APEA 3P High Stakes Exam 2026 | Questions
& Answers with Rationales | Complete Study
Guide | Latest Update | Pass Guaranteed |
Instant Download
Section 1: Cardiovascular System (Questions 1–25)
Question 1
A 72-year-old male with hypertension and type 2 diabetes presents with a 3-day history of
severe, tearing chest pain radiating to his back. His blood pressure is 180/100 mmHg in the
right arm and 140/80 mmHg in the left arm. Which is the most appropriate initial diagnostic
test?
A. Transthoracic echocardiogram
B. Computed tomography angiography (CTA) of the chest
C. Electrocardiogram (ECG)
D. Chest X-ray
Correct Answer: B
Rationale: The presentation of acute, severe, tearing chest pain radiating to the back with a
significant blood pressure differential between arms is classic for an acute aortic dissection.
,CTA of the chest is the gold standard and most appropriate initial diagnostic test due to its
high sensitivity, specificity, and ability to define the extent of the dissection .
Question 2
A 55-year-old male presents with progressive dyspnea on exertion, orthopnea, and bilateral
lower extremity edema. Vital signs: BP 156/94, HR 88, RR 22, SpO2 94%. Exam reveals
jugular venous distension, an S3 gallop, and bibasilar crackles. BNP is 850 pg/mL. Which
diagnosis is most likely?
A. Chronic obstructive pulmonary disease exacerbation
B. Heart failure with reduced ejection fraction
C. Pulmonary embolism
D. Pneumonia
Correct Answer: B
Rationale: The classic triad of heart failure (dyspnea, orthopnea, edema) plus objective
findings of JVD, S3 gallop, pulmonary congestion (crackles), and elevated BNP (>400
pg/mL strongly supports HF) indicates heart failure with reduced ejection fraction .
Question 3
A 58-year-old man with longstanding hypertension presents with progressive dyspnea on
exertion, orthopnea, and bilateral lower-extremity edema. Echocardiography shows left-
ventricular hypertrophy with an ejection fraction of 55% and elevated filling pressures. The
underlying pathophysiologic mechanism primarily responsible for his symptoms is:
A. Diastolic dysfunction with impaired ventricular relaxation and elevated left-ventricular
end-diastolic pressure
B. High-output heart failure driven by chronic anemia and volume overload
,C. Primary right-ventricular failure with secondary pulmonary hypertension
D. Systolic dysfunction with reduced stroke volume secondary to myocardial ischemia
Correct Answer: A
Rationale: The preserved ejection fraction with elevated filling pressures and clinical
congestion indicates heart failure with preserved ejection fraction (HFpEF) driven by
diastolic dysfunction. Impaired relaxation and increased stiffness raise end-diastolic
pressure, producing pulmonary congestion and edema despite normal systolic function .
Question 4
A patient on digoxin therapy is prescribed Pyridium for a UTI. What can Pyridium cause?
A. Increased digoxin levels
B. Hemolytic anemia
C. Decreased digoxin levels
D. Renal failure
Correct Answer: B
Rationale: Pyridium (phenazopyridine) can cause hemolytic anemia. It is also important to
note that it can affect digoxin levels, but the direct adverse effect is hemolytic anemia .
Question 5
What medication is indicated for the treatment of heart failure?
A. Beta-blockers alone
B. ACEs, ARBs, ARNI with beta-blockers, and aldosterone receptor antagonists
C. Calcium channel blockers
D. Alpha-blockers
, Correct Answer: B
Rationale: Guideline-directed medical therapy for heart failure includes ACE inhibitors,
ARBs, ARNI (angiotensin receptor-neprilysin inhibitors), beta-blockers, and aldosterone
receptor antagonists .
Question 6
A 45-year-old female presents with palpitations and is found to have a mid-systolic click on
exam. Which condition is most likely?
A. Mitral regurgitation
B. Mitral valve prolapse
C. Aortic stenosis
D. Aortic regurgitation
Correct Answer: B
Rationale: Mitral valve prolapse presents with a mid-systolic click, commonly in women
aged 14-30, and is associated with palpitations and chest pain .
Question 7
Which murmur is associated with a "physiologic" murmur in an asymptomatic patient?
A. Mitral regurgitation
B. Peyton Manning murmur
C. Aortic stenosis
D. Mitral stenosis
Correct Answer: B
& Answers with Rationales | Complete Study
Guide | Latest Update | Pass Guaranteed |
Instant Download
Section 1: Cardiovascular System (Questions 1–25)
Question 1
A 72-year-old male with hypertension and type 2 diabetes presents with a 3-day history of
severe, tearing chest pain radiating to his back. His blood pressure is 180/100 mmHg in the
right arm and 140/80 mmHg in the left arm. Which is the most appropriate initial diagnostic
test?
A. Transthoracic echocardiogram
B. Computed tomography angiography (CTA) of the chest
C. Electrocardiogram (ECG)
D. Chest X-ray
Correct Answer: B
Rationale: The presentation of acute, severe, tearing chest pain radiating to the back with a
significant blood pressure differential between arms is classic for an acute aortic dissection.
,CTA of the chest is the gold standard and most appropriate initial diagnostic test due to its
high sensitivity, specificity, and ability to define the extent of the dissection .
Question 2
A 55-year-old male presents with progressive dyspnea on exertion, orthopnea, and bilateral
lower extremity edema. Vital signs: BP 156/94, HR 88, RR 22, SpO2 94%. Exam reveals
jugular venous distension, an S3 gallop, and bibasilar crackles. BNP is 850 pg/mL. Which
diagnosis is most likely?
A. Chronic obstructive pulmonary disease exacerbation
B. Heart failure with reduced ejection fraction
C. Pulmonary embolism
D. Pneumonia
Correct Answer: B
Rationale: The classic triad of heart failure (dyspnea, orthopnea, edema) plus objective
findings of JVD, S3 gallop, pulmonary congestion (crackles), and elevated BNP (>400
pg/mL strongly supports HF) indicates heart failure with reduced ejection fraction .
Question 3
A 58-year-old man with longstanding hypertension presents with progressive dyspnea on
exertion, orthopnea, and bilateral lower-extremity edema. Echocardiography shows left-
ventricular hypertrophy with an ejection fraction of 55% and elevated filling pressures. The
underlying pathophysiologic mechanism primarily responsible for his symptoms is:
A. Diastolic dysfunction with impaired ventricular relaxation and elevated left-ventricular
end-diastolic pressure
B. High-output heart failure driven by chronic anemia and volume overload
,C. Primary right-ventricular failure with secondary pulmonary hypertension
D. Systolic dysfunction with reduced stroke volume secondary to myocardial ischemia
Correct Answer: A
Rationale: The preserved ejection fraction with elevated filling pressures and clinical
congestion indicates heart failure with preserved ejection fraction (HFpEF) driven by
diastolic dysfunction. Impaired relaxation and increased stiffness raise end-diastolic
pressure, producing pulmonary congestion and edema despite normal systolic function .
Question 4
A patient on digoxin therapy is prescribed Pyridium for a UTI. What can Pyridium cause?
A. Increased digoxin levels
B. Hemolytic anemia
C. Decreased digoxin levels
D. Renal failure
Correct Answer: B
Rationale: Pyridium (phenazopyridine) can cause hemolytic anemia. It is also important to
note that it can affect digoxin levels, but the direct adverse effect is hemolytic anemia .
Question 5
What medication is indicated for the treatment of heart failure?
A. Beta-blockers alone
B. ACEs, ARBs, ARNI with beta-blockers, and aldosterone receptor antagonists
C. Calcium channel blockers
D. Alpha-blockers
, Correct Answer: B
Rationale: Guideline-directed medical therapy for heart failure includes ACE inhibitors,
ARBs, ARNI (angiotensin receptor-neprilysin inhibitors), beta-blockers, and aldosterone
receptor antagonists .
Question 6
A 45-year-old female presents with palpitations and is found to have a mid-systolic click on
exam. Which condition is most likely?
A. Mitral regurgitation
B. Mitral valve prolapse
C. Aortic stenosis
D. Aortic regurgitation
Correct Answer: B
Rationale: Mitral valve prolapse presents with a mid-systolic click, commonly in women
aged 14-30, and is associated with palpitations and chest pain .
Question 7
Which murmur is associated with a "physiologic" murmur in an asymptomatic patient?
A. Mitral regurgitation
B. Peyton Manning murmur
C. Aortic stenosis
D. Mitral stenosis
Correct Answer: B
