APEA NP FINAL EXAM: HIGH
YIELD TOPICS TEST (2026)||
Questions And Answers With
Rationales/Graded A+/2026
Update/100% Correct /Instant
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Section 1: Cardiology & Hypertension
1. A 58-year-old male with HTN and DM presents with a blood pressure of
148/90 mmHg on lisinopril 20 mg/day. Current guidelines recommend adding
which medication next?
• A) Hydrochlorothiazide 12.5 mg
• B) Amlodipine 5 mg
• C) Chlorthalidone 12.5 mg
• D) Metoprolol 25 mg
Rationale: Updated 2026 guidelines prefer chlorthalidone over HCTZ for superior
CVD event reduction. Amlodipine is an option but thiazide-like diuretics are first-
line add-on after ACEi/ARB.
2. Which EKG finding is most specific for acute pericarditis?
• A) ST elevation in V1-V4 with reciprocal changes
• B) Deep Q waves in II, III, aVF
• C) Diffuse concave-up ST elevation with PR depression
• D) Tall peaked T waves
Rationale: Diffuse ST elevation (concave) + PR depression is classic for
pericarditis. STEMI has convex ST elevation with reciprocal changes.
,3. A 72-year-old with HFrEF (EF 30%) has worsening dyspnea, JVD, and
edema. Which medication should be held?
• A) Metoprolol succinate
• B) Furosemide
• C) Spironolactone
• D) Empagliflozin
Rationale: In acute decompensated HF, beta-blockers are held temporarily to
avoid negative inotropy. Diuretics and SGLT2 inhibitors are continued.
4. Which murmur best correlates with hypertrophic obstructive
cardiomyopathy (HOCM)?
• A) Systolic ejection murmur at left sternal border, increases with squatting
• B) Crescendo-decrescendo murmur at LLSB, increases with
Valsalva
• C) Holosystolic murmur at apex radiating to axilla
• D) Diastolic decrescendo murmur at right sternal border
Rationale: HOCM murmur intensifies with decreased preload (Valsalva, standing)
and decreases with squatting (increased preload).
5. A 45-year-old with palpitations. EKG shows narrow QRS tachycardia,
regular, rate 180 bpm, no visible P waves. Most likely diagnosis?
• A) AV nodal reentrant tachycardia (AVNRT)
• B) Atrial fibrillation
• C) Atrial flutter with 2:1 block
• D) Junctional tachycardia
Rationale: AVNRT presents with regular narrow complex tachycardia, often no
visible P waves (buried in QRS). Atrial flutter often has sawtooth waves.
Section 2: Pulmonology
, 6. Which finding on spirometry confirms a restrictive lung defect?
• A) FEV1/FVC < 70% with low FEV1
• B) FEV1/FVC ≥ 70% with low FVC
• C) FEV1/FVC normal with high FEV1
• D) FEV1/FVC < 50% with normal FVC
Rationale: Restriction = reduced FVC with preserved or increased FEV1/FVC
ratio. Obstruction = low FEV1/FVC.
7. A 33-year-old with sudden onset of sharp chest pain and dyspnea after a
long flight. Exam: diminished breath sounds on right. Next step?
• A) Chest x-ray
• B) CT pulmonary angiography (CTPA)
• C) D-dimer
• D) V/Q scan
Rationale: High pretest probability for PE → CTPA is diagnostic. D-dimer is for
low probability.
8. Which asthma medication has been shown to reduce exacerbations and
mortality in 2026 guidelines?
• A) Albuterol as needed
• B) Low-dose ICS-formoterol as needed
• C) Leukotriene receptor antagonist monotherapy
• D) Theophylline
Rationale: SMART therapy (ICS-formoterol for both maintenance and rescue) is
now preferred in GINA 2026 for step 1 and 2 asthma.
9. A 67-year-old smoker with COPD has worsening dyspnea and purulent
sputum. No fever or leukocytosis. Best antibiotic choice?
• A) Doxycycline
• B) Levofloxacin
YIELD TOPICS TEST (2026)||
Questions And Answers With
Rationales/Graded A+/2026
Update/100% Correct /Instant
Download
Section 1: Cardiology & Hypertension
1. A 58-year-old male with HTN and DM presents with a blood pressure of
148/90 mmHg on lisinopril 20 mg/day. Current guidelines recommend adding
which medication next?
• A) Hydrochlorothiazide 12.5 mg
• B) Amlodipine 5 mg
• C) Chlorthalidone 12.5 mg
• D) Metoprolol 25 mg
Rationale: Updated 2026 guidelines prefer chlorthalidone over HCTZ for superior
CVD event reduction. Amlodipine is an option but thiazide-like diuretics are first-
line add-on after ACEi/ARB.
2. Which EKG finding is most specific for acute pericarditis?
• A) ST elevation in V1-V4 with reciprocal changes
• B) Deep Q waves in II, III, aVF
• C) Diffuse concave-up ST elevation with PR depression
• D) Tall peaked T waves
Rationale: Diffuse ST elevation (concave) + PR depression is classic for
pericarditis. STEMI has convex ST elevation with reciprocal changes.
,3. A 72-year-old with HFrEF (EF 30%) has worsening dyspnea, JVD, and
edema. Which medication should be held?
• A) Metoprolol succinate
• B) Furosemide
• C) Spironolactone
• D) Empagliflozin
Rationale: In acute decompensated HF, beta-blockers are held temporarily to
avoid negative inotropy. Diuretics and SGLT2 inhibitors are continued.
4. Which murmur best correlates with hypertrophic obstructive
cardiomyopathy (HOCM)?
• A) Systolic ejection murmur at left sternal border, increases with squatting
• B) Crescendo-decrescendo murmur at LLSB, increases with
Valsalva
• C) Holosystolic murmur at apex radiating to axilla
• D) Diastolic decrescendo murmur at right sternal border
Rationale: HOCM murmur intensifies with decreased preload (Valsalva, standing)
and decreases with squatting (increased preload).
5. A 45-year-old with palpitations. EKG shows narrow QRS tachycardia,
regular, rate 180 bpm, no visible P waves. Most likely diagnosis?
• A) AV nodal reentrant tachycardia (AVNRT)
• B) Atrial fibrillation
• C) Atrial flutter with 2:1 block
• D) Junctional tachycardia
Rationale: AVNRT presents with regular narrow complex tachycardia, often no
visible P waves (buried in QRS). Atrial flutter often has sawtooth waves.
Section 2: Pulmonology
, 6. Which finding on spirometry confirms a restrictive lung defect?
• A) FEV1/FVC < 70% with low FEV1
• B) FEV1/FVC ≥ 70% with low FVC
• C) FEV1/FVC normal with high FEV1
• D) FEV1/FVC < 50% with normal FVC
Rationale: Restriction = reduced FVC with preserved or increased FEV1/FVC
ratio. Obstruction = low FEV1/FVC.
7. A 33-year-old with sudden onset of sharp chest pain and dyspnea after a
long flight. Exam: diminished breath sounds on right. Next step?
• A) Chest x-ray
• B) CT pulmonary angiography (CTPA)
• C) D-dimer
• D) V/Q scan
Rationale: High pretest probability for PE → CTPA is diagnostic. D-dimer is for
low probability.
8. Which asthma medication has been shown to reduce exacerbations and
mortality in 2026 guidelines?
• A) Albuterol as needed
• B) Low-dose ICS-formoterol as needed
• C) Leukotriene receptor antagonist monotherapy
• D) Theophylline
Rationale: SMART therapy (ICS-formoterol for both maintenance and rescue) is
now preferred in GINA 2026 for step 1 and 2 asthma.
9. A 67-year-old smoker with COPD has worsening dyspnea and purulent
sputum. No fever or leukocytosis. Best antibiotic choice?
• A) Doxycycline
• B) Levofloxacin
