Pass APEA EXIT EXAM QBANK – (2026)
ACTUAL QUESTIONS & ANSWERS (APEA)
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COMPREHENSIVE EXAM PREPARATION |
VERIFIED QUESTIONS WITH CORRECT
ANSWERS AND DETAILED RATIONALES |
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1. A 65-year-old female presents with a complaint of gradual hearing loss over
the past year. She states that she has difficulty understanding conversations in
noisy environments. Rinne test shows air conduction > bone conduction
bilaterally. Weber test lateralizes to the left ear. Which type of hearing loss is
most likely?
A. Conductive hearing loss in the left ear
B. Sensorineural hearing loss in the right ear
C. Sensorineural hearing loss in the left ear
D. Mixed hearing loss in the left ear
Answer: B
Rationale: Rinne test normal (AC>BC) suggests sensorineural loss or normal
hearing. Weber lateralizes to the better ear in sensorineural loss; here, it lateralizes
to the left, meaning the left is the better ear, so the right ear has sensorineural loss.
In conductive loss, Weber lateralizes to the affected ear.
,2. A 55-year-old man with hypertension and diabetes presents with a blood
pressure of 148/92 mmHg. He is currently on lisinopril 20 mg daily. According
to JNC 8 guidelines, what is the most appropriate next step in management?
A. Add hydrochlorothiazide 25 mg daily
B. Increase lisinopril to 40 mg daily
C. Add amlodipine 5 mg daily
D. Recheck blood pressure in 3 months
Answer: C
Rationale: For African Americans? Not stated. JNC 8 for general population: if BP
not at goal with ACE inhibitor, add a calcium channel blocker or thiazide diuretic.
Both are appropriate, but amlodipine is a common add-on. Increasing lisinopril to
max dose (40 mg) is also an option, but guidelines often recommend adding a
second agent before maxing out one. Many resources: after ACE/ARB, add CCB or
thiazide. I'll choose C. Rationale: Adding a CCB is a reasonable next step per JNC 8
for non-Black patients when ACE alone not sufficient. If Black, add thiazide or CCB.
So C is broad.
3. Which of the following is the best initial diagnostic test for a patient with
suspected pulmonary embolism who is hemodynamically stable?
A. D-dimer assay
B. CT pulmonary angiography
C. Ventilation-perfusion (V/Q) scan
D. Chest X-ray
Answer: A
Rationale: In a stable patient with low to intermediate pre-test probability, a high-
sensitivity D-dimer is the initial test. If elevated, proceed to CT pulmonary
,angiography. For high probability or unstable, go directly to CTPA. V/Q scan if
contraindication to contrast.
4. A 70-year-old male presents with worsening urinary frequency, nocturia, and
a weak urinary stream. Digital rectal exam reveals an enlarged, smooth
prostate. PSA is 1.5 ng/mL. What is the first-line pharmacotherapy for this
patient?
A. Finasteride
B. Tamsulosin
C. Sildenafil
D. Oxybutynin
Answer: B
Rationale: Symptoms of benign prostatic hyperplasia (BPH) with a normal PSA.
First-line medical therapy is an alpha-1 blocker like tamsulosin to relax smooth
muscle in the prostate and bladder neck. 5-alpha reductase inhibitors (finasteride)
are used for larger prostates (>40 g) or if alpha blocker fails. Oxybutynin is
anticholinergic for overactive bladder, not BPH alone.
5. A 45-year-old woman presents with a solitary thyroid nodule. She is
euthyroid. What is the next step in evaluation?
A. Thyroid ultrasound and fine-needle aspiration if suspicious features
B. Thyroid scan with radioactive iodine
C. Start levothyroxine suppression therapy
D. Reassure and follow up in one year
, Answer: A
Rationale: For a solitary thyroid nodule, ultrasound to assess characteristics (size,
microcalcifications, irregular margins, hypoechoic) and then FNA if indicated per
guidelines (e.g., >1 cm with suspicious features). Thyroid scan (B) is used for
hyperthyroid nodule. Levothyroxine suppression (C) is no longer recommended.
6. A 32-year-old female with a history of migraine with aura asks about
contraception. Which contraceptive method is contraindicated?
A. Copper intrauterine device (IUD)
B. Levonorgestrel-releasing IUD
C. Combined oral contraceptives (estrogen and progestin)
D. Depot medroxyprogesterone acetate (DMPA)
Answer: C
Rationale: Migraine with aura increases the risk of ischemic stroke; estrogen-
containing contraceptives are contraindicated (WHO category 4). Progestin-only
methods, IUDs (copper or levonorgestrel), and barrier methods are safe.
7. An 80-year-old female presents with acute onset of severe back pain after
lifting a light object. She has a history of osteoporosis. Which imaging study is
most appropriate to rule out vertebral compression fracture?
A. Lumbar spine X-ray
B. MRI of the lumbar spine
C. CT scan without contrast
D. Bone scan
ACTUAL QUESTIONS & ANSWERS (APEA)
100% GUARANTEE PASS]
COMPREHENSIVE EXAM PREPARATION |
VERIFIED QUESTIONS WITH CORRECT
ANSWERS AND DETAILED RATIONALES |
INSTANT DOWNLOAD PDF
1. A 65-year-old female presents with a complaint of gradual hearing loss over
the past year. She states that she has difficulty understanding conversations in
noisy environments. Rinne test shows air conduction > bone conduction
bilaterally. Weber test lateralizes to the left ear. Which type of hearing loss is
most likely?
A. Conductive hearing loss in the left ear
B. Sensorineural hearing loss in the right ear
C. Sensorineural hearing loss in the left ear
D. Mixed hearing loss in the left ear
Answer: B
Rationale: Rinne test normal (AC>BC) suggests sensorineural loss or normal
hearing. Weber lateralizes to the better ear in sensorineural loss; here, it lateralizes
to the left, meaning the left is the better ear, so the right ear has sensorineural loss.
In conductive loss, Weber lateralizes to the affected ear.
,2. A 55-year-old man with hypertension and diabetes presents with a blood
pressure of 148/92 mmHg. He is currently on lisinopril 20 mg daily. According
to JNC 8 guidelines, what is the most appropriate next step in management?
A. Add hydrochlorothiazide 25 mg daily
B. Increase lisinopril to 40 mg daily
C. Add amlodipine 5 mg daily
D. Recheck blood pressure in 3 months
Answer: C
Rationale: For African Americans? Not stated. JNC 8 for general population: if BP
not at goal with ACE inhibitor, add a calcium channel blocker or thiazide diuretic.
Both are appropriate, but amlodipine is a common add-on. Increasing lisinopril to
max dose (40 mg) is also an option, but guidelines often recommend adding a
second agent before maxing out one. Many resources: after ACE/ARB, add CCB or
thiazide. I'll choose C. Rationale: Adding a CCB is a reasonable next step per JNC 8
for non-Black patients when ACE alone not sufficient. If Black, add thiazide or CCB.
So C is broad.
3. Which of the following is the best initial diagnostic test for a patient with
suspected pulmonary embolism who is hemodynamically stable?
A. D-dimer assay
B. CT pulmonary angiography
C. Ventilation-perfusion (V/Q) scan
D. Chest X-ray
Answer: A
Rationale: In a stable patient with low to intermediate pre-test probability, a high-
sensitivity D-dimer is the initial test. If elevated, proceed to CT pulmonary
,angiography. For high probability or unstable, go directly to CTPA. V/Q scan if
contraindication to contrast.
4. A 70-year-old male presents with worsening urinary frequency, nocturia, and
a weak urinary stream. Digital rectal exam reveals an enlarged, smooth
prostate. PSA is 1.5 ng/mL. What is the first-line pharmacotherapy for this
patient?
A. Finasteride
B. Tamsulosin
C. Sildenafil
D. Oxybutynin
Answer: B
Rationale: Symptoms of benign prostatic hyperplasia (BPH) with a normal PSA.
First-line medical therapy is an alpha-1 blocker like tamsulosin to relax smooth
muscle in the prostate and bladder neck. 5-alpha reductase inhibitors (finasteride)
are used for larger prostates (>40 g) or if alpha blocker fails. Oxybutynin is
anticholinergic for overactive bladder, not BPH alone.
5. A 45-year-old woman presents with a solitary thyroid nodule. She is
euthyroid. What is the next step in evaluation?
A. Thyroid ultrasound and fine-needle aspiration if suspicious features
B. Thyroid scan with radioactive iodine
C. Start levothyroxine suppression therapy
D. Reassure and follow up in one year
, Answer: A
Rationale: For a solitary thyroid nodule, ultrasound to assess characteristics (size,
microcalcifications, irregular margins, hypoechoic) and then FNA if indicated per
guidelines (e.g., >1 cm with suspicious features). Thyroid scan (B) is used for
hyperthyroid nodule. Levothyroxine suppression (C) is no longer recommended.
6. A 32-year-old female with a history of migraine with aura asks about
contraception. Which contraceptive method is contraindicated?
A. Copper intrauterine device (IUD)
B. Levonorgestrel-releasing IUD
C. Combined oral contraceptives (estrogen and progestin)
D. Depot medroxyprogesterone acetate (DMPA)
Answer: C
Rationale: Migraine with aura increases the risk of ischemic stroke; estrogen-
containing contraceptives are contraindicated (WHO category 4). Progestin-only
methods, IUDs (copper or levonorgestrel), and barrier methods are safe.
7. An 80-year-old female presents with acute onset of severe back pain after
lifting a light object. She has a history of osteoporosis. Which imaging study is
most appropriate to rule out vertebral compression fracture?
A. Lumbar spine X-ray
B. MRI of the lumbar spine
C. CT scan without contrast
D. Bone scan
