APEA 3P Certification Exam Practice Test 2026 |
160 Q&A | Verified Answers | A+ Study Guide
Instructions
Each question has one Correct Answer. Rationales are provided after each Correct Answer.
Section 1: Cardiology (Questions 1–20)
Question 1: A 58-year-old male with hypertension presents with acute onset of tearing
chest pain radiating to the back. BP is 160/100 in right arm, 100/70 in left arm. What is the
most likely diagnosis?
A) Acute myocardial infarction
B) Pulmonary embolism
C) Aortic dissection
D) Pericarditis
Correct Answer: C
Rationale: Tearing chest pain radiating to back with unequal BP in arms is classic for aortic
dissection. MI pain is typically crushing/substernal. PE causes dyspnea/pleuritic pain.
Pericarditis pain is positional.
Question 2: Which antihypertensive is contraindicated in pregnancy?
A) Methyldopa
B) Labetalol
C) Nifedipine
D) Lisinopril
Correct Answer: D
Rationale: ACE inhibitors (lisinopril) and ARBs are teratogenic (fetal renal agenesis).
Methyldopa, labetalol, nifedipine are safe in pregnancy.
Question 3: A 72-year-old with HFrEF (EF 30%) presents with worsening dyspnea, JVD,
and peripheral edema. Cr 1.8 (baseline 1.0). Which medication should be held?
A) Furosemide
B) Metoprolol succinate
C) Spironolactone
D) Hydralazine
Correct Answer: C
Rationale: Spironolactone can cause life-threatening hyperkalemia, especially with AKI (Cr
rise). Hold until renal function improves. Beta-blockers continue cautiously.
Question 4: First-line therapy for stable angina in a patient with known CAD is:
A) Nitroglycerin PRN
B) Aspirin + beta-blocker
,C) Calcium channel blocker
D) Ranolazine
Correct Answer: B
Rationale: Beta-blockers reduce myocardial O2 demand; aspirin prevents thrombotic
events. Nitroglycerin is symptomatic relief only. CCBs are second-line.
Question 5: A heart murmur is heard best at the apex with the bell, radiating to axilla. It is
holosystolic. Most likely:
A) Aortic stenosis
B) Mitral regurgitation
C) Mitral stenosis
D) Aortic regurgitation
Correct Answer: B
Rationale: Holosystolic, apical murmur radiating to axilla = MR. Aortic stenosis is systolic
at 2nd RICS radiating to carotids. Mitral stenosis is diastolic. Aortic regurgitation is
diastolic.
Question 6: Which ECG finding is most specific for pericarditis?
A) ST elevation in V1–V4
B) Diffuse PR depression
C) Q waves
D) T wave inversion
Correct Answer: B
Rationale: PR depression (or PR elevation in aVR) is early and specific for pericarditis.
Diffuse ST elevation is also seen but less specific. Q waves = prior MI.
Question 7: A 45-year-old with palpitations has an irregularly irregular rhythm on ECG
with no visible P waves. Rate 140. Next step?
A) Adenosine IV push
B) Amiodarone
C) Rate control with metoprolol
D) Immediate cardioversion
Correct Answer: C
Rationale: Atrial fibrillation with rapid ventricular response. Stable → rate control.
Adenosine is for SVT. Cardioversion if unstable.
Question 8: Which statin is preferred for drug-drug interaction concerns (e.g., with
amiodarone)?
A) Atorvastatin
B) Simvastatin
C) Pravastatin
D) Rosuvastatin
Correct Answer: C
Rationale: Pravastatin is not metabolized by CYP3A4 (unlike atorvastatin, simvastatin), so
fewer interactions. Rosuvastatin has minimal but not zero interaction.
,Question 9: A patient with CHF reports dry cough and angioedema after starting a new
med. Which drug?
A) Losartan
B) Lisinopril
C) Metoprolol
D) Hydrochlorothiazide
Correct Answer: B
Rationale: ACE inhibitors cause dry cough (bradykinin) and angioedema. ARBs (losartan)
have lower risk but can still cause angioedema rarely.
Question 10: What is the target LDL for a diabetic patient with known CAD?
A) <100 mg/dL
B) <70 mg/dL
C) <130 mg/dL
D) <55 mg/dL
Correct Answer: B
Rationale: Very high-risk (CAD + diabetes) → <70 mg/dL (AHA/ACC). <55 is for extreme
risk (recurrent events).
Question 11: A 68-year-old with syncope has a murmur that increases with Valsalva.
Diagnosis?
A) Aortic stenosis
B) Hypertrophic cardiomyopathy
C) Mitral valve prolapse
D) Pulmonary stenosis
Correct Answer: B
Rationale: HCM murmur increases with decreased preload (Valsalva, standing). AS murmur
decreases with Valsalva.
Question 12: First-line anticoagulation for non-valvular atrial fibrillation with CHA₂DS₂-
VASc score ≥2 in a patient with normal renal function?
A) Warfarin
B) Apixaban
C) Aspirin
D) Clopidogrel
Correct Answer: B
Rationale: DOACs (apixaban, rivaroxaban) are preferred over warfarin unless mechanical
valve or mitral stenosis. Aspirin no longer recommended.
Question 13: Which beta-blocker is preferred in heart failure with reduced EF?
A) Metoprolol tartrate
B) Atenolol
C) Carvedilol
D) Propranolol
Correct Answer: C
, Rationale: Carvedilol, metoprolol succinate, bisoprolol are HFrEF approved. Metoprolol
tartrate is short-acting, not for HF.
Question 14: ECG shows prolonged QT. Which drug is most likely responsible?
A) Amiodarone
B) Metoprolol
C) Lisinopril
D) Atorvastatin
Correct Answer: A
Rationale: Amiodarone prolongs QT. Others do not significantly affect QT.
Question 15: A 55-year-old with sudden chest pain, hypotension, and JVD. Auscultation:
muffled heart sounds. Diagnosis?
A) Tension pneumothorax
B) Cardiac tamponade
C) Massive PE
D) Acute MI
Correct Answer: B
Rationale: Beck's triad (hypotension, JVD, muffled heart sounds) = tamponade. Tension
pneumothorax has absent breath sounds, tracheal deviation.
Question 16: Ankle-brachial index (ABI) <0.90 indicates:
A) Peripheral artery disease
B) Venous insufficiency
C) Normal
D) Calcified vessels
Correct Answer: A
Rationale: ABI <0.90 = PAD. >1.4 suggests non-compressible calcified vessels (diabetes).
Question 17: A patient with hypertension and asthma. Which beta-blocker is safest?
A) Propranolol
B) Metoprolol
C) Atenolol
D) Nadolol
Correct Answer: B
Rationale: Cardioselective beta-1 blockers (metoprolol, atenolol) are safer in asthma but
still use caution. Non-selective (propranolol, nadolol) can cause bronchospasm.
Question 18: Which finding is seen in hypertensive emergency?
A) BP 180/110 with headache
B) BP 200/120 with papilledema
C) BP 170/100 with anxiety
D) BP 160/90 with epistaxis
Correct Answer: B
Rationale: Hypertensive emergency = elevated BP with acute end-organ damage
160 Q&A | Verified Answers | A+ Study Guide
Instructions
Each question has one Correct Answer. Rationales are provided after each Correct Answer.
Section 1: Cardiology (Questions 1–20)
Question 1: A 58-year-old male with hypertension presents with acute onset of tearing
chest pain radiating to the back. BP is 160/100 in right arm, 100/70 in left arm. What is the
most likely diagnosis?
A) Acute myocardial infarction
B) Pulmonary embolism
C) Aortic dissection
D) Pericarditis
Correct Answer: C
Rationale: Tearing chest pain radiating to back with unequal BP in arms is classic for aortic
dissection. MI pain is typically crushing/substernal. PE causes dyspnea/pleuritic pain.
Pericarditis pain is positional.
Question 2: Which antihypertensive is contraindicated in pregnancy?
A) Methyldopa
B) Labetalol
C) Nifedipine
D) Lisinopril
Correct Answer: D
Rationale: ACE inhibitors (lisinopril) and ARBs are teratogenic (fetal renal agenesis).
Methyldopa, labetalol, nifedipine are safe in pregnancy.
Question 3: A 72-year-old with HFrEF (EF 30%) presents with worsening dyspnea, JVD,
and peripheral edema. Cr 1.8 (baseline 1.0). Which medication should be held?
A) Furosemide
B) Metoprolol succinate
C) Spironolactone
D) Hydralazine
Correct Answer: C
Rationale: Spironolactone can cause life-threatening hyperkalemia, especially with AKI (Cr
rise). Hold until renal function improves. Beta-blockers continue cautiously.
Question 4: First-line therapy for stable angina in a patient with known CAD is:
A) Nitroglycerin PRN
B) Aspirin + beta-blocker
,C) Calcium channel blocker
D) Ranolazine
Correct Answer: B
Rationale: Beta-blockers reduce myocardial O2 demand; aspirin prevents thrombotic
events. Nitroglycerin is symptomatic relief only. CCBs are second-line.
Question 5: A heart murmur is heard best at the apex with the bell, radiating to axilla. It is
holosystolic. Most likely:
A) Aortic stenosis
B) Mitral regurgitation
C) Mitral stenosis
D) Aortic regurgitation
Correct Answer: B
Rationale: Holosystolic, apical murmur radiating to axilla = MR. Aortic stenosis is systolic
at 2nd RICS radiating to carotids. Mitral stenosis is diastolic. Aortic regurgitation is
diastolic.
Question 6: Which ECG finding is most specific for pericarditis?
A) ST elevation in V1–V4
B) Diffuse PR depression
C) Q waves
D) T wave inversion
Correct Answer: B
Rationale: PR depression (or PR elevation in aVR) is early and specific for pericarditis.
Diffuse ST elevation is also seen but less specific. Q waves = prior MI.
Question 7: A 45-year-old with palpitations has an irregularly irregular rhythm on ECG
with no visible P waves. Rate 140. Next step?
A) Adenosine IV push
B) Amiodarone
C) Rate control with metoprolol
D) Immediate cardioversion
Correct Answer: C
Rationale: Atrial fibrillation with rapid ventricular response. Stable → rate control.
Adenosine is for SVT. Cardioversion if unstable.
Question 8: Which statin is preferred for drug-drug interaction concerns (e.g., with
amiodarone)?
A) Atorvastatin
B) Simvastatin
C) Pravastatin
D) Rosuvastatin
Correct Answer: C
Rationale: Pravastatin is not metabolized by CYP3A4 (unlike atorvastatin, simvastatin), so
fewer interactions. Rosuvastatin has minimal but not zero interaction.
,Question 9: A patient with CHF reports dry cough and angioedema after starting a new
med. Which drug?
A) Losartan
B) Lisinopril
C) Metoprolol
D) Hydrochlorothiazide
Correct Answer: B
Rationale: ACE inhibitors cause dry cough (bradykinin) and angioedema. ARBs (losartan)
have lower risk but can still cause angioedema rarely.
Question 10: What is the target LDL for a diabetic patient with known CAD?
A) <100 mg/dL
B) <70 mg/dL
C) <130 mg/dL
D) <55 mg/dL
Correct Answer: B
Rationale: Very high-risk (CAD + diabetes) → <70 mg/dL (AHA/ACC). <55 is for extreme
risk (recurrent events).
Question 11: A 68-year-old with syncope has a murmur that increases with Valsalva.
Diagnosis?
A) Aortic stenosis
B) Hypertrophic cardiomyopathy
C) Mitral valve prolapse
D) Pulmonary stenosis
Correct Answer: B
Rationale: HCM murmur increases with decreased preload (Valsalva, standing). AS murmur
decreases with Valsalva.
Question 12: First-line anticoagulation for non-valvular atrial fibrillation with CHA₂DS₂-
VASc score ≥2 in a patient with normal renal function?
A) Warfarin
B) Apixaban
C) Aspirin
D) Clopidogrel
Correct Answer: B
Rationale: DOACs (apixaban, rivaroxaban) are preferred over warfarin unless mechanical
valve or mitral stenosis. Aspirin no longer recommended.
Question 13: Which beta-blocker is preferred in heart failure with reduced EF?
A) Metoprolol tartrate
B) Atenolol
C) Carvedilol
D) Propranolol
Correct Answer: C
, Rationale: Carvedilol, metoprolol succinate, bisoprolol are HFrEF approved. Metoprolol
tartrate is short-acting, not for HF.
Question 14: ECG shows prolonged QT. Which drug is most likely responsible?
A) Amiodarone
B) Metoprolol
C) Lisinopril
D) Atorvastatin
Correct Answer: A
Rationale: Amiodarone prolongs QT. Others do not significantly affect QT.
Question 15: A 55-year-old with sudden chest pain, hypotension, and JVD. Auscultation:
muffled heart sounds. Diagnosis?
A) Tension pneumothorax
B) Cardiac tamponade
C) Massive PE
D) Acute MI
Correct Answer: B
Rationale: Beck's triad (hypotension, JVD, muffled heart sounds) = tamponade. Tension
pneumothorax has absent breath sounds, tracheal deviation.
Question 16: Ankle-brachial index (ABI) <0.90 indicates:
A) Peripheral artery disease
B) Venous insufficiency
C) Normal
D) Calcified vessels
Correct Answer: A
Rationale: ABI <0.90 = PAD. >1.4 suggests non-compressible calcified vessels (diabetes).
Question 17: A patient with hypertension and asthma. Which beta-blocker is safest?
A) Propranolol
B) Metoprolol
C) Atenolol
D) Nadolol
Correct Answer: B
Rationale: Cardioselective beta-1 blockers (metoprolol, atenolol) are safer in asthma but
still use caution. Non-selective (propranolol, nadolol) can cause bronchospasm.
Question 18: Which finding is seen in hypertensive emergency?
A) BP 180/110 with headache
B) BP 200/120 with papilledema
C) BP 170/100 with anxiety
D) BP 160/90 with epistaxis
Correct Answer: B
Rationale: Hypertensive emergency = elevated BP with acute end-organ damage
