APEA PREDICTOR EXAM
COMPREHENSIVE REVIEW 2026/2027
QUESTIONS AND ANSWERS
1. A 65-year-old male presents with a new onset of a harsh, mid-systolic crescendo-
decrescendo murmur heard best at the second intercostal space, right sternal border,
radiating to the carotids. What is the most likely diagnosis?
A. Mitral Regurgitation
B. Mitral Stenosis
C. Aortic Regurgitation
D. Aortic Stenosis
Answer: D
Conceptual Explanation: Aortic stenosis presents as a systolic murmur at the right upper
sternal border radiating to the neck; it is often associated with aging and calcification.
2. According to the GOLD criteria for COPD, which of the following is the requirement for a
diagnosis of airflow limitation?
A. Post-bronchodilator FEV1/FVC < 0.70
B. Pre-bronchodilator FEV1/FVC < 0.80
,C. Post-bronchodilator FEV1 > 80% predicted
D. Total Lung Capacity < 70%
Answer: A
Conceptual Explanation: The Global Initiative for Chronic Obstructive Lung Disease
(GOLD) defines COPD by a post-bronchodilator FEV1/FVC ratio of less than 0.70.
3. A 45-year-old female presents with fatigue, weight gain, and cold intolerance. Her TSH is
12.4 mIU/L and Free T4 is low. What is the recommended starting dose of Levothyroxine for a
healthy adult without cardiac disease?
A. 12.5 mcg/day
B. 25 mcg/day
C. 1.6 mcg/kg/day
D. 5.0 mcg/kg/day
Answer: C
Conceptual Explanation: For young, healthy adults, the replacement dose of
Levothyroxine is calculated based on weight, typically 1.6 mcg/kg/day.
4. Which physical exam finding is most suggestive of Acute Appendicitis?
A. Murphy’s Sign
B. Cullen’s Sign
C. McBurney’s Point tenderness
, D. Grey Turner’s Sign
Answer: C
Conceptual Explanation: McBurney’s Point tenderness (one-third the distance from the
ASIS to the umbilicus) is a classic sign of appendicitis.
5. An 82-year-old patient with Chronic Kidney Disease (CKD) Stage 3b has a GFR of 35. Which
of the following medications should be used with extreme caution or avoided?
A. Acetaminophen
B. Lisinopril
C. Amlodipine
D. Naproxen
Answer: D
Conceptual Explanation: NSAIDs like Naproxen should be avoided in CKD patients as they
can further decrease renal perfusion and cause acute kidney injury.
6. A patient is diagnosed with Community-Acquired Pneumonia (CAP). He has no
comorbidities and no recent antibiotic use. According to current guidelines, what is the first-
line treatment?
A. Amoxicillin or Doxycycline
B. Levofloxacin
C. Ciprofloxacin
COMPREHENSIVE REVIEW 2026/2027
QUESTIONS AND ANSWERS
1. A 65-year-old male presents with a new onset of a harsh, mid-systolic crescendo-
decrescendo murmur heard best at the second intercostal space, right sternal border,
radiating to the carotids. What is the most likely diagnosis?
A. Mitral Regurgitation
B. Mitral Stenosis
C. Aortic Regurgitation
D. Aortic Stenosis
Answer: D
Conceptual Explanation: Aortic stenosis presents as a systolic murmur at the right upper
sternal border radiating to the neck; it is often associated with aging and calcification.
2. According to the GOLD criteria for COPD, which of the following is the requirement for a
diagnosis of airflow limitation?
A. Post-bronchodilator FEV1/FVC < 0.70
B. Pre-bronchodilator FEV1/FVC < 0.80
,C. Post-bronchodilator FEV1 > 80% predicted
D. Total Lung Capacity < 70%
Answer: A
Conceptual Explanation: The Global Initiative for Chronic Obstructive Lung Disease
(GOLD) defines COPD by a post-bronchodilator FEV1/FVC ratio of less than 0.70.
3. A 45-year-old female presents with fatigue, weight gain, and cold intolerance. Her TSH is
12.4 mIU/L and Free T4 is low. What is the recommended starting dose of Levothyroxine for a
healthy adult without cardiac disease?
A. 12.5 mcg/day
B. 25 mcg/day
C. 1.6 mcg/kg/day
D. 5.0 mcg/kg/day
Answer: C
Conceptual Explanation: For young, healthy adults, the replacement dose of
Levothyroxine is calculated based on weight, typically 1.6 mcg/kg/day.
4. Which physical exam finding is most suggestive of Acute Appendicitis?
A. Murphy’s Sign
B. Cullen’s Sign
C. McBurney’s Point tenderness
, D. Grey Turner’s Sign
Answer: C
Conceptual Explanation: McBurney’s Point tenderness (one-third the distance from the
ASIS to the umbilicus) is a classic sign of appendicitis.
5. An 82-year-old patient with Chronic Kidney Disease (CKD) Stage 3b has a GFR of 35. Which
of the following medications should be used with extreme caution or avoided?
A. Acetaminophen
B. Lisinopril
C. Amlodipine
D. Naproxen
Answer: D
Conceptual Explanation: NSAIDs like Naproxen should be avoided in CKD patients as they
can further decrease renal perfusion and cause acute kidney injury.
6. A patient is diagnosed with Community-Acquired Pneumonia (CAP). He has no
comorbidities and no recent antibiotic use. According to current guidelines, what is the first-
line treatment?
A. Amoxicillin or Doxycycline
B. Levofloxacin
C. Ciprofloxacin
