APEA 3P
Predictor Exam
Test Bank Questions
2025/2026 Edition
50 Questions
Detailed Explanations & Clinical Pearls
CARDIOVASCULAR SYSTEM
Questions 1-10
Question 1
A 65-year-old male presents with crushing substernal chest pain radiating to the
left arm. His ECG shows ST-segment elevation in leads II, III, and aVF. What is the
most likely diagnosis?
A) Anterior wall MI
B) Inferior wall MI
C) Lateral wall MI
D) Posterior wall MI
💡 EXPLANATION
Inferior wall MI presents with ST elevation in leads II, III, and aVF (inferior leads). These leads reflect the
inferior surface of the heart, typically supplied by the right coronary artery (RCA). Associated findings may
include bradycardia and heart blocks.
⚠️ CRITICAL ACTION
Activate STEMI protocol immediately. Time to reperfusion is critical. Check for right ventricular involvement (V4R
lead) as IV fluids, not nitrates, are needed for RV infarction.
Question 2
What is the first-line medication for treating hypertension in an African American
patient without diabetes?
A) ACE inhibitor
B) ARB
, C) Calcium channel blocker or thiazide diuretic
D) Beta-blocker
💡 EXPLANATION
Per JNC-8 guidelines, calcium channel blockers or thiazide diuretics are first-line for African American
patients without CKD. This population has lower renin levels and responds better to these agents than
ACE inhibitors or ARBs.
✓ CLINICAL PEARL
If patient has diabetes or CKD, then ACE inhibitor or ARB becomes first-line regardless of race due to renoprotective
effects.
Question 3
A patient with atrial fibrillation has a CHA2DS2-VASc score of 3. What is the
recommended treatment?
A) Aspirin only
B) No anticoagulation needed
C) Oral anticoagulation (warfarin or DOAC)
D) Aspirin plus clopidogrel
💡 EXPLANATION
CHA2DS2-VASc score ≥2 in males or ≥3 in females indicates need for oral anticoagulation. DOACs
(apixaban, rivaroxaban, edoxaban, dabigatran) are preferred over warfarin due to lower bleeding risk and
no need for INR monitoring. Score of 3 represents significant stroke risk.
Question 4
What is the primary mechanism of action of statins?
A) Inhibit cholesterol absorption
B) Increase HDL production
C) Inhibit HMG-CoA reductase
D) Bind bile acids
💡 EXPLANATION
Statins work by inhibiting HMG-CoA reductase, the rate-limiting enzyme in cholesterol synthesis. This
decreases hepatic cholesterol production, causing upregulation of LDL receptors and increased LDL
clearance from blood. Also have pleiotropic anti-inflammatory effects.
⚠️ MONITORING
Check baseline LFTs and CK. Monitor for myalgias (rhabdomyolysis risk). Avoid grapefruit juice with certain statins
(increases drug levels).
Question 5
Predictor Exam
Test Bank Questions
2025/2026 Edition
50 Questions
Detailed Explanations & Clinical Pearls
CARDIOVASCULAR SYSTEM
Questions 1-10
Question 1
A 65-year-old male presents with crushing substernal chest pain radiating to the
left arm. His ECG shows ST-segment elevation in leads II, III, and aVF. What is the
most likely diagnosis?
A) Anterior wall MI
B) Inferior wall MI
C) Lateral wall MI
D) Posterior wall MI
💡 EXPLANATION
Inferior wall MI presents with ST elevation in leads II, III, and aVF (inferior leads). These leads reflect the
inferior surface of the heart, typically supplied by the right coronary artery (RCA). Associated findings may
include bradycardia and heart blocks.
⚠️ CRITICAL ACTION
Activate STEMI protocol immediately. Time to reperfusion is critical. Check for right ventricular involvement (V4R
lead) as IV fluids, not nitrates, are needed for RV infarction.
Question 2
What is the first-line medication for treating hypertension in an African American
patient without diabetes?
A) ACE inhibitor
B) ARB
, C) Calcium channel blocker or thiazide diuretic
D) Beta-blocker
💡 EXPLANATION
Per JNC-8 guidelines, calcium channel blockers or thiazide diuretics are first-line for African American
patients without CKD. This population has lower renin levels and responds better to these agents than
ACE inhibitors or ARBs.
✓ CLINICAL PEARL
If patient has diabetes or CKD, then ACE inhibitor or ARB becomes first-line regardless of race due to renoprotective
effects.
Question 3
A patient with atrial fibrillation has a CHA2DS2-VASc score of 3. What is the
recommended treatment?
A) Aspirin only
B) No anticoagulation needed
C) Oral anticoagulation (warfarin or DOAC)
D) Aspirin plus clopidogrel
💡 EXPLANATION
CHA2DS2-VASc score ≥2 in males or ≥3 in females indicates need for oral anticoagulation. DOACs
(apixaban, rivaroxaban, edoxaban, dabigatran) are preferred over warfarin due to lower bleeding risk and
no need for INR monitoring. Score of 3 represents significant stroke risk.
Question 4
What is the primary mechanism of action of statins?
A) Inhibit cholesterol absorption
B) Increase HDL production
C) Inhibit HMG-CoA reductase
D) Bind bile acids
💡 EXPLANATION
Statins work by inhibiting HMG-CoA reductase, the rate-limiting enzyme in cholesterol synthesis. This
decreases hepatic cholesterol production, causing upregulation of LDL receptors and increased LDL
clearance from blood. Also have pleiotropic anti-inflammatory effects.
⚠️ MONITORING
Check baseline LFTs and CK. Monitor for myalgias (rhabdomyolysis risk). Avoid grapefruit juice with certain statins
(increases drug levels).
Question 5
