APEA PREDICTOR EXAM NEWEST EXAM QUESTIONS AND
CORRECT DETAILED ANSWERS A NEW UPDATED VERSION
LATEST 2026-2027 (100% CORRECT VERIFIED ANSWERS) PLUS
DETAILED RATIONALES ALREADY GRADED A+
1. A 72-year-old male reports progressive difficulty starting urination, a weak stream, and nocturia
three times per night. His prostate exam reveals a smooth, symmetrically enlarged gland without
nodules. What is the most likely diagnosis?
A. Prostate cancer
B. Acute bacterial prostatitis
C. Benign prostatic hyperplasia
D. Chronic pelvic pain syndrome
Rationale: Benign prostatic hyperplasia (BPH) typically presents with lower urinary tract symptoms
(LUTS), including hesitancy, weak stream, and nocturia. The prostate is symmetrically enlarged and
smooth. Prostate cancer often has a hard, irregular nodule. Acute prostatitis presents with fever and
dysuria.
2. A 45-year-old female with no prior psychiatric history presents with episodic palpitations, sweating,
trembling, and a fear of “going crazy.” Episodes last 10 minutes and occur unexpectedly. Between
episodes, she is completely asymptomatic. What is the first-line pharmacologic treatment?
A. Sertraline
B. Alprazolam
C. SSRI such as escitalopram
D. Buspirone
Rationale: Panic disorder is treated first-line with SSRIs (e.g., escitalopram) or SNRIs.
Benzodiazepines (e.g., alprazolam) are effective but have abuse potential and are not first-line due to
tolerance/withdrawal risks.
3. A 60-year-old man with hypertension presents with acute onset of severe “tearing” chest pain
radiating to the back, unequal blood pressures in arms (right 160/90, left 110/70), and a widened
mediastinum on chest X-ray. What is the most appropriate next step?
A. Administer thrombolytics
B. Emergent cardiothoracic surgery consultation and CT angiography
C. Admit for observation and start heparin
D. Obtain serial troponins for rule-out MI
,Rationale: This presentation is classic for aortic dissection. Immediate imaging (CT angiography) and
surgical consultation are critical. Thrombolytics are contraindicated and can be fatal.
4. A 28-year-old woman with 3 days of dysuria, frequency, and suprapubic pain has a urine dipstick
positive for nitrites and leukocyte esterase. She has no flank pain, fever, or vomiting. What is the most
appropriate treatment duration for uncomplicated cystitis?
A. 1 day
B. 3 to 5 days
C. 7 to 10 days
D. 14 days
Rationale: Uncomplicated acute cystitis in a young, non-pregnant woman without signs of
pyelonephritis is typically treated with a short course of antibiotics (3–5 days), e.g., nitrofurantoin or
TMP-SMX.
5. A 55-year-old diabetic presents with progressive dyspnea on exertion, orthopnea, and bilateral lower
extremity edema. Lung auscultation reveals crackles up to mid-lung fields. An S3 gallop is present.
What is the most likely diagnosis?
A. COPD exacerbation
B. Heart failure with reduced ejection fraction
C. Pulmonary embolism
D. Nephrotic syndrome
Rationale: The triad of dyspnea, orthopnea, S3 gallop, and crackles suggests heart failure. In a diabetic
with risk factors, HFrEF is common. COPD lacks orthopnea and S3.
6. A 42-year-old male has a 2-cm non-tender, mobile mass in the right scrotum that transilluminates
brightly. Testis is palpable separately. What is the most likely diagnosis?
A. Testicular tumor
B. Epididymitis
C. Hydrocele
D. Varicocele
Rationale: A hydrocele presents as a smooth, non-tender scrotal mass that transilluminates. Testis is
palpable separately. Tumors are solid, do not transilluminate, and testis is not separable.
7. A 70-year-old with osteoarthritis reports bilateral knee pain and stiffness lasting <30 minutes after
waking. She has bony enlargement at the DIP and PIP joints. Which lab finding is most likely normal
in this condition?
A. Rheumatoid factor
B. Erythrocyte sedimentation rate
, C. Antinuclear antibody
D. Uric acid
Rationale: Osteoarthritis is non-inflammatory; ESR is usually normal. RF and ANA are normal unless
another condition is present. Uric acid is normal unless gout coexists.
8. A 30-year-old woman with fatigue, weight gain, constipation, and cold intolerance has a TSH of
12.5 mIU/L (normal 0.4–4.0) and free T4 of 0.5 ng/dL (normal 0.8–1.8). What is the most appropriate
initial treatment?
A. Methimazole
B. Levothyroxine
C. Liothyronine
D. Watchful waiting
Rationale: This is primary hypothyroidism (high TSH, low free T4). Levothyroxine is first-line.
Methimazole treats hyperthyroidism. Liothyronine is not first-line due to a shorter half-life.
9. A 5-year-old child presents with a barking cough, inspiratory stridor, and low-grade fever, worse at
night. Immunizations are up to date. What is the most likely diagnosis?
A. Bacterial tracheitis
B. Epiglottitis
C. Croup (laryngotracheobronchitis)
D. Foreign body aspiration
Rationale: Croup presents with barking cough, stridor, and worse symptoms at night. Epiglottitis
presents with drooling and toxic appearance. Foreign body aspiration has sudden onset.
10. A 68-year-old with chronic atrial fibrillation on warfarin has an INR of 4.2 without bleeding. What
is the appropriate next step?
A. Give vitamin K 10 mg IM
B. Hold warfarin and monitor INR
C. Give fresh frozen plasma
D. Increase warfarin dose
Rationale: INR 4.0–4.9 without bleeding: hold warfarin and recheck INR. Vitamin K is for INR >10 or
bleeding. FFP is for severe bleeding.
11. A 48-year-old female presents with episodic headache, palpitations, sweating, and hypertension
lasting 15 minutes. During an episode, BP is 200/110, but between episodes, BP is 120/80. What is the
most appropriate diagnostic test?
A. 24-hour urine metanephrines
CORRECT DETAILED ANSWERS A NEW UPDATED VERSION
LATEST 2026-2027 (100% CORRECT VERIFIED ANSWERS) PLUS
DETAILED RATIONALES ALREADY GRADED A+
1. A 72-year-old male reports progressive difficulty starting urination, a weak stream, and nocturia
three times per night. His prostate exam reveals a smooth, symmetrically enlarged gland without
nodules. What is the most likely diagnosis?
A. Prostate cancer
B. Acute bacterial prostatitis
C. Benign prostatic hyperplasia
D. Chronic pelvic pain syndrome
Rationale: Benign prostatic hyperplasia (BPH) typically presents with lower urinary tract symptoms
(LUTS), including hesitancy, weak stream, and nocturia. The prostate is symmetrically enlarged and
smooth. Prostate cancer often has a hard, irregular nodule. Acute prostatitis presents with fever and
dysuria.
2. A 45-year-old female with no prior psychiatric history presents with episodic palpitations, sweating,
trembling, and a fear of “going crazy.” Episodes last 10 minutes and occur unexpectedly. Between
episodes, she is completely asymptomatic. What is the first-line pharmacologic treatment?
A. Sertraline
B. Alprazolam
C. SSRI such as escitalopram
D. Buspirone
Rationale: Panic disorder is treated first-line with SSRIs (e.g., escitalopram) or SNRIs.
Benzodiazepines (e.g., alprazolam) are effective but have abuse potential and are not first-line due to
tolerance/withdrawal risks.
3. A 60-year-old man with hypertension presents with acute onset of severe “tearing” chest pain
radiating to the back, unequal blood pressures in arms (right 160/90, left 110/70), and a widened
mediastinum on chest X-ray. What is the most appropriate next step?
A. Administer thrombolytics
B. Emergent cardiothoracic surgery consultation and CT angiography
C. Admit for observation and start heparin
D. Obtain serial troponins for rule-out MI
,Rationale: This presentation is classic for aortic dissection. Immediate imaging (CT angiography) and
surgical consultation are critical. Thrombolytics are contraindicated and can be fatal.
4. A 28-year-old woman with 3 days of dysuria, frequency, and suprapubic pain has a urine dipstick
positive for nitrites and leukocyte esterase. She has no flank pain, fever, or vomiting. What is the most
appropriate treatment duration for uncomplicated cystitis?
A. 1 day
B. 3 to 5 days
C. 7 to 10 days
D. 14 days
Rationale: Uncomplicated acute cystitis in a young, non-pregnant woman without signs of
pyelonephritis is typically treated with a short course of antibiotics (3–5 days), e.g., nitrofurantoin or
TMP-SMX.
5. A 55-year-old diabetic presents with progressive dyspnea on exertion, orthopnea, and bilateral lower
extremity edema. Lung auscultation reveals crackles up to mid-lung fields. An S3 gallop is present.
What is the most likely diagnosis?
A. COPD exacerbation
B. Heart failure with reduced ejection fraction
C. Pulmonary embolism
D. Nephrotic syndrome
Rationale: The triad of dyspnea, orthopnea, S3 gallop, and crackles suggests heart failure. In a diabetic
with risk factors, HFrEF is common. COPD lacks orthopnea and S3.
6. A 42-year-old male has a 2-cm non-tender, mobile mass in the right scrotum that transilluminates
brightly. Testis is palpable separately. What is the most likely diagnosis?
A. Testicular tumor
B. Epididymitis
C. Hydrocele
D. Varicocele
Rationale: A hydrocele presents as a smooth, non-tender scrotal mass that transilluminates. Testis is
palpable separately. Tumors are solid, do not transilluminate, and testis is not separable.
7. A 70-year-old with osteoarthritis reports bilateral knee pain and stiffness lasting <30 minutes after
waking. She has bony enlargement at the DIP and PIP joints. Which lab finding is most likely normal
in this condition?
A. Rheumatoid factor
B. Erythrocyte sedimentation rate
, C. Antinuclear antibody
D. Uric acid
Rationale: Osteoarthritis is non-inflammatory; ESR is usually normal. RF and ANA are normal unless
another condition is present. Uric acid is normal unless gout coexists.
8. A 30-year-old woman with fatigue, weight gain, constipation, and cold intolerance has a TSH of
12.5 mIU/L (normal 0.4–4.0) and free T4 of 0.5 ng/dL (normal 0.8–1.8). What is the most appropriate
initial treatment?
A. Methimazole
B. Levothyroxine
C. Liothyronine
D. Watchful waiting
Rationale: This is primary hypothyroidism (high TSH, low free T4). Levothyroxine is first-line.
Methimazole treats hyperthyroidism. Liothyronine is not first-line due to a shorter half-life.
9. A 5-year-old child presents with a barking cough, inspiratory stridor, and low-grade fever, worse at
night. Immunizations are up to date. What is the most likely diagnosis?
A. Bacterial tracheitis
B. Epiglottitis
C. Croup (laryngotracheobronchitis)
D. Foreign body aspiration
Rationale: Croup presents with barking cough, stridor, and worse symptoms at night. Epiglottitis
presents with drooling and toxic appearance. Foreign body aspiration has sudden onset.
10. A 68-year-old with chronic atrial fibrillation on warfarin has an INR of 4.2 without bleeding. What
is the appropriate next step?
A. Give vitamin K 10 mg IM
B. Hold warfarin and monitor INR
C. Give fresh frozen plasma
D. Increase warfarin dose
Rationale: INR 4.0–4.9 without bleeding: hold warfarin and recheck INR. Vitamin K is for INR >10 or
bleeding. FFP is for severe bleeding.
11. A 48-year-old female presents with episodic headache, palpitations, sweating, and hypertension
lasting 15 minutes. During an episode, BP is 200/110, but between episodes, BP is 120/80. What is the
most appropriate diagnostic test?
A. 24-hour urine metanephrines
