APEA PRE-PREDICTOR Exam Test Bank 2026/2027
| 670+ Board-Style Questions & Clinical Rationales
| Complete A+ Guide
SECTION I: CARDIOVASCULAR DISORDERS (Questions 1–85)
1. A 65-year-old man presents with chest pressure radiating to the jaw,
diaphoresis, and nausea. ECG shows ST-segment elevation in leads V1–V4. What is
the most likely diagnosis?
A. Stable angina
B. Acute anterior myocardial infarction
C. Pericarditis
D. Aortic dissection
B. Acute anterior myocardial infarction.
ST-segment elevation in leads V1–V4 indicates an anterior wall myocardial infarction. The
anterior wall is supplied by the left anterior descending (LAD) artery. Diaphoresis, nausea,
and radiating chest pressure are classic symptoms.
,2. A 60-year-old male with hypertension presents with sudden "tearing" chest pain
radiating to the back. BP is 185/110 in the right arm and 140/85 in the left arm.
What is the most likely diagnosis?
A. Acute myocardial infarction
B. Pulmonary embolism
C. Aortic dissection
D. Pericarditis
C. Aortic dissection.
Sudden, severe, tearing chest pain radiating to the back with unequal blood pressures in
the arms is the classic presentation of aortic dissection. Immediate imaging (CT
angiography) and blood pressure control are critical.
3. A 64-year-old patient reports substernal chest pressure that began while
climbing stairs and resolves after resting for 5 minutes. Which diagnosis is most
likely?
A. Pericarditis
B. Stable angina
C. Unstable angina
D. Prinzmetal angina
B. Stable angina.
Stable angina is characterized by predictable chest pain that occurs with exertion and
resolves with rest or nitroglycerin. The pain is caused by myocardial ischemia due to
coronary artery narrowing.
,4. A patient has repeated office blood pressure readings of 158/94 mm Hg.
According to ACC/AHA guidelines, what is the first step in management?
A. Start a thiazide diuretic immediately
B. Initiate lifestyle modifications and confirm with home BP monitoring
C. Order renal artery duplex ultrasound
D. Start an ACE inhibitor
B. Initiate lifestyle modifications and confirm with home BP monitoring.
Stage 2 hypertension (≥140/90) warrants prompt initiation of pharmacotherapy. However,
confirmation with home or ambulatory BP monitoring and lifestyle modifications are
appropriate first steps before or alongside medication initiation.
5. Which of the following is the most common cause of heart failure with
preserved ejection fraction (HFpEF)?
A. Coronary artery disease
B. Hypertension
C. Valvular heart disease
D. Viral myocarditis
B. Hypertension.
Hypertension is the most common cause of HFpEF, leading to left ventricular hypertrophy
and diastolic dysfunction. Other causes include diabetes, obesity, and aging.
, 6. A 72-year-old woman presents with dyspnea on exertion, orthopnea, and
bilateral crackles on lung auscultation. BNP is elevated. What is the most likely
diagnosis?
A. COPD exacerbation
B. Pneumonia
C. Heart failure
D. Pulmonary embolism
C. Heart failure.
Dyspnea on exertion, orthopnea, bilateral crackles, and elevated BNP are classic findings
in heart failure. BNP is a sensitive marker for ventricular stretch and heart failure.
7. Which medication is first-line for a patient with heart failure with reduced
ejection fraction (HFrEF) to reduce mortality?
A. Furosemide
B. Metoprolol succinate
C. Digoxin
D. Amlodipine
B. Metoprolol succinate.
Beta-blockers (specifically metoprolol succinate, carvedilol, or bisoprolol) are first-line for
HFrEF and have been shown to reduce mortality. Furosemide is used for symptom relief,
and digoxin reduces hospitalizations but not mortality.
| 670+ Board-Style Questions & Clinical Rationales
| Complete A+ Guide
SECTION I: CARDIOVASCULAR DISORDERS (Questions 1–85)
1. A 65-year-old man presents with chest pressure radiating to the jaw,
diaphoresis, and nausea. ECG shows ST-segment elevation in leads V1–V4. What is
the most likely diagnosis?
A. Stable angina
B. Acute anterior myocardial infarction
C. Pericarditis
D. Aortic dissection
B. Acute anterior myocardial infarction.
ST-segment elevation in leads V1–V4 indicates an anterior wall myocardial infarction. The
anterior wall is supplied by the left anterior descending (LAD) artery. Diaphoresis, nausea,
and radiating chest pressure are classic symptoms.
,2. A 60-year-old male with hypertension presents with sudden "tearing" chest pain
radiating to the back. BP is 185/110 in the right arm and 140/85 in the left arm.
What is the most likely diagnosis?
A. Acute myocardial infarction
B. Pulmonary embolism
C. Aortic dissection
D. Pericarditis
C. Aortic dissection.
Sudden, severe, tearing chest pain radiating to the back with unequal blood pressures in
the arms is the classic presentation of aortic dissection. Immediate imaging (CT
angiography) and blood pressure control are critical.
3. A 64-year-old patient reports substernal chest pressure that began while
climbing stairs and resolves after resting for 5 minutes. Which diagnosis is most
likely?
A. Pericarditis
B. Stable angina
C. Unstable angina
D. Prinzmetal angina
B. Stable angina.
Stable angina is characterized by predictable chest pain that occurs with exertion and
resolves with rest or nitroglycerin. The pain is caused by myocardial ischemia due to
coronary artery narrowing.
,4. A patient has repeated office blood pressure readings of 158/94 mm Hg.
According to ACC/AHA guidelines, what is the first step in management?
A. Start a thiazide diuretic immediately
B. Initiate lifestyle modifications and confirm with home BP monitoring
C. Order renal artery duplex ultrasound
D. Start an ACE inhibitor
B. Initiate lifestyle modifications and confirm with home BP monitoring.
Stage 2 hypertension (≥140/90) warrants prompt initiation of pharmacotherapy. However,
confirmation with home or ambulatory BP monitoring and lifestyle modifications are
appropriate first steps before or alongside medication initiation.
5. Which of the following is the most common cause of heart failure with
preserved ejection fraction (HFpEF)?
A. Coronary artery disease
B. Hypertension
C. Valvular heart disease
D. Viral myocarditis
B. Hypertension.
Hypertension is the most common cause of HFpEF, leading to left ventricular hypertrophy
and diastolic dysfunction. Other causes include diabetes, obesity, and aging.
, 6. A 72-year-old woman presents with dyspnea on exertion, orthopnea, and
bilateral crackles on lung auscultation. BNP is elevated. What is the most likely
diagnosis?
A. COPD exacerbation
B. Pneumonia
C. Heart failure
D. Pulmonary embolism
C. Heart failure.
Dyspnea on exertion, orthopnea, bilateral crackles, and elevated BNP are classic findings
in heart failure. BNP is a sensitive marker for ventricular stretch and heart failure.
7. Which medication is first-line for a patient with heart failure with reduced
ejection fraction (HFrEF) to reduce mortality?
A. Furosemide
B. Metoprolol succinate
C. Digoxin
D. Amlodipine
B. Metoprolol succinate.
Beta-blockers (specifically metoprolol succinate, carvedilol, or bisoprolol) are first-line for
HFrEF and have been shown to reduce mortality. Furosemide is used for symptom relief,
and digoxin reduces hospitalizations but not mortality.
