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100+ Free NCCPA CAQ Geriatrics Practice Questions

Pass your NCCPA Certificate of Added Qualifications in Geriatric Medicine exam on the first try — instant access, no signup required.

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An 85-year-old with mild cognitive impairment is being considered for major surgery. What is the most appropriate preoperative assessment?

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2026 Statistics

Key Facts: NCCPA CAQ Geriatrics Exam

~120

MCQ Items

Standard NCCPA CAQ format

2 hr

Total Exam Time

Computer-based at Pearson VUE

~$350

Exam Fee

NCCPA CAQ standard pricing 2026

10 yr

Certification Validity

NCCPA CAQ cycle

2026

New CAQ Launch

NCCPA Geriatric Medicine CAQ

PA-C

Required Foundation

Current PA-C certification + state license + specialty experience

The NCCPA CAQ in Geriatric Medicine launches in 2026 as a new specialty credential for PAs caring for older adults. The exam is a 2-hour computer-based test at Pearson VUE with approximately 120 single-best-answer MCQs covering aging physiology and geriatric syndromes (~25-30%), chronic conditions (~25%), polypharmacy (~10-15%), cognitive disorders (~10-15%), end-of-life and palliative care (~10%), functional assessment and transitions of care (~10%), and ethics/legal (~5-10%). Exam fee is approximately $350. Eligibility requires current PA-C certification, unrestricted state license, and documented geriatrics experience plus Category I CME per NCCPA CAQ rules.

Sample NCCPA CAQ Geriatrics Practice Questions

Try these sample questions to test your NCCPA CAQ Geriatrics exam readiness. Each question includes a detailed explanation. Start the interactive quiz above for the full 100+ question experience with AI tutoring.

1An 82-year-old patient has decreased glomerular filtration rate (GFR) despite a serum creatinine of 0.9 mg/dL. Which physiologic aging change explains this finding?
A.Increased creatinine production with age
B.Decreased muscle mass leading to lower creatinine production, masking true reduction in GFR
C.Improved tubular secretion of creatinine
D.Increased glomerular hyperfiltration
Explanation: Sarcopenia (age-related loss of muscle mass) reduces endogenous creatinine production, so serum creatinine underestimates renal impairment in older adults. Use estimated GFR (CKD-EPI without race) or cystatin C; avoid Cockcroft-Gault overestimation. Dose renally cleared drugs based on eGFR, not serum creatinine alone.
2Which age-related cardiovascular change increases risk of postural hypotension in older adults?
A.Increased baroreceptor sensitivity
B.Reduced baroreceptor sensitivity and decreased beta-adrenergic responsiveness
C.Increased ventricular compliance
D.Decreased aortic stiffness
Explanation: Aging causes reduced baroreceptor sensitivity and blunted beta-adrenergic responsiveness, impairing reflex tachycardia and vasoconstriction during posture change. Combined with arterial stiffness and decreased renal sodium conservation, this predisposes to orthostatic hypotension and falls.
3Which respiratory change is a hallmark of normal aging?
A.Increased forced expiratory volume (FEV1)
B.Decreased lung elasticity, increased residual volume, and decreased FEV1
C.Increased respiratory muscle strength
D.Improved gas exchange
Explanation: Normal pulmonary aging includes decreased lung elastic recoil ("senile emphysema"), increased residual volume and functional residual capacity, decreased FEV1 (~30 mL/year after age 30), reduced respiratory muscle strength, and modest decline in PaO2 (alveolar-arterial gradient widening).
4Which finding distinguishes delirium from dementia in an 85-year-old hospitalized patient?
A.Gradual cognitive decline over months
B.Acute onset with fluctuating attention and altered level of consciousness
C.Stable, progressive memory loss
D.Normal vital signs and stable orientation
Explanation: Delirium is characterized by acute onset (hours to days), fluctuating course, INATTENTION (CAM core feature), and altered consciousness. Dementia has insidious onset and progresses over months to years, with attention usually preserved early. Use the Confusion Assessment Method (CAM): acute change + inattention + (disorganized thinking OR altered consciousness).
5Which is the most common precipitant of delirium in a hospitalized older adult?
A.Urinary tract infection
B.Medications (especially anticholinergics, benzodiazepines, opioids)
C.Heart failure
D.Pulmonary embolism
Explanation: Medications cause up to 40% of delirium in older hospitalized adults. Highest risk: anticholinergics (diphenhydramine, scopolamine), benzodiazepines, opioids (especially meperidine), and corticosteroids. Use the mnemonic DELIRIUMS: Drugs, Electrolytes/dehydration, Lack of drugs (withdrawal), Infection, Reduced sensory input, Intracranial, Urinary/fecal retention, Myocardial/pulmonary, Subdural hematoma.
6Which assessment tool is the gold standard for cognitive screening in primary care for older adults?
A.Mini-Mental State Examination (MMSE)
B.Montreal Cognitive Assessment (MoCA) or Mini-Cog as initial screen
C.Brief Cognitive Rating Scale
D.Clock Drawing Test alone
Explanation: Mini-Cog (3-item recall + clock drawing) is a fast and validated initial primary care screen. MoCA is more sensitive for mild cognitive impairment than MMSE, especially for executive function deficits. MMSE is no longer freely accessible due to copyright. Positive screens warrant formal neuropsychological testing.
7A 78-year-old has had two falls in the past year. Which is the most important assessment?
A.MRI brain
B.Comprehensive multifactorial falls assessment including gait/balance (Timed Up and Go), orthostatic vital signs, vision, medications, and home safety
C.Bone density alone
D.EEG
Explanation: Per CDC STEADI and USPSTF, any older adult with 2+ falls in the past year (or one fall with injury) requires multifactorial assessment: gait/balance (Timed Up and Go >12 sec abnormal; 30-second chair stand), orthostatic vitals, vision, polypharmacy review (especially BZDs, anticholinergics, antipsychotics, antihypertensives), home hazards, vitamin D, footwear, and cognitive screen.
8Which intervention has the strongest evidence for preventing falls in community-dwelling older adults?
A.Vitamin D 800 IU daily in all older adults
B.Multi-component exercise programs (balance training, tai chi, strength) plus medication review and home safety
C.Hip protectors alone
D.Aspirin 81 mg daily
Explanation: Multi-component interventions (exercise — especially balance and strength; medication review with deprescribing; vision correction; home modifications) have the strongest evidence. USPSTF (2024) recommends exercise interventions for community-dwelling older adults at increased fall risk. Vitamin D is no longer recommended for prevention in the general population.
9A 72-year-old has slow gait speed, weak grip strength, low activity, exhaustion, and weight loss. Which syndrome is most consistent with these findings?
A.Frailty (Fried criteria)
B.Major depression
C.Hyperthyroidism
D.Polymyalgia rheumatica
Explanation: Fried frailty phenotype: 3 or more of (1) unintentional weight loss >10 lb in past year, (2) self-reported exhaustion, (3) weakness (grip strength), (4) slow walking speed, (5) low physical activity. Frailty is a clinical state of vulnerability to stressors; pre-frail = 1-2 criteria. Address with resistance exercise, protein-rich diet, multidisciplinary care, and avoid hospitalizations.
10Which is the first-line treatment for stress urinary incontinence in an older woman?
A.Anticholinergic medications
B.Pelvic floor muscle training (Kegel exercises) and lifestyle modifications
C.Surgical sling
D.Loop diuretic
Explanation: Pelvic floor muscle training (Kegels) is first-line for stress UI; lifestyle changes (weight loss, caffeine reduction, smoking cessation) augment effect. Pessary may be added for prolapse. Surgical mid-urethral sling is reserved for severe cases failing conservative treatment. Anticholinergics treat urge UI, not stress.

About the NCCPA CAQ Geriatrics Exam

The NCCPA Certificate of Added Qualifications (CAQ) in Geriatric Medicine is a specialty credential launching in 2026 for physician assistants (PAs) who provide care to older adults. The 2-hour computer-based exam at Pearson VUE centers contains approximately 120 single-best-answer MCQs (consistent with the standard NCCPA CAQ format) and covers normal aging physiology, geriatric syndromes (delirium, falls, frailty, incontinence, dysphagia, pressure injuries), common chronic conditions in older adults (hypertension, diabetes, heart failure with reduced and preserved EF, COPD, CKD, osteoporosis, atrial fibrillation, valvular heart disease), polypharmacy and medication safety (AGS Beers Criteria 2023, STOPP/START, deprescribing), cognitive disorders (MCI, Alzheimer disease, Lewy body, frontotemporal, vascular, NPH; anti-amyloid antibodies lecanemab/donanemab), end-of-life and palliative care (Medicare hospice eligibility, POLST, REMAP goals-of-care, opioid-based symptom management), functional assessment and transitions of care (ADLs/IADLs, comprehensive geriatric assessment, Care Transitions Intervention, PACE, ePrognosis life-expectancy tools), and ethical/legal issues (decision-making capacity per Appelbaum, elder abuse mandatory reporting, advance directives). Eligibility requires current PA-C certification, unrestricted state license, and documented geriatrics experience and CME per NCCPA CAQ requirements.

Questions

100 scored questions

Time Limit

2-hour CBT at Pearson VUE

Passing Score

Criterion-referenced scaled score set by NCCPA

Exam Fee

~$350 NCCPA CAQ exam fee (National Commission on Certification of Physician Assistants (NCCPA) / Pearson VUE)

NCCPA CAQ Geriatrics Exam Content Outline

~25-30%

Physiologic Aging and Geriatric Syndromes

Renal aging (sarcopenia reduces creatinine — use eGFR), cardiovascular (decreased baroreceptor sensitivity, orthostatic hypotension), pulmonary (decreased FEV1, elastic recoil), thermoregulation (decreased shivering/sweating, blunted thirst), delirium (CAM acute change + inattention + disorganized thinking/altered LOC; medications are leading cause; HELP program prevention; low-dose haloperidol 0.25-0.5 mg for severe agitation; AVOID benzodiazepines except in ETOH/BZD withdrawal), falls (CDC STEADI, multifactorial assessment, exercise > vitamin D per USPSTF 2024), frailty (Fried phenotype — weight loss, exhaustion, weakness, slow gait, low activity), incontinence (stress = Kegels first-line, urge = mirabegron preferred over anticholinergic), pressure injury staging, dysphagia evaluation, and BPPV (Dix-Hallpike + Epley).

~25%

Common Chronic Conditions

Hypertension target <130/80 in community-dwelling 65+ (SPRINT), relaxed A1c <8.0-8.5% in frail elderly (avoid glyburide per Beers; metformin + SGLT2/GLP-1 for CV/CKD benefit), HFpEF SGLT2i Class 2A (EMPEROR-Preserved, DELIVER), AFib with CHA2DS2-VASc ≥2 (men)/≥3 (women) — DOAC preferred over warfarin (apixaban often best in renal impairment/fall risk); severe symptomatic AS → TAVR (Class I); osteoporosis DEXA at 65+ women, fragility fracture diagnoses without DEXA, bisphosphonate first-line; PCV20 (or PCV15+PPSV23), Shingrix 50+, RSV vaccine 75+ (ACIP 2024), high-dose/adjuvanted flu 65+; asymptomatic bacteriuria do NOT treat (IDSA); recurrent C. diff → fidaxomicin/FMT/bezlotoxumab.

~10-15%

Polypharmacy and Medication Safety

AGS Beers Criteria 2023 avoidances (anticholinergics — diphenhydramine; benzodiazepines; glyburide; meperidine; sliding-scale insulin; tertiary TCAs amitriptyline; chronic NSAIDs). STOPP/START criteria. Deprescribing principles: reconcile medications, identify high-risk meds, prioritize tapering with shared decision-making. Mirabegron preferred over oxybutynin in elderly for urge UI. CBT-I first-line for insomnia (avoid Z-drugs, BZDs, diphenhydramine, off-label quetiapine). Gabapentin or duloxetine for neuropathic pain (avoid TCAs). Acetaminophen first-line analgesic (max 2-3 g/day with hepatic impairment).

~10-15%

Cognitive Disorders

MCI vs dementia distinction (MCI = objective cognitive decline with ADLs preserved). Mini-Cog or MoCA initial screen. Alzheimer disease: donepezil/rivastigmine/galantamine (mild-moderate); add memantine for moderate-severe (MMSE <17). Anti-amyloid antibodies (lecanemab, donanemab) for MCI/early AD with confirmed amyloid pathology — ARIA-E/H monitoring required. Lewy body dementia core features (fluctuation, visual hallucinations, parkinsonism, RBD) and EXTREME neuroleptic sensitivity (avoid typical antipsychotics). Frontotemporal (behavioral disinhibition, PPA). Vascular dementia. NPH triad (gait, urinary, cognitive) → LP and possible VP shunt. BPSD non-pharmacologic first; antipsychotic BLACK BOX mortality warning in dementia. GDS-15 or PHQ-9 for depression screening.

~10%

End-of-Life and Palliative Care

Medicare hospice benefit: prognosis ≤6 months if disease follows usual course, certified by attending and hospice medical director; recertification 60-90 days; comfort-focused care. POLST/MOLST translates patient values into actionable medical orders that travel across settings (distinct from advance directive legal document). Low-dose opioids (morphine 2.5-5 mg PO/SC) most evidence-based for refractory dyspnea. AVOID meperidine (Beers — neurotoxic metabolite) and fentanyl patch in opioid-naïve elderly. REMAP framework (Reframe, Expect emotion, Map values, Align, Plan) for goals-of-care discussions. Acetaminophen first-line for pain.

~10%

Functional Assessment and Transitions of Care

ADLs (bathing, dressing, toileting, transferring, continence, feeding) and IADLs (medications, finances, telephone, shopping, transportation, housework, cooking). Timed Up and Go (>12 sec abnormal). Comprehensive Geriatric Assessment (CGA) and multidisciplinary team. MNA-validated for malnutrition. Hip fracture rehab predictors (pre-fracture function, cognition, early surgery <48 hr). Care Transitions Intervention (Coleman) and Transitional Care Model (Naylor) — medication reconciliation, follow-up <7 days, education. ACE units, PACE, GRACE, home-based primary care. ePrognosis life-expectancy tools (Lee, Schonberg, Suemoto) inform screening decisions.

~5-10%

Ethics, Legal, and Psychosocial Issues

Appelbaum 4 elements of decision-making capacity (communicate choice, understand, appreciate, reason); decision-specific not all-or-nothing. Advance directives, POLST, surrogate decision-making. Elder abuse red flags (fearful patient, caregiver dominates, inconsistent history, unusual bruising patterns, untreated wounds, isolation); mandatory reporting in most US states. Driving safety. Sexual health (older adults sexually active; STI risk; counseling). Ageism awareness.

How to Pass the NCCPA CAQ Geriatrics Exam

What You Need to Know

  • Passing score: Criterion-referenced scaled score set by NCCPA
  • Exam length: 100 questions
  • Time limit: 2-hour CBT at Pearson VUE
  • Exam fee: ~$350 NCCPA CAQ exam fee

Keys to Passing

  • Complete 500+ practice questions
  • Score 80%+ consistently before scheduling
  • Focus on highest-weighted sections
  • Use our AI tutor for tough concepts

NCCPA CAQ Geriatrics Study Tips from Top Performers

1Master the AGS Beers Criteria 2023 'avoid in older adults' list cold. The highest-yield avoidances are: first-generation antihistamines (diphenhydramine, hydroxyzine — anticholinergic burden), benzodiazepines and Z-drugs (zolpidem — falls, cognition), glyburide (hypoglycemia, CV risk), meperidine (normeperidine neurotoxicity), tertiary TCAs (amitriptyline — anticholinergic, cardiac), chronic NSAIDs (GI bleed, renal injury, HTN/CHF), and sliding-scale insulin alone. Pair each avoidance with the preferred alternative — e.g., mirabegron for urge UI instead of oxybutynin, gabapentin/duloxetine for neuropathic pain instead of TCAs, acetaminophen first-line for pain, melatonin or low-dose doxepin if pharmacotherapy needed for insomnia (CBT-I is first-line).
2Internalize the delirium framework: CAM (acute change + inattention + (disorganized thinking OR altered consciousness)). Medications cause up to 40% of delirium — anticholinergics, benzodiazepines, opioids (meperidine worst), and steroids are the worst offenders. Prevention with Hospital Elder Life Program (HELP) bundle: orientation, sleep, early mobilization, vision/hearing aids, hydration, pain control, AVOID benzodiazepines and restraints. Severe agitation with risk of harm and failed non-pharmacologic management: low-dose haloperidol 0.25-0.5 mg or olanzapine 2.5-5 mg short-term. NEVER use benzodiazepines for delirium except in alcohol/BZD withdrawal.
3Drill end-of-life essentials. Medicare hospice benefit: ≤6 month prognosis if disease follows usual course, certified by attending AND hospice medical director, patient elects comfort care. POLST/MOLST translates values into actionable medical orders that travel across care settings (different from legal advance directive). For refractory dyspnea: low-dose morphine 2.5-5 mg PO/SC/IV — strongest evidence base. Benzodiazepines for associated anxiety only, not for dyspnea itself. Oxygen only if hypoxic. Avoid meperidine and fentanyl patch in opioid-naïve elderly. Use REMAP (Reframe, Expect emotion, Map values, Align, Plan) or Serious Illness Conversation Guide.
4Memorize cognitive disorder differentiation. Alzheimer disease: insidious memory loss, hippocampal atrophy; cholinesterase inhibitors mild-moderate, add memantine for moderate-severe (MMSE <17), lecanemab/donanemab for MCI/early AD with amyloid confirmation. Lewy body: fluctuating cognition, visual hallucinations, parkinsonism, RBD, EXTREME neuroleptic sensitivity (avoid typical antipsychotics). Frontotemporal: behavioral disinhibition/apathy or PPA, memory preserved early. Vascular: stepwise decline, focal deficits. NPH: gait apraxia (magnetic), urinary incontinence, cognitive decline ("wet, wobbly, weird") — high-volume LP and possible VP shunt. BPSD: non-pharmacologic FIRST; antipsychotic BLACK BOX mortality warning in dementia.
5For chronic disease management in older adults, know the targets and exceptions. Hypertension: <130/80 community-dwelling 65+ per 2017 ACC/AHA (SPRINT), but relax for frail/institutionalized. Diabetes A1c: <8.0-8.5% for frail elderly (avoid hypoglycemia); SGLT2i (empagliflozin, dapagliflozin) and GLP-1 RA (semaglutide, liraglutide) preferred when CV disease, CHF, or CKD present. AFib: DOAC preferred over warfarin in elderly with CHA2DS2-VASc ≥2 men/≥3 women — apixaban often preferred for fall risk or renal impairment (2.5 mg BID if 2 of: age ≥80, weight ≤60 kg, creatinine ≥1.5). Fall risk is rarely sufficient to withhold anticoagulation. PCV20 single dose OR PCV15+PPSV23, Shingrix 2-dose 50+, RSV vaccine 75+ (or 60-74 if high-risk), high-dose/adjuvanted flu 65+. Do NOT treat asymptomatic bacteriuria (IDSA).

Frequently Asked Questions

What is the NCCPA CAQ in Geriatric Medicine?

The NCCPA Certificate of Added Qualifications (CAQ) in Geriatric Medicine is a specialty credential launching in 2026 from the National Commission on Certification of Physician Assistants for PAs who care for older adults. It recognizes additional training and experience in geriatrics beyond the PA-C certification.

Who is eligible for the CAQ in Geriatric Medicine?

Eligibility requires: current PA-C certification with NCCPA, unrestricted state PA license, and documented experience and Category I CME in geriatric medicine per NCCPA CAQ requirements (NCCPA CAQs have historically required approximately ≥2 years and ≥3,000 hours of clinical practice in the specialty, plus Category I CME hours and a self-assessment or performance improvement activity; verify the current Geriatric Medicine CAQ requirements on NCCPA's site).

What is the format of the exam?

Following the standard NCCPA CAQ format, the Geriatric Medicine exam is a 2-hour computer-based test at Pearson VUE centers consisting of approximately 120 single-best-answer multiple-choice questions. Content is distributed across normal aging physiology, geriatric syndromes, chronic conditions in older adults, polypharmacy, cognitive disorders, end-of-life care, functional assessment, and ethics.

How much does the CAQ exam cost in 2026?

The NCCPA CAQ exam fee is approximately $350 (verify the current fee on the NCCPA Geriatric Medicine CAQ page). Application/registration fees and CME costs are additional. Review courses and question banks may add $200-$800.

How long should I study for the exam?

Experienced PAs working in geriatrics typically need 80-150 hours of focused review over 3-6 months. PAs newer to geriatrics may need 200+ hours over 6-12 months. Use the NCCPA Geriatric Medicine CAQ content blueprint as a roadmap, prioritize high-frequency topics (Beers Criteria, falls, delirium, dementia management, end-of-life care), and complete timed practice question sets to build pattern recognition.

What topics are most heavily weighted on the exam?

Anticipated highest-weight content areas based on the typical CAQ blueprint format and geriatrics scope: aging physiology and geriatric syndromes (~25-30%), common chronic conditions in older adults (~25%), polypharmacy and medication safety including Beers Criteria (~10-15%), cognitive disorders (~10-15%), end-of-life and palliative care (~10%), functional assessment and transitions of care (~10%), and ethics/legal/psychosocial (~5-10%).

When can I sit for the 2026 CAQ exam?

The NCCPA CAQ in Geriatric Medicine launches in 2026. Specific application windows, testing dates, and registration deadlines are announced on the NCCPA Geriatric Medicine CAQ page (nccpa.net). Plan to apply during the first available eligibility window after meeting experience and CME requirements.

Is the CAQ certification time-limited?

Yes — NCCPA CAQs are 10-year certifications that must be maintained through continued PA-C certification and ongoing specialty CME requirements. Re-certification of the CAQ involves additional Category I CME and possibly a re-examination per current NCCPA policy.