100+ Free ABPS Geriatric Medicine Practice Questions

Dementia & Cognitive Impairment

Alzheimer disease (amyloid/tau pathology, anti-amyloid monoclonal antibodies lecanemab and donanemab with ARIA-E and ARIA-H MRI monitoring per AAN appropriate use recommendations), Dementia with Lewy bodies (REM sleep behavior disorder, visual hallucinations, parkinsonism, severe neuroleptic sensitivity), vascular dementia (stepwise decline, vascular risk factors), frontotemporal dementia (behavioral variant and PPA language variants), mild cognitive impairment, Mini-Cog/MoCA/SLUMS screening, BPSD with non-pharmacologic first-line management (DICE approach), cholinesterase inhibitors (donepezil, rivastigmine, galantamine), memantine for moderate-severe AD, AGS Beers caution against antipsychotics for BPSD (FDA black-box mortality warning).

Polypharmacy & AGS 2023 Beers Criteria

AGS 2023 Beers Criteria PIMs in adults ≥65: first-generation antihistamines (diphenhydramine), long-acting and short-acting benzodiazepines, sliding-scale insulin, glyburide and chlorpropamide, chronic NSAIDs, tertiary TCAs (amitriptyline), strong anticholinergics (oxybutynin), antipsychotics for BPSD (avoid except severe danger), PPIs >8 weeks without indication, skeletal muscle relaxants (cyclobenzaprine, methocarbamol). STOPP/START criteria, anticholinergic burden score, prescribing cascades, deprescribing principles, drug-disease interactions, renal dose adjustments (CrCl with Cockcroft-Gault), pharmacokinetic and pharmacodynamic changes with aging.

End-of-Life, Palliative Care & Pain

Hospice eligibility (Medicare hospice benefit — physician certifies prognosis ≤6 months if disease runs usual course), POLST/MOLST forms (portable medical orders, NOT advance directives), advance directives and durable power of attorney for healthcare, surrogate decision-making hierarchy, AGS persistent pain guidelines (acetaminophen first-line up to 3 g/day, avoid chronic NSAIDs in older adults, opioids when needed with proactive bowel regimen), dyspnea management (low-dose opioids first-line), terminal secretions, palliative sedation, hospice levels of care (routine, continuous, GIP, respite), prognostic tools (Palliative Performance Scale, FAST stage 7c for dementia hospice eligibility).

Delirium

Confusion Assessment Method (CAM — acute onset/fluctuating + inattention + either disorganized thinking or altered level of consciousness) and CAM-ICU, hyperactive vs hypoactive vs mixed subtypes (hypoactive most common and most missed), hospital-acquired delirium prevention via HELP (Hospital Elder Life Program) bundles (orientation, early mobilization, sleep hygiene, hydration, vision/hearing aids, avoid restraints), risk factors and precipitants (infection, dehydration, anticholinergics, opioids, restraints, sleep disruption), distinguishing delirium from dementia and depression, non-pharmacologic management is first-line, low-dose haloperidol or quetiapine reserved for severe agitation/safety risk.

Falls, Gait & Mobility

CDC STEADI algorithm (Screen, Assess, Intervene), Timed Up and Go (TUG) ≥12 seconds suggests fall risk, 30-second chair stand, 4-stage balance test, gait speed <0.8 m/s indicates slow walking and increased mortality risk, orthostatic hypotension assessment (drop ≥20 mmHg systolic or ≥10 diastolic within 3 minutes of standing), USPSTF 2024 recommendation against routine vitamin D for fall prevention in community-dwelling adults ≥60 (Grade D — change from prior Grade I), exercise interventions (Otago, tai chi), home hazard modification, medication review and deprescribing of fall-risk-increasing drugs.

Frailty, Sarcopenia & Functional Status

Fried frailty phenotype (5 criteria: unintentional weight loss ≥10 lb, exhaustion, low physical activity, slow gait speed, weak grip strength — frail ≥3, prefrail 1-2), Rockwood Clinical Frailty Scale (1 very fit through 9 terminally ill), sarcopenia per EWGSOP2 (low muscle strength + low muscle quantity/quality, severe if low physical performance added), comprehensive geriatric assessment (CGA — multidisciplinary), ADLs (Katz — bathing, dressing, toileting, transferring, continence, feeding) and IADLs (Lawton — phone, shopping, cooking, housework, laundry, transportation, medications, finances), resistance exercise and protein intake (1.0-1.2 g/kg/day for healthy older adults), Mini Nutritional Assessment (MNA).

Urinary Incontinence & GU

Incontinence subtypes: urge (overactive bladder/detrusor overactivity), stress (sphincter weakness), overflow (BPH or detrusor underactivity), functional (cognitive/mobility), mixed. DIAPPERS reversible causes (Delirium, Infection, Atrophic vaginitis, Pharmaceuticals, Psychological, Excess urine output, Restricted mobility, Stool impaction). Post-void residual, urodynamics indications, behavioral therapy first-line (bladder training, pelvic floor exercises, prompted voiding), AGS Beers caution on anticholinergic OAB drugs (oxybutynin, tolterodine — anticholinergic burden), mirabegron β3 agonist as alternative, BPH management (alpha-blockers, 5-ARI), asymptomatic bacteriuria — DO NOT treat in older adults absent urinary symptoms (IDSA 2019).

Chronic Disease in Older Adults

Heart failure GDMT (ARNI/ACEI/ARB, beta-blocker, MRA, SGLT2 inhibitor — quadruple therapy for HFrEF; SGLT2i now also recommended for HFpEF per 2022 AHA/ACC/HFSA), COPD GOLD 2026 ABE assessment groups and triple therapy (LABA+LAMA+ICS) when indicated, diabetes A1C target 7.5-8.0% for most older adults per ADA Standards of Care 2026 (relax to 8.0-8.5% in complex/poor health), avoid sulfonylureas/sliding scale insulin (Beers), hypertension target <130/80 if tolerated per 2025 AHA/ACC update — individualize and watch orthostatic hypotension, osteoporosis (DXA T-score ≤-2.5; bisphosphonates first-line, denosumab, romosozumab for very high risk).

Depression & Mental Health

Geriatric Depression Scale (GDS-15 ≥5 suggests depression), PHQ-9, late-life depression presentation (somatic complaints, cognitive complaints — pseudodementia), suicide risk in older adults (highest rates in older white men ≥85), SSRIs first-line (sertraline and escitalopram preferred for tolerability — citalopram dose-limited to 20 mg in adults ≥60 due to QT prolongation), avoid TCAs and paroxetine (anticholinergic burden — Beers), psychotherapy options (Problem-Solving Therapy, CBT, IPT), late-life anxiety disorders, late-life bipolar disorder, alcohol use disorder screening (SMAST-G — Short Michigan Alcoholism Screening Test Geriatric).

Pressure Injury & Skin Care

NPIAP 2016 staging: Stage 1 intact skin with non-blanchable erythema, Stage 2 partial-thickness skin loss with exposed dermis, Stage 3 full-thickness skin loss (subcutaneous fat may be visible), Stage 4 full-thickness skin and tissue loss with exposed bone/tendon/muscle, unstageable (obscured by slough/eschar), deep tissue pressure injury (persistent non-blanchable deep red/maroon/purple discoloration). Braden Scale risk assessment (≤18 at risk), repositioning q2h in bed and q1h in chair, support surfaces (high-specification foam, alternating pressure), nutrition optimization, moisture management, debridement options (autolytic, enzymatic, mechanical, sharp), distinguish from MASD (moisture-associated skin damage).

Elder Abuse

Types of elder mistreatment: physical abuse, sexual abuse, emotional/psychological abuse, financial exploitation, neglect (caregiver neglect and self-neglect), abandonment. Screening tools include the Elder Abuse Suspicion Index (EASI). Risk factors include cognitive impairment, social isolation, caregiver burden, and substance use. Mandatory reporting laws vary by state — Adult Protective Services (APS) is the primary reporting agency for community-dwelling adults; state long-term care ombudsman for facility residents. Documentation requirements, capacity assessment of the older adult to refuse intervention, safety planning, and multidisciplinary response.

Capacity, Consent & Ethics

Capacity is decision-specific (not global) and clinical; competence is the legal determination by a court. The four pillars of decision-making capacity: understanding, appreciation, reasoning, and expression of choice. Capacity assessment tools (Aid to Capacity Evaluation — ACE; MacArthur Competence Assessment Tool for Treatment — MacCAT-T). Surrogate decision-making hierarchy varies by state law. Substituted judgment (what the patient would have wanted) vs best interest standard. Informed consent for older adults with MCI/early dementia. Goals-of-care conversations using the Serious Illness Conversation Guide. Driving safety and physician reporting obligations vary by state.