NR 509 APEA 3P EXAM WEEK 4 2025 LATEST
QUESTIONS AND GUARANTEED CORRECT
ANSWERS WITH RATIONALES ALREADY
GRADED A+.
Ai73-year-
oldiretiredisalesmanipresentsitoitheiEmergencyiDepartmenticomplainingiof
chestipainithatistartediabouti2ihoursiago.iElectrocardiogram,icardiacienzymes,iand
chestix-rayiareinormal.iTheinurseinotesithatihisibloodipressuresiinitheirightiarmiare
significantlyilowerithaniofibloodipressuresiinihisileftiarm.iBasedionihistoryiandiphysi
cal
examination,iwhichiofitheifollowingiwillimostilikelyiexplainihisisignsiandisymptoms
?i -
ANSWER-ia.iDissectingiaorticianeurysm
Rationale:iPatientsiwithidissectingiaorticianeurysmsitypicallyipresentiwithichestipai
n,
manyitimesidescribediasiai"tearing"itypeipain.iTheyiareiusuallyielderly,iand,idueitoit
he
dissectioniofitheiaorta,iasymmetricipulsesiinibloodipressuresiinitheiextremitiesimayi
be
present.iCoarctationiofitheiaortaicanialsoicauseisimilarisymptoms;ihowever,iitiwould
ibe
unlikelyidueitoitheipatient'siageiasithisiisiaicongenitalidefect.iMI,iPE,iandipericarditi
s
areialsoicommonicausesioficoncerningichestipain;ihowever,ineitheritypicallyiwillicau
se
asymmetricibloodipressuresioripulsesiinitheiextremities.
,Ai19-year-oldicarwashiattendantisustainediailacerationitoitheiulnariaspectiofihisimid-
forearmiwhileiatiworkilastiweek.iHeididinotihaveiitievaluatediatithatitimeiandiisinow
noticingipurulentidischargeiandiincreasingipainifromitheiwoundialongiwithifeverian
d
chills.iWhereiwoulditheiclinicianiexpectitoifinditheifirstisignsiofilymphadenopathy?i-
ANSWER-ia.iEpitrochlearinodes
,Rationale:iTheiepitrochlearinodesiareitheifirstinodesiinitheidrainageiregionifromithe
ulnarisurfaceiofitheiforearmiandihand,ilittleiandiringifingers,iandiadjacentisurfaceiofit
he
middleifinger.iAxillaryinodes,iinfraclavicularinodes,iandicervicalichaininodesiareiall
distalitoithisiareaiandimayishowievidenceiofilymphadenopathyiasiwell;ihowever,ithat
wouldibeisecondaryiafteritheiepitrochlearinodes.
Wheniassessingiforitheifemoralipulse,iwhereishoulditheiclinicianibeginideeply
palpating?i-iANSWER-
iC.iBelowitheiinguinaliligament,imidwayibetweenitheianterior
superioriiliacispineiandisymphysisipubis
Rationale:iTheiclinicianiwouldibeginideeplyipalpatingibelowitheiinguinaliligament,
midwayibetweenitheianteriorisuperioriiliacispineiinitheisymphysisipubis.iTheiextern
al
iliaciarteryitransitionsiintoitheifemoraliarteryiatitheileveliofitheiinguinaliligament.
Therefore,ipalpatingiaboveitheiinguinaliligamentiwouldibeiassessingitheiexternaliilia
c
artery.iTheifemoraliarteryiisitypicallyilocatedimidwayibetweenitheianteriorisuperioriil
iac
spineiinitheisymphysisipubisiinimostipatients.
Theiclinicianiisipalpatingipulsesiinitheifootiofiaidiabeticipatientiwhileiinitheiclinic.iA
strongipulseiisifeltilocatedionitheidorsumiofitheifoot,ijustilateralitoitheiextensoritendo
n
ofitheibigitoe.iWhichiarteryiisibeingiassessed?i-iANSWER-iC.iDorsalisipedis
, Rationale:iTheidorsalisipedisiarteryiisiusuallyipalpableionitheidorsumiofitheifootijust
lateralitoitheiextensoritendoniofitheibigitoe.iTheiarterialiarchiofitheifootiisimoreidistal
andirunsitransverselyiandiisinotiusuallyipalpable.iTheiposterioritibialiarteryiisifound
QUESTIONS AND GUARANTEED CORRECT
ANSWERS WITH RATIONALES ALREADY
GRADED A+.
Ai73-year-
oldiretiredisalesmanipresentsitoitheiEmergencyiDepartmenticomplainingiof
chestipainithatistartediabouti2ihoursiago.iElectrocardiogram,icardiacienzymes,iand
chestix-rayiareinormal.iTheinurseinotesithatihisibloodipressuresiinitheirightiarmiare
significantlyilowerithaniofibloodipressuresiinihisileftiarm.iBasedionihistoryiandiphysi
cal
examination,iwhichiofitheifollowingiwillimostilikelyiexplainihisisignsiandisymptoms
?i -
ANSWER-ia.iDissectingiaorticianeurysm
Rationale:iPatientsiwithidissectingiaorticianeurysmsitypicallyipresentiwithichestipai
n,
manyitimesidescribediasiai"tearing"itypeipain.iTheyiareiusuallyielderly,iand,idueitoit
he
dissectioniofitheiaorta,iasymmetricipulsesiinibloodipressuresiinitheiextremitiesimayi
be
present.iCoarctationiofitheiaortaicanialsoicauseisimilarisymptoms;ihowever,iitiwould
ibe
unlikelyidueitoitheipatient'siageiasithisiisiaicongenitalidefect.iMI,iPE,iandipericarditi
s
areialsoicommonicausesioficoncerningichestipain;ihowever,ineitheritypicallyiwillicau
se
asymmetricibloodipressuresioripulsesiinitheiextremities.
,Ai19-year-oldicarwashiattendantisustainediailacerationitoitheiulnariaspectiofihisimid-
forearmiwhileiatiworkilastiweek.iHeididinotihaveiitievaluatediatithatitimeiandiisinow
noticingipurulentidischargeiandiincreasingipainifromitheiwoundialongiwithifeverian
d
chills.iWhereiwoulditheiclinicianiexpectitoifinditheifirstisignsiofilymphadenopathy?i-
ANSWER-ia.iEpitrochlearinodes
,Rationale:iTheiepitrochlearinodesiareitheifirstinodesiinitheidrainageiregionifromithe
ulnarisurfaceiofitheiforearmiandihand,ilittleiandiringifingers,iandiadjacentisurfaceiofit
he
middleifinger.iAxillaryinodes,iinfraclavicularinodes,iandicervicalichaininodesiareiall
distalitoithisiareaiandimayishowievidenceiofilymphadenopathyiasiwell;ihowever,ithat
wouldibeisecondaryiafteritheiepitrochlearinodes.
Wheniassessingiforitheifemoralipulse,iwhereishoulditheiclinicianibeginideeply
palpating?i-iANSWER-
iC.iBelowitheiinguinaliligament,imidwayibetweenitheianterior
superioriiliacispineiandisymphysisipubis
Rationale:iTheiclinicianiwouldibeginideeplyipalpatingibelowitheiinguinaliligament,
midwayibetweenitheianteriorisuperioriiliacispineiinitheisymphysisipubis.iTheiextern
al
iliaciarteryitransitionsiintoitheifemoraliarteryiatitheileveliofitheiinguinaliligament.
Therefore,ipalpatingiaboveitheiinguinaliligamentiwouldibeiassessingitheiexternaliilia
c
artery.iTheifemoraliarteryiisitypicallyilocatedimidwayibetweenitheianteriorisuperioriil
iac
spineiinitheisymphysisipubisiinimostipatients.
Theiclinicianiisipalpatingipulsesiinitheifootiofiaidiabeticipatientiwhileiinitheiclinic.iA
strongipulseiisifeltilocatedionitheidorsumiofitheifoot,ijustilateralitoitheiextensoritendo
n
ofitheibigitoe.iWhichiarteryiisibeingiassessed?i-iANSWER-iC.iDorsalisipedis
, Rationale:iTheidorsalisipedisiarteryiisiusuallyipalpableionitheidorsumiofitheifootijust
lateralitoitheiextensoritendoniofitheibigitoe.iTheiarterialiarchiofitheifootiisimoreidistal
andirunsitransverselyiandiisinotiusuallyipalpable.iTheiposterioritibialiarteryiisifound
