Page 1 of 96
APEA 3P (GCU) ACTUAL EXAM QUESTIONS AND CORRECT
VERIFIED SOLUTIONS LATEST UPDATE THIS YEAR – JUST
RELEASED
EXAM COVERAGE — APEA 3P (GCU)
The APEA 3P Exam assesses clinical readiness across three domains:
Advanced Pathophysiology — Cellular regulation, immunology, inflammation, neurology,
endocrinology, cardiology, pulmonology, nephrology, gastroenterology, hematology, oncology,
and genetics.
Advanced Pharmacology — Pharmacokinetics, pharmacodynamics, medication indications,
contraindications, adverse effects (e.g., ototoxicity, nephrotoxicity, hepatotoxicity), drug
interactions, therapeutic monitoring, antibiotic stewardship, controlled substances, and
prescribing for special populations (pregnancy, pediatrics, geriatrics).
Advanced Physical Assessment — Comprehensive history-taking, differential diagnosis,
interpretation of physical exam findings, diagnostic reasoning, screening guidelines, and clinical
decision-making.
200 RANDOMIZED SCENARIO-BASED MCQS
, Page 2 of 96
1. A 45-year-old female presents with fatigue, weight gain, cold intolerance, and constipation.
Labs show TSH 12.5 mIU/L (normal 0.4-4.5) and free T4 0.6 ng/dL (normal 0.8-1.8). What is the
most appropriate treatment?
A) Levothyroxine 50 mcg daily
B) Methimazole 10 mg daily
C) Levothyroxine 200 mcg daily
D) Liothyronine 25 mcg daily
Answer: A
*RATIONALE: This patient has primary hypothyroidism; levothyroxine is started at a low dose
(50 mcg daily) in otherwise healthy adults, with dose titration based on TSH every 6-8 weeks.*
2. A 68-year-old male with hypertension and type 2 diabetes presents with dizziness when
standing. BP seated 135/80, standing 100/65. He takes lisinopril 20 mg daily and metformin
1000 mg BID. What is the most appropriate next step?
A) Increase lisinopril to 40 mg daily
B) Add amlodipine 5 mg daily
C) Reduce lisinopril to 10 mg daily
D) Start fludrocortisone 0.1 mg daily
Answer: C
RATIONALE: Orthostatic hypotension in an older adult on ACE inhibitor requires dose reduction
of the antihypertensive; reducing lisinopril is the first step.
, Page 3 of 96
3. A 52-year-old female reports palpitations, heat intolerance, and weight loss despite increased
appetite. HR 110, irregularly irregular. TSH <0.01 mIU/L, free T4 3.5 ng/dL. What is the most
likely diagnosis?
A) Subclinical hyperthyroidism
B) Graves' disease with atrial fibrillation
C) Hashimoto's thyroiditis
D) Thyroid storm
Answer: B
RATIONALE: Suppressed TSH with elevated free T4 indicates hyperthyroidism; irregularly
irregular rhythm is atrial fibrillation, commonly associated with Graves' disease.
4. A 35-year-old male presents with a rash on his trunk consisting of multiple 2-4 mm
erythematous macules with central clearing ("herald patch" noted 5 days ago). He reports mild
pruritus. What is the most likely diagnosis?
A) Tinea corporis
B) Pityriasis rosea
C) Psoriasis guttate
D) Secondary syphilis
Answer: B
RATIONALE: Pityriasis rosea typically presents with a single herald patch followed by a
generalized rash with "Christmas tree" distribution; often self-limiting.
, Page 4 of 96
5. A 72-year-old female with heart failure with reduced ejection fraction (HFrEF) is on carvedilol,
lisinopril, spironolactone, and furosemide. Labs: K 5.9, Na 134, BUN 48, Cr 1.8 (baseline 1.2).
What medication should be held?
A) Carvedilol
B) Lisinopril
C) Spironolactone
D) Furosemide
Answer: C
RATIONALE: Hyperkalemia (K >5.5) in a patient on spironolactone with rising creatinine requires
holding spironolactone; monitor potassium and renal function.
6. A 28-year-old G2P1 at 28 weeks gestation presents with a blood pressure of 155/95 and 2+
proteinuria on dipstick. She denies headache or visual changes. What is the most appropriate
next step?
A) Start labetalol 100 mg BID
B) Admit for magnesium sulfate
C) Start methyldopa 250 mg BID
D) Outpatient monitoring with repeat BP in 1 week
Answer: B
*RATIONALE: This patient meets criteria for preeclampsia with severe features (BP ≥160/110 or
proteinuria with BP ≥140/90 at ≥20 weeks); requires hospital admission for maternal and fetal
monitoring.*
APEA 3P (GCU) ACTUAL EXAM QUESTIONS AND CORRECT
VERIFIED SOLUTIONS LATEST UPDATE THIS YEAR – JUST
RELEASED
EXAM COVERAGE — APEA 3P (GCU)
The APEA 3P Exam assesses clinical readiness across three domains:
Advanced Pathophysiology — Cellular regulation, immunology, inflammation, neurology,
endocrinology, cardiology, pulmonology, nephrology, gastroenterology, hematology, oncology,
and genetics.
Advanced Pharmacology — Pharmacokinetics, pharmacodynamics, medication indications,
contraindications, adverse effects (e.g., ototoxicity, nephrotoxicity, hepatotoxicity), drug
interactions, therapeutic monitoring, antibiotic stewardship, controlled substances, and
prescribing for special populations (pregnancy, pediatrics, geriatrics).
Advanced Physical Assessment — Comprehensive history-taking, differential diagnosis,
interpretation of physical exam findings, diagnostic reasoning, screening guidelines, and clinical
decision-making.
200 RANDOMIZED SCENARIO-BASED MCQS
, Page 2 of 96
1. A 45-year-old female presents with fatigue, weight gain, cold intolerance, and constipation.
Labs show TSH 12.5 mIU/L (normal 0.4-4.5) and free T4 0.6 ng/dL (normal 0.8-1.8). What is the
most appropriate treatment?
A) Levothyroxine 50 mcg daily
B) Methimazole 10 mg daily
C) Levothyroxine 200 mcg daily
D) Liothyronine 25 mcg daily
Answer: A
*RATIONALE: This patient has primary hypothyroidism; levothyroxine is started at a low dose
(50 mcg daily) in otherwise healthy adults, with dose titration based on TSH every 6-8 weeks.*
2. A 68-year-old male with hypertension and type 2 diabetes presents with dizziness when
standing. BP seated 135/80, standing 100/65. He takes lisinopril 20 mg daily and metformin
1000 mg BID. What is the most appropriate next step?
A) Increase lisinopril to 40 mg daily
B) Add amlodipine 5 mg daily
C) Reduce lisinopril to 10 mg daily
D) Start fludrocortisone 0.1 mg daily
Answer: C
RATIONALE: Orthostatic hypotension in an older adult on ACE inhibitor requires dose reduction
of the antihypertensive; reducing lisinopril is the first step.
, Page 3 of 96
3. A 52-year-old female reports palpitations, heat intolerance, and weight loss despite increased
appetite. HR 110, irregularly irregular. TSH <0.01 mIU/L, free T4 3.5 ng/dL. What is the most
likely diagnosis?
A) Subclinical hyperthyroidism
B) Graves' disease with atrial fibrillation
C) Hashimoto's thyroiditis
D) Thyroid storm
Answer: B
RATIONALE: Suppressed TSH with elevated free T4 indicates hyperthyroidism; irregularly
irregular rhythm is atrial fibrillation, commonly associated with Graves' disease.
4. A 35-year-old male presents with a rash on his trunk consisting of multiple 2-4 mm
erythematous macules with central clearing ("herald patch" noted 5 days ago). He reports mild
pruritus. What is the most likely diagnosis?
A) Tinea corporis
B) Pityriasis rosea
C) Psoriasis guttate
D) Secondary syphilis
Answer: B
RATIONALE: Pityriasis rosea typically presents with a single herald patch followed by a
generalized rash with "Christmas tree" distribution; often self-limiting.
, Page 4 of 96
5. A 72-year-old female with heart failure with reduced ejection fraction (HFrEF) is on carvedilol,
lisinopril, spironolactone, and furosemide. Labs: K 5.9, Na 134, BUN 48, Cr 1.8 (baseline 1.2).
What medication should be held?
A) Carvedilol
B) Lisinopril
C) Spironolactone
D) Furosemide
Answer: C
RATIONALE: Hyperkalemia (K >5.5) in a patient on spironolactone with rising creatinine requires
holding spironolactone; monitor potassium and renal function.
6. A 28-year-old G2P1 at 28 weeks gestation presents with a blood pressure of 155/95 and 2+
proteinuria on dipstick. She denies headache or visual changes. What is the most appropriate
next step?
A) Start labetalol 100 mg BID
B) Admit for magnesium sulfate
C) Start methyldopa 250 mg BID
D) Outpatient monitoring with repeat BP in 1 week
Answer: B
*RATIONALE: This patient meets criteria for preeclampsia with severe features (BP ≥160/110 or
proteinuria with BP ≥140/90 at ≥20 weeks); requires hospital admission for maternal and fetal
monitoring.*
