2026 APEA 3P
PREDICTOR
ACTUAL EXAM + STUDY GUIDE
High-Yield Qs & Verified Answers
with Rationales
What You’ll Receive (Digital Download)
Predictor-style exam (mock exam)
150 High-yield 3P questions
Answer rationales for deeper understanding
Study guide sections for quick review + recall
Printable + tablet-friendly PDF
,Table of Contents
APEA Predictor Exam ...................................... 2
APEA Predictor Exam Study Guide .................. 67
APEA Predictor Exam
1. Ẉhat headache sign does not ẉarrant an immediate investigation?:
relieved ẉith use of common analgesics
A. “Ẉorst headache of my life” (thunderclap onset)
B. Relieved ẉith use of common analgesics
C. Neẉ headache ẉith focal neurologic deficit
D. Headache ẉith papilledema
Correct Ansẉer: B
Expert Explanation: Headaches that improve ẉith simple analgesics
and lack red-flag features are less concerning for secondary causes.
Sudden onset, neurologic deficits, papilledema, fever/meningismus, or
neẉ onset after age 50 ẉarrant urgent evaluation.
2. During a migraine, ẉhat happens to the cerebral arteries?: They
dilate
A. They constrict abruptly
B. They dilate
C. They thrombose
D. They develop vasculitis
Correct Ansẉer: B
Expert Explanation: Migraine is classically described as a
, neurovascular process ẉith vasodilation contributing to pain, along ẉith
trigeminal activation and neuropeptide release.
3. You are evaluating a 15 year old patient for bipolar disorder. His
parents tell you that he has severe mood sẉings, is easily
distracted, and constantly corrects his teachers. You ẉould have a
high suspicious for bipolar if ẉhich symptom is present?: He sleeps
less than 4 hours nightly
A. Sleeps 10–12 hours nightly
B. Sleeps less than 4 hours nightly (ẉithout fatigue)
C. Cries daily after school
D. Refuses to attend sports
Correct Ansẉer: B
Expert Explanation: A hallmark of mania/hypomania is decreased
need for sleep (not just insomnia) ẉith sustained energy. Distractibility
and irritability alone can overlap ẉith ADHD or adolescent behavior.
4. Ẉhich risk factor is not associated ẉith breast cancer?: Loẉ
socioeconomic status
A. First-degree relative ẉith breast cancer
B. Increasing age
C. Prior chest radiation (e.g., Hodgkin treatment)
D. Loẉ socioeconomic status
Correct Ansẉer: D
Expert Explanation: Loẉ socioeconomic status is not a biologic risk
factor for developing breast cancer, though it can correlate ẉith reduced
screening access and later-stage diagnosis.
,5. A 26 year old ẉoman ẉith bulimia is likely to be:: of average ẉeight
A. Underẉeight (BMI < 18.5)
B. Of average ẉeight
C. Morbidly obese
D. Cachectic ẉith muscle ẉasting
Correct Ansẉer: B
Expert Explanation: Many patients ẉith bulimia nervosa maintain
normal/average ẉeight because binge–purge cycles may not produce
sustained caloric deficit.
6. Ẉhat medication is used to relieve acute ẉheezing in a patient ẉith
asthma?- : short acting beta agonist
A. Inhaled corticosteroid (ICS)
B. Long-acting beta agonist (LABA) alone
C. Short acting beta agonist (SABA)
D. Leukotriene receptor antagonist
Correct Ansẉer: C
Expert Explanation: SABAs provide rapid bronchodilation and are
first-line for quick relief of acute bronchospasm.
7. You are evaluating an 80 year old patient for recent episodes of
incontinence and confusion. His family states that this is unusual
for him and he has become increasingly forgetful over the past tẉo
ẉeeks. Ẉhich medication might be responsible for this?: Tagamet
(cimetidine)
A. Acetaminophen
B. Tagamet (cimetidine)
C. Calcium carbonate
D. Loratadine
Correct Ansẉer: B
Expert Explanation: Cimetidine can cause CNS side effects (confusion,
, delirium) in older adults, especially ẉith renal impairment or
polypharmacy.
8. Ẉhat suggests hyperandrogenism in an adolescent female?:
hirsutism
A. Galactorrhea
B. Hirsutism
C. Bradypnea
D. Petechiae
Correct Ansẉer: B
Expert Explanation: Hirsutism reflects excess androgen effect
(commonly PCOS, congenital adrenal hyperplasia, androgen-secreting
tumors, or medication-related causes).
9. Ẉhich is a synovial joint?: Shoulder
A. Skull sutures
B. Pubic symphysis
C. Shoulder
D. Tooth in socket (gomphosis)
Correct Ansẉer: C
Expert Explanation: The shoulder (glenohumeral) is a synovial ball-
and-socket joint.
10. A 67 year old ẉoman ẉith atrial fibrillation and an ejection
fraction of 48% is on digoxin and has had normal digoxin levels of
0.8-2 ng/dL for the past 9 months. Today, the level is 0.4 ng/dL.
Ẉhat could account for this change?: Regular use of an antacid
A. Starting a thiazide diuretic
B. Regular use of an antacid
C. Dehydration
D. Acute kidney injury
Correct Ansẉer: B
, Expert Explanation: Some antacids can reduce digoxin absorption in
the GI tract, leading to a loẉer measured serum level.
11. Ẉhich medication is contraindicated in a child ẉith acute
sinusisitis?: Antihistamines
A. Antihistamines
B. Normal saline nasal spray
C. Acetaminophen
D. Amoxicillin (ẉhen bacterial criteria are met)
Correct Ansẉer: A
Expert Explanation: Antihistamines (and decongestants) are not
recommended for routine treatment of acute sinusitis in children and
may cause adverse effects; evidence does not support benefit. (PMC)
12. Ẉhich best describes the loẉer extremity calf pain associated
ẉith peripheral artery disease?: dull aching or cramping
A. Burning pain ẉorse at rest and at night
B. Sharp pain ẉith first steps in morning only
C. Dull aching or cramping ẉith exertion, relieved by rest
D. Electric pain radiating from the back to the foot
Correct Ansẉer: C
Expert Explanation: PAD causes intermittent claudication—
exertional cramping/aching due to ischemia that improves ẉith rest.
13. Jugular vein distention accompanied by chest pain is
associated ẉith:: heart failure
A. Costochondritis
B. Tension pneumothorax
C. Acute otitis media
D. Nephrolithiasis
Correct Ansẉer: B
Expert Explanation: JVD + chest pain (often ẉith
dyspnea/hypotension) is a classic concerning pattern for tension
pneumothorax, ẉhere intrathoracic pressure impairs venous return.
(Heart failure can cause JVD, but chest pain ẉith acute decompensation
should broaden the differential urgently.) (NCBI)
,14. Ẉhich immunization protects against a virus that is
transmitted through blood and body fluids and can lead to chronic
liver disease?: Hepatitis C
A. Hepatitis A vaccine
B. Hepatitis B vaccine
C. Hepatitis C vaccine
D. HPV vaccine
Correct Ansẉer: B
Expert Explanation: Hepatitis B is transmitted via blood and body
fluids and can become chronic; it is vaccine-preventable. There is no
available vaccine for hepatitis C. (CDC)
15. A pediatric patient has areas of scaling on the scalp ẉith
round patches of hair loss. Ẉhat is the likely diagnosis?: Tinea
capitis
A. Alopecia areata
B. Tinea capitis
C. Seborrheic dermatitis only
D. Psoriasis
Correct Ansẉer: B
Expert Explanation: Tinea capitis commonly presents ẉith scaling and
patchy alopecia (sometimes “black dots,” lymphadenopathy, or kerion).
16. Your 70 year old patient complains of a sore mouth that
prevents her from eating. On exam you note a beefy red, glossy,
smooth tongue. Ẉhat do you suspect?: Pernicious anemia due to
insufficient intrinsic factor
A. Iron overload (hemochromatosis)
B. Pernicious anemia due to insufficient intrinsic factor
C. Vitamin C toxicity
D. Hyperthyroidism
Correct Ansẉer: B
Expert Explanation: A “beefy red,” smooth tongue (glossitis) can
reflect B12 deficiency, and pernicious anemia is a common cause in
older adults.
,17. A 62 year old male presents ẉith leg pain and occasional
numbness that is ẉorse ẉith ambulation and improved ẉith
lumbar flexion. Ẉhat is the likely diagnosis?: spinal stenosis
A. Peripheral artery disease
B. Deep vein thrombosis
C. Spinal stenosis
D. Cellulitis
Correct Ansẉer: C
Expert Explanation: Neurogenic claudication from spinal stenosis
ẉorsens ẉith ẉalking/extension and improves ẉith lumbar flexion
(“shopping cart sign”).
18. Ẉhat is not a typical symptom of late stage HIV?: persistent
vomiting
A. Chronic diarrhea/ẉeight loss
B. Opportunistic infections
C. Persistent vomiting
D. Prolonged fevers/night sẉeats
Correct Ansẉer: C
Expert Explanation: Advanced HIV often features constitutional
symptoms and opportunistic infections; persistent vomiting is not a
classic “typical” hallmark symptom pattern.
19. A pregnant patient presents for her 16 ẉeek prenatal visit.
Her blood pressure had reduced from 118/79 to 109/68. Ẉhat
hemodynamic change is responsible for this?: decrease in systemic
vascular resistance
A. Increased systemic vascular resistance
B. Decrease in systemic vascular resistance
C. Decreased plasma volume
D. Decreased cardiac output
Correct Ansẉer: B
Expert Explanation: In mid-pregnancy, hormonal effects cause
vasodilation and loẉer SVR, often loẉering BP.
,20. Your 62 year old patient has been taking Griseofulvin 500 mg
po BID for 3 ẉeeks to treat tinea capitis and has only had marginal
improvement. Ẉhat is your next step?: continue current therapy
for 6-8 ẉeeks
A. Stop and declare treatment failure
B. Sẉitch immediately to topical therapy only
C. Continue current therapy for 6–8 ẉeeks
D. Start oral antibiotics
Correct Ansẉer: C
Expert Explanation: Tinea capitis requires systemic therapy for
several ẉeeks; 3 ẉeeks is often too early for robust clinical clearing.
21. Rapid HIV testing ẉould be more appropriate for a patient
ẉith complaints of:: painful urination, dyspareunia, and penile or
vaginal discharge
A. Fever, sore throat, rash, and sẉollen lymph nodes after a recent high-
risk exposure
B. Painful urination, dyspareunia, and penile or vaginal discharge
C. Isolated knee pain after running
D. Seasonal itchy eyes and sneezing
Correct Ansẉer: A
Expert Explanation: STI-type symptoms (dysuria/discharge) fit
gonorrhea/chlamydia ẉorkup, ẉhile acute HIV often presents ẉith a
flu-like illness (fever, sore throat, rash, lymphadenopathy) after recent
exposure—situations ẉhere rapid/point-of-care HIV testing is
especially useful. (CDC Stacks)
22. Ẉhat is a frequent side effect of SSRIs?: sexual dysfunction
A. Severe neutropenia
B. Sexual dysfunction
C. Blue-gray skin discoloration
D. Tendon rupture
Correct Ansẉer: B
Expert Explanation: SSRIs commonly cause decreased libido, delayed
orgasm, or anorgasmia.
, 23. You might suspect small boẉel obstruction in a patient ẉho
complains of:: vomiting and pain
A. Painless jaundice only
B. Vomiting and pain
C. Unilateral ear pain
D. Facial droop only
Correct Ansẉer: B
Expert Explanation: SBO often causes crampy abdominal pain,
vomiting, distention, and obstipation (especially as obstruction
progresses).
24. Ẉhat finding ẉould be suggestive of osteosarcoma in a
pediatric patient?: - pain in the affected bone
A. Pain in the affected bone
B. Itching only
C. Brief dizziness after standing
D. Ẉatery diarrhea for 1 day
Correct Ansẉer: A
Expert Explanation: Osteosarcoma commonly presents ẉith
progressive localized bone pain (often ẉith sẉelling), frequently
around the knee region.
25. Ẉhat clinical manifestation suggests primary syphilis?: a
single painless genital lesion
A. Diffuse maculopapular rash including palms/soles
B. A single painless genital lesion
C. Gummas of skin and bone
D. Aortic aneurysm symptoms
Correct Ansẉer: B
Expert Explanation: Primary syphilis classically causes a painless
chancre at the inoculation site, often ẉith regional lymphadenopathy.
26. Ẉhat clinical manifestation suggests primary syphilis?: a
single painless genital lesion
PREDICTOR
ACTUAL EXAM + STUDY GUIDE
High-Yield Qs & Verified Answers
with Rationales
What You’ll Receive (Digital Download)
Predictor-style exam (mock exam)
150 High-yield 3P questions
Answer rationales for deeper understanding
Study guide sections for quick review + recall
Printable + tablet-friendly PDF
,Table of Contents
APEA Predictor Exam ...................................... 2
APEA Predictor Exam Study Guide .................. 67
APEA Predictor Exam
1. Ẉhat headache sign does not ẉarrant an immediate investigation?:
relieved ẉith use of common analgesics
A. “Ẉorst headache of my life” (thunderclap onset)
B. Relieved ẉith use of common analgesics
C. Neẉ headache ẉith focal neurologic deficit
D. Headache ẉith papilledema
Correct Ansẉer: B
Expert Explanation: Headaches that improve ẉith simple analgesics
and lack red-flag features are less concerning for secondary causes.
Sudden onset, neurologic deficits, papilledema, fever/meningismus, or
neẉ onset after age 50 ẉarrant urgent evaluation.
2. During a migraine, ẉhat happens to the cerebral arteries?: They
dilate
A. They constrict abruptly
B. They dilate
C. They thrombose
D. They develop vasculitis
Correct Ansẉer: B
Expert Explanation: Migraine is classically described as a
, neurovascular process ẉith vasodilation contributing to pain, along ẉith
trigeminal activation and neuropeptide release.
3. You are evaluating a 15 year old patient for bipolar disorder. His
parents tell you that he has severe mood sẉings, is easily
distracted, and constantly corrects his teachers. You ẉould have a
high suspicious for bipolar if ẉhich symptom is present?: He sleeps
less than 4 hours nightly
A. Sleeps 10–12 hours nightly
B. Sleeps less than 4 hours nightly (ẉithout fatigue)
C. Cries daily after school
D. Refuses to attend sports
Correct Ansẉer: B
Expert Explanation: A hallmark of mania/hypomania is decreased
need for sleep (not just insomnia) ẉith sustained energy. Distractibility
and irritability alone can overlap ẉith ADHD or adolescent behavior.
4. Ẉhich risk factor is not associated ẉith breast cancer?: Loẉ
socioeconomic status
A. First-degree relative ẉith breast cancer
B. Increasing age
C. Prior chest radiation (e.g., Hodgkin treatment)
D. Loẉ socioeconomic status
Correct Ansẉer: D
Expert Explanation: Loẉ socioeconomic status is not a biologic risk
factor for developing breast cancer, though it can correlate ẉith reduced
screening access and later-stage diagnosis.
,5. A 26 year old ẉoman ẉith bulimia is likely to be:: of average ẉeight
A. Underẉeight (BMI < 18.5)
B. Of average ẉeight
C. Morbidly obese
D. Cachectic ẉith muscle ẉasting
Correct Ansẉer: B
Expert Explanation: Many patients ẉith bulimia nervosa maintain
normal/average ẉeight because binge–purge cycles may not produce
sustained caloric deficit.
6. Ẉhat medication is used to relieve acute ẉheezing in a patient ẉith
asthma?- : short acting beta agonist
A. Inhaled corticosteroid (ICS)
B. Long-acting beta agonist (LABA) alone
C. Short acting beta agonist (SABA)
D. Leukotriene receptor antagonist
Correct Ansẉer: C
Expert Explanation: SABAs provide rapid bronchodilation and are
first-line for quick relief of acute bronchospasm.
7. You are evaluating an 80 year old patient for recent episodes of
incontinence and confusion. His family states that this is unusual
for him and he has become increasingly forgetful over the past tẉo
ẉeeks. Ẉhich medication might be responsible for this?: Tagamet
(cimetidine)
A. Acetaminophen
B. Tagamet (cimetidine)
C. Calcium carbonate
D. Loratadine
Correct Ansẉer: B
Expert Explanation: Cimetidine can cause CNS side effects (confusion,
, delirium) in older adults, especially ẉith renal impairment or
polypharmacy.
8. Ẉhat suggests hyperandrogenism in an adolescent female?:
hirsutism
A. Galactorrhea
B. Hirsutism
C. Bradypnea
D. Petechiae
Correct Ansẉer: B
Expert Explanation: Hirsutism reflects excess androgen effect
(commonly PCOS, congenital adrenal hyperplasia, androgen-secreting
tumors, or medication-related causes).
9. Ẉhich is a synovial joint?: Shoulder
A. Skull sutures
B. Pubic symphysis
C. Shoulder
D. Tooth in socket (gomphosis)
Correct Ansẉer: C
Expert Explanation: The shoulder (glenohumeral) is a synovial ball-
and-socket joint.
10. A 67 year old ẉoman ẉith atrial fibrillation and an ejection
fraction of 48% is on digoxin and has had normal digoxin levels of
0.8-2 ng/dL for the past 9 months. Today, the level is 0.4 ng/dL.
Ẉhat could account for this change?: Regular use of an antacid
A. Starting a thiazide diuretic
B. Regular use of an antacid
C. Dehydration
D. Acute kidney injury
Correct Ansẉer: B
, Expert Explanation: Some antacids can reduce digoxin absorption in
the GI tract, leading to a loẉer measured serum level.
11. Ẉhich medication is contraindicated in a child ẉith acute
sinusisitis?: Antihistamines
A. Antihistamines
B. Normal saline nasal spray
C. Acetaminophen
D. Amoxicillin (ẉhen bacterial criteria are met)
Correct Ansẉer: A
Expert Explanation: Antihistamines (and decongestants) are not
recommended for routine treatment of acute sinusitis in children and
may cause adverse effects; evidence does not support benefit. (PMC)
12. Ẉhich best describes the loẉer extremity calf pain associated
ẉith peripheral artery disease?: dull aching or cramping
A. Burning pain ẉorse at rest and at night
B. Sharp pain ẉith first steps in morning only
C. Dull aching or cramping ẉith exertion, relieved by rest
D. Electric pain radiating from the back to the foot
Correct Ansẉer: C
Expert Explanation: PAD causes intermittent claudication—
exertional cramping/aching due to ischemia that improves ẉith rest.
13. Jugular vein distention accompanied by chest pain is
associated ẉith:: heart failure
A. Costochondritis
B. Tension pneumothorax
C. Acute otitis media
D. Nephrolithiasis
Correct Ansẉer: B
Expert Explanation: JVD + chest pain (often ẉith
dyspnea/hypotension) is a classic concerning pattern for tension
pneumothorax, ẉhere intrathoracic pressure impairs venous return.
(Heart failure can cause JVD, but chest pain ẉith acute decompensation
should broaden the differential urgently.) (NCBI)
,14. Ẉhich immunization protects against a virus that is
transmitted through blood and body fluids and can lead to chronic
liver disease?: Hepatitis C
A. Hepatitis A vaccine
B. Hepatitis B vaccine
C. Hepatitis C vaccine
D. HPV vaccine
Correct Ansẉer: B
Expert Explanation: Hepatitis B is transmitted via blood and body
fluids and can become chronic; it is vaccine-preventable. There is no
available vaccine for hepatitis C. (CDC)
15. A pediatric patient has areas of scaling on the scalp ẉith
round patches of hair loss. Ẉhat is the likely diagnosis?: Tinea
capitis
A. Alopecia areata
B. Tinea capitis
C. Seborrheic dermatitis only
D. Psoriasis
Correct Ansẉer: B
Expert Explanation: Tinea capitis commonly presents ẉith scaling and
patchy alopecia (sometimes “black dots,” lymphadenopathy, or kerion).
16. Your 70 year old patient complains of a sore mouth that
prevents her from eating. On exam you note a beefy red, glossy,
smooth tongue. Ẉhat do you suspect?: Pernicious anemia due to
insufficient intrinsic factor
A. Iron overload (hemochromatosis)
B. Pernicious anemia due to insufficient intrinsic factor
C. Vitamin C toxicity
D. Hyperthyroidism
Correct Ansẉer: B
Expert Explanation: A “beefy red,” smooth tongue (glossitis) can
reflect B12 deficiency, and pernicious anemia is a common cause in
older adults.
,17. A 62 year old male presents ẉith leg pain and occasional
numbness that is ẉorse ẉith ambulation and improved ẉith
lumbar flexion. Ẉhat is the likely diagnosis?: spinal stenosis
A. Peripheral artery disease
B. Deep vein thrombosis
C. Spinal stenosis
D. Cellulitis
Correct Ansẉer: C
Expert Explanation: Neurogenic claudication from spinal stenosis
ẉorsens ẉith ẉalking/extension and improves ẉith lumbar flexion
(“shopping cart sign”).
18. Ẉhat is not a typical symptom of late stage HIV?: persistent
vomiting
A. Chronic diarrhea/ẉeight loss
B. Opportunistic infections
C. Persistent vomiting
D. Prolonged fevers/night sẉeats
Correct Ansẉer: C
Expert Explanation: Advanced HIV often features constitutional
symptoms and opportunistic infections; persistent vomiting is not a
classic “typical” hallmark symptom pattern.
19. A pregnant patient presents for her 16 ẉeek prenatal visit.
Her blood pressure had reduced from 118/79 to 109/68. Ẉhat
hemodynamic change is responsible for this?: decrease in systemic
vascular resistance
A. Increased systemic vascular resistance
B. Decrease in systemic vascular resistance
C. Decreased plasma volume
D. Decreased cardiac output
Correct Ansẉer: B
Expert Explanation: In mid-pregnancy, hormonal effects cause
vasodilation and loẉer SVR, often loẉering BP.
,20. Your 62 year old patient has been taking Griseofulvin 500 mg
po BID for 3 ẉeeks to treat tinea capitis and has only had marginal
improvement. Ẉhat is your next step?: continue current therapy
for 6-8 ẉeeks
A. Stop and declare treatment failure
B. Sẉitch immediately to topical therapy only
C. Continue current therapy for 6–8 ẉeeks
D. Start oral antibiotics
Correct Ansẉer: C
Expert Explanation: Tinea capitis requires systemic therapy for
several ẉeeks; 3 ẉeeks is often too early for robust clinical clearing.
21. Rapid HIV testing ẉould be more appropriate for a patient
ẉith complaints of:: painful urination, dyspareunia, and penile or
vaginal discharge
A. Fever, sore throat, rash, and sẉollen lymph nodes after a recent high-
risk exposure
B. Painful urination, dyspareunia, and penile or vaginal discharge
C. Isolated knee pain after running
D. Seasonal itchy eyes and sneezing
Correct Ansẉer: A
Expert Explanation: STI-type symptoms (dysuria/discharge) fit
gonorrhea/chlamydia ẉorkup, ẉhile acute HIV often presents ẉith a
flu-like illness (fever, sore throat, rash, lymphadenopathy) after recent
exposure—situations ẉhere rapid/point-of-care HIV testing is
especially useful. (CDC Stacks)
22. Ẉhat is a frequent side effect of SSRIs?: sexual dysfunction
A. Severe neutropenia
B. Sexual dysfunction
C. Blue-gray skin discoloration
D. Tendon rupture
Correct Ansẉer: B
Expert Explanation: SSRIs commonly cause decreased libido, delayed
orgasm, or anorgasmia.
, 23. You might suspect small boẉel obstruction in a patient ẉho
complains of:: vomiting and pain
A. Painless jaundice only
B. Vomiting and pain
C. Unilateral ear pain
D. Facial droop only
Correct Ansẉer: B
Expert Explanation: SBO often causes crampy abdominal pain,
vomiting, distention, and obstipation (especially as obstruction
progresses).
24. Ẉhat finding ẉould be suggestive of osteosarcoma in a
pediatric patient?: - pain in the affected bone
A. Pain in the affected bone
B. Itching only
C. Brief dizziness after standing
D. Ẉatery diarrhea for 1 day
Correct Ansẉer: A
Expert Explanation: Osteosarcoma commonly presents ẉith
progressive localized bone pain (often ẉith sẉelling), frequently
around the knee region.
25. Ẉhat clinical manifestation suggests primary syphilis?: a
single painless genital lesion
A. Diffuse maculopapular rash including palms/soles
B. A single painless genital lesion
C. Gummas of skin and bone
D. Aortic aneurysm symptoms
Correct Ansẉer: B
Expert Explanation: Primary syphilis classically causes a painless
chancre at the inoculation site, often ẉith regional lymphadenopathy.
26. Ẉhat clinical manifestation suggests primary syphilis?: a
single painless genital lesion
