. Laboratory studies show hemoglobin 9.6 g/dL and mean corpuscular volume 71 fL. Which combination of iron studies best supports iron deficiency anemia?

  1. Elevated ferritin with normal MCV
  2. Normal ferritin with high MCV
  3. Low ferritin with elevated TIBC Correct answer.
  4. Elevated ferritin with low TIBC

Explanation

Iron deficiency produces low ferritin with increased total iron-binding capacity and low transferrin saturation, reflecting depleted stores and compensatory transferrin production. Ferritin is an acute-phase reactant, so a low value is highly specific for iron deficiency.