APEA PRE-PREDICTOR & NP BOARD EXAM MEGA TEST BANK (QUESTIONS 1-300) – HIGH-YIELD PRACTICE
QUESTIONS AND CORRECT ANSWERS (VERIFIED ANSWERS) PLUS RATIONALES 2026 Q&A | LATEST EXAM
UPDATE 2026/2027
SECTION ONE: QUESTIONS 1–100
1. A 72-year-old male presents with a several-month history of progressive urinary hesitancy, weak stream,
and nocturia. A digital rectal exam reveals a symmetrically enlarged, firm, rubbery prostate. Which of the
following is the most appropriate initial screening test for prostate cancer in this patient?
A. Serum prostate-specific antigen (PSA)
B. Transrectal ultrasound (TRUS)
C. Prostate biopsy
D. Serum BUN and creatinine
🟢 A. Serum prostate-specific antigen (PSA)
🔴 RATIONALE: PSA is the recommended initial screening test for prostate cancer. While the exam findings are
suggestive of BPH, a PSA test helps differentiate risk. TRUS and biopsy are subsequent diagnostic steps, not
initial screening tools. BUN/Cr assess renal function, not prostate cancer.
,2. A 45-year-old female with a history of migraines presents with a new onset of severe, unilateral headache
that is associated with autonomic symptoms such as conjunctival injection, lacrimation, and nasal
congestion. The pain is described as stabbing and occurs in clusters. What is the first-line treatment for an
acute episode of this condition?
A. Sumatriptan subcutaneous
B. High-flow oxygen
C. Oral propranolol
D. Ibuprofen
🟢 B. High-flow oxygen
🔴 RATIONALE: The presentation is classic for cluster headaches. High-flow oxygen (100% at 12-15 L/min) is a
safe and effective first-line abortive therapy. Sumatriptan SC is also used but often second-line or in specific
cases. Propranolol is a prophylactic treatment for migraines. Ibuprofen is ineffective for cluster headaches.
3. A 68-year-old male with a history of hypertension presents with acute onset of severe, "tearing" chest pain
that radiates to his back. He is diaphoretic and has a blood pressure of 150/90 in his right arm and 110/70 in
his left arm. Which of the following is the most appropriate initial imaging study for diagnosis?
A. Chest X-ray
B. CT angiography of the chest
C. Transthoracic echocardiogram
D. EKG
🟢 B. CT angiography of the chest
🔴 RATIONALE: The presentation is highly suggestive of an acute aortic dissection. CT angiography is the
,preferred initial imaging modality due to its high sensitivity and specificity. A chest X-ray is often normal and
cannot rule out dissection. EKG may show ischemia but is not diagnostic. TTE has lower sensitivity for thoracic
aortic dissection.
4. A 55-year-old male with a 30-pack-year smoking history presents with a new, persistent cough and blood-
tinged sputum. He reports unintentional weight loss. A chest X-ray reveals a solitary pulmonary nodule in
the right upper lobe. Which of the following is the most appropriate next step in management?
A. Start a course of antibiotics and repeat the chest X-ray in 4 weeks.
B. Order a CT-guided biopsy of the nodule.
C. Order a PET-CT scan.
D. Schedule a bronchoscopy.
🟢 C. Order a PET-CT scan.
🔴 RATIONALE: The patient has a high-risk pulmonary nodule (smoking history, suspicious symptoms). A PET-
CT scan is the appropriate next step to characterize the nodule further and assess for metastatic disease. A
biopsy would be guided by the findings from the PET-CT. Antibiotics are inappropriate as an initial step without
evidence of infection. Bronchoscopy is often used to biopsy central lesions.
5. A 32-year-old woman presents with fatigue, palpitations, and heat intolerance. On physical exam, she has
a fine tremor, tachycardia, and mild proptosis. Laboratory studies show a low TSH, elevated free T4, and
elevated T3. Which of the following is the most likely underlying etiology?
, A. Hashimoto's thyroiditis
B. Graves' disease
C. Toxic multinodular goiter
D. Subacute thyroiditis
🟢 B. Graves' disease
🔴 RATIONALE: Graves' disease is the most common cause of hyperthyroidism and is an autoimmune disorder.
The presence of ophthalmopathy (proptosis) is a hallmark of Graves' disease. Hashimoto's causes
hypothyroidism. Toxic multinodular goiter does not typically cause ophthalmopathy. Subacute thyroiditis is
painful and often follows a viral infection.
6. A 72-year-old female presents with progressive dyspnea on exertion and orthopnea. She has bilateral
pitting edema in her lower extremities. A jugular venous pressure is elevated at 12 cm H2O. Which of the
following is the most likely diagnosis?
A. Left-sided heart failure
B. Right-sided heart failure
C. Cor pulmonale
D. Pulmonary embolism
🟢 B. Right-sided heart failure
🔴 RATIONALE: The classic signs of right-sided heart failure include peripheral edema, jugular venous
distention, and hepatomegaly. Left-sided heart failure primarily presents with pulmonary congestion (dyspnea,
crackles). Cor pulmonale is right ventricular dysfunction due to pulmonary hypertension. Pulmonary embolism
can cause acute right heart strain, but chronic presentation is more consistent with right-sided heart failure.
QUESTIONS AND CORRECT ANSWERS (VERIFIED ANSWERS) PLUS RATIONALES 2026 Q&A | LATEST EXAM
UPDATE 2026/2027
SECTION ONE: QUESTIONS 1–100
1. A 72-year-old male presents with a several-month history of progressive urinary hesitancy, weak stream,
and nocturia. A digital rectal exam reveals a symmetrically enlarged, firm, rubbery prostate. Which of the
following is the most appropriate initial screening test for prostate cancer in this patient?
A. Serum prostate-specific antigen (PSA)
B. Transrectal ultrasound (TRUS)
C. Prostate biopsy
D. Serum BUN and creatinine
🟢 A. Serum prostate-specific antigen (PSA)
🔴 RATIONALE: PSA is the recommended initial screening test for prostate cancer. While the exam findings are
suggestive of BPH, a PSA test helps differentiate risk. TRUS and biopsy are subsequent diagnostic steps, not
initial screening tools. BUN/Cr assess renal function, not prostate cancer.
,2. A 45-year-old female with a history of migraines presents with a new onset of severe, unilateral headache
that is associated with autonomic symptoms such as conjunctival injection, lacrimation, and nasal
congestion. The pain is described as stabbing and occurs in clusters. What is the first-line treatment for an
acute episode of this condition?
A. Sumatriptan subcutaneous
B. High-flow oxygen
C. Oral propranolol
D. Ibuprofen
🟢 B. High-flow oxygen
🔴 RATIONALE: The presentation is classic for cluster headaches. High-flow oxygen (100% at 12-15 L/min) is a
safe and effective first-line abortive therapy. Sumatriptan SC is also used but often second-line or in specific
cases. Propranolol is a prophylactic treatment for migraines. Ibuprofen is ineffective for cluster headaches.
3. A 68-year-old male with a history of hypertension presents with acute onset of severe, "tearing" chest pain
that radiates to his back. He is diaphoretic and has a blood pressure of 150/90 in his right arm and 110/70 in
his left arm. Which of the following is the most appropriate initial imaging study for diagnosis?
A. Chest X-ray
B. CT angiography of the chest
C. Transthoracic echocardiogram
D. EKG
🟢 B. CT angiography of the chest
🔴 RATIONALE: The presentation is highly suggestive of an acute aortic dissection. CT angiography is the
,preferred initial imaging modality due to its high sensitivity and specificity. A chest X-ray is often normal and
cannot rule out dissection. EKG may show ischemia but is not diagnostic. TTE has lower sensitivity for thoracic
aortic dissection.
4. A 55-year-old male with a 30-pack-year smoking history presents with a new, persistent cough and blood-
tinged sputum. He reports unintentional weight loss. A chest X-ray reveals a solitary pulmonary nodule in
the right upper lobe. Which of the following is the most appropriate next step in management?
A. Start a course of antibiotics and repeat the chest X-ray in 4 weeks.
B. Order a CT-guided biopsy of the nodule.
C. Order a PET-CT scan.
D. Schedule a bronchoscopy.
🟢 C. Order a PET-CT scan.
🔴 RATIONALE: The patient has a high-risk pulmonary nodule (smoking history, suspicious symptoms). A PET-
CT scan is the appropriate next step to characterize the nodule further and assess for metastatic disease. A
biopsy would be guided by the findings from the PET-CT. Antibiotics are inappropriate as an initial step without
evidence of infection. Bronchoscopy is often used to biopsy central lesions.
5. A 32-year-old woman presents with fatigue, palpitations, and heat intolerance. On physical exam, she has
a fine tremor, tachycardia, and mild proptosis. Laboratory studies show a low TSH, elevated free T4, and
elevated T3. Which of the following is the most likely underlying etiology?
, A. Hashimoto's thyroiditis
B. Graves' disease
C. Toxic multinodular goiter
D. Subacute thyroiditis
🟢 B. Graves' disease
🔴 RATIONALE: Graves' disease is the most common cause of hyperthyroidism and is an autoimmune disorder.
The presence of ophthalmopathy (proptosis) is a hallmark of Graves' disease. Hashimoto's causes
hypothyroidism. Toxic multinodular goiter does not typically cause ophthalmopathy. Subacute thyroiditis is
painful and often follows a viral infection.
6. A 72-year-old female presents with progressive dyspnea on exertion and orthopnea. She has bilateral
pitting edema in her lower extremities. A jugular venous pressure is elevated at 12 cm H2O. Which of the
following is the most likely diagnosis?
A. Left-sided heart failure
B. Right-sided heart failure
C. Cor pulmonale
D. Pulmonary embolism
🟢 B. Right-sided heart failure
🔴 RATIONALE: The classic signs of right-sided heart failure include peripheral edema, jugular venous
distention, and hepatomegaly. Left-sided heart failure primarily presents with pulmonary congestion (dyspnea,
crackles). Cor pulmonale is right ventricular dysfunction due to pulmonary hypertension. Pulmonary embolism
can cause acute right heart strain, but chronic presentation is more consistent with right-sided heart failure.
