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Ultimate APEA 3P 2026/2027 Exam Prep
Bundle – 4 Real Exams, Answer Key, and
Complete Study Guide for Success
1. A 58-year-old male with hypertension and type 2
diabetes presents for a follow-up. His blood pressure is
148/90 mmHg. Current medications: lisinopril 20 mg daily,
metformin 1000 mg BID. What is the most appropriate next
step?
A. Add hydrochlorothiazide 12.5 mg daily
B. Increase lisinopril to 40 mg daily
C. Add amlodipine 5 mg daily
D. Continue current regimen and reassess in 3 months
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Answer: A. Add hydrochlorothiazide 12.5 mg daily
Rationale: For patients with diabetes and hypertension, the
target BP is <130/80 mmHg. This patient is not at goal on an
ACE inhibitor alone. Adding a low-dose thiazide diuretic is
first-line add-on therapy per JNC 8/ACC/AHA guidelines.
Increasing lisinopril to 40 mg may cause hyperkalemia or renal
issues. Amlodipine is also an option but thiazide is preferred
first add-on .
2. A 72-year-old female reports 3 months of bilateral hand
stiffness and pain that is worse in the morning and lasts
over 1 hour. She also has dry eyes and dry mouth. On
exam, you note swollen MCP and PIP joints bilaterally.
What is the most likely diagnosis?
A. Osteoarthritis
B. Rheumatoid arthritis
C. Sjögren's syndrome with inflammatory arthritis
D. Gout
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Answer: C. Sjögren's syndrome with inflammatory arthritis
Rationale: The patient has sicca symptoms (dry eyes, dry
mouth) combined with symmetric inflammatory polyarthritis.
Primary Sjögren's syndrome can present with extraglandular
manifestations including arthritis. Rheumatoid arthritis is also
possible but the sicca symptoms point to Sjögren's.
Osteoarthritis does not cause prolonged morning stiffness.
Gout is typically monoarticular .
3. A 45-year-old obese female presents with right upper
quadrant pain after fatty meals. Ultrasound shows
gallstones. She is otherwise healthy. What is the
appropriate management?
A. Ursodeoxycholic acid therapy
B. Laparoscopic cholecystectomy
C. Low-fat diet and observation
D. ERCP with sphincterotomy