1|Page
APEA 3P COMPREHENSIVE ACTUAL EXAM
PREP 2026 ALL QUESTIONS AND CORRECT
DETAILED ANSWERS WITH RATIONALES
ALREADY A GRADED WITH EXPERT
FEEDBACK|NEEW AND REVISED
1. A 68-year-old male with a 45-pack-year smoking history presents
with a chronic cough, hemoptysis, and a 15-pound unintentional weight
loss over the past 4 months. Chest X-ray reveals a right hilar mass with
associated atelectasis. Which physical assessment finding would most
strongly support a diagnosis of lung cancer over a benign pulmonary
process?
A) Egophony and increased tactile fremitus
B) Hoarseness and unilateral diaphragmatic paralysis
C) Clubbing of the fingernails
D) Pleuritic chest pain exacerbated by inspiration
Rationale: Hoarseness (recurrent laryngeal nerve involvement) and
diaphragmatic paralysis (phrenic nerve involvement) are indicative of
malignant invasion of surrounding structures. Egophony and
increased fremitus suggest consolidation from infection; clubbing can
occur in both malignancy and chronic lung disease; pleuritic pain is
more typical of pleuritis or pulmonary embolism.
2. A 52-year-old female with a history of hypertension presents with a 3-
month history of progressive fatigue, cold intolerance, and constipation.
On examination, you note bradycardia, dry skin, and a non-tender,
diffusely enlarged thyroid gland. Laboratory studies reveal an elevated
TSH of 18 mIU/L and a free T4 of 0.5 ng/dL. Anti-thyroid peroxidase
antibodies are markedly elevated. Which of the following is the most
appropriate pharmacologic management?
,2|Page
A) Methimazole 10 mg daily
B) Levothyroxine 1.6 mcg/kg/day
C) Liothyronine 25 mcg daily
D) Propranolol 20 mg BID
Rationale: This patient has overt primary hypothyroidism due to
Hashimoto's thyroiditis. Levothyroxine is the standard replacement
therapy, dosed at approximately 1.6 mcg/kg/day. Methimazole and
propranolol are used for hyperthyroidism; liothyronine is not first-line
for hypothyroidism.
3. A 26-year-old male presents with a painless, 5-mm, indurated ulcer on
the shaft of his penis. He reports unprotected sexual contact with
multiple partners over the past 3 months. Bilateral inguinal
lymphadenopathy is present and non-tender. The lymph nodes are firm
and rubbery. Which of the following is the most likely diagnosis?
A) Genital herpes simplex
B) Condylomata acuminata
C) Primary syphilis (Chancre)
D) Chancroid
Rationale: Primary syphilis classically presents as a painless,
indurated ulcer (chancre) with nontender regional lymphadenopathy.
Genital herpes typically presents with painful vesicles; condylomata
are verrucous lesions; chancroid presents with a painful ulcer and
suppurative lymphadenopathy.
4. A 72-year-old male with type 2 diabetes and hypertension presents for
a routine visit. His blood pressure today is 152/94 mmHg. He reports
taking his lisinopril 10 mg daily as prescribed. He also reports taking
ibuprofen 600 mg TID for chronic knee pain. Which of the following is
the most appropriate next step in managing his blood pressure?
A) Increase lisinopril to 20 mg daily
B) Add hydrochlorothiazide 12.5 mg daily
C) Discontinue ibuprofen and reassess blood pressure
,3|Page
D) Refer to cardiology for further evaluation
Rationale: NSAIDs, including ibuprofen, can reduce the efficacy of
antihypertensive medications, particularly ACE inhibitors, and can
also cause sodium and water retention. Discontinuing the NSAID and
reassessing blood pressure is the most appropriate first step before
adjusting or adding antihypertensive therapy.
5. A 62-year-old male with a 40-pack-year smoking history presents
with progressive dyspnea on exertion and a chronic productive cough.
On pulmonary function testing, the FEV1/FVC ratio is 0.65 with
bronchodilator administration. Which of the following additional
findings on pulmonary function testing would confirm the diagnosis of
COPD?
A) Reduced total lung capacity
B) Elevated residual volume and functional residual capacity
C) Normal diffusing capacity of the lung for carbon monoxide (DLCO)
D) Reduced FVC with normal FEV1
Rationale: COPD is characterized by irreversible airflow obstruction
(FEV1/FVC < 0.70) with air trapping, leading to elevated residual
volume and functional residual capacity. Total lung capacity is
typically normal or increased; DLCO is reduced; a reduced FVC with
normal FEV1 suggests a restrictive pattern.
6. A 30-year-old pregnant woman at 32 weeks gestation presents with a
blood pressure of 158/102 mmHg and 2+ proteinuria on dipstick. She
reports a severe frontal headache and blurred vision. Which of the
following is the most appropriate immediate management?
A) Prescribe labetalol 200 mg PO and discharge with home blood
pressure monitoring
B) Admit to labor and delivery for immediate evaluation and
magnesium sulfate therapy
C) Schedule a follow-up appointment in 48 hours
D) Recommend strict bed rest and a low-sodium diet
, 4|Page
Rationale: This patient has severe preeclampsia with concerning
neurologic symptoms (headache, visual changes). Magnesium sulfate
is indicated for seizure prophylaxis, and antihypertensive therapy is
needed for blood pressure control. Admission is mandatory for
maternal and fetal monitoring; outpatient management is
contraindicated.
7. A 6-year-old male presents with a 2-day history of fever (102°F),
severe sore throat, and difficulty swallowing. On examination, you note
tonsillar erythema and exudates, palatal petechiae, and tender anterior
cervical lymphadenopathy. A rapid streptococcal antigen test is positive.
Which of the following is the most appropriate antibiotic regimen?
A) Azithromycin 10 mg/kg/day for 5 days
B) Penicillin VK 250 mg BID for 10 days
C) Amoxicillin 50 mg/kg/day divided BID for 10 days
D) Cephalexin 25 mg/kg/day divided BID for 10 days
Rationale: Penicillin or amoxicillin remains the first-line treatment for
group A streptococcal pharyngitis. Penicillin VK is preferred due to its
narrow spectrum, efficacy, and cost. Amoxicillin is acceptable, but
penicillin is the drug of choice; azithromycin is a second-line agent for
penicillin-allergic patients.
8. A 70-year-old female with osteoporosis is prescribed alendronate 70
mg once weekly. Which of the following instructions is most critical to
provide to this patient to prevent esophageal injury?
A) Take the medication with a full meal to minimize gastrointestinal
upset
B) Take on an empty stomach with a full glass of plain water and
remain upright for at least 30 minutes
C) Take with calcium and vitamin D supplements to enhance absorption
D) Take at bedtime to improve compliance
Rationale: Alendronate must be taken on an empty stomach with plain
water, and the patient must remain upright for at least 30 minutes to
APEA 3P COMPREHENSIVE ACTUAL EXAM
PREP 2026 ALL QUESTIONS AND CORRECT
DETAILED ANSWERS WITH RATIONALES
ALREADY A GRADED WITH EXPERT
FEEDBACK|NEEW AND REVISED
1. A 68-year-old male with a 45-pack-year smoking history presents
with a chronic cough, hemoptysis, and a 15-pound unintentional weight
loss over the past 4 months. Chest X-ray reveals a right hilar mass with
associated atelectasis. Which physical assessment finding would most
strongly support a diagnosis of lung cancer over a benign pulmonary
process?
A) Egophony and increased tactile fremitus
B) Hoarseness and unilateral diaphragmatic paralysis
C) Clubbing of the fingernails
D) Pleuritic chest pain exacerbated by inspiration
Rationale: Hoarseness (recurrent laryngeal nerve involvement) and
diaphragmatic paralysis (phrenic nerve involvement) are indicative of
malignant invasion of surrounding structures. Egophony and
increased fremitus suggest consolidation from infection; clubbing can
occur in both malignancy and chronic lung disease; pleuritic pain is
more typical of pleuritis or pulmonary embolism.
2. A 52-year-old female with a history of hypertension presents with a 3-
month history of progressive fatigue, cold intolerance, and constipation.
On examination, you note bradycardia, dry skin, and a non-tender,
diffusely enlarged thyroid gland. Laboratory studies reveal an elevated
TSH of 18 mIU/L and a free T4 of 0.5 ng/dL. Anti-thyroid peroxidase
antibodies are markedly elevated. Which of the following is the most
appropriate pharmacologic management?
,2|Page
A) Methimazole 10 mg daily
B) Levothyroxine 1.6 mcg/kg/day
C) Liothyronine 25 mcg daily
D) Propranolol 20 mg BID
Rationale: This patient has overt primary hypothyroidism due to
Hashimoto's thyroiditis. Levothyroxine is the standard replacement
therapy, dosed at approximately 1.6 mcg/kg/day. Methimazole and
propranolol are used for hyperthyroidism; liothyronine is not first-line
for hypothyroidism.
3. A 26-year-old male presents with a painless, 5-mm, indurated ulcer on
the shaft of his penis. He reports unprotected sexual contact with
multiple partners over the past 3 months. Bilateral inguinal
lymphadenopathy is present and non-tender. The lymph nodes are firm
and rubbery. Which of the following is the most likely diagnosis?
A) Genital herpes simplex
B) Condylomata acuminata
C) Primary syphilis (Chancre)
D) Chancroid
Rationale: Primary syphilis classically presents as a painless,
indurated ulcer (chancre) with nontender regional lymphadenopathy.
Genital herpes typically presents with painful vesicles; condylomata
are verrucous lesions; chancroid presents with a painful ulcer and
suppurative lymphadenopathy.
4. A 72-year-old male with type 2 diabetes and hypertension presents for
a routine visit. His blood pressure today is 152/94 mmHg. He reports
taking his lisinopril 10 mg daily as prescribed. He also reports taking
ibuprofen 600 mg TID for chronic knee pain. Which of the following is
the most appropriate next step in managing his blood pressure?
A) Increase lisinopril to 20 mg daily
B) Add hydrochlorothiazide 12.5 mg daily
C) Discontinue ibuprofen and reassess blood pressure
,3|Page
D) Refer to cardiology for further evaluation
Rationale: NSAIDs, including ibuprofen, can reduce the efficacy of
antihypertensive medications, particularly ACE inhibitors, and can
also cause sodium and water retention. Discontinuing the NSAID and
reassessing blood pressure is the most appropriate first step before
adjusting or adding antihypertensive therapy.
5. A 62-year-old male with a 40-pack-year smoking history presents
with progressive dyspnea on exertion and a chronic productive cough.
On pulmonary function testing, the FEV1/FVC ratio is 0.65 with
bronchodilator administration. Which of the following additional
findings on pulmonary function testing would confirm the diagnosis of
COPD?
A) Reduced total lung capacity
B) Elevated residual volume and functional residual capacity
C) Normal diffusing capacity of the lung for carbon monoxide (DLCO)
D) Reduced FVC with normal FEV1
Rationale: COPD is characterized by irreversible airflow obstruction
(FEV1/FVC < 0.70) with air trapping, leading to elevated residual
volume and functional residual capacity. Total lung capacity is
typically normal or increased; DLCO is reduced; a reduced FVC with
normal FEV1 suggests a restrictive pattern.
6. A 30-year-old pregnant woman at 32 weeks gestation presents with a
blood pressure of 158/102 mmHg and 2+ proteinuria on dipstick. She
reports a severe frontal headache and blurred vision. Which of the
following is the most appropriate immediate management?
A) Prescribe labetalol 200 mg PO and discharge with home blood
pressure monitoring
B) Admit to labor and delivery for immediate evaluation and
magnesium sulfate therapy
C) Schedule a follow-up appointment in 48 hours
D) Recommend strict bed rest and a low-sodium diet
, 4|Page
Rationale: This patient has severe preeclampsia with concerning
neurologic symptoms (headache, visual changes). Magnesium sulfate
is indicated for seizure prophylaxis, and antihypertensive therapy is
needed for blood pressure control. Admission is mandatory for
maternal and fetal monitoring; outpatient management is
contraindicated.
7. A 6-year-old male presents with a 2-day history of fever (102°F),
severe sore throat, and difficulty swallowing. On examination, you note
tonsillar erythema and exudates, palatal petechiae, and tender anterior
cervical lymphadenopathy. A rapid streptococcal antigen test is positive.
Which of the following is the most appropriate antibiotic regimen?
A) Azithromycin 10 mg/kg/day for 5 days
B) Penicillin VK 250 mg BID for 10 days
C) Amoxicillin 50 mg/kg/day divided BID for 10 days
D) Cephalexin 25 mg/kg/day divided BID for 10 days
Rationale: Penicillin or amoxicillin remains the first-line treatment for
group A streptococcal pharyngitis. Penicillin VK is preferred due to its
narrow spectrum, efficacy, and cost. Amoxicillin is acceptable, but
penicillin is the drug of choice; azithromycin is a second-line agent for
penicillin-allergic patients.
8. A 70-year-old female with osteoporosis is prescribed alendronate 70
mg once weekly. Which of the following instructions is most critical to
provide to this patient to prevent esophageal injury?
A) Take the medication with a full meal to minimize gastrointestinal
upset
B) Take on an empty stomach with a full glass of plain water and
remain upright for at least 30 minutes
C) Take with calcium and vitamin D supplements to enhance absorption
D) Take at bedtime to improve compliance
Rationale: Alendronate must be taken on an empty stomach with plain
water, and the patient must remain upright for at least 30 minutes to
