NSG 6998 APEA Pre-Predictor Exam | South
University 2025/2026 Edition | 150 Real Q&A
Section 1: Cardiology & Vascular (Questions 1-15)
1. A 58-year-old male presents with chest pressure that occurs during exertion and resolves
with rest. He has a 40-pack-year smoking history. What is the most likely diagnosis?
A. Stable Angina
B. Unstable Angina
C. Pericarditis
D. Aortic Stenosis
Answer: A. Stable Angina
Explanation: Stable angina is characterized by chest pain triggered by physical exertion or
emotional stress and relieved by rest or nitroglycerin. Unstable angina occurs at rest.
Pericarditis pain is typically positional (worse lying down). Aortic stenosis may cause exertional
syncope, not necessarily pain relieved by rest.
2. On auscultation, you hear a high-pitched, blowing, decrescendo diastolic murmur best
heard at the left sternal border. Which valvular lesion is most likely?
A. Mitral Stenosis
B. Aortic Stenosis
C. Aortic Regurgitation
D. Mitral Regurgitation
Answer: C. Aortic Regurgitation
Explanation: Aortic regurgitation produces a high-pitched, blowing, decrescendo diastolic
murmur best heard at the left sternal border (Erb's point). Mitral stenosis is a low-pitched
diastolic rumble. Aortic stenosis is a systolic ejection murmur. Mitral regurgitation is a
pansystolic murmur.
3. A patient presents with acute onset of unilateral leg swelling, warmth, and tenderness in
the calf. Homan's sign is positive. What is the initial diagnostic test of choice?
A. D-dimer
B. Venous duplex ultrasound
C. CT angiography of the lower extremities
D. Venography
Answer: B. Venous duplex ultrasound
Explanation: While a D-dimer is a sensitive screening test, the confirmatory and initial
diagnostic test of choice for suspected DVT is venous duplex ultrasound. It is non-invasive and
identifies the location and extent of the clot.
4. A 72-year-old female reports "dizziness" every time she stands up from her chair. Her BP is
130/80 supine and 100/60 standing. What is the pathophysiology of this condition?
A. Inability of the heart to increase contractility
B. Failure of the autonomic nervous system to compensate for gravitational shifts
C. Vasovagal response to pain
D. Carotid sinus hypersensitivity
Answer: B. Failure of the autonomic nervous system to compensate for gravitational shifts
Explanation: This describes orthostatic hypotension, defined by a drop in systolic BP >20
Page 1 of 30
,mmHg or diastolic >10 mmHg upon standing. It results from autonomic nervous system
dysfunction that fails to appropriately vasoconstrict and increase heart rate to maintain
cerebral perfusion.
5. What ECG finding is most characteristic of pericarditis?
A. ST-segment elevation in a diffuse, concave-up pattern
B. ST-segment depression in the precordial leads
C. Pathological Q waves
D. Peaked T waves
Answer: A. ST-segment elevation in a diffuse, concave-up pattern
Explanation: Pericarditis classically presents with diffuse ST elevations (concave upward) and
PR depressions across most leads, without the reciprocal changes seen in myocardial
infarction.
6. A patient with a history of hypertension presents with a blood pressure of 185/110 mmHg
but denies any symptoms. What is the appropriate next step?
A. Admit to ICU for IV nitroprusside
B. Administer sublingual nifedipine immediately
C. Administer oral antihypertensive and schedule follow-up in 24 hours
D. Recheck BP in 5 minutes; if unchanged, start oral agent and manage as outpatient
Answer: D. Recheck BP in 5 minutes; if unchanged, start oral agent and manage as outpatient
Explanation: This is asymptomatic hypertensive urgency. Rapid lowering of BP in
asymptomatic patients is dangerous (can cause stroke/MI). The patient should have BP
rechecked, oral antihypertensive initiated, and outpatient follow-up arranged.
7. The JVP is elevated to 12 cm H2O. You note a prominent "v" wave. This is most suggestive
of:
A. Tricuspid regurgitation
B. Cardiac tamponade
C. Constrictive pericarditis
D. Right ventricular failure
Answer: A. Tricuspid regurgitation
Explanation: A prominent "v" wave (cannon wave) in the JVP occurs due to backflow of blood
into the right atrium during ventricular systole, pathognomonic for tricuspid regurgitation.
8. A 55-year-old male presents with claudication of the left calf after walking one block,
relieved by rest. Femoral pulses are 2+ bilaterally, but the left dorsalis pedis is absent. What
is the most likely finding on the ankle-brachial index (ABI)?
A. >1.3
B. 1.0 – 1.2
C. 0.5 – 0.9
D. <0.4
Answer: C. 0.5 – 0.9
Explanation: An ABI of 0.5-0.9 is consistent with mild to moderate peripheral artery disease
(PAD) causing claudication. An ABI >1.3 suggests non-compressible vessels (calcification). <0.4
suggests severe PAD/rest pain.
9. Which of the following is a first-line medication for chronic heart failure with reduced
ejection fraction (HFrEF)?
A. Metoprolol succinate
B. Metoprolol tartrate
C. Diltiazem
D. Digoxin
Page 2 of 30
, Answer: A. Metoprolol succinate
Explanation: Beta-blockers proven to reduce mortality in HFrEF are carvedilol, metoprolol
succinate (extended release), and bisoprolol. Metoprolol tartrate (short-acting) is not indicated
for HF.
10. A 35-year-old woman presents with palpitations. ECG shows irregularly irregular rhythm
with no discernible P waves. What is the best initial treatment for rate control in a
hemodynamically stable patient?
A. Amiodarone
B. Synchronized cardioversion
C. Metoprolol
D. Aspirin
Answer: C. Metoprolol
Explanation: This is atrial fibrillation. In a stable patient, rate control is achieved with beta-
blockers (metoprolol) or calcium channel blockers. Cardioversion is for unstable patients or
those with new-onset AF.
11. What is the hallmark physical exam finding of hypertrophic cardiomyopathy?
A. Fixed split S2
B. Opening snap
C. Harsh systolic murmur that increases with Valsalva
D. Pericardial friction rub
Answer: C. Harsh systolic murmur that increases with Valsalva
Explanation: The murmur of hypertrophic obstructive cardiomyopathy (HOCM) is a systolic
murmur that increases with maneuvers that decrease preload (Valsalva, standing) and
decreases with handgrip or squatting.
12. A patient presents with tearing chest pain radiating to the back. BP is 160/90 in the right
arm and 110/70 in the left arm. What is the priority diagnostic test?
A. ECG
B. Chest X-ray
C. CT angiography of the chest
D. Transthoracic echocardiogram
Answer: C. CT angiography of the chest
Explanation: The presentation is classic for aortic dissection. CTA of the chest is the gold
standard for diagnosis, allowing visualization of the intimal flap and extent of the dissection.
13. S4 heart sound (atrial gallop) is most commonly associated with:
A. Heart failure
B. Hypertension and ventricular hypertrophy
C. Mitral valve prolapse
D. Pulmonary hypertension
Answer: B. Hypertension and ventricular hypertrophy
Explanation: An S4 occurs during atrial contraction against a non-compliant, hypertrophied
ventricle. It is commonly heard in hypertension, aortic stenosis, and hypertrophic
cardiomyopathy.
14. Which lipid-lowering medication has been shown to provide the most significant
reduction in cardiovascular mortality and is first-line for secondary prevention?
A. Ezetimibe
B. Fenofibrate
C. Atorvastatin
D. Niacin
Page 3 of 30
University 2025/2026 Edition | 150 Real Q&A
Section 1: Cardiology & Vascular (Questions 1-15)
1. A 58-year-old male presents with chest pressure that occurs during exertion and resolves
with rest. He has a 40-pack-year smoking history. What is the most likely diagnosis?
A. Stable Angina
B. Unstable Angina
C. Pericarditis
D. Aortic Stenosis
Answer: A. Stable Angina
Explanation: Stable angina is characterized by chest pain triggered by physical exertion or
emotional stress and relieved by rest or nitroglycerin. Unstable angina occurs at rest.
Pericarditis pain is typically positional (worse lying down). Aortic stenosis may cause exertional
syncope, not necessarily pain relieved by rest.
2. On auscultation, you hear a high-pitched, blowing, decrescendo diastolic murmur best
heard at the left sternal border. Which valvular lesion is most likely?
A. Mitral Stenosis
B. Aortic Stenosis
C. Aortic Regurgitation
D. Mitral Regurgitation
Answer: C. Aortic Regurgitation
Explanation: Aortic regurgitation produces a high-pitched, blowing, decrescendo diastolic
murmur best heard at the left sternal border (Erb's point). Mitral stenosis is a low-pitched
diastolic rumble. Aortic stenosis is a systolic ejection murmur. Mitral regurgitation is a
pansystolic murmur.
3. A patient presents with acute onset of unilateral leg swelling, warmth, and tenderness in
the calf. Homan's sign is positive. What is the initial diagnostic test of choice?
A. D-dimer
B. Venous duplex ultrasound
C. CT angiography of the lower extremities
D. Venography
Answer: B. Venous duplex ultrasound
Explanation: While a D-dimer is a sensitive screening test, the confirmatory and initial
diagnostic test of choice for suspected DVT is venous duplex ultrasound. It is non-invasive and
identifies the location and extent of the clot.
4. A 72-year-old female reports "dizziness" every time she stands up from her chair. Her BP is
130/80 supine and 100/60 standing. What is the pathophysiology of this condition?
A. Inability of the heart to increase contractility
B. Failure of the autonomic nervous system to compensate for gravitational shifts
C. Vasovagal response to pain
D. Carotid sinus hypersensitivity
Answer: B. Failure of the autonomic nervous system to compensate for gravitational shifts
Explanation: This describes orthostatic hypotension, defined by a drop in systolic BP >20
Page 1 of 30
,mmHg or diastolic >10 mmHg upon standing. It results from autonomic nervous system
dysfunction that fails to appropriately vasoconstrict and increase heart rate to maintain
cerebral perfusion.
5. What ECG finding is most characteristic of pericarditis?
A. ST-segment elevation in a diffuse, concave-up pattern
B. ST-segment depression in the precordial leads
C. Pathological Q waves
D. Peaked T waves
Answer: A. ST-segment elevation in a diffuse, concave-up pattern
Explanation: Pericarditis classically presents with diffuse ST elevations (concave upward) and
PR depressions across most leads, without the reciprocal changes seen in myocardial
infarction.
6. A patient with a history of hypertension presents with a blood pressure of 185/110 mmHg
but denies any symptoms. What is the appropriate next step?
A. Admit to ICU for IV nitroprusside
B. Administer sublingual nifedipine immediately
C. Administer oral antihypertensive and schedule follow-up in 24 hours
D. Recheck BP in 5 minutes; if unchanged, start oral agent and manage as outpatient
Answer: D. Recheck BP in 5 minutes; if unchanged, start oral agent and manage as outpatient
Explanation: This is asymptomatic hypertensive urgency. Rapid lowering of BP in
asymptomatic patients is dangerous (can cause stroke/MI). The patient should have BP
rechecked, oral antihypertensive initiated, and outpatient follow-up arranged.
7. The JVP is elevated to 12 cm H2O. You note a prominent "v" wave. This is most suggestive
of:
A. Tricuspid regurgitation
B. Cardiac tamponade
C. Constrictive pericarditis
D. Right ventricular failure
Answer: A. Tricuspid regurgitation
Explanation: A prominent "v" wave (cannon wave) in the JVP occurs due to backflow of blood
into the right atrium during ventricular systole, pathognomonic for tricuspid regurgitation.
8. A 55-year-old male presents with claudication of the left calf after walking one block,
relieved by rest. Femoral pulses are 2+ bilaterally, but the left dorsalis pedis is absent. What
is the most likely finding on the ankle-brachial index (ABI)?
A. >1.3
B. 1.0 – 1.2
C. 0.5 – 0.9
D. <0.4
Answer: C. 0.5 – 0.9
Explanation: An ABI of 0.5-0.9 is consistent with mild to moderate peripheral artery disease
(PAD) causing claudication. An ABI >1.3 suggests non-compressible vessels (calcification). <0.4
suggests severe PAD/rest pain.
9. Which of the following is a first-line medication for chronic heart failure with reduced
ejection fraction (HFrEF)?
A. Metoprolol succinate
B. Metoprolol tartrate
C. Diltiazem
D. Digoxin
Page 2 of 30
, Answer: A. Metoprolol succinate
Explanation: Beta-blockers proven to reduce mortality in HFrEF are carvedilol, metoprolol
succinate (extended release), and bisoprolol. Metoprolol tartrate (short-acting) is not indicated
for HF.
10. A 35-year-old woman presents with palpitations. ECG shows irregularly irregular rhythm
with no discernible P waves. What is the best initial treatment for rate control in a
hemodynamically stable patient?
A. Amiodarone
B. Synchronized cardioversion
C. Metoprolol
D. Aspirin
Answer: C. Metoprolol
Explanation: This is atrial fibrillation. In a stable patient, rate control is achieved with beta-
blockers (metoprolol) or calcium channel blockers. Cardioversion is for unstable patients or
those with new-onset AF.
11. What is the hallmark physical exam finding of hypertrophic cardiomyopathy?
A. Fixed split S2
B. Opening snap
C. Harsh systolic murmur that increases with Valsalva
D. Pericardial friction rub
Answer: C. Harsh systolic murmur that increases with Valsalva
Explanation: The murmur of hypertrophic obstructive cardiomyopathy (HOCM) is a systolic
murmur that increases with maneuvers that decrease preload (Valsalva, standing) and
decreases with handgrip or squatting.
12. A patient presents with tearing chest pain radiating to the back. BP is 160/90 in the right
arm and 110/70 in the left arm. What is the priority diagnostic test?
A. ECG
B. Chest X-ray
C. CT angiography of the chest
D. Transthoracic echocardiogram
Answer: C. CT angiography of the chest
Explanation: The presentation is classic for aortic dissection. CTA of the chest is the gold
standard for diagnosis, allowing visualization of the intimal flap and extent of the dissection.
13. S4 heart sound (atrial gallop) is most commonly associated with:
A. Heart failure
B. Hypertension and ventricular hypertrophy
C. Mitral valve prolapse
D. Pulmonary hypertension
Answer: B. Hypertension and ventricular hypertrophy
Explanation: An S4 occurs during atrial contraction against a non-compliant, hypertrophied
ventricle. It is commonly heard in hypertension, aortic stenosis, and hypertrophic
cardiomyopathy.
14. Which lipid-lowering medication has been shown to provide the most significant
reduction in cardiovascular mortality and is first-line for secondary prevention?
A. Ezetimibe
B. Fenofibrate
C. Atorvastatin
D. Niacin
Page 3 of 30
