Page 1 of 97
APEA 3P Predictor Exam Updated Questions
& Detailed Answers, 100% Guaranteed Pass
|| Complete A+ Guide
1. Scenario: A 58-year-old male with hypertension reports
substernal chest pressure radiating to the jaw with exertion,
relieved by rest within 5 minutes.
Answer: Stable angina
Rationale: Exertional chest pain relieved by rest is classic for
stable angina due to fixed coronary artery stenosis. Pain is
reproducible by same level of activity.
2. Scenario: A patient with heart failure has jugular venous
distension, hepatomegaly, and peripheral edema.
Answer: Right-sided heart failure
Rationale: JVD, hepatomegaly, and edema indicate increased
systemic venous pressure from right ventricular dysfunction.
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3. Scenario: On auscultation, you hear an S3 gallop best
heard with the bell at the apex in left lateral decubitus.
Answer: Reduced left ventricular compliance (e.g., HFrEF)
Rationale: S3 occurs from rapid ventricular filling in a dilated
or failing ventricle. It is associated with poor prognosis.
4. Scenario: A 72-year-old with hypertension has a sustained,
forceful PMI displaced to the left.
Answer: Left ventricular hypertrophy
Rationale: Chronic pressure overload from hypertension leads
to LV hypertrophy, producing a sustained, displaced apical
impulse.
5. Scenario: A patient presents with acute onset of tearing
chest pain radiating to the back, with a BP difference of 20
mmHg between arms.
Answer: STAT chest CT angiography
Rationale: Suspect aortic dissection; CT angiography is the
definitive diagnostic study. Immediate imaging is critical.
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6. Scenario: A 45-year-old smoker has diminished femoral
pulses and a blood pressure of 160/90 in arms but 110/70 in
legs.
Answer: Coarctation of the aorta
Rationale: Upper extremity hypertension with delayed or
diminished lower extremity pulses is pathognomonic for
coarctation.
7. Scenario: A patient with atrial fibrillation on warfarin has
an INR of 4.5 without bleeding.
Answer: Hold warfarin and monitor INR daily
Rationale: No bleeding with INR 4.5–5.0 → hold warfarin
until INR <3. Vitamin K not needed unless bleeding or INR
>10.
8. Scenario: A murmur that increases with squatting and
decreases with standing is most likely:
Answer: Hypertrophic obstructive cardiomyopathy (HOCM)
Rationale: Squatting increases preload, reducing LV outflow
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obstruction → murmur decreases. Standing decreases preload
→ murmur increases.
9. Scenario: An ECG shows a wide QRS, irregularly irregular
rhythm at 140 bpm.
Answer: Atrial fibrillation with aberrancy
Rationale: Irregularly irregular wide QRS → consider AF with
aberrant conduction or pre-excited AF. Rate control is key.
10. Scenario: A patient with sudden dyspnea, unilateral leg
swelling, and hypoxia. What is the most sensitive initial test?
Answer: D-dimer
Rationale: D-dimer has high sensitivity for PE; negative D-
dimer rules out PE in low/moderate pre-test probability.
11. Scenario: A 60-year-old with chronic HTN has a BP of
180/110 with headache and blurred vision. Fundoscopy shows
hemorrhages and exudates.
Answer: Hypertensive emergency
Rationale: Severe HTN with target organ damage
APEA 3P Predictor Exam Updated Questions
& Detailed Answers, 100% Guaranteed Pass
|| Complete A+ Guide
1. Scenario: A 58-year-old male with hypertension reports
substernal chest pressure radiating to the jaw with exertion,
relieved by rest within 5 minutes.
Answer: Stable angina
Rationale: Exertional chest pain relieved by rest is classic for
stable angina due to fixed coronary artery stenosis. Pain is
reproducible by same level of activity.
2. Scenario: A patient with heart failure has jugular venous
distension, hepatomegaly, and peripheral edema.
Answer: Right-sided heart failure
Rationale: JVD, hepatomegaly, and edema indicate increased
systemic venous pressure from right ventricular dysfunction.
,Page 2 of 97
3. Scenario: On auscultation, you hear an S3 gallop best
heard with the bell at the apex in left lateral decubitus.
Answer: Reduced left ventricular compliance (e.g., HFrEF)
Rationale: S3 occurs from rapid ventricular filling in a dilated
or failing ventricle. It is associated with poor prognosis.
4. Scenario: A 72-year-old with hypertension has a sustained,
forceful PMI displaced to the left.
Answer: Left ventricular hypertrophy
Rationale: Chronic pressure overload from hypertension leads
to LV hypertrophy, producing a sustained, displaced apical
impulse.
5. Scenario: A patient presents with acute onset of tearing
chest pain radiating to the back, with a BP difference of 20
mmHg between arms.
Answer: STAT chest CT angiography
Rationale: Suspect aortic dissection; CT angiography is the
definitive diagnostic study. Immediate imaging is critical.
,Page 3 of 97
6. Scenario: A 45-year-old smoker has diminished femoral
pulses and a blood pressure of 160/90 in arms but 110/70 in
legs.
Answer: Coarctation of the aorta
Rationale: Upper extremity hypertension with delayed or
diminished lower extremity pulses is pathognomonic for
coarctation.
7. Scenario: A patient with atrial fibrillation on warfarin has
an INR of 4.5 without bleeding.
Answer: Hold warfarin and monitor INR daily
Rationale: No bleeding with INR 4.5–5.0 → hold warfarin
until INR <3. Vitamin K not needed unless bleeding or INR
>10.
8. Scenario: A murmur that increases with squatting and
decreases with standing is most likely:
Answer: Hypertrophic obstructive cardiomyopathy (HOCM)
Rationale: Squatting increases preload, reducing LV outflow
, Page 4 of 97
obstruction → murmur decreases. Standing decreases preload
→ murmur increases.
9. Scenario: An ECG shows a wide QRS, irregularly irregular
rhythm at 140 bpm.
Answer: Atrial fibrillation with aberrancy
Rationale: Irregularly irregular wide QRS → consider AF with
aberrant conduction or pre-excited AF. Rate control is key.
10. Scenario: A patient with sudden dyspnea, unilateral leg
swelling, and hypoxia. What is the most sensitive initial test?
Answer: D-dimer
Rationale: D-dimer has high sensitivity for PE; negative D-
dimer rules out PE in low/moderate pre-test probability.
11. Scenario: A 60-year-old with chronic HTN has a BP of
180/110 with headache and blurred vision. Fundoscopy shows
hemorrhages and exudates.
Answer: Hypertensive emergency
Rationale: Severe HTN with target organ damage
