APEA PRE-PREDICTOR EXAM COMPLETE
EXAM QUESTIONS WITH 100% VERIFIED
ANSWERS
1. A patient presents with sudden, severe “tearing” chest pain radiating to the
back, with a difference in blood pressure between arms. What is the most likely
diagnosis?
A) Acute coronary syndrome
B) Pulmonary embolism
C) Aortic dissection
D) Aortic dissection
Rationale: Aortic dissection classically causes sudden, severe tearing chest pain
radiating to the back, often with a pulse or BP differential between arms. ACS is
more pressure-like; PE causes pleuritic pain and hypoxia.
2. A 45-year-old male has a BMI of 32, hypertension, and fasting glucose of 115
mg/dL. Which medication is first-line for his condition to reduce cardiovascular
risk?
A) Metformin
B) Lisinopril
C) Atorvastatin
D) Metformin
Rationale: Metformin is first-line for prediabetes (impaired fasting glucose) with
obesity to prevent progression to diabetes and reduce CV risk. Lisinopril treats HTN
but not the primary dysglycemia; atorvastatin is for lipids.
,3. A child presents with a barking cough, stridor, and subcostal retractions. The
most likely diagnosis is:
A) Bronchiolitis
B) Epiglottitis
C) Croup
D) Bacterial tracheitis
Rationale: Croup (laryngotracheobronchitis) causes barking cough, stridor, and
retractions, typically viral. Epiglottitis causes drooling and tripod positioning;
bronchiolitis causes wheezing.
4. Which EKG finding is most specific for pericarditis?
A) ST elevation in a single lead
B) Diffuse PR depression
C) Diffuse ST elevation with PR depression
D) Q waves
Rationale: Pericarditis shows diffuse ST elevation and PR depression (early
repolarization mimics but lacks PR changes). Q waves suggest prior MI.
5. A 68-year-old woman with osteoporosis is started on alendronate. What
instruction is most important?
A) Take with orange juice
B) Take at bedtime
C) Take with a full glass of water after waking, remain upright for 30 minutes
D) Take with a full glass of water after waking, remain upright for 30 minutes
Rationale: Alendronate must be taken on an empty stomach with water, upright
for 30 min to prevent esophagitis. Bedtime or with juice increases reflux risk.
6. A patient with COPD has an FEV1/FVC ratio of 0.65 and FEV1 50% of predicted.
What is the GOLD stage?
A) 1
,B) 2
C) 3
D) 4
*Rationale: GOLD stage 3 = FEV1 30-50% predicted. Stage 2 = 50-80%; stage 4
<30%. Fixed ratio <0.70 confirms obstruction.*
7. Which finding on urinalysis most suggests glomerulonephritis rather than a
UTI?
A) Leukocyte esterase positive
B) Nitrite positive
C) Dysmorphic RBCs and RBC casts
D) Dysmorphic RBCs and RBC casts
Rationale: Dysmorphic RBCs and RBC casts indicate glomerular bleeding.
Leukocyte esterase/nitrite suggest infection.
8. A 32-year-old female has episodic palpitations, sweating, headache, and
hypertension. Which test is initial best?
A) Thyroid function tests
B) 24-hour urine metanephrines
C) Plasma free metanephrines
D) Serum cortisol
*Rationale: Plasma free metanephrines is first-line for pheochromocytoma
(paroxysmal HTN, headache, sweating, palpitations). 24h urine is alternative but
less convenient.*
9. A newborn fails to pass meconium in 48 hours, has abdominal distension, and
bilious vomiting. Next step?
A) Rectal stimulation
B) Barium enema
C) Immediate surgical consult
, D) Oral feeds trial
Rationale: Suspect Hirschsprung disease or intestinal atresia; bilious vomiting in
newborn is surgical emergency until proven otherwise. Rectal stimulation may
help meconium plug but not with bilious vomiting.
10. A 55-year-old with diabetes has a non-healing ulcer on the plantar foot,
probing to bone. What is the best initial imaging?
A) MRI
B) Plain radiograph
C) CT angiography
D) Ultrasound
Rationale: Plain radiograph can show osteomyelitis (bone destruction, gas) and is
first-line. MRI is more sensitive but not initial. Probing to bone suggests
osteomyelitis.
11. Which vaccine is contraindicated in pregnancy?
A) Tdap
B) Influenza inactivated
C) MMR
D) Hep B
Rationale: MMR is live-attenuated, contraindicated in pregnancy due to
theoretical fetal risk. Tdap, inactivated flu, Hep B are safe.
12. A patient on warfarin has INR 5.0 without bleeding. Management?
A) IV vitamin K 10 mg
B) Hold warfarin, give oral vitamin K 1-2.5 mg
C) Give FFP immediately
D) Increase warfarin dose
*Rationale: For INR 4.5-10 without bleeding: hold warfarin, low-dose oral vitamin
K (1-2.5 mg). IV vitamin K for higher INR or bleeding.*
EXAM QUESTIONS WITH 100% VERIFIED
ANSWERS
1. A patient presents with sudden, severe “tearing” chest pain radiating to the
back, with a difference in blood pressure between arms. What is the most likely
diagnosis?
A) Acute coronary syndrome
B) Pulmonary embolism
C) Aortic dissection
D) Aortic dissection
Rationale: Aortic dissection classically causes sudden, severe tearing chest pain
radiating to the back, often with a pulse or BP differential between arms. ACS is
more pressure-like; PE causes pleuritic pain and hypoxia.
2. A 45-year-old male has a BMI of 32, hypertension, and fasting glucose of 115
mg/dL. Which medication is first-line for his condition to reduce cardiovascular
risk?
A) Metformin
B) Lisinopril
C) Atorvastatin
D) Metformin
Rationale: Metformin is first-line for prediabetes (impaired fasting glucose) with
obesity to prevent progression to diabetes and reduce CV risk. Lisinopril treats HTN
but not the primary dysglycemia; atorvastatin is for lipids.
,3. A child presents with a barking cough, stridor, and subcostal retractions. The
most likely diagnosis is:
A) Bronchiolitis
B) Epiglottitis
C) Croup
D) Bacterial tracheitis
Rationale: Croup (laryngotracheobronchitis) causes barking cough, stridor, and
retractions, typically viral. Epiglottitis causes drooling and tripod positioning;
bronchiolitis causes wheezing.
4. Which EKG finding is most specific for pericarditis?
A) ST elevation in a single lead
B) Diffuse PR depression
C) Diffuse ST elevation with PR depression
D) Q waves
Rationale: Pericarditis shows diffuse ST elevation and PR depression (early
repolarization mimics but lacks PR changes). Q waves suggest prior MI.
5. A 68-year-old woman with osteoporosis is started on alendronate. What
instruction is most important?
A) Take with orange juice
B) Take at bedtime
C) Take with a full glass of water after waking, remain upright for 30 minutes
D) Take with a full glass of water after waking, remain upright for 30 minutes
Rationale: Alendronate must be taken on an empty stomach with water, upright
for 30 min to prevent esophagitis. Bedtime or with juice increases reflux risk.
6. A patient with COPD has an FEV1/FVC ratio of 0.65 and FEV1 50% of predicted.
What is the GOLD stage?
A) 1
,B) 2
C) 3
D) 4
*Rationale: GOLD stage 3 = FEV1 30-50% predicted. Stage 2 = 50-80%; stage 4
<30%. Fixed ratio <0.70 confirms obstruction.*
7. Which finding on urinalysis most suggests glomerulonephritis rather than a
UTI?
A) Leukocyte esterase positive
B) Nitrite positive
C) Dysmorphic RBCs and RBC casts
D) Dysmorphic RBCs and RBC casts
Rationale: Dysmorphic RBCs and RBC casts indicate glomerular bleeding.
Leukocyte esterase/nitrite suggest infection.
8. A 32-year-old female has episodic palpitations, sweating, headache, and
hypertension. Which test is initial best?
A) Thyroid function tests
B) 24-hour urine metanephrines
C) Plasma free metanephrines
D) Serum cortisol
*Rationale: Plasma free metanephrines is first-line for pheochromocytoma
(paroxysmal HTN, headache, sweating, palpitations). 24h urine is alternative but
less convenient.*
9. A newborn fails to pass meconium in 48 hours, has abdominal distension, and
bilious vomiting. Next step?
A) Rectal stimulation
B) Barium enema
C) Immediate surgical consult
, D) Oral feeds trial
Rationale: Suspect Hirschsprung disease or intestinal atresia; bilious vomiting in
newborn is surgical emergency until proven otherwise. Rectal stimulation may
help meconium plug but not with bilious vomiting.
10. A 55-year-old with diabetes has a non-healing ulcer on the plantar foot,
probing to bone. What is the best initial imaging?
A) MRI
B) Plain radiograph
C) CT angiography
D) Ultrasound
Rationale: Plain radiograph can show osteomyelitis (bone destruction, gas) and is
first-line. MRI is more sensitive but not initial. Probing to bone suggests
osteomyelitis.
11. Which vaccine is contraindicated in pregnancy?
A) Tdap
B) Influenza inactivated
C) MMR
D) Hep B
Rationale: MMR is live-attenuated, contraindicated in pregnancy due to
theoretical fetal risk. Tdap, inactivated flu, Hep B are safe.
12. A patient on warfarin has INR 5.0 without bleeding. Management?
A) IV vitamin K 10 mg
B) Hold warfarin, give oral vitamin K 1-2.5 mg
C) Give FFP immediately
D) Increase warfarin dose
*Rationale: For INR 4.5-10 without bleeding: hold warfarin, low-dose oral vitamin
K (1-2.5 mg). IV vitamin K for higher INR or bleeding.*
