APEA 3P Predictor Exam 2026–2027 (New Version) |
Complete Questions with Verified Solutions and
Rationales | Latest Updated A+ Study Guide
(Topics Covered)
• Cardiology
• Pulmonology
• Nephrology/Urology
• Gastroenterology
• Endocrinology
• Neurology
• Infectious Disease
• Hematology/Oncology
• Musculoskeletal/Rheumatology
• Psychiatric/Mental Health
• Professional Issues/Pharmacology
1. A 72-year-old male with a 40-pack-year smoking history presents with
progressive dyspnea on exertion and a chronic cough with clear sputum.
Spirometry shows FEV1/FVC ratio of 0.65 and FEV1 45% of predicted. Which
medication has been shown to reduce mortality in this condition?
A. Inhaled albuterol as needed
B. Inhaled fluticasone alone
C. Long-acting muscarinic antagonist (LAMA)
D. Oral prednisone daily
Answer: C
Rationale: This patient has moderate-to-severe COPD (GOLD stage 3). LAMAs
(e.g., tiotropium) reduce exacerbations and improve survival. Inhaled
corticosteroids alone are not first-line; LABAs+LAMA are preferred.
,2. A 34-year-old woman presents with fatigue, cold intolerance, weight gain, and
constipation. Labs: TSH 18.5 mIU/mL (0.4–4.0), free T4 0.5 ng/dL (0.8–1.8). She
desires pregnancy. What is the appropriate next step?
A. Refer to endocrinology in 6 months
B. Start levothyroxine 1.6 mcg/kg/day, target TSH <2.5 mIU/mL
C. Start methimazole
D. Repeat TSH in 3 months
Answer: B
Rationale: Overt hypothyroidism before/during pregnancy increases miscarriage
and neurocognitive deficits. Treatment is levothyroxine with goal TSH 0.5–2.5
mIU/mL preconception.
3. A 55-year-old with diabetes presents with sudden, painless vision loss in the
right eye. Funduscopy reveals a cherry-red spot and retinal pallor. What is the most
likely diagnosis?
A. Diabetic retinopathy
B. Central retinal artery occlusion (CRAO)
C. Retinal detachment
D. Vitreous hemorrhage
Answer: B
Rationale: CRAO presents with acute, painless monocular vision loss, cherry-red
spot (fovea appearing red against pale retina). This is an ocular emergency; rule
out giant cell arteritis.
4. A 28-year-old male has a non-tender, freely moveable left inguinal bulge that
reduces spontaneously when supine. No bowel obstruction symptoms. What is the
most appropriate management?
A. Emergency surgery
B. Elective hernia repair
C. Ultrasound-guided aspiration
D. Observation with truss
, Answer: B
Rationale: This describes a reducible indirect inguinal hernia. Elective repair is
indicated to prevent strangulation. Trusses are outdated; observation is not standard
in young adults.
5. A 45-year-old female with SLE presents with acute-onset shortness of breath
and pleuritic chest pain. D-dimer is elevated. CTA chest is negative for PE. CT
also shows peripheral ground-glass opacities and interlobular septal thickening.
Next step?
A. Repeat CTA with higher contrast
B. Echocardiogram to assess for pulmonary hypertension
C. Bronchoscopy with lavage
D. Discharge with NSAIDs
Answer: B
Rationale: SLE patient with acute dyspnea, negative PE, and imaging showing
septal thickening → consider acute lupus pneumonitis or pulmonary hypertension.
Echo assesses for chronic thromboembolic disease or primary pulmonary
hypertension, a known SLE complication.
6. A 62-year-old with CKD stage 4 (eGFR 28 mL/min) is started on lisinopril for
hypertension. Three days later, creatinine rises to 2.8 mg/dL (baseline 1.9).
Potassium is 4.2 mEq/L. What should you do?
A. Stop lisinopril immediately
B. Continue lisinopril, recheck creatinine in 2 weeks
C. Double the lisinopril dose
D. Add spironolactone
Answer: B
Rationale: An expected rise in creatinine of up to 30% within 1–2 weeks of
starting ACEi is hemodynamically mediated and indicates effective renal perfusion
pressure reduction. Continue unless hyperkalemia or >30% rise.
7. A 19-year-old college student presents with sore throat, fever, and fatigue.
Exam: pharyngeal erythema with exudates, tender anterior cervical
Complete Questions with Verified Solutions and
Rationales | Latest Updated A+ Study Guide
(Topics Covered)
• Cardiology
• Pulmonology
• Nephrology/Urology
• Gastroenterology
• Endocrinology
• Neurology
• Infectious Disease
• Hematology/Oncology
• Musculoskeletal/Rheumatology
• Psychiatric/Mental Health
• Professional Issues/Pharmacology
1. A 72-year-old male with a 40-pack-year smoking history presents with
progressive dyspnea on exertion and a chronic cough with clear sputum.
Spirometry shows FEV1/FVC ratio of 0.65 and FEV1 45% of predicted. Which
medication has been shown to reduce mortality in this condition?
A. Inhaled albuterol as needed
B. Inhaled fluticasone alone
C. Long-acting muscarinic antagonist (LAMA)
D. Oral prednisone daily
Answer: C
Rationale: This patient has moderate-to-severe COPD (GOLD stage 3). LAMAs
(e.g., tiotropium) reduce exacerbations and improve survival. Inhaled
corticosteroids alone are not first-line; LABAs+LAMA are preferred.
,2. A 34-year-old woman presents with fatigue, cold intolerance, weight gain, and
constipation. Labs: TSH 18.5 mIU/mL (0.4–4.0), free T4 0.5 ng/dL (0.8–1.8). She
desires pregnancy. What is the appropriate next step?
A. Refer to endocrinology in 6 months
B. Start levothyroxine 1.6 mcg/kg/day, target TSH <2.5 mIU/mL
C. Start methimazole
D. Repeat TSH in 3 months
Answer: B
Rationale: Overt hypothyroidism before/during pregnancy increases miscarriage
and neurocognitive deficits. Treatment is levothyroxine with goal TSH 0.5–2.5
mIU/mL preconception.
3. A 55-year-old with diabetes presents with sudden, painless vision loss in the
right eye. Funduscopy reveals a cherry-red spot and retinal pallor. What is the most
likely diagnosis?
A. Diabetic retinopathy
B. Central retinal artery occlusion (CRAO)
C. Retinal detachment
D. Vitreous hemorrhage
Answer: B
Rationale: CRAO presents with acute, painless monocular vision loss, cherry-red
spot (fovea appearing red against pale retina). This is an ocular emergency; rule
out giant cell arteritis.
4. A 28-year-old male has a non-tender, freely moveable left inguinal bulge that
reduces spontaneously when supine. No bowel obstruction symptoms. What is the
most appropriate management?
A. Emergency surgery
B. Elective hernia repair
C. Ultrasound-guided aspiration
D. Observation with truss
, Answer: B
Rationale: This describes a reducible indirect inguinal hernia. Elective repair is
indicated to prevent strangulation. Trusses are outdated; observation is not standard
in young adults.
5. A 45-year-old female with SLE presents with acute-onset shortness of breath
and pleuritic chest pain. D-dimer is elevated. CTA chest is negative for PE. CT
also shows peripheral ground-glass opacities and interlobular septal thickening.
Next step?
A. Repeat CTA with higher contrast
B. Echocardiogram to assess for pulmonary hypertension
C. Bronchoscopy with lavage
D. Discharge with NSAIDs
Answer: B
Rationale: SLE patient with acute dyspnea, negative PE, and imaging showing
septal thickening → consider acute lupus pneumonitis or pulmonary hypertension.
Echo assesses for chronic thromboembolic disease or primary pulmonary
hypertension, a known SLE complication.
6. A 62-year-old with CKD stage 4 (eGFR 28 mL/min) is started on lisinopril for
hypertension. Three days later, creatinine rises to 2.8 mg/dL (baseline 1.9).
Potassium is 4.2 mEq/L. What should you do?
A. Stop lisinopril immediately
B. Continue lisinopril, recheck creatinine in 2 weeks
C. Double the lisinopril dose
D. Add spironolactone
Answer: B
Rationale: An expected rise in creatinine of up to 30% within 1–2 weeks of
starting ACEi is hemodynamically mediated and indicates effective renal perfusion
pressure reduction. Continue unless hyperkalemia or >30% rise.
7. A 19-year-old college student presents with sore throat, fever, and fatigue.
Exam: pharyngeal erythema with exudates, tender anterior cervical
