1
APEA Predictor Exam | 2025/2026 Latest Edition – Questions,
Correct Answers, and Rationales
1. Cardiology
A 58-year-old male with hypertension reports a persistent dry cough after starting
lisinopril 2 weeks ago. What is the best next step?
• A) Add a thiazide diuretic
• B) Switch to losartan
• C) Continue lisinopril; cough will subside
• D) Order chest X-ray
Rationale: Persistent dry cough is a classic ACE inhibitor side effect due to bradykinin
accumulation. Switching to an ARB (e.g., losartan) maintains efficacy without the cough.
2. Endocrinology
A 45-year-old female presents with fatigue, weight gain, cold intolerance, and
constipation. TSH is 12.4 mIU/mL (0.4–4.0). What is first-line treatment?
• A) Methimazole
• B) Radioactive iodine
• C) Levothyroxine
• D) Levothyroxine + liothyronine
Rationale: Overt hypothyroidism (elevated TSH) is treated with levothyroxine
monotherapy, starting at 1.6 mcg/kg/day.
,2
3. Neurology
A 72-year-old male suddenly develops right-sided weakness and aphasia. Last known
well was 2 hours ago. Non-contrast head CT is normal. What is the priority?
• A) Aspirin 325 mg
• B) IV alteplase (tPA)
• C) Clopidogrel 300 mg
• D) Transfer for thrombectomy
Rationale: Within 3–4.5 hours of last known well, with no hemorrhage on CT, IV tPA is
indicated if no contraindications.
4. Pulmonology
A 68-year-old with COPD has worsening dyspnea, increased sputum purulence, and
volume. Vital signs: RR 24, O2 sat 88% on room air. What is first-line treatment?
• A) Oral prednisone alone
• B) Antibiotics + systemic corticosteroids + bronchodilators
• C) High-flow nasal cannula
• D) Noninvasive ventilation only
Rationale: Acute exacerbation of COPD with increased sputum purulence and volume
requires antibiotics (e.g., azithromycin or doxycycline), systemic steroids, and aggressive
bronchodilators.
,3
5. Dermatology
A 32-year-old presents with pruritic, erythematous plaques with silvery scales on elbows
and knees. What is first-line topical therapy?
• A) Clotrimazole cream
• B) Betamethasone dipropionate ointment
• C) Tacrolimus ointment
• D) Calcipotriene alone
Rationale: Plaque psoriasis responds to medium- to high-potency topical
corticosteroids (e.g., betamethasone). Calcipotriene is an adjunct, not first-line alone.
6. Infectious Disease
A 22-year-old sexually active female reports dysuria, frequency, and urgency. Urinalysis
shows positive nitrites and LE. Which antibiotic is appropriate for empiric treatment?
• A) Doxycycline 100 mg BID × 7 days
• B) Nitrofurantoin 100 mg BID × 5 days
• C) Ceftriaxone 250 mg IM once
• D) Azithromycin 1 g orally once
Rationale: Uncomplicated cystitis in a young woman is treated with nitrofurantoin (5
days), TMP-SMX (3 days), or fosfomycin (1 dose).
7. Women’s Health
, 4
A 30-year-old G2P1 at 28 weeks gestation presents with painless, bright red vaginal
bleeding. Fetal heart rate is reassuring. What is the next step?
• A) Digital cervical exam
• B) Bed rest and transabdominal ultrasound
• C) Immediate cesarean section
• D) Speculum exam only
Rationale: Painless bleeding in the third trimester is placenta previa until proven
otherwise. Digital exam is contraindicated. Ultrasound confirms diagnosis.
8. Pediatrics
A 6-month-old infant with fever (39.5°C), irritability, and bulging anterior fontanelle.
What is the most critical diagnostic test?
• A) CBC with differential
• B) Blood culture
• C) Lumbar puncture
• D) Head ultrasound
Rationale: Bulging fontanelle + fever suggests meningitis. LP is essential before
antibiotics to identify the pathogen.
9. Geriatrics
APEA Predictor Exam | 2025/2026 Latest Edition – Questions,
Correct Answers, and Rationales
1. Cardiology
A 58-year-old male with hypertension reports a persistent dry cough after starting
lisinopril 2 weeks ago. What is the best next step?
• A) Add a thiazide diuretic
• B) Switch to losartan
• C) Continue lisinopril; cough will subside
• D) Order chest X-ray
Rationale: Persistent dry cough is a classic ACE inhibitor side effect due to bradykinin
accumulation. Switching to an ARB (e.g., losartan) maintains efficacy without the cough.
2. Endocrinology
A 45-year-old female presents with fatigue, weight gain, cold intolerance, and
constipation. TSH is 12.4 mIU/mL (0.4–4.0). What is first-line treatment?
• A) Methimazole
• B) Radioactive iodine
• C) Levothyroxine
• D) Levothyroxine + liothyronine
Rationale: Overt hypothyroidism (elevated TSH) is treated with levothyroxine
monotherapy, starting at 1.6 mcg/kg/day.
,2
3. Neurology
A 72-year-old male suddenly develops right-sided weakness and aphasia. Last known
well was 2 hours ago. Non-contrast head CT is normal. What is the priority?
• A) Aspirin 325 mg
• B) IV alteplase (tPA)
• C) Clopidogrel 300 mg
• D) Transfer for thrombectomy
Rationale: Within 3–4.5 hours of last known well, with no hemorrhage on CT, IV tPA is
indicated if no contraindications.
4. Pulmonology
A 68-year-old with COPD has worsening dyspnea, increased sputum purulence, and
volume. Vital signs: RR 24, O2 sat 88% on room air. What is first-line treatment?
• A) Oral prednisone alone
• B) Antibiotics + systemic corticosteroids + bronchodilators
• C) High-flow nasal cannula
• D) Noninvasive ventilation only
Rationale: Acute exacerbation of COPD with increased sputum purulence and volume
requires antibiotics (e.g., azithromycin or doxycycline), systemic steroids, and aggressive
bronchodilators.
,3
5. Dermatology
A 32-year-old presents with pruritic, erythematous plaques with silvery scales on elbows
and knees. What is first-line topical therapy?
• A) Clotrimazole cream
• B) Betamethasone dipropionate ointment
• C) Tacrolimus ointment
• D) Calcipotriene alone
Rationale: Plaque psoriasis responds to medium- to high-potency topical
corticosteroids (e.g., betamethasone). Calcipotriene is an adjunct, not first-line alone.
6. Infectious Disease
A 22-year-old sexually active female reports dysuria, frequency, and urgency. Urinalysis
shows positive nitrites and LE. Which antibiotic is appropriate for empiric treatment?
• A) Doxycycline 100 mg BID × 7 days
• B) Nitrofurantoin 100 mg BID × 5 days
• C) Ceftriaxone 250 mg IM once
• D) Azithromycin 1 g orally once
Rationale: Uncomplicated cystitis in a young woman is treated with nitrofurantoin (5
days), TMP-SMX (3 days), or fosfomycin (1 dose).
7. Women’s Health
, 4
A 30-year-old G2P1 at 28 weeks gestation presents with painless, bright red vaginal
bleeding. Fetal heart rate is reassuring. What is the next step?
• A) Digital cervical exam
• B) Bed rest and transabdominal ultrasound
• C) Immediate cesarean section
• D) Speculum exam only
Rationale: Painless bleeding in the third trimester is placenta previa until proven
otherwise. Digital exam is contraindicated. Ultrasound confirms diagnosis.
8. Pediatrics
A 6-month-old infant with fever (39.5°C), irritability, and bulging anterior fontanelle.
What is the most critical diagnostic test?
• A) CBC with differential
• B) Blood culture
• C) Lumbar puncture
• D) Head ultrasound
Rationale: Bulging fontanelle + fever suggests meningitis. LP is essential before
antibiotics to identify the pathogen.
9. Geriatrics
