APEA 3P HIGH STAKES EXAM 2026/2027 | Questions &
Answers from Actual Test | 100% Verified Answers | NP
Certification | Pass Guaranteed - A+ Graded
Section 1: Assessment & Diagnostic Reasoning (History, Physical Exam, Tests)
(Q1-35)
Q1. A 68-year-old male presents with progressive dyspnea on exertion and orthopnea.
On physical exam, you note a laterally displaced PMI, an S3 gallop, and bilateral basilar
crackles. Which finding is most specific for left ventricular systolic dysfunction?
A. Orthopnea
B. Bilateral basilar crackles
C. Laterally displaced PMI
D. S3 gallop
Correct Answer: D
Rationale: An S3 gallop (ventricular gallop) is highly specific for left ventricular systolic
dysfunction and volume overload in adults over age 40. While orthopnea (A) and
crackles (B) support heart failure, they lack specificity. A displaced PMI (C) indicates
cardiomegaly but does not distinguish systolic from diastolic dysfunction. ACC/AHA
Heart Failure Guidelines.
Q2. During cardiac auscultation of a 55-year-old patient, you hear a harsh,
crescendo-decrescendo systolic murmur at the right upper sternal border radiating to
the carotids. The murmur decreases with Valsalva maneuver. What is the most likely
diagnosis?
A. Mitral regurgitation
B. Aortic stenosis
C. Hypertrophic cardiomyopathy
D. Mitral valve prolapse
Correct Answer: B
,Rationale: A harsh crescendo-decrescendo systolic murmur at the right upper sternal
border radiating to the carotids is classic for aortic stenosis. The murmur decreases
with Valsalva (decreased preload) because reduced venous return lessens flow across
the stenotic valve. Hypertrophic cardiomyopathy (C) would increase with Valsalva.
Aortic stenosis murmur characteristics per AHA/ACC Valvular Heart Disease
Guidelines.
Q3. A 42-year-old female reports palpitations. ECG reveals an irregularly irregular
rhythm, absent P waves, and fibrillatory waves with a ventricular rate of 110 bpm. What
is the most appropriate initial pharmacologic strategy for rate control?
A. Adenosine
B. Diltiazem
C. Amiodarone
D. Sotalol
Correct Answer: B
Rationale: This ECG describes atrial fibrillation with rapid ventricular response.
Diltiazem, a non-dihydropyridine calcium channel blocker, is first-line for acute rate
control in hemodynamically stable patients. Adenosine (A) is used for SVT. Amiodarone
(C) is reserved for refractory cases or when rhythm control is needed. Sotalol (D)
requires inpatient initiation due to QT prolongation risk. AHA/ACC/HRS AFib Guidelines.
Q4. You are examining a patient with suspected pleural effusion. Which physical exam
finding best confirms the presence of fluid in the pleural space?
A. Egophony at the lung base
B. Dullness to percussion with decreased fremitus
C. Bronchophony throughout the lung fields
D. Hyperresonance to percussion
Correct Answer: B
Rationale: Pleural effusion causes dullness to percussion (fluid does not vibrate) and
decreased tactile fremitus (fluid insulates vibration transmission). Egophony (A)
suggests consolidation (pneumonia). Bronchophony (C) also indicates consolidation.
,Hyperresonance (D) suggests pneumothorax or emphysema. Physical diagnosis
principles.
Q5. A 35-year-old male presents with right upper quadrant pain after eating fatty meals.
During abdominal exam, you ask the patient to inhale deeply while palpating the right
subcostal area. The patient abruptly stops inspiration due to pain. What is this sign
called, and what does it indicate?
A. McBurney sign; appendicitis
B. Murphy sign; cholecystitis
C. Rovsing sign; appendicitis
D. Grey Turner sign; pancreatitis
Correct Answer: B
Rationale: Murphy sign (inspiratory arrest during deep palpation of the right upper
quadrant) is pathognomonic for acute cholecystitis. McBurney sign (A) is tenderness at
the McBurney point for appendicitis. Rovsing sign (C) is referred left lower quadrant
pain with right-sided palpation in appendicitis. Grey Turner sign (D) is flank ecchymosis
in severe pancreatitis. Clinical examination standards.
Q6. A 28-year-old football player injured his knee during a tackle. He reports feeling a
"pop" and now has significant swelling within 2 hours. On exam, the knee has anterior
instability with the tibia translating forward relative to the femur when the knee is flexed
at 30 degrees. Which test is being performed, and what is the likely diagnosis?
A. McMurray test; meniscal tear
B. Lachman test; ACL tear
C. Drawer test; PCL tear
D. Valgus stress test; MCL tear
Correct Answer: B
Rationale: The Lachman test (knee flexed 20-30 degrees, anterior tibial translation) is
the most sensitive test for ACL rupture (95% sensitive). A "pop" with rapid swelling (<2
hours) indicates hemarthrosis from ACL tear. McMurray test (A) assesses meniscal
tears with rotation. Drawer test (C) at 90 degrees assesses ACL/PCL. Valgus stress (D)
tests MCL integrity. Orthopedic examination standards.
, Q7. A 62-year-old with type 2 diabetes presents for follow-up. Which finding on
monofilament testing indicates loss of protective sensation and increased ulcer risk?
A. Inability to feel the 4.17 monofilament at the plantar foot
B. Inability to feel the 2.83 monofilament at the dorsal foot
C. Inability to feel the 6.65 monofilament at the ankle
D. Inability to feel the 10.00 monofilament at the heel
Correct Answer: A
Rationale: The 5.07 Semmes-Weinstein monofilament (equivalent to 4.17 in some
systems/10-gram force) is the standard for screening diabetic peripheral neuropathy.
Inability to feel it at the plantar foot indicates loss of protective sensation and
significantly increases ulcer risk. ADA Standards of Care in Diabetes.
Q8. A patient presents with suspected carpal tunnel syndrome. Which physical exam
maneuver involves tapping over the median nerve at the wrist to elicit paresthesia in the
thumb, index, and middle fingers?
A. Phalen maneuver
B. Tinel sign
C. Finkelstein test
D. Durkan compression test
Correct Answer: B
Rationale: Tinel sign is performed by tapping over the median nerve at the carpal tunnel
to reproduce paresthesias in the median nerve distribution. Phalen maneuver (A)
involves wrist flexion for 60 seconds. Finkelstein test (C) assesses de Quervain
tenosynovitis. Durkan test (D) applies direct pressure over the carpal tunnel. AAOS
Clinical Practice Guidelines.
Q9. A 58-year-old male with hypertension presents with acute chest pain. ECG shows
ST-segment elevation in leads II, III, and aVF with reciprocal ST depression in leads I and
aVL. Which coronary artery territory is involved?
A. Left anterior descending
B. Left circumflex
C. Right coronary artery
D. Posterior descending artery
Answers from Actual Test | 100% Verified Answers | NP
Certification | Pass Guaranteed - A+ Graded
Section 1: Assessment & Diagnostic Reasoning (History, Physical Exam, Tests)
(Q1-35)
Q1. A 68-year-old male presents with progressive dyspnea on exertion and orthopnea.
On physical exam, you note a laterally displaced PMI, an S3 gallop, and bilateral basilar
crackles. Which finding is most specific for left ventricular systolic dysfunction?
A. Orthopnea
B. Bilateral basilar crackles
C. Laterally displaced PMI
D. S3 gallop
Correct Answer: D
Rationale: An S3 gallop (ventricular gallop) is highly specific for left ventricular systolic
dysfunction and volume overload in adults over age 40. While orthopnea (A) and
crackles (B) support heart failure, they lack specificity. A displaced PMI (C) indicates
cardiomegaly but does not distinguish systolic from diastolic dysfunction. ACC/AHA
Heart Failure Guidelines.
Q2. During cardiac auscultation of a 55-year-old patient, you hear a harsh,
crescendo-decrescendo systolic murmur at the right upper sternal border radiating to
the carotids. The murmur decreases with Valsalva maneuver. What is the most likely
diagnosis?
A. Mitral regurgitation
B. Aortic stenosis
C. Hypertrophic cardiomyopathy
D. Mitral valve prolapse
Correct Answer: B
,Rationale: A harsh crescendo-decrescendo systolic murmur at the right upper sternal
border radiating to the carotids is classic for aortic stenosis. The murmur decreases
with Valsalva (decreased preload) because reduced venous return lessens flow across
the stenotic valve. Hypertrophic cardiomyopathy (C) would increase with Valsalva.
Aortic stenosis murmur characteristics per AHA/ACC Valvular Heart Disease
Guidelines.
Q3. A 42-year-old female reports palpitations. ECG reveals an irregularly irregular
rhythm, absent P waves, and fibrillatory waves with a ventricular rate of 110 bpm. What
is the most appropriate initial pharmacologic strategy for rate control?
A. Adenosine
B. Diltiazem
C. Amiodarone
D. Sotalol
Correct Answer: B
Rationale: This ECG describes atrial fibrillation with rapid ventricular response.
Diltiazem, a non-dihydropyridine calcium channel blocker, is first-line for acute rate
control in hemodynamically stable patients. Adenosine (A) is used for SVT. Amiodarone
(C) is reserved for refractory cases or when rhythm control is needed. Sotalol (D)
requires inpatient initiation due to QT prolongation risk. AHA/ACC/HRS AFib Guidelines.
Q4. You are examining a patient with suspected pleural effusion. Which physical exam
finding best confirms the presence of fluid in the pleural space?
A. Egophony at the lung base
B. Dullness to percussion with decreased fremitus
C. Bronchophony throughout the lung fields
D. Hyperresonance to percussion
Correct Answer: B
Rationale: Pleural effusion causes dullness to percussion (fluid does not vibrate) and
decreased tactile fremitus (fluid insulates vibration transmission). Egophony (A)
suggests consolidation (pneumonia). Bronchophony (C) also indicates consolidation.
,Hyperresonance (D) suggests pneumothorax or emphysema. Physical diagnosis
principles.
Q5. A 35-year-old male presents with right upper quadrant pain after eating fatty meals.
During abdominal exam, you ask the patient to inhale deeply while palpating the right
subcostal area. The patient abruptly stops inspiration due to pain. What is this sign
called, and what does it indicate?
A. McBurney sign; appendicitis
B. Murphy sign; cholecystitis
C. Rovsing sign; appendicitis
D. Grey Turner sign; pancreatitis
Correct Answer: B
Rationale: Murphy sign (inspiratory arrest during deep palpation of the right upper
quadrant) is pathognomonic for acute cholecystitis. McBurney sign (A) is tenderness at
the McBurney point for appendicitis. Rovsing sign (C) is referred left lower quadrant
pain with right-sided palpation in appendicitis. Grey Turner sign (D) is flank ecchymosis
in severe pancreatitis. Clinical examination standards.
Q6. A 28-year-old football player injured his knee during a tackle. He reports feeling a
"pop" and now has significant swelling within 2 hours. On exam, the knee has anterior
instability with the tibia translating forward relative to the femur when the knee is flexed
at 30 degrees. Which test is being performed, and what is the likely diagnosis?
A. McMurray test; meniscal tear
B. Lachman test; ACL tear
C. Drawer test; PCL tear
D. Valgus stress test; MCL tear
Correct Answer: B
Rationale: The Lachman test (knee flexed 20-30 degrees, anterior tibial translation) is
the most sensitive test for ACL rupture (95% sensitive). A "pop" with rapid swelling (<2
hours) indicates hemarthrosis from ACL tear. McMurray test (A) assesses meniscal
tears with rotation. Drawer test (C) at 90 degrees assesses ACL/PCL. Valgus stress (D)
tests MCL integrity. Orthopedic examination standards.
, Q7. A 62-year-old with type 2 diabetes presents for follow-up. Which finding on
monofilament testing indicates loss of protective sensation and increased ulcer risk?
A. Inability to feel the 4.17 monofilament at the plantar foot
B. Inability to feel the 2.83 monofilament at the dorsal foot
C. Inability to feel the 6.65 monofilament at the ankle
D. Inability to feel the 10.00 monofilament at the heel
Correct Answer: A
Rationale: The 5.07 Semmes-Weinstein monofilament (equivalent to 4.17 in some
systems/10-gram force) is the standard for screening diabetic peripheral neuropathy.
Inability to feel it at the plantar foot indicates loss of protective sensation and
significantly increases ulcer risk. ADA Standards of Care in Diabetes.
Q8. A patient presents with suspected carpal tunnel syndrome. Which physical exam
maneuver involves tapping over the median nerve at the wrist to elicit paresthesia in the
thumb, index, and middle fingers?
A. Phalen maneuver
B. Tinel sign
C. Finkelstein test
D. Durkan compression test
Correct Answer: B
Rationale: Tinel sign is performed by tapping over the median nerve at the carpal tunnel
to reproduce paresthesias in the median nerve distribution. Phalen maneuver (A)
involves wrist flexion for 60 seconds. Finkelstein test (C) assesses de Quervain
tenosynovitis. Durkan test (D) applies direct pressure over the carpal tunnel. AAOS
Clinical Practice Guidelines.
Q9. A 58-year-old male with hypertension presents with acute chest pain. ECG shows
ST-segment elevation in leads II, III, and aVF with reciprocal ST depression in leads I and
aVL. Which coronary artery territory is involved?
A. Left anterior descending
B. Left circumflex
C. Right coronary artery
D. Posterior descending artery
