APEA PREDITOR EXAM WITH QUESTIONS AND ANSWERS ALREADY GRADED A+. 100% VERIFIED
SOLUTIONS | UPDATED PER LATEST GUIDELINES | GRADED A+...
Question 1
A 24-year-old female presents with a 3-day history of dysuria, urinary frequency, and suprapubic tenderness.
She denies fever, flank pain, or vaginal discharge. Urine dipstick is positive for leukocyte esterase and nitrites.
What is the most appropriate initial management?
A. Order a urine culture and wait for results before treating
B. Prescribe a 3-day course of trimethoprim-sulfamethoxazole
C. Prescribe a 7-day course of ciprofloxacin
D. Recommend increased fluid intake and cranberry juice only
🟢 Correct Answer:
B. Prescribe a 3-day course of trimethoprim-sulfamethoxazole
🔴 RATIONALE:
This presentation is consistent with uncomplicated acute cystitis in a young, nonpregnant female. A 3-day
course of trimethoprim-sulfamethoxazole or nitrofurantoin is appropriate first-line treatment. A 7-day
fluoroquinolone course is reserved for complicated infections or pyelonephritis. Delaying treatment while
awaiting culture is unnecessary in uncomplicated cases.
Question 2
A 56-year-old male with a history of hypertension and type 2 diabetes presents with a blood pressure of 154/92
mm Hg at a routine visit. His current medication is lisinopril 10 mg daily. What is the most appropriate next
step?
A. Add a thiazide diuretic
,B. Increase lisinopril to 40 mg daily
C. Recheck blood pressure manually before adjusting therapy
D. Discontinue lisinopril and start a beta-blocker
🟢 Correct Answer:
C. Recheck blood pressure manually before adjusting therapy
🔴 RATIONALE:
Before changing antihypertensive therapy based on a single elevated reading, the blood pressure should be
confirmed with a manual reading and possibly repeated on another occasion. White coat effect, improper cuff
size, or recent activity can cause falsely elevated readings. If confirmed, adding a thiazide diuretic is a
reasonable next step, but the initial action is verification.
Question 3
A 34-year-old woman presents with fatigue, weight gain, and cold intolerance. Physical exam reveals dry skin,
bradycardia, and delayed deep tendon reflexes. Which laboratory finding is most consistent with the suspected
diagnosis?
A. Low TSH, low free T4
B. High TSH, low free T4
C. Low TSH, high free T4
D. High TSH, high free T4
🟢 Correct Answer:
B. High TSH, low free T4
🔴 RATIONALE:
The clinical presentation suggests primary hypothyroidism. In primary hypothyroidism, the thyroid gland fails to
,produce adequate thyroid hormone, leading to low free T4 and a compensatory elevation of TSH from the
pituitary gland.
Question 4
A 68-year-old male presents with acute-onset unilateral eye pain, headache, nausea, and blurred vision. On
exam, the eye is red, the pupil is mid-dilated and nonreactive, and the cornea appears hazy. What is the priority
action?
A. Prescribe antibiotic eye drops
B. Arrange immediate ophthalmology evaluation for suspected acute angle-closure glaucoma
C. Apply a warm compress and reassess in 24 hours
D. Refer for cataract surgery
🟢 Correct Answer:
B. Arrange immediate ophthalmology evaluation for suspected acute angle-closure glaucoma
🔴 RATIONALE:
Acute angle-closure glaucoma is an ophthalmic emergency characterized by acute eye pain, mid-dilated
nonreactive pupil, corneal haze, and elevated intraocular pressure. Immediate ophthalmology referral is
required to prevent permanent vision loss. Antibiotics, warm compresses, and cataract referral are
inappropriate.
Question 5
A 45-year-old female presents with a painless lump in her right breast. She has no family history of breast
cancer. What is the most appropriate initial diagnostic test?
A. Mammogram only
B. Diagnostic mammogram and ultrasound
, C. Fine-needle aspiration biopsy
D. MRI of the breast
🟢 Correct Answer:
B. Diagnostic mammogram and ultrasound
🔴 RATIONALE:
For a palpable breast lump in a woman over 30, the initial evaluation includes diagnostic mammography and
targeted ultrasound to characterize the mass. Biopsy is performed if imaging suggests malignancy. MRI is not
an initial test for a palpable lump.
Question 6
A 22-year-old college student presents with sore throat, fever, fatigue, and posterior cervical lymphadenopathy.
Splenomegaly is noted on exam. What is the most likely diagnosis?
A. Streptococcal pharyngitis
B. Infectious mononucleosis
C. Influenza
D. Acute HIV infection
🟢 Correct Answer:
B. Infectious mononucleosis
🔴 RATIONALE:
Infectious mononucleosis, often caused by Epstein-Barr virus, presents with sore throat, fever, fatigue, posterior
cervical lymphadenopathy, and splenomegaly. Streptococcal pharyngitis does not typically cause splenomegaly.
Influenza and acute HIV have different clinical features.
SOLUTIONS | UPDATED PER LATEST GUIDELINES | GRADED A+...
Question 1
A 24-year-old female presents with a 3-day history of dysuria, urinary frequency, and suprapubic tenderness.
She denies fever, flank pain, or vaginal discharge. Urine dipstick is positive for leukocyte esterase and nitrites.
What is the most appropriate initial management?
A. Order a urine culture and wait for results before treating
B. Prescribe a 3-day course of trimethoprim-sulfamethoxazole
C. Prescribe a 7-day course of ciprofloxacin
D. Recommend increased fluid intake and cranberry juice only
🟢 Correct Answer:
B. Prescribe a 3-day course of trimethoprim-sulfamethoxazole
🔴 RATIONALE:
This presentation is consistent with uncomplicated acute cystitis in a young, nonpregnant female. A 3-day
course of trimethoprim-sulfamethoxazole or nitrofurantoin is appropriate first-line treatment. A 7-day
fluoroquinolone course is reserved for complicated infections or pyelonephritis. Delaying treatment while
awaiting culture is unnecessary in uncomplicated cases.
Question 2
A 56-year-old male with a history of hypertension and type 2 diabetes presents with a blood pressure of 154/92
mm Hg at a routine visit. His current medication is lisinopril 10 mg daily. What is the most appropriate next
step?
A. Add a thiazide diuretic
,B. Increase lisinopril to 40 mg daily
C. Recheck blood pressure manually before adjusting therapy
D. Discontinue lisinopril and start a beta-blocker
🟢 Correct Answer:
C. Recheck blood pressure manually before adjusting therapy
🔴 RATIONALE:
Before changing antihypertensive therapy based on a single elevated reading, the blood pressure should be
confirmed with a manual reading and possibly repeated on another occasion. White coat effect, improper cuff
size, or recent activity can cause falsely elevated readings. If confirmed, adding a thiazide diuretic is a
reasonable next step, but the initial action is verification.
Question 3
A 34-year-old woman presents with fatigue, weight gain, and cold intolerance. Physical exam reveals dry skin,
bradycardia, and delayed deep tendon reflexes. Which laboratory finding is most consistent with the suspected
diagnosis?
A. Low TSH, low free T4
B. High TSH, low free T4
C. Low TSH, high free T4
D. High TSH, high free T4
🟢 Correct Answer:
B. High TSH, low free T4
🔴 RATIONALE:
The clinical presentation suggests primary hypothyroidism. In primary hypothyroidism, the thyroid gland fails to
,produce adequate thyroid hormone, leading to low free T4 and a compensatory elevation of TSH from the
pituitary gland.
Question 4
A 68-year-old male presents with acute-onset unilateral eye pain, headache, nausea, and blurred vision. On
exam, the eye is red, the pupil is mid-dilated and nonreactive, and the cornea appears hazy. What is the priority
action?
A. Prescribe antibiotic eye drops
B. Arrange immediate ophthalmology evaluation for suspected acute angle-closure glaucoma
C. Apply a warm compress and reassess in 24 hours
D. Refer for cataract surgery
🟢 Correct Answer:
B. Arrange immediate ophthalmology evaluation for suspected acute angle-closure glaucoma
🔴 RATIONALE:
Acute angle-closure glaucoma is an ophthalmic emergency characterized by acute eye pain, mid-dilated
nonreactive pupil, corneal haze, and elevated intraocular pressure. Immediate ophthalmology referral is
required to prevent permanent vision loss. Antibiotics, warm compresses, and cataract referral are
inappropriate.
Question 5
A 45-year-old female presents with a painless lump in her right breast. She has no family history of breast
cancer. What is the most appropriate initial diagnostic test?
A. Mammogram only
B. Diagnostic mammogram and ultrasound
, C. Fine-needle aspiration biopsy
D. MRI of the breast
🟢 Correct Answer:
B. Diagnostic mammogram and ultrasound
🔴 RATIONALE:
For a palpable breast lump in a woman over 30, the initial evaluation includes diagnostic mammography and
targeted ultrasound to characterize the mass. Biopsy is performed if imaging suggests malignancy. MRI is not
an initial test for a palpable lump.
Question 6
A 22-year-old college student presents with sore throat, fever, fatigue, and posterior cervical lymphadenopathy.
Splenomegaly is noted on exam. What is the most likely diagnosis?
A. Streptococcal pharyngitis
B. Infectious mononucleosis
C. Influenza
D. Acute HIV infection
🟢 Correct Answer:
B. Infectious mononucleosis
🔴 RATIONALE:
Infectious mononucleosis, often caused by Epstein-Barr virus, presents with sore throat, fever, fatigue, posterior
cervical lymphadenopathy, and splenomegaly. Streptococcal pharyngitis does not typically cause splenomegaly.
Influenza and acute HIV have different clinical features.
