APEA Predictor Exam Blueprint 2026 |
APEA Predictor Exam 2026 | 120
Comprehensive Practice Questions and
Answers with Rationales | 100% Correct.
GRADED A+
1. A 68-year-old male is evaluated for sudden-onset right-sided
weakness and expressive aphasia. A non-contrast head CT scan rules
out acute intracranial hemorrhage. What is the critical therapeutic
window for the administration of intravenous recombinant tissue
plasminogen activator (rt-PA)?
A. Within 1 hour of symptom onset
B. Within 3.5 to 4.5 hours of symptom onset
C. Within 12 hours of symptom onset
D. Within 24 hours of symptom onset
Correct Answer: B. Within 3.5 to 4.5 hours of symptom onset
Rationale: For acute ischemic stroke, intravenous thrombolytic therapy
with rt-PA (alteplase) is most beneficial when administered within a strict
time window. The FDA labeling typically recommends within 3 hours, but
professional guidelines extend this window up to 4.5 hours from symptom
onset in carefully selected eligible patients. Administering rt-PA outside this
window significantly increases the risk of fatal intracranial hemorrhage.
Option A (1 hour) is often a target for "door-to-needle" time within the
hospital but is not the absolute therapeutic limit. Options C and D are
outside the accepted window for IV rt-PA.
, 2. A 4-year-old child is brought to the pediatric clinic with a 2-day
history of high fever, barking cough, and inspiratory stridor that
worsens at night. A neck radiograph reveals a classic "steeple sign."
What is the most common viral etiology of this presentation?
A. Respiratory syncytial virus (RSV)
B. Parainfluenza virus
C. Adenovirus
D. Bordetella pertussis
Correct Answer: B. Parainfluenza virus
Rationale: The clinical picture of a barking cough, inspiratory stridor, and
the characteristic subglottic narrowing ("steeple sign") on radiography
defines croup (laryngotracheobronchitis). Croup is most frequently caused
by human parainfluenza viruses (types 1 and 3). RSV (Option A) is the
primary cause of bronchiolitis in infants. Bordetella pertussis (Option D)
causes whooping cough, characterized by paroxysmal coughing fits
followed by a "whoop".
3. A 72-year-old male with a history of hypertension presents with the
acute onset of a tearing chest pain that radiates to the back. His blood
pressure is 180/95 mmHg in the right arm and 130/80 mmHg in the
left arm. What is the most likely diagnosis?
A. Acute Myocardial Infarction
B. Aortic Dissection
C. Pulmonary Embolism
D. Pericarditis
Correct Answer: B. Aortic Dissection
, Rationale: This presentation is classic for an aortic dissection. Key features
include the sudden onset of severe, tearing chest pain that radiates to the
back, often accompanied by a significant blood pressure differential
between the arms (≥20 mmHg difference). This is a hypertensive
emergency that requires immediate CT angiography for diagnosis.
Myocardial infarction (A) typically presents with pressure-like chest pain,
not a tearing quality. Pulmonary embolism (C) often presents with pleuritic
chest pain and dyspnea. Pericarditis (D) pain is typically worsened when
lying flat and improved by sitting forward.
4. A 65-year-old male with a 40-pack-year smoking history presents
with progressive shortness of breath, chronic cough, and peripheral
edema. Physical examination reveals jugular venous distention and
hepatomegaly. Which pathophysiological process best explains these
findings?
A. Left-sided heart failure with pulmonary congestion
B. Right-sided heart failure with systemic venous congestion
C. Chronic obstructive pulmonary disease (COPD)
D. Cor pulmonale with left ventricular failure
Correct Answer: B. Right-sided heart failure with systemic venous
congestion
Rationale: The patient's presentation (peripheral edema, JVD,
hepatomegaly) is classic for right-sided heart failure, which results in
systemic venous congestion. The patient's smoking history and chronic
respiratory symptoms suggest underlying COPD, which can lead to
pulmonary hypertension and subsequently right-sided heart failure (cor
pulmonale). Left-sided heart failure (A) typically presents with pulmonary
congestion (dyspnea, crackles, orthopnea). While COPD (C) is a contributing
factor, it does not fully explain the JVD and hepatomegaly.
, 5. A 48-year-old female complains of pain and stiffness in her right hip
and knee that is mild upon awakening, gets worse as the day
progresses, and is relieved with hot baths and ibuprofen. Crepitus is
palpated on range of motion of the knee. Signs of inflammation are
notably absent. What is the most likely diagnosis?
A. Rheumatoid Arthritis (RA)
B. Gout
C. Osteoarthritis (OA)
D. Osteoporosis
Correct Answer: C. Osteoarthritis (OA)
Rationale: OA typically causes "mechanical" joint pain. Key features include
brief morning stiffness (often less than 30 minutes), pain that worsens with
activity and improves with rest, and the presence of crepitus. The notable
absence of systemic inflammatory signs helps differentiate OA from
inflammatory arthritides like RA (A) or gout (B). Osteoporosis (D) is
generally asymptomatic until a fracture occurs.
6. A 34-year-old G2P1 woman at 28 weeks gestation presents with a
blood pressure of 155/100 mmHg and 3+ proteinuria on dipstick. She
reports a severe headache and epigastric pain. Which laboratory
finding would confirm the diagnosis of severe preeclampsia with end-
organ involvement?
A. Elevated BUN and creatinine
B. Platelet count of 85,000/µL
C. Elevated serum AST and ALT
D. All of the above
Correct Answer: D. All of the above
APEA Predictor Exam 2026 | 120
Comprehensive Practice Questions and
Answers with Rationales | 100% Correct.
GRADED A+
1. A 68-year-old male is evaluated for sudden-onset right-sided
weakness and expressive aphasia. A non-contrast head CT scan rules
out acute intracranial hemorrhage. What is the critical therapeutic
window for the administration of intravenous recombinant tissue
plasminogen activator (rt-PA)?
A. Within 1 hour of symptom onset
B. Within 3.5 to 4.5 hours of symptom onset
C. Within 12 hours of symptom onset
D. Within 24 hours of symptom onset
Correct Answer: B. Within 3.5 to 4.5 hours of symptom onset
Rationale: For acute ischemic stroke, intravenous thrombolytic therapy
with rt-PA (alteplase) is most beneficial when administered within a strict
time window. The FDA labeling typically recommends within 3 hours, but
professional guidelines extend this window up to 4.5 hours from symptom
onset in carefully selected eligible patients. Administering rt-PA outside this
window significantly increases the risk of fatal intracranial hemorrhage.
Option A (1 hour) is often a target for "door-to-needle" time within the
hospital but is not the absolute therapeutic limit. Options C and D are
outside the accepted window for IV rt-PA.
, 2. A 4-year-old child is brought to the pediatric clinic with a 2-day
history of high fever, barking cough, and inspiratory stridor that
worsens at night. A neck radiograph reveals a classic "steeple sign."
What is the most common viral etiology of this presentation?
A. Respiratory syncytial virus (RSV)
B. Parainfluenza virus
C. Adenovirus
D. Bordetella pertussis
Correct Answer: B. Parainfluenza virus
Rationale: The clinical picture of a barking cough, inspiratory stridor, and
the characteristic subglottic narrowing ("steeple sign") on radiography
defines croup (laryngotracheobronchitis). Croup is most frequently caused
by human parainfluenza viruses (types 1 and 3). RSV (Option A) is the
primary cause of bronchiolitis in infants. Bordetella pertussis (Option D)
causes whooping cough, characterized by paroxysmal coughing fits
followed by a "whoop".
3. A 72-year-old male with a history of hypertension presents with the
acute onset of a tearing chest pain that radiates to the back. His blood
pressure is 180/95 mmHg in the right arm and 130/80 mmHg in the
left arm. What is the most likely diagnosis?
A. Acute Myocardial Infarction
B. Aortic Dissection
C. Pulmonary Embolism
D. Pericarditis
Correct Answer: B. Aortic Dissection
, Rationale: This presentation is classic for an aortic dissection. Key features
include the sudden onset of severe, tearing chest pain that radiates to the
back, often accompanied by a significant blood pressure differential
between the arms (≥20 mmHg difference). This is a hypertensive
emergency that requires immediate CT angiography for diagnosis.
Myocardial infarction (A) typically presents with pressure-like chest pain,
not a tearing quality. Pulmonary embolism (C) often presents with pleuritic
chest pain and dyspnea. Pericarditis (D) pain is typically worsened when
lying flat and improved by sitting forward.
4. A 65-year-old male with a 40-pack-year smoking history presents
with progressive shortness of breath, chronic cough, and peripheral
edema. Physical examination reveals jugular venous distention and
hepatomegaly. Which pathophysiological process best explains these
findings?
A. Left-sided heart failure with pulmonary congestion
B. Right-sided heart failure with systemic venous congestion
C. Chronic obstructive pulmonary disease (COPD)
D. Cor pulmonale with left ventricular failure
Correct Answer: B. Right-sided heart failure with systemic venous
congestion
Rationale: The patient's presentation (peripheral edema, JVD,
hepatomegaly) is classic for right-sided heart failure, which results in
systemic venous congestion. The patient's smoking history and chronic
respiratory symptoms suggest underlying COPD, which can lead to
pulmonary hypertension and subsequently right-sided heart failure (cor
pulmonale). Left-sided heart failure (A) typically presents with pulmonary
congestion (dyspnea, crackles, orthopnea). While COPD (C) is a contributing
factor, it does not fully explain the JVD and hepatomegaly.
, 5. A 48-year-old female complains of pain and stiffness in her right hip
and knee that is mild upon awakening, gets worse as the day
progresses, and is relieved with hot baths and ibuprofen. Crepitus is
palpated on range of motion of the knee. Signs of inflammation are
notably absent. What is the most likely diagnosis?
A. Rheumatoid Arthritis (RA)
B. Gout
C. Osteoarthritis (OA)
D. Osteoporosis
Correct Answer: C. Osteoarthritis (OA)
Rationale: OA typically causes "mechanical" joint pain. Key features include
brief morning stiffness (often less than 30 minutes), pain that worsens with
activity and improves with rest, and the presence of crepitus. The notable
absence of systemic inflammatory signs helps differentiate OA from
inflammatory arthritides like RA (A) or gout (B). Osteoporosis (D) is
generally asymptomatic until a fracture occurs.
6. A 34-year-old G2P1 woman at 28 weeks gestation presents with a
blood pressure of 155/100 mmHg and 3+ proteinuria on dipstick. She
reports a severe headache and epigastric pain. Which laboratory
finding would confirm the diagnosis of severe preeclampsia with end-
organ involvement?
A. Elevated BUN and creatinine
B. Platelet count of 85,000/µL
C. Elevated serum AST and ALT
D. All of the above
Correct Answer: D. All of the above
