APEA 3P Test Bank |2025/2026
Latest Edition 150 -Based
Questions with Verified
1. A 58-year-old male presents with a 3-month history of progressive dysphagia,
initially to solids and now to liquids. He reports a 15-pound unintentional weight
loss. Which is the most appropriate next step?
A) Trial of proton pump inhibitor
B) Barium swallow
C) Upper endoscopy
D) Esophageal manometry
Correct Answer: C) Upper endoscopy
Rationale: Progressive dysphagia with weight loss is concerning for esophageal
malignancy. Upper endoscopy with biopsy is the gold standard for diagnosis.
2. A nurse practitioner prescribes lisinopril for a patient recently diagnosed with
hypertension. Which adverse effect should the clinician discuss as a possible
reason to discontinue the medication?
A. Bradycardia
B. Cough
C. Constipation
D. Hypoglycemia
CORRECT ANSWER: B. Cough
RATIONALE: ACE inhibitors such as lisinopril can cause a persistent dry cough due to
accumulation of bradykinin. This side effect often leads to a switch to an ARB.
3. A 72-year-old female presents with a 2-day history of right upper quadrant
pain, nausea, and fever. She reports similar episodes after fatty meals. Murphy's
sign is positive. What is the most likely diagnosis?
A) Acute pancreatitis
B) Acute cholecystitis
C) Peptic ulcer disease
D) Renal colic
Correct Answer: B) Acute cholecystitis
Rationale: RUQ pain, positive Murphy's sign, fever, and association with fatty meals are
classic for acute cholecystitis.
,4. Which of the following best describes first-pass metabolism?
A. The process by which a drug is metabolized in the kidneys before reaching systemic
circulation
B. The metabolism of a drug before it reaches systemic circulation, primarily in the liver
C. The rapid absorption of a drug through lung tissue
D. The excretion of drugs unchanged in the urine
CORRECT ANSWER: B. The metabolism of a drug before it reaches systemic circulation,
primarily in the liver
RATIONALE: First-pass metabolism occurs when orally administered drugs are
extensively metabolized in the liver before reaching the bloodstream, reducing
bioavailability.
5. A 32-year-old male complains of urinary frequency and burning on urination for
3 days. Urinalysis reveals bacteriuria and positive nitrites. He denies past history of
UTIs. What is the initial treatment?
A) Trimethoprim-sulfamethoxazole for 7-10 days
B) Ciprofloxacin for 3-5 days
C) Trimethoprim-sulfamethoxazole for 3 days
D) 750 mg ciprofloxacin as a one-time dose
Correct Answer: A) Trimethoprim-sulfamethoxazole for 7-10 days
Rationale: In men, UTIs are often treated as complicated until proven otherwise, so
longer courses are typically used compared with uncomplicated cystitis in women.
6. A diabetic patient on metformin develops renal impairment. What is the
primary concern?
A. Increased risk of hypoglycemia
B. Risk of lactic acidosis
C. Weight gain
D. Hyperosmolar state
CORRECT ANSWER: B. Risk of lactic acidosis
RATIONALE: Decreased renal clearance of metformin can lead to accumulation and
lactic acidosis, a rare but life-threatening adverse event.
7. A patient with benign prostatic hyperplasia (BPH) should be taught to avoid
which drug class?
A) Alpha-adrenergic antagonists
B) Anti-androgen agents
C) Tricyclic antidepressants (TCAs)
D) Sulfonamides
Correct Answer: C) Tricyclic antidepressants (TCAs)
,Rationale: TCAs have anticholinergic effects that can worsen urinary retention and
obstructive symptoms in BPH.
8. A patient with asthma is started on a non-selective beta blocker. What adverse
event might occur?
A. Hypotension crisis
B. Bronchoconstriction
C. Cardiac arrhythmias
D. Diuresis
CORRECT ANSWER: B. Bronchoconstriction
RATIONALE: Non-selective beta blockers (e.g., propranolol) block both β1 and β2
receptors; β2 blockade in bronchial smooth muscle can provoke bronchospasm in
asthmatic patients.
9. A 65-year-old female presents with a 2-week history of temporal headache, jaw
claudication, vision changes, scalp tenderness, and fatigue. What is the most likely
diagnosis?
A) Migraine
B) Tension headache
C) Giant cell (temporal) arteritis
D) Trigeminal neuralgia
Correct Answer: C) Giant cell (temporal) arteritis
Rationale: Giant cell arteritis presents with temporal headache, jaw claudication, vision
changes, and scalp tenderness. It is a medical emergency due to risk of blindness.
10. Which of the following findings is most specific for left-sided heart failure?
A. Peripheral edema
B. Ascites
C. Bibasilar crackles
D. Hepatomegaly
CORRECT ANSWER: C. Bibasilar crackles
RATIONALE: Left-sided heart failure leads to pulmonary congestion, presenting as
bibasilar crackles on auscultation.
11. A 72-year-old female presents with sudden-onset, painless loss of vision in the
left eye. She reports a "curtain" coming down over her vision. What is the most
likely diagnosis?
A) Retinal detachment
B) Central retinal artery occlusion
C) Vitreous hemorrhage
D) Age-related macular degeneration
, Correct Answer: A) Retinal detachment
Rationale: A "curtain" or "shadow" coming over vision is classic for retinal detachment.
12. A patient with classic signs and symptoms of appendicitis is not referred to a
surgeon. The appendix ruptures and the woman dies. This is an example of:
A) Failure of diligence
B) Professional liability
C) Negligence
D) Malpractice
Correct Answer: D) Malpractice
Rationale: Malpractice is professional negligence—failure to meet the standard of care
resulting in harm.
13. A patient presents with a painless ulcer on the genital area and non-tender
lymphadenopathy. Which is the most likely diagnosis?
A. Gonorrhea
B. Syphilis (primary stage)
C. Chancroid
D. Herpes simplex
CORRECT ANSWER: B. Syphilis (primary stage)
RATIONALE: Primary syphilis classically presents with a painless chancre and non-
tender lymphadenopathy.
14. A 68-year-old female presents with a 4-week history of fatigue, unintentional
weight loss, and early satiety. She reports vague abdominal discomfort. Physical
exam reveals splenomegaly. What is the most likely diagnosis?
A) Gastric cancer
B) Chronic lymphocytic leukemia
C) Myelofibrosis
D) Lymphoma
Correct Answer: D) Lymphoma
Rationale: Lymphoma can present with B symptoms (fever, night sweats, weight loss),
early satiety, and splenomegaly from extensive intra-abdominal disease.
15. A 45-year-old with COPD is switched from short-acting to long-acting inhaled
therapy. Which agent is most appropriate?
A. Albuterol
B. Tiotropium
C. Ipratropium
D. Cromolyn sodium
CORRECT ANSWER: B. Tiotropium
Latest Edition 150 -Based
Questions with Verified
1. A 58-year-old male presents with a 3-month history of progressive dysphagia,
initially to solids and now to liquids. He reports a 15-pound unintentional weight
loss. Which is the most appropriate next step?
A) Trial of proton pump inhibitor
B) Barium swallow
C) Upper endoscopy
D) Esophageal manometry
Correct Answer: C) Upper endoscopy
Rationale: Progressive dysphagia with weight loss is concerning for esophageal
malignancy. Upper endoscopy with biopsy is the gold standard for diagnosis.
2. A nurse practitioner prescribes lisinopril for a patient recently diagnosed with
hypertension. Which adverse effect should the clinician discuss as a possible
reason to discontinue the medication?
A. Bradycardia
B. Cough
C. Constipation
D. Hypoglycemia
CORRECT ANSWER: B. Cough
RATIONALE: ACE inhibitors such as lisinopril can cause a persistent dry cough due to
accumulation of bradykinin. This side effect often leads to a switch to an ARB.
3. A 72-year-old female presents with a 2-day history of right upper quadrant
pain, nausea, and fever. She reports similar episodes after fatty meals. Murphy's
sign is positive. What is the most likely diagnosis?
A) Acute pancreatitis
B) Acute cholecystitis
C) Peptic ulcer disease
D) Renal colic
Correct Answer: B) Acute cholecystitis
Rationale: RUQ pain, positive Murphy's sign, fever, and association with fatty meals are
classic for acute cholecystitis.
,4. Which of the following best describes first-pass metabolism?
A. The process by which a drug is metabolized in the kidneys before reaching systemic
circulation
B. The metabolism of a drug before it reaches systemic circulation, primarily in the liver
C. The rapid absorption of a drug through lung tissue
D. The excretion of drugs unchanged in the urine
CORRECT ANSWER: B. The metabolism of a drug before it reaches systemic circulation,
primarily in the liver
RATIONALE: First-pass metabolism occurs when orally administered drugs are
extensively metabolized in the liver before reaching the bloodstream, reducing
bioavailability.
5. A 32-year-old male complains of urinary frequency and burning on urination for
3 days. Urinalysis reveals bacteriuria and positive nitrites. He denies past history of
UTIs. What is the initial treatment?
A) Trimethoprim-sulfamethoxazole for 7-10 days
B) Ciprofloxacin for 3-5 days
C) Trimethoprim-sulfamethoxazole for 3 days
D) 750 mg ciprofloxacin as a one-time dose
Correct Answer: A) Trimethoprim-sulfamethoxazole for 7-10 days
Rationale: In men, UTIs are often treated as complicated until proven otherwise, so
longer courses are typically used compared with uncomplicated cystitis in women.
6. A diabetic patient on metformin develops renal impairment. What is the
primary concern?
A. Increased risk of hypoglycemia
B. Risk of lactic acidosis
C. Weight gain
D. Hyperosmolar state
CORRECT ANSWER: B. Risk of lactic acidosis
RATIONALE: Decreased renal clearance of metformin can lead to accumulation and
lactic acidosis, a rare but life-threatening adverse event.
7. A patient with benign prostatic hyperplasia (BPH) should be taught to avoid
which drug class?
A) Alpha-adrenergic antagonists
B) Anti-androgen agents
C) Tricyclic antidepressants (TCAs)
D) Sulfonamides
Correct Answer: C) Tricyclic antidepressants (TCAs)
,Rationale: TCAs have anticholinergic effects that can worsen urinary retention and
obstructive symptoms in BPH.
8. A patient with asthma is started on a non-selective beta blocker. What adverse
event might occur?
A. Hypotension crisis
B. Bronchoconstriction
C. Cardiac arrhythmias
D. Diuresis
CORRECT ANSWER: B. Bronchoconstriction
RATIONALE: Non-selective beta blockers (e.g., propranolol) block both β1 and β2
receptors; β2 blockade in bronchial smooth muscle can provoke bronchospasm in
asthmatic patients.
9. A 65-year-old female presents with a 2-week history of temporal headache, jaw
claudication, vision changes, scalp tenderness, and fatigue. What is the most likely
diagnosis?
A) Migraine
B) Tension headache
C) Giant cell (temporal) arteritis
D) Trigeminal neuralgia
Correct Answer: C) Giant cell (temporal) arteritis
Rationale: Giant cell arteritis presents with temporal headache, jaw claudication, vision
changes, and scalp tenderness. It is a medical emergency due to risk of blindness.
10. Which of the following findings is most specific for left-sided heart failure?
A. Peripheral edema
B. Ascites
C. Bibasilar crackles
D. Hepatomegaly
CORRECT ANSWER: C. Bibasilar crackles
RATIONALE: Left-sided heart failure leads to pulmonary congestion, presenting as
bibasilar crackles on auscultation.
11. A 72-year-old female presents with sudden-onset, painless loss of vision in the
left eye. She reports a "curtain" coming down over her vision. What is the most
likely diagnosis?
A) Retinal detachment
B) Central retinal artery occlusion
C) Vitreous hemorrhage
D) Age-related macular degeneration
, Correct Answer: A) Retinal detachment
Rationale: A "curtain" or "shadow" coming over vision is classic for retinal detachment.
12. A patient with classic signs and symptoms of appendicitis is not referred to a
surgeon. The appendix ruptures and the woman dies. This is an example of:
A) Failure of diligence
B) Professional liability
C) Negligence
D) Malpractice
Correct Answer: D) Malpractice
Rationale: Malpractice is professional negligence—failure to meet the standard of care
resulting in harm.
13. A patient presents with a painless ulcer on the genital area and non-tender
lymphadenopathy. Which is the most likely diagnosis?
A. Gonorrhea
B. Syphilis (primary stage)
C. Chancroid
D. Herpes simplex
CORRECT ANSWER: B. Syphilis (primary stage)
RATIONALE: Primary syphilis classically presents with a painless chancre and non-
tender lymphadenopathy.
14. A 68-year-old female presents with a 4-week history of fatigue, unintentional
weight loss, and early satiety. She reports vague abdominal discomfort. Physical
exam reveals splenomegaly. What is the most likely diagnosis?
A) Gastric cancer
B) Chronic lymphocytic leukemia
C) Myelofibrosis
D) Lymphoma
Correct Answer: D) Lymphoma
Rationale: Lymphoma can present with B symptoms (fever, night sweats, weight loss),
early satiety, and splenomegaly from extensive intra-abdominal disease.
15. A 45-year-old with COPD is switched from short-acting to long-acting inhaled
therapy. Which agent is most appropriate?
A. Albuterol
B. Tiotropium
C. Ipratropium
D. Cromolyn sodium
CORRECT ANSWER: B. Tiotropium
