APEA 3P 2026/2027 Actual Exam (Orthopedics -
APEA Testbank) – 200 Questions & Answers
with In-Depth Explanations | Complete A+ Guide
Exam Blueprint:
Musculoskeletal Assessment (20%) – 40 Qs
Fractures & Trauma (15%) – 30 Qs
Joint Disorders & Arthritis (20%) – 40 Qs
Back & Spinal Disorders (15%) – 30 Qs
Soft Tissue & Sports Injuries (15%) – 30 Qs
Metabolic Bone Disease & Orthopedic Emergencies (15%) – 30 Qs
SECTION 1: MUSCULOSKELETAL ASSESSMENT – Questions 1–40
1. A 58-year-old male with type 2 diabetes reports burning foot pain worse at
night. Exam reveals diminished pinprick sensation distal to the ankles and
absent Achilles reflexes. What is the most likely diagnosis?
A) Peripheral artery disease
B) Lumbar radiculopathy
C) Diabetic peripheral neuropathy
D) Vitamin B12 deficiency
Answer: C
Rationale: Distal symmetric polyneuropathy in diabetes presents with
burning pain, nocturnal exacerbation, loss of sensation, and areflexia. PAD
causes intermittent claudication, not burning dysesthesia.
,2. A 45-year-old woman reports difficulty rising from a chair and climbing
stairs. Exam shows proximal muscle weakness, no sensory loss, and markedly
elevated creatine kinase (CK). What is the most likely diagnosis?
A) Polymyositis
B) Myasthenia gravis
C) Lambert-Eaton syndrome
D) Guillain-Barré syndrome
Answer: A
Rationale: Proximal symmetric muscle weakness with elevated CK suggests
polymyositis (or dermatomyositis if rash is present).
3. A 68-year-old woman with osteoporosis on alendronate for 5 years
develops severe thigh and groin pain. X-ray shows transverse cortical
thickening in the lateral femoral shaft. What is the most likely diagnosis?
A) Osteosarcoma
B) Atypical femoral fracture precursor
C) Paget’s disease of bone
D) Osteomalacia
Answer: B
Rationale: Atypical femoral fractures from bisphosphonates present with
prodromal thigh pain and radiographic cortical beaking/thickening.
4. A 65-year-old woman with sudden severe lumbar back pain after sneezing
has a history of osteoporosis. Exam reveals midline tenderness at L1 with
intact neurologic exam. What is the best initial imaging study?
A) MRI lumbar spine
B) CT lumbar spine
C) X-ray lumbar spine
,D) Bone scan
Answer: C
Rationale: Plain X-ray is first-line for suspected vertebral compression
fracture in osteoporosis; MRI is indicated if a neurologic deficit is present.
5. A 32-year-old man has recurrent episodes of unilateral, severe, pulsatile
headache with tearing, rhinorrhea, and restlessness lasting 30-60 minutes.
What is the best acute treatment?
A) Sumatriptan 6 mg subcutaneous
B) Naproxen 500 mg oral
C) Oxygen 15 L/min via non-rebreather mask
D) Ergotamine
Answer: C
Rationale: High-flow oxygen (100% at 12-15 L/min) is first-line for acute
cluster headache; it is highly effective and safe.
6. A 45-year-old woman with rheumatoid arthritis on methotrexate develops
dyspnea and non-productive cough. HRCT shows bilateral ground-glass
opacities. What is the most likely diagnosis?
A) Methotrexate pneumonitis
B) Rheumatoid lung nodules
C) Pulmonary embolism
D) Bacterial pneumonia
Answer: A
Rationale: Methotrexate-induced lung injury (hypersensitivity pneumonitis)
presents with subacute dyspnea, cough, and ground-glass opacities.
7. A 55-year-old man with chronic heavy alcohol use presents with
confusion, ataxia, and ophthalmoplegia. What is the most likely deficiency?
A) Vitamin B12
, B) Thiamine (B1)
C) Niacin (B3)
D) Folate
Answer: B
Rationale: Wernicke encephalopathy (confusion, ataxia, ophthalmoplegia) is
caused by thiamine deficiency, often in alcohol use disorder.
8. A 3-year-old child with fever, cough, and inspiratory stridor presents with
a “barking” cough. Immunizations are up to date. What is the most likely
diagnosis?
A) Epiglottitis
B) Croup (laryngotracheobronchitis)
C) Bacterial tracheitis
D) Peritonsillar abscess
Answer: B
Rationale: Croup presents with a barking cough, inspiratory stridor, and
fever; it is usually viral (parainfluenza) and is less severe than epiglottitis.
9. A 45-year-old man presents with acute low back pain radiating to the
lateral foot, numbness, and tingling. The straight leg raise test is positive on
the affected side. What is the most likely diagnosis?
A) Lumbar radiculopathy (L5/S1 disc herniation)
B) Compression fracture
C) Spinal stenosis
D) Sacroiliac joint dysfunction
Answer: A
Rationale: Radiculopathy causes dermatomal pain/paresthesia and a positive
straight leg raise; L5/S1 herniations are the most common.
APEA Testbank) – 200 Questions & Answers
with In-Depth Explanations | Complete A+ Guide
Exam Blueprint:
Musculoskeletal Assessment (20%) – 40 Qs
Fractures & Trauma (15%) – 30 Qs
Joint Disorders & Arthritis (20%) – 40 Qs
Back & Spinal Disorders (15%) – 30 Qs
Soft Tissue & Sports Injuries (15%) – 30 Qs
Metabolic Bone Disease & Orthopedic Emergencies (15%) – 30 Qs
SECTION 1: MUSCULOSKELETAL ASSESSMENT – Questions 1–40
1. A 58-year-old male with type 2 diabetes reports burning foot pain worse at
night. Exam reveals diminished pinprick sensation distal to the ankles and
absent Achilles reflexes. What is the most likely diagnosis?
A) Peripheral artery disease
B) Lumbar radiculopathy
C) Diabetic peripheral neuropathy
D) Vitamin B12 deficiency
Answer: C
Rationale: Distal symmetric polyneuropathy in diabetes presents with
burning pain, nocturnal exacerbation, loss of sensation, and areflexia. PAD
causes intermittent claudication, not burning dysesthesia.
,2. A 45-year-old woman reports difficulty rising from a chair and climbing
stairs. Exam shows proximal muscle weakness, no sensory loss, and markedly
elevated creatine kinase (CK). What is the most likely diagnosis?
A) Polymyositis
B) Myasthenia gravis
C) Lambert-Eaton syndrome
D) Guillain-Barré syndrome
Answer: A
Rationale: Proximal symmetric muscle weakness with elevated CK suggests
polymyositis (or dermatomyositis if rash is present).
3. A 68-year-old woman with osteoporosis on alendronate for 5 years
develops severe thigh and groin pain. X-ray shows transverse cortical
thickening in the lateral femoral shaft. What is the most likely diagnosis?
A) Osteosarcoma
B) Atypical femoral fracture precursor
C) Paget’s disease of bone
D) Osteomalacia
Answer: B
Rationale: Atypical femoral fractures from bisphosphonates present with
prodromal thigh pain and radiographic cortical beaking/thickening.
4. A 65-year-old woman with sudden severe lumbar back pain after sneezing
has a history of osteoporosis. Exam reveals midline tenderness at L1 with
intact neurologic exam. What is the best initial imaging study?
A) MRI lumbar spine
B) CT lumbar spine
C) X-ray lumbar spine
,D) Bone scan
Answer: C
Rationale: Plain X-ray is first-line for suspected vertebral compression
fracture in osteoporosis; MRI is indicated if a neurologic deficit is present.
5. A 32-year-old man has recurrent episodes of unilateral, severe, pulsatile
headache with tearing, rhinorrhea, and restlessness lasting 30-60 minutes.
What is the best acute treatment?
A) Sumatriptan 6 mg subcutaneous
B) Naproxen 500 mg oral
C) Oxygen 15 L/min via non-rebreather mask
D) Ergotamine
Answer: C
Rationale: High-flow oxygen (100% at 12-15 L/min) is first-line for acute
cluster headache; it is highly effective and safe.
6. A 45-year-old woman with rheumatoid arthritis on methotrexate develops
dyspnea and non-productive cough. HRCT shows bilateral ground-glass
opacities. What is the most likely diagnosis?
A) Methotrexate pneumonitis
B) Rheumatoid lung nodules
C) Pulmonary embolism
D) Bacterial pneumonia
Answer: A
Rationale: Methotrexate-induced lung injury (hypersensitivity pneumonitis)
presents with subacute dyspnea, cough, and ground-glass opacities.
7. A 55-year-old man with chronic heavy alcohol use presents with
confusion, ataxia, and ophthalmoplegia. What is the most likely deficiency?
A) Vitamin B12
, B) Thiamine (B1)
C) Niacin (B3)
D) Folate
Answer: B
Rationale: Wernicke encephalopathy (confusion, ataxia, ophthalmoplegia) is
caused by thiamine deficiency, often in alcohol use disorder.
8. A 3-year-old child with fever, cough, and inspiratory stridor presents with
a “barking” cough. Immunizations are up to date. What is the most likely
diagnosis?
A) Epiglottitis
B) Croup (laryngotracheobronchitis)
C) Bacterial tracheitis
D) Peritonsillar abscess
Answer: B
Rationale: Croup presents with a barking cough, inspiratory stridor, and
fever; it is usually viral (parainfluenza) and is less severe than epiglottitis.
9. A 45-year-old man presents with acute low back pain radiating to the
lateral foot, numbness, and tingling. The straight leg raise test is positive on
the affected side. What is the most likely diagnosis?
A) Lumbar radiculopathy (L5/S1 disc herniation)
B) Compression fracture
C) Spinal stenosis
D) Sacroiliac joint dysfunction
Answer: A
Rationale: Radiculopathy causes dermatomal pain/paresthesia and a positive
straight leg raise; L5/S1 herniations are the most common.
