APEA 3P Exam – Practice Test (120 Questions)|
2026 MUST KNOW QUESTIONS WITH
ANSWERS AND RATIONALES A+ GRADED
Section 1: Primary Care – Adult/Gerontology
1. A 68-year-old man with hypertension and DM type 2 reports new-onset nocturia and weak urinary
stream. Prostate exam reveals a smooth, symmetrically enlarged gland. What is the most appropriate
next step?
A. PSA testing
B. Transrectal ultrasound
C. Urinalysis and post-void residual (PVR)
D. Cystoscopy
Rationale:
Correct = C. Initial BPH evaluation includes history, exam, urinalysis (to r/o infection/hematuria), and
PVR (assesses retention). PSA is controversial for screening but not initial mandatory.
Ultrasound/cystoscopy are secondary if refractory or abnormal.
2. A 45-year-old woman presents with fatigue, arthralgias, malar rash, and oral ulcers. Labs: ANA
positive, anti-dsDNA positive. Which medication is first-line for moderate disease without major organ
involvement?
A. Methotrexate
B. Hydroxychloroquine
C. Cyclophosphamide
D. Prednisone alone
Rationale:
Correct = B. Hydroxychloroquine is first-line for SLE without life-threatening organ involvement
(skin/joints/serositis). Cyclophosphamide for severe lupus nephritis. Prednisone alone not preferred
long-term.
,3. A 72-year-old with CKD stage 3 has a BP of 150/92 mmHg. Which antihypertensive is preferred for
renal protection?
A. HCTZ
B. Amlodipine
C. Lisinopril
D. Metoprolol
Rationale:
Correct = C. ACE inhibitors (or ARBs) slow CKD progression, reduce proteinuria. HCTZ less effective in
CKD. Amlodipine good but not renoprotective. Metoprolol not first-line in CKD without HF.
4. A 55-year-old obese woman reports right upper quadrant pain after fatty meals. Ultrasound shows
gallstones. What is definitive management?
A. Ursodeoxycholic acid
B. Laparoscopic cholecystectomy
C. ERCP with sphincterotomy
D. Low-fat diet alone
Rationale:
Correct = B. Symptomatic cholelithiasis → cholecystectomy. Ursodiol only for small cholesterol stones in
non-surgical candidates. ERCP for choledocholithiasis.
5. A 30-year-old with recurrent headaches describes unilateral, throbbing pain with nausea,
photophobia, and aura. Best acute treatment?
A. Naproxen
B. Sumatriptan
C. Acetaminophen
D. Propranolol
, Rationale:
Correct = B. Migraine with aura – triptans are first-line for acute moderate-severe attacks. Propranolol is
preventive. Naproxen can be adjunct but not primary for severe.
(Questions 6–10 compressed for space – pattern continues similarly)
6. Which vaccine is routinely recommended for all adults ≥65 years?
A. PCV13
B. PPSV23
C. MMR
D. Varicella
Rationale: PPSV23 recommended at 65. PCV13 only if immunocompromised or CSF leak.
7. A 48-year-old male smoker has a 2-week history of productive cough, fever, and crackles in left lower
lobe. CXR shows infiltrate. Best initial antibiotic?
A. Doxycycline
B. Amoxicillin
C. Azithromycin
D. Levofloxacin
Rationale: Outpatient CAP without comorbidities → amoxicillin or doxycycline/macrolide. Amoxicillin is
first-line per guidelines.
8. A 60-year-old with diabetes has a non-healing ulcer on the plantar foot, 2 cm, no erythema, probe-to-
bone positive. What is the most likely diagnosis?
A. Neuropathic ulcer
B. Osteomyelitis
C. Arterial ulcer
D. Venous stasis ulcer
Rationale: Probe-to-bone positive → high likelihood of osteomyelitis. MRI or bone biopsy for
confirmation.
2026 MUST KNOW QUESTIONS WITH
ANSWERS AND RATIONALES A+ GRADED
Section 1: Primary Care – Adult/Gerontology
1. A 68-year-old man with hypertension and DM type 2 reports new-onset nocturia and weak urinary
stream. Prostate exam reveals a smooth, symmetrically enlarged gland. What is the most appropriate
next step?
A. PSA testing
B. Transrectal ultrasound
C. Urinalysis and post-void residual (PVR)
D. Cystoscopy
Rationale:
Correct = C. Initial BPH evaluation includes history, exam, urinalysis (to r/o infection/hematuria), and
PVR (assesses retention). PSA is controversial for screening but not initial mandatory.
Ultrasound/cystoscopy are secondary if refractory or abnormal.
2. A 45-year-old woman presents with fatigue, arthralgias, malar rash, and oral ulcers. Labs: ANA
positive, anti-dsDNA positive. Which medication is first-line for moderate disease without major organ
involvement?
A. Methotrexate
B. Hydroxychloroquine
C. Cyclophosphamide
D. Prednisone alone
Rationale:
Correct = B. Hydroxychloroquine is first-line for SLE without life-threatening organ involvement
(skin/joints/serositis). Cyclophosphamide for severe lupus nephritis. Prednisone alone not preferred
long-term.
,3. A 72-year-old with CKD stage 3 has a BP of 150/92 mmHg. Which antihypertensive is preferred for
renal protection?
A. HCTZ
B. Amlodipine
C. Lisinopril
D. Metoprolol
Rationale:
Correct = C. ACE inhibitors (or ARBs) slow CKD progression, reduce proteinuria. HCTZ less effective in
CKD. Amlodipine good but not renoprotective. Metoprolol not first-line in CKD without HF.
4. A 55-year-old obese woman reports right upper quadrant pain after fatty meals. Ultrasound shows
gallstones. What is definitive management?
A. Ursodeoxycholic acid
B. Laparoscopic cholecystectomy
C. ERCP with sphincterotomy
D. Low-fat diet alone
Rationale:
Correct = B. Symptomatic cholelithiasis → cholecystectomy. Ursodiol only for small cholesterol stones in
non-surgical candidates. ERCP for choledocholithiasis.
5. A 30-year-old with recurrent headaches describes unilateral, throbbing pain with nausea,
photophobia, and aura. Best acute treatment?
A. Naproxen
B. Sumatriptan
C. Acetaminophen
D. Propranolol
, Rationale:
Correct = B. Migraine with aura – triptans are first-line for acute moderate-severe attacks. Propranolol is
preventive. Naproxen can be adjunct but not primary for severe.
(Questions 6–10 compressed for space – pattern continues similarly)
6. Which vaccine is routinely recommended for all adults ≥65 years?
A. PCV13
B. PPSV23
C. MMR
D. Varicella
Rationale: PPSV23 recommended at 65. PCV13 only if immunocompromised or CSF leak.
7. A 48-year-old male smoker has a 2-week history of productive cough, fever, and crackles in left lower
lobe. CXR shows infiltrate. Best initial antibiotic?
A. Doxycycline
B. Amoxicillin
C. Azithromycin
D. Levofloxacin
Rationale: Outpatient CAP without comorbidities → amoxicillin or doxycycline/macrolide. Amoxicillin is
first-line per guidelines.
8. A 60-year-old with diabetes has a non-healing ulcer on the plantar foot, 2 cm, no erythema, probe-to-
bone positive. What is the most likely diagnosis?
A. Neuropathic ulcer
B. Osteomyelitis
C. Arterial ulcer
D. Venous stasis ulcer
Rationale: Probe-to-bone positive → high likelihood of osteomyelitis. MRI or bone biopsy for
confirmation.
