1
2025 APEA FNP Predictor Exam – 200
Practice Questions with Answers & Detailed
Rationales"
1. A 42-year-old female presents with fatigue, cold intolerance, and
weight gain. On examination, she has dry skin, bradycardia, and non-
pitting edema. Which of the following is the most likely diagnosis?
, 2
A. Hyperthyroidism
B. Hypothyroidism
C. Cushing's syndrome
D. Addison’s disease
✅ Correct Answer: B. Hypothyroidism
Rationale: The patient presents with classic signs of hypothyroidism—
fatigue, cold intolerance, weight gain, dry skin, and bradycardia. Non-pitting
edema (myxedema) is also a hallmark. These symptoms occur due to the
decreased metabolic rate associated with deficient thyroid hormone.
Hyperthyroidism would present with weight loss, heat intolerance, and
tachycardia. Cushing’s syndrome includes central obesity, striae, and
hypertension. Addison’s disease would present with hypotension and
hyperpigmentation.
2. A 65-year-old male smoker complains of chronic cough and sputum
production for at least 3 months each year for the past 2 years. What is
the most likely diagnosis?
A. Bronchiectasis
B. Asthma
C. Chronic bronchitis
D. Emphysema
✅ Correct Answer: C. Chronic bronchitis
Rationale: Chronic bronchitis, a form of COPD, is diagnosed clinically with
a productive cough for at least 3 months in 2 consecutive years. The history
of long-term smoking supports this diagnosis. Bronchiectasis presents with
, 3
copious sputum and recurrent infections. Asthma has reversible airway
obstruction and is typically intermittent. Emphysema presents with dyspnea
and decreased breath sounds but not a productive cough to this degree.
3. A 29-year-old woman presents with dysuria and increased urinary
frequency. Urinalysis reveals positive nitrites and leukocyte esterase.
What is the most appropriate first-line treatment?
A. Ciprofloxacin
B. Nitrofurantoin
C. Amoxicillin
D. Azithromycin
✅ Correct Answer: B. Nitrofurantoin
Rationale: Nitrofurantoin is recommended for uncomplicated urinary tract
infections (UTIs) in women due to its efficacy and low resistance. Positive
nitrites and leukocyte esterase on UA are highly suggestive of bacterial UTI.
Fluoroquinolones like ciprofloxacin are now reserved for complicated cases.
Amoxicillin and azithromycin are not preferred due to increasing resistance.
4. A 55-year-old male with a history of diabetes and hypertension
presents for a physical. Fundoscopic exam reveals microaneurysms and
cotton wool spots. What condition does this most likely indicate?
A. Glaucoma
B. Diabetic retinopathy
C. Retinal detachment
, 4
D. Hypertensive crisis
✅ Correct Answer: B. Diabetic retinopathy
Rationale: Microaneurysms and cotton wool spots are hallmark findings in
diabetic retinopathy. These result from microvascular damage due to chronic
hyperglycemia. Glaucoma involves increased intraocular pressure and
cupping of the optic disc. Retinal detachment presents with floaters or vision
loss. Hypertensive crisis can also cause retinal changes, but in this scenario,
diabetic damage is more likely.
5. A 22-year-old female presents with right lower quadrant pain,
nausea, and rebound tenderness. A pregnancy test is negative. What is
the most appropriate initial diagnostic test?
A. Pelvic MRI
B. Laparoscopy
C. Transvaginal ultrasound
D. CT abdomen
✅ Correct Answer: D. CT abdomen
Rationale: In a non-pregnant female with suspected appendicitis, a CT
abdomen with contrast is the gold standard for diagnosis. It offers superior
visualization of the appendix and surrounding tissues. If the patient were
pregnant, transvaginal ultrasound or MRI would be preferred. Laparoscopy
is invasive and usually performed after imaging.
2025 APEA FNP Predictor Exam – 200
Practice Questions with Answers & Detailed
Rationales"
1. A 42-year-old female presents with fatigue, cold intolerance, and
weight gain. On examination, she has dry skin, bradycardia, and non-
pitting edema. Which of the following is the most likely diagnosis?
, 2
A. Hyperthyroidism
B. Hypothyroidism
C. Cushing's syndrome
D. Addison’s disease
✅ Correct Answer: B. Hypothyroidism
Rationale: The patient presents with classic signs of hypothyroidism—
fatigue, cold intolerance, weight gain, dry skin, and bradycardia. Non-pitting
edema (myxedema) is also a hallmark. These symptoms occur due to the
decreased metabolic rate associated with deficient thyroid hormone.
Hyperthyroidism would present with weight loss, heat intolerance, and
tachycardia. Cushing’s syndrome includes central obesity, striae, and
hypertension. Addison’s disease would present with hypotension and
hyperpigmentation.
2. A 65-year-old male smoker complains of chronic cough and sputum
production for at least 3 months each year for the past 2 years. What is
the most likely diagnosis?
A. Bronchiectasis
B. Asthma
C. Chronic bronchitis
D. Emphysema
✅ Correct Answer: C. Chronic bronchitis
Rationale: Chronic bronchitis, a form of COPD, is diagnosed clinically with
a productive cough for at least 3 months in 2 consecutive years. The history
of long-term smoking supports this diagnosis. Bronchiectasis presents with
, 3
copious sputum and recurrent infections. Asthma has reversible airway
obstruction and is typically intermittent. Emphysema presents with dyspnea
and decreased breath sounds but not a productive cough to this degree.
3. A 29-year-old woman presents with dysuria and increased urinary
frequency. Urinalysis reveals positive nitrites and leukocyte esterase.
What is the most appropriate first-line treatment?
A. Ciprofloxacin
B. Nitrofurantoin
C. Amoxicillin
D. Azithromycin
✅ Correct Answer: B. Nitrofurantoin
Rationale: Nitrofurantoin is recommended for uncomplicated urinary tract
infections (UTIs) in women due to its efficacy and low resistance. Positive
nitrites and leukocyte esterase on UA are highly suggestive of bacterial UTI.
Fluoroquinolones like ciprofloxacin are now reserved for complicated cases.
Amoxicillin and azithromycin are not preferred due to increasing resistance.
4. A 55-year-old male with a history of diabetes and hypertension
presents for a physical. Fundoscopic exam reveals microaneurysms and
cotton wool spots. What condition does this most likely indicate?
A. Glaucoma
B. Diabetic retinopathy
C. Retinal detachment
, 4
D. Hypertensive crisis
✅ Correct Answer: B. Diabetic retinopathy
Rationale: Microaneurysms and cotton wool spots are hallmark findings in
diabetic retinopathy. These result from microvascular damage due to chronic
hyperglycemia. Glaucoma involves increased intraocular pressure and
cupping of the optic disc. Retinal detachment presents with floaters or vision
loss. Hypertensive crisis can also cause retinal changes, but in this scenario,
diabetic damage is more likely.
5. A 22-year-old female presents with right lower quadrant pain,
nausea, and rebound tenderness. A pregnancy test is negative. What is
the most appropriate initial diagnostic test?
A. Pelvic MRI
B. Laparoscopy
C. Transvaginal ultrasound
D. CT abdomen
✅ Correct Answer: D. CT abdomen
Rationale: In a non-pregnant female with suspected appendicitis, a CT
abdomen with contrast is the gold standard for diagnosis. It offers superior
visualization of the appendix and surrounding tissues. If the patient were
pregnant, transvaginal ultrasound or MRI would be preferred. Laparoscopy
is invasive and usually performed after imaging.
