APEA 3P 2026/2027 Actual Exam (Orthopedics - APEA
Testbank) – 300 Questions & Answers with In-Depth
Explanations | Complete A+ Guide
Section 1: Upper Extremity Disorders (Questions 1-60)
1. A 45-year-old female presents with progressive pain and stiffness in both
hands. On exam, you note bilateral swelling of the PIP and MCP joints, along
with ulnar deviation. What is the most likely diagnosis?
A) Osteoarthritis
B) Rheumatoid arthritis
C) Gout
D) Psoriatic arthritis
Answer: B – Rheumatoid arthritis typically presents with symmetric
inflammatory arthritis involving the small joints of the hands and feet (PIP,
MCP, wrists). Ulnar deviation is a classic deformity of chronic RA.
Osteoarthritis (A) typically affects DIP joints, not MCP/PIP. Gout (C) is more
acute and episodic. Psoriatic arthritis (D) may present with dactylitis or
asymmetric joint involvement.
2. A 60-year-old male presents with right shoulder pain that worsens at night
and when lying on the affected side. He has difficulty reaching behind his
back. On exam, there is pain with passive abduction between 70-120 degrees.
What is the most likely diagnosis?
A) Adhesive capsulitis
B) Rotator cuff impingement
C) Glenohumeral osteoarthritis
D) Biceps tendinopathy
,Answer: B – Pain with active and passive abduction in the "painful arc" (60-
120 degrees) is classic for rotator cuff impingement. Night pain and difficulty
with overhead or behind-the-back activities are common. Adhesive
capsulitis (A) presents with global restriction of motion. Osteoarthritis (C) is
less common in the shoulder.
3. A 35-year-old mechanic presents with numbness and tingling in the
thumb, index, and middle fingers that wakes him at night. He reports
shaking his hands to relieve the symptoms. Phalen's test reproduces his
symptoms. What is the most likely diagnosis?
A) Cervical radiculopathy
B) Carpal tunnel syndrome
C) Cubital tunnel syndrome
D) Thoracic outlet syndrome
Answer: B – Carpal tunnel syndrome (median nerve compression) causes
paresthesias in the thumb, index, and middle fingers (median nerve
distribution). Night symptoms relieved by shaking the hand (the "flick sign")
and positive Phalen's test are classic. Cervical radiculopathy (A) would
involve the neck and may have a different pattern.
4. A 28-year-old baseball pitcher reports sudden onset of severe pain in the
right elbow after throwing a fastball. On exam, there is tenderness over the
medial epicondyle. What is the most likely diagnosis?
A) Lateral epicondylitis
B) Medial epicondylitis
C) Olecranon bursitis
D) Ulnar collateral ligament injury
Answer: D – Acute, severe pain after throwing in a baseball pitcher suggests
ulnar collateral ligament (UCL) injury (Tommy John injury). While medial
,epicondylitis (B) causes medial elbow pain, it is typically a chronic overuse
condition, not acute with a specific traumatic event.
5. A 50-year-old female presents with thumb pain at the base of the thumb
that worsens with grasping and pinching. On exam, there is tenderness over
the radial styloid and a positive Finkelstein test. What is the most likely
diagnosis?
A) Carpal tunnel syndrome
B) De Quervain's tenosynovitis
C) Trigger thumb
D) Basal joint arthritis
Answer: B – De Quervain's tenosynovitis is inflammation of the abductor
pollicis longus and extensor pollicis brevis tendons. Finkelstein test (ulnar
deviation with the thumb flexed into the palm) reproduces pain. Trigger
thumb (C) causes catching or locking.
6. A 72-year-old female reports chronic right shoulder pain and progressive
loss of motion. On exam, there is significant limitation of both active and
passive range of motion in all directions. The most likely diagnosis is:
A) Rotator cuff tear
B) Adhesive capsulitis (frozen shoulder)
C) Shoulder impingement
D) Acromioclavicular joint arthritis
Answer: B – Adhesive capsulitis is characterized by global restriction of both
active and passive shoulder motion. It is more common in women aged 40-
70 and is associated with diabetes. Rotator cuff tear (A) typically causes
weakness and pain but not global stiffness.
7. A 30-year-old rock climber reports elbow pain that is worse with gripping
and lifting objects. On exam, there is tenderness over the lateral epicondyle.
, Resisted wrist extension reproduces the pain. What is the most likely
diagnosis?
A) Medial epicondylitis
B) Lateral epicondylitis
C) Olecranon bursitis
D) Radial tunnel syndrome
Answer: B – Lateral epicondylitis (tennis elbow) presents with lateral elbow
pain worsened by gripping and resisted wrist extension. Medial epicondylitis
(A) causes medial elbow pain. Rock climbing (gripping activities) is a
common cause.
8. A 55-year-old diabetic female presents with the inability to fully extend
the ring finger. The finger is locked in flexion at the PIP joint but can be
passively extended with a painful snap. What is the most likely diagnosis?
A) Dupuytren's contracture
B) Trigger finger (stenosing tenosynovitis)
C) Mallet finger
D) Boutonnière deformity
Answer: B – Trigger finger is caused by nodular thickening of the flexor
tendon sheath, causing the finger to lock in flexion and then snap into
extension. It is more common in diabetics. Dupuytren's (A) causes palmar
fascial thickening and flexion contractures without snapping.
9. A 25-year-old male sustains a fall onto an outstretched hand. He now has
tenderness in the "anatomic snuffbox." What is the most concerning
potential injury?
A) Scaphoid fracture
B) Distal radius fracture
Testbank) – 300 Questions & Answers with In-Depth
Explanations | Complete A+ Guide
Section 1: Upper Extremity Disorders (Questions 1-60)
1. A 45-year-old female presents with progressive pain and stiffness in both
hands. On exam, you note bilateral swelling of the PIP and MCP joints, along
with ulnar deviation. What is the most likely diagnosis?
A) Osteoarthritis
B) Rheumatoid arthritis
C) Gout
D) Psoriatic arthritis
Answer: B – Rheumatoid arthritis typically presents with symmetric
inflammatory arthritis involving the small joints of the hands and feet (PIP,
MCP, wrists). Ulnar deviation is a classic deformity of chronic RA.
Osteoarthritis (A) typically affects DIP joints, not MCP/PIP. Gout (C) is more
acute and episodic. Psoriatic arthritis (D) may present with dactylitis or
asymmetric joint involvement.
2. A 60-year-old male presents with right shoulder pain that worsens at night
and when lying on the affected side. He has difficulty reaching behind his
back. On exam, there is pain with passive abduction between 70-120 degrees.
What is the most likely diagnosis?
A) Adhesive capsulitis
B) Rotator cuff impingement
C) Glenohumeral osteoarthritis
D) Biceps tendinopathy
,Answer: B – Pain with active and passive abduction in the "painful arc" (60-
120 degrees) is classic for rotator cuff impingement. Night pain and difficulty
with overhead or behind-the-back activities are common. Adhesive
capsulitis (A) presents with global restriction of motion. Osteoarthritis (C) is
less common in the shoulder.
3. A 35-year-old mechanic presents with numbness and tingling in the
thumb, index, and middle fingers that wakes him at night. He reports
shaking his hands to relieve the symptoms. Phalen's test reproduces his
symptoms. What is the most likely diagnosis?
A) Cervical radiculopathy
B) Carpal tunnel syndrome
C) Cubital tunnel syndrome
D) Thoracic outlet syndrome
Answer: B – Carpal tunnel syndrome (median nerve compression) causes
paresthesias in the thumb, index, and middle fingers (median nerve
distribution). Night symptoms relieved by shaking the hand (the "flick sign")
and positive Phalen's test are classic. Cervical radiculopathy (A) would
involve the neck and may have a different pattern.
4. A 28-year-old baseball pitcher reports sudden onset of severe pain in the
right elbow after throwing a fastball. On exam, there is tenderness over the
medial epicondyle. What is the most likely diagnosis?
A) Lateral epicondylitis
B) Medial epicondylitis
C) Olecranon bursitis
D) Ulnar collateral ligament injury
Answer: D – Acute, severe pain after throwing in a baseball pitcher suggests
ulnar collateral ligament (UCL) injury (Tommy John injury). While medial
,epicondylitis (B) causes medial elbow pain, it is typically a chronic overuse
condition, not acute with a specific traumatic event.
5. A 50-year-old female presents with thumb pain at the base of the thumb
that worsens with grasping and pinching. On exam, there is tenderness over
the radial styloid and a positive Finkelstein test. What is the most likely
diagnosis?
A) Carpal tunnel syndrome
B) De Quervain's tenosynovitis
C) Trigger thumb
D) Basal joint arthritis
Answer: B – De Quervain's tenosynovitis is inflammation of the abductor
pollicis longus and extensor pollicis brevis tendons. Finkelstein test (ulnar
deviation with the thumb flexed into the palm) reproduces pain. Trigger
thumb (C) causes catching or locking.
6. A 72-year-old female reports chronic right shoulder pain and progressive
loss of motion. On exam, there is significant limitation of both active and
passive range of motion in all directions. The most likely diagnosis is:
A) Rotator cuff tear
B) Adhesive capsulitis (frozen shoulder)
C) Shoulder impingement
D) Acromioclavicular joint arthritis
Answer: B – Adhesive capsulitis is characterized by global restriction of both
active and passive shoulder motion. It is more common in women aged 40-
70 and is associated with diabetes. Rotator cuff tear (A) typically causes
weakness and pain but not global stiffness.
7. A 30-year-old rock climber reports elbow pain that is worse with gripping
and lifting objects. On exam, there is tenderness over the lateral epicondyle.
, Resisted wrist extension reproduces the pain. What is the most likely
diagnosis?
A) Medial epicondylitis
B) Lateral epicondylitis
C) Olecranon bursitis
D) Radial tunnel syndrome
Answer: B – Lateral epicondylitis (tennis elbow) presents with lateral elbow
pain worsened by gripping and resisted wrist extension. Medial epicondylitis
(A) causes medial elbow pain. Rock climbing (gripping activities) is a
common cause.
8. A 55-year-old diabetic female presents with the inability to fully extend
the ring finger. The finger is locked in flexion at the PIP joint but can be
passively extended with a painful snap. What is the most likely diagnosis?
A) Dupuytren's contracture
B) Trigger finger (stenosing tenosynovitis)
C) Mallet finger
D) Boutonnière deformity
Answer: B – Trigger finger is caused by nodular thickening of the flexor
tendon sheath, causing the finger to lock in flexion and then snap into
extension. It is more common in diabetics. Dupuytren's (A) causes palmar
fascial thickening and flexion contractures without snapping.
9. A 25-year-old male sustains a fall onto an outstretched hand. He now has
tenderness in the "anatomic snuffbox." What is the most concerning
potential injury?
A) Scaphoid fracture
B) Distal radius fracture
