APEA 3 EXAM TEST BANK 2026 WITH
ACTUAL CORRECT QUESTIONS AND
VERIFIED DETAILED RATIONALE ANSWERS
|CURRENTLY TESTING QUESTIONS AND
SOLUTIONS|ALREADY GRADED A+|NEWEST
|JUST RELEASED!!|BRAND NEW VERSION
Question 1
A 52-year-old man presents with exertional chest pressure that resolves with rest. He has HTN
and hyperlipidemia. Which diagnostic test is MOST appropriate as the initial evaluation?
A. Coronary angiography
B. Exercise stress test
C. Cardiac MRI
D. Troponin level
Correct Answer: B. Exercise stress test
Rationale:
This patient has stable angina symptoms (predictable exertional chest pain relieved by rest).
The first-line diagnostic test in a stable patient able to exercise is an exercise stress test.
• Angiography is invasive and not first-line
• Troponins are for suspected acute coronary syndrome
• Cardiac MRI is not initial testing
Question 2
A 26-year-old woman presents with dysuria, frequency, and urgency. No fever or flank pain.
Urinalysis shows leukocyte esterase and nitrites. Best initial treatment?
1|Page
,A. Ciprofloxacin
B. Nitrofurantoin
C. Amoxicillin
D. TMP-SMX for 14 days
Correct Answer: B. Nitrofurantoin
Rationale:
This is uncomplicated cystitis. First-line treatments include:
• Nitrofurantoin (5 days)
• TMP-SMX (3 days if local resistance <20%)
Fluoroquinolones are not first-line due to resistance and side effects.
Question 3
A 68-year-old smoker presents with weight loss, hemoptysis, and a chronic cough. Chest X-ray
shows a central lung mass. Most likely diagnosis?
A. Adenocarcinoma
B. Squamous cell carcinoma
C. Small cell carcinoma
D. Large cell carcinoma
Correct Answer: B. Squamous cell carcinoma
Rationale:
Squamous cell carcinoma is strongly associated with smoking and typically presents as a
central lung mass.
• Adenocarcinoma = peripheral, most common overall
• Small cell = central but aggressive with paraneoplastic syndromes
2|Page
,Question 4
A patient with type 2 diabetes has an A1C of 9.2% despite maximum metformin therapy. What
is the NEXT best step?
A. Add insulin
B. Add a second oral agent
C. Stop metformin
D. Lifestyle modification only
Correct Answer: B. Add a second oral agent
Rationale:
When A1C remains above goal (>9%) on metformin, add a second agent (GLP-1 RA, SGLT2
inhibitor, or sulfonylurea).
• Insulin is considered if A1C >10% or symptomatic
Question 5
A 34-year-old woman presents with episodic palpitations, sweating, and headaches. BP is
180/100. Best initial test?
A. CT abdomen
B. Plasma free metanephrines
C. Urine VMA
D. Serum cortisol
Correct Answer: B. Plasma free metanephrines
Rationale:
Classic pheochromocytoma triad. Best initial screening test is plasma free metanephrines
(most sensitive).
3|Page
, Question 6
A 7-year-old child presents with sore throat, fever, and tender anterior cervical nodes. No
cough. Next step?
A. Empiric antibiotics
B. Rapid strep test
C. Throat culture only
D. Supportive care
Correct Answer: B. Rapid strep test
Rationale:
This meets Centor criteria. In children, diagnosis should be confirmed with rapid antigen
detection test before treatment.
Question 7
A 60-year-old woman presents with bone pain and fatigue. Labs show elevated calcium, anemia,
and renal dysfunction. Most likely diagnosis?
A. Metastatic breast cancer
B. Multiple myeloma
C. Hyperparathyroidism
D. Osteoporosis
Correct Answer: B. Multiple myeloma
Rationale:
Classic CRAB criteria:
• Calcium ↑
• Renal failure
• Anemia
4|Page
ACTUAL CORRECT QUESTIONS AND
VERIFIED DETAILED RATIONALE ANSWERS
|CURRENTLY TESTING QUESTIONS AND
SOLUTIONS|ALREADY GRADED A+|NEWEST
|JUST RELEASED!!|BRAND NEW VERSION
Question 1
A 52-year-old man presents with exertional chest pressure that resolves with rest. He has HTN
and hyperlipidemia. Which diagnostic test is MOST appropriate as the initial evaluation?
A. Coronary angiography
B. Exercise stress test
C. Cardiac MRI
D. Troponin level
Correct Answer: B. Exercise stress test
Rationale:
This patient has stable angina symptoms (predictable exertional chest pain relieved by rest).
The first-line diagnostic test in a stable patient able to exercise is an exercise stress test.
• Angiography is invasive and not first-line
• Troponins are for suspected acute coronary syndrome
• Cardiac MRI is not initial testing
Question 2
A 26-year-old woman presents with dysuria, frequency, and urgency. No fever or flank pain.
Urinalysis shows leukocyte esterase and nitrites. Best initial treatment?
1|Page
,A. Ciprofloxacin
B. Nitrofurantoin
C. Amoxicillin
D. TMP-SMX for 14 days
Correct Answer: B. Nitrofurantoin
Rationale:
This is uncomplicated cystitis. First-line treatments include:
• Nitrofurantoin (5 days)
• TMP-SMX (3 days if local resistance <20%)
Fluoroquinolones are not first-line due to resistance and side effects.
Question 3
A 68-year-old smoker presents with weight loss, hemoptysis, and a chronic cough. Chest X-ray
shows a central lung mass. Most likely diagnosis?
A. Adenocarcinoma
B. Squamous cell carcinoma
C. Small cell carcinoma
D. Large cell carcinoma
Correct Answer: B. Squamous cell carcinoma
Rationale:
Squamous cell carcinoma is strongly associated with smoking and typically presents as a
central lung mass.
• Adenocarcinoma = peripheral, most common overall
• Small cell = central but aggressive with paraneoplastic syndromes
2|Page
,Question 4
A patient with type 2 diabetes has an A1C of 9.2% despite maximum metformin therapy. What
is the NEXT best step?
A. Add insulin
B. Add a second oral agent
C. Stop metformin
D. Lifestyle modification only
Correct Answer: B. Add a second oral agent
Rationale:
When A1C remains above goal (>9%) on metformin, add a second agent (GLP-1 RA, SGLT2
inhibitor, or sulfonylurea).
• Insulin is considered if A1C >10% or symptomatic
Question 5
A 34-year-old woman presents with episodic palpitations, sweating, and headaches. BP is
180/100. Best initial test?
A. CT abdomen
B. Plasma free metanephrines
C. Urine VMA
D. Serum cortisol
Correct Answer: B. Plasma free metanephrines
Rationale:
Classic pheochromocytoma triad. Best initial screening test is plasma free metanephrines
(most sensitive).
3|Page
, Question 6
A 7-year-old child presents with sore throat, fever, and tender anterior cervical nodes. No
cough. Next step?
A. Empiric antibiotics
B. Rapid strep test
C. Throat culture only
D. Supportive care
Correct Answer: B. Rapid strep test
Rationale:
This meets Centor criteria. In children, diagnosis should be confirmed with rapid antigen
detection test before treatment.
Question 7
A 60-year-old woman presents with bone pain and fatigue. Labs show elevated calcium, anemia,
and renal dysfunction. Most likely diagnosis?
A. Metastatic breast cancer
B. Multiple myeloma
C. Hyperparathyroidism
D. Osteoporosis
Correct Answer: B. Multiple myeloma
Rationale:
Classic CRAB criteria:
• Calcium ↑
• Renal failure
• Anemia
4|Page
