APEA 3P ACTUAL EXAM 2026 COMPLETE
WITH 100% CORRECT ANSWERS AND
EXPLANATIONS
Which headache sign does not warrant an immediate investigation?
a. Sudden ―thunderclap‖ onset
b. New headache after age 50
c. Progressive headache with focal neurologic deficits
d. Mild bilateral tension-type headache that responds to over-the-counter analgesics
Correct answer: d. Mild bilateral tension-type headache that responds to over-the-counter
analgesics
Explanation: Thunderclap onset, new headache after age 50, and progressive headaches with
neurologic deficits are red-flag features requiring urgent evaluation (e.g., subarachnoid
hemorrhage, mass lesion, temporal arteritis). A typical mild tension-type headache does not.
During a migraine, what happens to the cerebral arteries?
a. Vasoconstriction followed by vasodilation
b. Persistent vasoconstriction only
c. No change in caliber
d. Permanent stenosis
Correct answer: a. Vasoconstriction followed by vasodilation
Explanation: Classic migraine pathophysiology involves an initial vasoconstrictive phase (often
linked to aura) followed by vasodilation and sterile inflammation of meningeal vessels,
producing the throbbing pain.
You are evaluating a 15 year old patient for bipolar disorder. His parents tell you that he
has severe mood swings, is easily distracted, and constantly corrects his teachers. You
would have a high suspicion for bipolar if which symptom was present?
a. Distinct periods of elevated or irritable mood lasting ≥7 days (or requiring hospitalization)
with decreased need for sleep and grandiosity
b. Chronic low-grade irritability only
c. Occasional sadness after setbacks
d. Preference for solitary activities
Correct answer: a. Distinct periods of elevated or irritable mood lasting ≥7 days (or
requiring hospitalization) with decreased need for sleep and grandiosity
Explanation: Bipolar I requires at least one full manic episode; the described features
(distractibility, grandiosity via correcting teachers) raise suspicion only when discrete manic
episodes are present.
,Which risk factor is not associated with breast cancer?
a. Early menarche / late menopause
b. Nulliparity or first pregnancy after age 30
c. BRCA1/BRCA2 mutations
d. Multiparity with first pregnancy before age 20
Correct answer: d. Multiparity with first pregnancy before age 20
Explanation: Early first full-term pregnancy and multiparity are protective; the other factors
increase lifetime estrogen exposure or genetic risk.
A 26 year old woman with bulimia is likely to be:
a. Normal weight or slightly overweight
b. Severely underweight (BMI <15)
c. Morbidly obese
d. Cachectic with lanugo
Correct answer: a. Normal weight or slightly overweight
Explanation: Patients with bulimia nervosa typically maintain near-normal body weight, in
contrast to anorexia nervosa.
What medication is used to relieve acute wheezing in a patient with asthma?
a. Short-acting beta-2 agonist (e.g., albuterol)
b. Inhaled corticosteroid alone
c. Long-acting beta agonist alone
d. Leukotriene modifier alone
Correct answer: a. Short-acting beta-2 agonist (e.g., albuterol)
Explanation: SABAs are the rescue therapy for acute bronchospasm; controllers (ICS, LABA,
LTRA) are for maintenance.
You are evaluating an 80 year old patient for recent episodes of incontinence and
confusion. His family states that this is unusual for him and he has become increasingly
forgetful over the past two weeks. Which medication might be responsible for this?
a. Anticholinergic medication (e.g., oxybutynin, diphenhydramine)
b. Acetaminophen
c. Low-dose aspirin
d. Vitamin D
Correct answer: a. Anticholinergic medication (e.g., oxybutynin, diphenhydramine)
Explanation: Anticholinergics commonly cause acute confusion, memory impairment, and
urinary retention/overflow incontinence in older adults.
What suggests hyperandrogenism in an adolescent female?
a. Hirsutism, acne, and menstrual irregularity
b. Breast development only
, c. Tall stature alone
d. Delayed puberty
Correct answer: a. Hirsutism, acne, and menstrual irregularity
Explanation: Clinical hyperandrogenism is manifested by excess terminal hair, acne, and
oligo/amenorrhea (often PCOS).
Which is a synovial joint?
a. Knee (or shoulder, hip)
b. Skull suture
c. Pubic symphysis
d. Intervertebral disc
Correct answer: a. Knee (or shoulder, hip)
Explanation: Synovial joints have a joint cavity lined by synovial membrane (diarthroses);
sutures, symphyses, and discs are fibrous or cartilaginous.
A 67 year old woman with atrial fibrillation and an ejection fraction of 48% is on digoxin
and has had normal digoxin levels of 0.8–2 ng/dL for the past 9 months. Today, the level is
0.4 ng/dL. What could account for this change?
a. Addition of a medication that induces CYP3A4 or P-glycoprotein (e.g., rifampin, St. John’s
wort) or non-adherence
b. Worsening renal failure
c. Addition of amiodarone or verapamil
d. Hypokalemia
Correct answer: a. Addition of a medication that induces CYP3A4 or P-glycoprotein (e.g.,
rifampin, St. John’s wort) or non-adherence
Explanation: Digoxin levels fall with inducers of its clearance pathways or with missed doses;
inhibitors (amiodarone, verapamil) and reduced GFR raise levels.
Which medication is contraindicated in a child with acute sinusitis?
a. Oral decongestants or first-generation antihistamines in young children (or fluoroquinolones)
b. Amoxicillin
c. Intranasal saline
d. Acetaminophen
Correct answer: a. Oral decongestants or first-generation antihistamines in young children
(or fluoroquinolones)
Explanation: Oral decongestants and sedating antihistamines have limited efficacy and safety
concerns in young children; fluoroquinolones are avoided for cartilage toxicity.
Which best describes the lower extremity calf pain associated with peripheral artery
disease?
a. Intermittent claudication that occurs with walking and is relieved by rest
b. Pain at rest that is worse with elevation
WITH 100% CORRECT ANSWERS AND
EXPLANATIONS
Which headache sign does not warrant an immediate investigation?
a. Sudden ―thunderclap‖ onset
b. New headache after age 50
c. Progressive headache with focal neurologic deficits
d. Mild bilateral tension-type headache that responds to over-the-counter analgesics
Correct answer: d. Mild bilateral tension-type headache that responds to over-the-counter
analgesics
Explanation: Thunderclap onset, new headache after age 50, and progressive headaches with
neurologic deficits are red-flag features requiring urgent evaluation (e.g., subarachnoid
hemorrhage, mass lesion, temporal arteritis). A typical mild tension-type headache does not.
During a migraine, what happens to the cerebral arteries?
a. Vasoconstriction followed by vasodilation
b. Persistent vasoconstriction only
c. No change in caliber
d. Permanent stenosis
Correct answer: a. Vasoconstriction followed by vasodilation
Explanation: Classic migraine pathophysiology involves an initial vasoconstrictive phase (often
linked to aura) followed by vasodilation and sterile inflammation of meningeal vessels,
producing the throbbing pain.
You are evaluating a 15 year old patient for bipolar disorder. His parents tell you that he
has severe mood swings, is easily distracted, and constantly corrects his teachers. You
would have a high suspicion for bipolar if which symptom was present?
a. Distinct periods of elevated or irritable mood lasting ≥7 days (or requiring hospitalization)
with decreased need for sleep and grandiosity
b. Chronic low-grade irritability only
c. Occasional sadness after setbacks
d. Preference for solitary activities
Correct answer: a. Distinct periods of elevated or irritable mood lasting ≥7 days (or
requiring hospitalization) with decreased need for sleep and grandiosity
Explanation: Bipolar I requires at least one full manic episode; the described features
(distractibility, grandiosity via correcting teachers) raise suspicion only when discrete manic
episodes are present.
,Which risk factor is not associated with breast cancer?
a. Early menarche / late menopause
b. Nulliparity or first pregnancy after age 30
c. BRCA1/BRCA2 mutations
d. Multiparity with first pregnancy before age 20
Correct answer: d. Multiparity with first pregnancy before age 20
Explanation: Early first full-term pregnancy and multiparity are protective; the other factors
increase lifetime estrogen exposure or genetic risk.
A 26 year old woman with bulimia is likely to be:
a. Normal weight or slightly overweight
b. Severely underweight (BMI <15)
c. Morbidly obese
d. Cachectic with lanugo
Correct answer: a. Normal weight or slightly overweight
Explanation: Patients with bulimia nervosa typically maintain near-normal body weight, in
contrast to anorexia nervosa.
What medication is used to relieve acute wheezing in a patient with asthma?
a. Short-acting beta-2 agonist (e.g., albuterol)
b. Inhaled corticosteroid alone
c. Long-acting beta agonist alone
d. Leukotriene modifier alone
Correct answer: a. Short-acting beta-2 agonist (e.g., albuterol)
Explanation: SABAs are the rescue therapy for acute bronchospasm; controllers (ICS, LABA,
LTRA) are for maintenance.
You are evaluating an 80 year old patient for recent episodes of incontinence and
confusion. His family states that this is unusual for him and he has become increasingly
forgetful over the past two weeks. Which medication might be responsible for this?
a. Anticholinergic medication (e.g., oxybutynin, diphenhydramine)
b. Acetaminophen
c. Low-dose aspirin
d. Vitamin D
Correct answer: a. Anticholinergic medication (e.g., oxybutynin, diphenhydramine)
Explanation: Anticholinergics commonly cause acute confusion, memory impairment, and
urinary retention/overflow incontinence in older adults.
What suggests hyperandrogenism in an adolescent female?
a. Hirsutism, acne, and menstrual irregularity
b. Breast development only
, c. Tall stature alone
d. Delayed puberty
Correct answer: a. Hirsutism, acne, and menstrual irregularity
Explanation: Clinical hyperandrogenism is manifested by excess terminal hair, acne, and
oligo/amenorrhea (often PCOS).
Which is a synovial joint?
a. Knee (or shoulder, hip)
b. Skull suture
c. Pubic symphysis
d. Intervertebral disc
Correct answer: a. Knee (or shoulder, hip)
Explanation: Synovial joints have a joint cavity lined by synovial membrane (diarthroses);
sutures, symphyses, and discs are fibrous or cartilaginous.
A 67 year old woman with atrial fibrillation and an ejection fraction of 48% is on digoxin
and has had normal digoxin levels of 0.8–2 ng/dL for the past 9 months. Today, the level is
0.4 ng/dL. What could account for this change?
a. Addition of a medication that induces CYP3A4 or P-glycoprotein (e.g., rifampin, St. John’s
wort) or non-adherence
b. Worsening renal failure
c. Addition of amiodarone or verapamil
d. Hypokalemia
Correct answer: a. Addition of a medication that induces CYP3A4 or P-glycoprotein (e.g.,
rifampin, St. John’s wort) or non-adherence
Explanation: Digoxin levels fall with inducers of its clearance pathways or with missed doses;
inhibitors (amiodarone, verapamil) and reduced GFR raise levels.
Which medication is contraindicated in a child with acute sinusitis?
a. Oral decongestants or first-generation antihistamines in young children (or fluoroquinolones)
b. Amoxicillin
c. Intranasal saline
d. Acetaminophen
Correct answer: a. Oral decongestants or first-generation antihistamines in young children
(or fluoroquinolones)
Explanation: Oral decongestants and sedating antihistamines have limited efficacy and safety
concerns in young children; fluoroquinolones are avoided for cartilage toxicity.
Which best describes the lower extremity calf pain associated with peripheral artery
disease?
a. Intermittent claudication that occurs with walking and is relieved by rest
b. Pain at rest that is worse with elevation
