APEA Predictor Test Bank - Questions with Correct Answers & Complete Solutions - Cardiology & Pulmonology Focus - Graded
A+
APEA Predictor Exam | Advanced Practice Education Associates | NP Certification Review | Graded A+
TABLE OF CONTENTS
1. I. Adult Health - Chronic Disease Management, Hypertension, Diabetes, COPD, Heart Failure, Asthma Classification
2. II. Cardiology - Atrial Fibrillation Warfarin INR Management, Chest Pain Unstable Angina NSTEMI ST Depression Aspirin Heparin Troponin
TIMI Risk, Heart Failure HFrEF EF 30% ACE Beta Blocker Diuretic Aldosterone Antagonist ARNI SGLT2
3. III. Pulmonology - COPD Exacerbation Albuterol Ipratropium Prednisone 40 mg Antibiotics Purulent Sputum Oxygen Target 88-92%, Asthma
Mild Intermittent vs Mild Persistent vs Moderate Persistent FEV1
4. IV. Endocrine - Hypothyroidism Elevated TSH Low Free T4 Fatigue Weight Gain Cold Intolerance Levothyroxine Empty Stomach,
Hyperthyroidism Graves Low TSH High Free T4 Palpitations Weight Loss Heat Intolerance Tremor Exophthalmos Methimazole PTU Beta Blocker
Propranolol
5. V. Pharmacology - Warfarin INR 4.5 No Bleeding Hold Low Dose Vitamin K, Lithium Level 0.6-1.2 TSH Creatinine Toxicity Tremor Confusion
Ataxia Hydration, SSRI Black Box Suicidal Ideation Safety Plan
6. VI. Women's Health & OB - Preeclampsia BP 140/90 After 20 Weeks Proteinuria 300 mg Severe BP 160/110 Headache Visual Platelets LFTs
Magnesium Sulfate Delivery, Abortion Types Threatened Os Closed Inevitable Os Open Incomplete Complete, Postmenopausal Bleeding
Endometrial Thickness >4-5 mm Biopsy Rule Out Cancer
7. VII. Infectious Disease - Acute Cystitis Dysuria Frequency Suprapubic Pain Leuk Esterase Nitrites E. coli Nitrofurantoin 100 BID 5 Days
TMP-SMX 3 Days Fosfomycin, Strep Throat Centor Criteria Sore Throat Fever Exudates Anterior Cervical No Cough Rapid Strep Penicillin
Amoxicillin
8. VIII. Pediatrics - Croup Barky Cough Inspiratory Stridor Night Parainfluenza Cool Mist Dexamethasone 0.6 mg/kg Racemic Epi, Epiglottitis Hib
Drooling Tripod Muffled Voice Stridor Emergency Do Not Examine Throat Secure Airway Ceftriaxone, Physiologic Jaundice After 24 Hours
Bilirubin <12-15 vs Pathologic <24 Hours >15
9. IX. Neurology - Normal Pressure Hydrocephalus Triad Wet Wobbly Wacky Confusion Incontinence Gait Disturbance Enlarged Ventricles VP
Shunt
10. X. Psychiatry - Major Depressive Disorder SSRI Sertraline Agitation Insomnia Suicidal Ideation Black Box Warning Young Adults Safety
Monitoring
11. XI. Musculoskeletal - OA Knee Pain Worse Activity Morning Stiffness <30 min Crepitus No Systemic Weight Loss PT Acetaminophen Topical
NSAIDs Oral NSAIDs Intra-articular Steroids vs RA >30 min Systemic Symmetric Small Joints
12. XII. GI - Duodenal Ulcer Pain Worse Night Relieved Food NSAID H. pylori Epigastric Triple Therapy Clarithromycin Amoxicillin PPI Quadruple
Bismuth Metronidazole Tetracycline
13. XIII. Practice Questions - Each Asked Like Real APEA Predictor Exam - Original Questions
14. XIV. Answer Key with Correct Answers & Complete Solutions - Graded A+
,APEA PREDICTOR TEST BANK - PRACTICE QUESTIONS - EACH QUESTION ASKED LIKE REAL EXAM
Based on APEA Predictor Blueprint - Adult, Women's Health, Pediatrics, Pharmacology, Cardiology, Endocrine, Psych, Infectious Disease. High Yield.
1. A 55-year-old male with diabetes, HTN, presents with chest pain exertional, relieved rest, SOB, diaphoresis. EKG shows ST depression. What is
next step?
A. Give antacid
B. Discharge home
C. Unstable angina/NSTEMI - admit, aspirin, heparin, troponin, EKG monitoring, cardiology consult, risk stratification TIMI, avoid nitrates if hypotensive, no
stress test acutely
D. Only reassurance
Answer: C
Rationale: Exertional chest pain relieved rest ST depression unstable angina/NSTEMI admit aspirin heparin troponin monitoring cardiology risk stratification.
2. A 60-year-old with heart failure with reduced ejection fraction 30%, on lisinopril, metoprolol, furosemide. What additional medication improves
mortality?
A. No additional
B. Stop ACE
C. Add NSAID
D. Add aldosterone antagonist eplerenone or spironolactone if K <5 creatinine <2.5 NYHA II-IV, also consider ARNI sacubitril-valsartan instead ACE, SGLT2
inhibitor dapagliflozin - all improve mortality HFrEF
Answer: D
Rationale: HFrEF EF 30% on ACE beta blocker diuretic add aldosterone antagonist eplerenone spironolactone if K <5 creatinine <2.5 NYHA II-IV also ARNI
sacubitril-valsartan SGLT2 dapagliflozin improve mortality.
3. A 55-year-old female with postmenopausal bleeding, endometrial thickness 8 mm on ultrasound. Next step?
A. Reassure
B. No biopsy
C. Postmenopausal bleeding always concerning - endometrial biopsy to rule out endometrial cancer - thickness >4-5 mm postmenopausal bleeding requires
biopsy
D. Only repeat ultrasound
Answer: C
Rationale: Postmenopausal bleeding concerning endometrial cancer endometrial thickness >4-5 mm requires biopsy endometrial biopsy.
4. A 65-year-old male with atrial fibrillation on warfarin presents with INR 4.5 and no bleeding. What is management?
A. Increase warfarin
B. No action
C. Give FFP immediately
D. Hold warfarin, consider low dose oral vitamin K 2.5 mg if high risk, recheck INR, assess bleeding risk, review diet drug interactions - INR 4.5 no bleeding hold
1-2 doses
Answer: D
Rationale: INR 4.5 no bleeding hold warfarin 1-2 doses consider low dose vitamin K 2.5 mg oral if high bleeding risk, recheck INR, assess diet drugs.
5. A 55-year-old female with postmenopausal bleeding, endometrial thickness 8 mm on ultrasound. Next step?
A. Postmenopausal bleeding always concerning - endometrial biopsy to rule out endometrial cancer - thickness >4-5 mm postmenopausal bleeding requires
biopsy
B. Only repeat ultrasound
C. No biopsy
D. Reassure
Answer: A
Rationale: Postmenopausal bleeding concerning endometrial cancer endometrial thickness >4-5 mm requires biopsy endometrial biopsy.
6. A 55-year-old male with diabetes, HTN, presents with chest pain exertional, relieved rest, SOB, diaphoresis. EKG shows ST depression. What is
next step?
A. Discharge home
B. Only reassurance
C. Unstable angina/NSTEMI - admit, aspirin, heparin, troponin, EKG monitoring, cardiology consult, risk stratification TIMI, avoid nitrates if hypotensive, no
stress test acutely
D. Give antacid
Answer: C
Rationale: Exertional chest pain relieved rest ST depression unstable angina/NSTEMI admit aspirin heparin troponin monitoring cardiology risk stratification.
7. A 25-year-old with sore throat, fever, exudates, anterior cervical lymphadenopathy, no cough, Centor criteria. Next step?
A. Centor criteria sore throat fever exudates anterior cervical lymphadenopathy no cough age - if 3-4 criteria test rapid strep - if positive treat penicillin
amoxicillin
B. No antibiotics
C. Only supportive
D. No test
Answer: A
Rationale: Centor criteria strep sore throat fever exudates anterior cervical lymphadenopathy no cough age - if 3-4 test rapid strep positive treat penicillin
amoxicillin.
,8. A 65-year-old male with atrial fibrillation on warfarin presents with INR 4.5 and no bleeding. What is management?
A. Give FFP immediately
B. Hold warfarin, consider low dose oral vitamin K 2.5 mg if high risk, recheck INR, assess bleeding risk, review diet drug interactions - INR 4.5 no bleeding hold
1-2 doses
C. Increase warfarin
D. No action
Answer: B
Rationale: INR 4.5 no bleeding hold warfarin 1-2 doses consider low dose vitamin K 2.5 mg oral if high bleeding risk, recheck INR, assess diet drugs.
9. A 25-year-old with sore throat, fever, exudates, anterior cervical lymphadenopathy, no cough, Centor criteria. Next step?
A. No antibiotics
B. Centor criteria sore throat fever exudates anterior cervical lymphadenopathy no cough age - if 3-4 criteria test rapid strep - if positive treat penicillin
amoxicillin
C. No test
D. Only supportive
Answer: B
Rationale: Centor criteria strep sore throat fever exudates anterior cervical lymphadenopathy no cough age - if 3-4 test rapid strep positive treat penicillin
amoxicillin.
10. A patient with asthma uses albuterol daily, nighttime symptoms 2x/week, FEV1 75%. Classification and treatment?
A. Mild persistent - symptoms >2 days/week but <daily, nighttime 3-4/month, FEV1 >=80%? Actually mild persistent symptoms >2 days/week <daily nighttime
3-4/month FEV1 >=80, moderate persistent daily nighttime >1/week FEV1 60-80 - this case moderate persistent daily albuterol nighttime 2/week FEV1 75%
moderate persistent - add low dose ICS
B. No asthma
C. Mild intermittent
D. Severe
Answer: A
Rationale: Asthma classification mild intermittent symptoms <=2 days/week nighttime <=2/month FEV1 >=80, mild persistent >2 days/week <daily nighttime
3-4/month FEV1 >=80, moderate persistent daily nighttime >1/week FEV1 60-80, severe continuous nighttime frequent FEV1 <60 - treatment ICS stepwise.
11. A 60-year-old with osteoarthritis knee pain worse with activity, morning stiffness <30 min, crepitus, no systemic symptoms. Treatment?
A. Only surgery
B. No treatment
C. OA knee - nonpharmacologic weight loss PT exercise, pharmacologic acetaminophen topical NSAIDs oral NSAIDs if no contraindications, intra-articular
steroids, no systemic inflammation - vs RA morning stiffness >30 min systemic symmetric small joints
D. Only opioids
Answer: C
Rationale: OA knee pain worse activity morning stiffness <30 min crepitus no systemic weight loss PT acetaminophen topical NSAIDs oral NSAIDs
intra-articular steroids vs RA >30 min systemic symmetric small joints.
12. A 18-month-old with fever, drooling, tripod position, muffled voice, stridor. Diagnosis?
A. Epiglottitis - Hib, medical emergency, drooling tripod muffled voice stridor fever - do not examine throat, secure airway ENT anesthesia, ceftriaxone
B. No emergency
C. Asthma
D. Croup
Answer: A
Rationale: Epiglottitis Hib emergency drooling tripod muffled voice stridor fever do not examine throat secure airway ceftriaxone.
13. A patient with asthma uses albuterol daily, nighttime symptoms 2x/week, FEV1 75%. Classification and treatment?
A. Mild persistent - symptoms >2 days/week but <daily, nighttime 3-4/month, FEV1 >=80%? Actually mild persistent symptoms >2 days/week <daily nighttime
3-4/month FEV1 >=80, moderate persistent daily nighttime >1/week FEV1 60-80 - this case moderate persistent daily albuterol nighttime 2/week FEV1 75%
moderate persistent - add low dose ICS
B. Mild intermittent
C. No asthma
D. Severe
Answer: A
Rationale: Asthma classification mild intermittent symptoms <=2 days/week nighttime <=2/month FEV1 >=80, mild persistent >2 days/week <daily nighttime
3-4/month FEV1 >=80, moderate persistent daily nighttime >1/week FEV1 60-80, severe continuous nighttime frequent FEV1 <60 - treatment ICS stepwise.
14. A 70-year-old with new confusion, urinary incontinence, gait disturbance, CT shows enlarged ventricles. Diagnosis?
A. Alzheimer
B. Parkinson
C. Normal pressure hydrocephalus - triad wet wobbly wacky - confusion incontinence gait disturbance enlarged ventricles - treat VP shunt
D. No disease
Answer: C
Rationale: Normal pressure hydrocephalus triad confusion incontinence gait disturbance wet wobbly wacky enlarged ventricles treat VP shunt.
15. A newborn with yellow skin day 2, bilirubin 12 mg/dL. Type of jaundice?
A. Physiologic jaundice - appears after 24 hours, bilirubin <12-15, no hemolysis, normal exam - pathologic if <24 hours bilirubin >15 rapid rise hemolysis
B. No jaundice
C. Always pathologic
, D. Pathologic
Answer: A
Rationale: Physiologic jaundice appears after 24 hours bilirubin <12-15 no hemolysis normal exam pathologic <24 hours >15 rapid rise hemolysis.
16. A 60-year-old with heart failure with reduced ejection fraction 30%, on lisinopril, metoprolol, furosemide. What additional medication improves
mortality?
A. No additional
B. Stop ACE
C. Add NSAID
D. Add aldosterone antagonist eplerenone or spironolactone if K <5 creatinine <2.5 NYHA II-IV, also consider ARNI sacubitril-valsartan instead ACE, SGLT2
inhibitor dapagliflozin - all improve mortality HFrEF
Answer: D
Rationale: HFrEF EF 30% on ACE beta blocker diuretic add aldosterone antagonist eplerenone spironolactone if K <5 creatinine <2.5 NYHA II-IV also ARNI
sacubitril-valsartan SGLT2 dapagliflozin improve mortality.
17. A 60-year-old with heart failure with reduced ejection fraction 30%, on lisinopril, metoprolol, furosemide. What additional medication improves
mortality?
A. No additional
B. Add aldosterone antagonist eplerenone or spironolactone if K <5 creatinine <2.5 NYHA II-IV, also consider ARNI sacubitril-valsartan instead ACE, SGLT2
inhibitor dapagliflozin - all improve mortality HFrEF
C. Stop ACE
D. Add NSAID
Answer: B
Rationale: HFrEF EF 30% on ACE beta blocker diuretic add aldosterone antagonist eplerenone spironolactone if K <5 creatinine <2.5 NYHA II-IV also ARNI
sacubitril-valsartan SGLT2 dapagliflozin improve mortality.
18. A 60-year-old with heart failure with reduced ejection fraction 30%, on lisinopril, metoprolol, furosemide. What additional medication improves
mortality?
A. Add aldosterone antagonist eplerenone or spironolactone if K <5 creatinine <2.5 NYHA II-IV, also consider ARNI sacubitril-valsartan instead ACE, SGLT2
inhibitor dapagliflozin - all improve mortality HFrEF
B. Stop ACE
C. Add NSAID
D. No additional
Answer: A
Rationale: HFrEF EF 30% on ACE beta blocker diuretic add aldosterone antagonist eplerenone spironolactone if K <5 creatinine <2.5 NYHA II-IV also ARNI
sacubitril-valsartan SGLT2 dapagliflozin improve mortality.
19. A 30-year-old pregnant female at 28 weeks presents with headache, visual changes, BP 160/100, proteinuria 2+, edema. What is diagnosis?
A. Gestational HTN only
B. Chronic HTN
C. Preeclampsia - BP >=140/90 after 20 weeks plus proteinuria >=300 mg or protein/creatinine >=0.3 or severe features headache visual changes platelets
<100K creatinine >1.1 LFTs twice normal pulmonary edema - severe preeclampsia if BP >=160/110 headache visual
D. No disease
Answer: C
Rationale: Preeclampsia BP >=140/90 after 20 weeks proteinuria >=300 mg or protein/creatinine >=0.3 or severe features headache visual changes platelets
<100K creatinine >1.1 LFTs 2x normal pulmonary edema. Severe if BP >=160/110 headache visual etc. Manage magnesium sulfate delivery.
20. A patient on lithium presents with tremor, polyuria, polydipsia, weight gain, hypothyroidism. What monitoring is required?
A. Only lithium level
B. No monitoring
C. No TSH
D. Lithium monitoring - lithium level 0.6-1.2, TSH baseline 6 months, creatinine BUN, electrolytes, pregnancy test, signs toxicity tremor confusion ataxia -
narrow therapeutic index, hydration
Answer: D
Rationale: Lithium narrow therapeutic index monitoring lithium level 0.6-1.2 TSH baseline 6 months creatinine BUN electrolytes toxicity tremor confusion ataxia
hydration.
21. A 60-year-old with heart failure with reduced ejection fraction 30%, on lisinopril, metoprolol, furosemide. What additional medication improves
mortality?
A. Add aldosterone antagonist eplerenone or spironolactone if K <5 creatinine <2.5 NYHA II-IV, also consider ARNI sacubitril-valsartan instead ACE, SGLT2
inhibitor dapagliflozin - all improve mortality HFrEF
B. Stop ACE
C. No additional
D. Add NSAID
Answer: A
Rationale: HFrEF EF 30% on ACE beta blocker diuretic add aldosterone antagonist eplerenone spironolactone if K <5 creatinine <2.5 NYHA II-IV also ARNI
sacubitril-valsartan SGLT2 dapagliflozin improve mortality.
22. A 50-year-old with major depressive disorder started sertraline 2 weeks ago reports worsening agitation, insomnia, suicidal ideation. What is
action?
A. Continue same dose
B. No concern
A+
APEA Predictor Exam | Advanced Practice Education Associates | NP Certification Review | Graded A+
TABLE OF CONTENTS
1. I. Adult Health - Chronic Disease Management, Hypertension, Diabetes, COPD, Heart Failure, Asthma Classification
2. II. Cardiology - Atrial Fibrillation Warfarin INR Management, Chest Pain Unstable Angina NSTEMI ST Depression Aspirin Heparin Troponin
TIMI Risk, Heart Failure HFrEF EF 30% ACE Beta Blocker Diuretic Aldosterone Antagonist ARNI SGLT2
3. III. Pulmonology - COPD Exacerbation Albuterol Ipratropium Prednisone 40 mg Antibiotics Purulent Sputum Oxygen Target 88-92%, Asthma
Mild Intermittent vs Mild Persistent vs Moderate Persistent FEV1
4. IV. Endocrine - Hypothyroidism Elevated TSH Low Free T4 Fatigue Weight Gain Cold Intolerance Levothyroxine Empty Stomach,
Hyperthyroidism Graves Low TSH High Free T4 Palpitations Weight Loss Heat Intolerance Tremor Exophthalmos Methimazole PTU Beta Blocker
Propranolol
5. V. Pharmacology - Warfarin INR 4.5 No Bleeding Hold Low Dose Vitamin K, Lithium Level 0.6-1.2 TSH Creatinine Toxicity Tremor Confusion
Ataxia Hydration, SSRI Black Box Suicidal Ideation Safety Plan
6. VI. Women's Health & OB - Preeclampsia BP 140/90 After 20 Weeks Proteinuria 300 mg Severe BP 160/110 Headache Visual Platelets LFTs
Magnesium Sulfate Delivery, Abortion Types Threatened Os Closed Inevitable Os Open Incomplete Complete, Postmenopausal Bleeding
Endometrial Thickness >4-5 mm Biopsy Rule Out Cancer
7. VII. Infectious Disease - Acute Cystitis Dysuria Frequency Suprapubic Pain Leuk Esterase Nitrites E. coli Nitrofurantoin 100 BID 5 Days
TMP-SMX 3 Days Fosfomycin, Strep Throat Centor Criteria Sore Throat Fever Exudates Anterior Cervical No Cough Rapid Strep Penicillin
Amoxicillin
8. VIII. Pediatrics - Croup Barky Cough Inspiratory Stridor Night Parainfluenza Cool Mist Dexamethasone 0.6 mg/kg Racemic Epi, Epiglottitis Hib
Drooling Tripod Muffled Voice Stridor Emergency Do Not Examine Throat Secure Airway Ceftriaxone, Physiologic Jaundice After 24 Hours
Bilirubin <12-15 vs Pathologic <24 Hours >15
9. IX. Neurology - Normal Pressure Hydrocephalus Triad Wet Wobbly Wacky Confusion Incontinence Gait Disturbance Enlarged Ventricles VP
Shunt
10. X. Psychiatry - Major Depressive Disorder SSRI Sertraline Agitation Insomnia Suicidal Ideation Black Box Warning Young Adults Safety
Monitoring
11. XI. Musculoskeletal - OA Knee Pain Worse Activity Morning Stiffness <30 min Crepitus No Systemic Weight Loss PT Acetaminophen Topical
NSAIDs Oral NSAIDs Intra-articular Steroids vs RA >30 min Systemic Symmetric Small Joints
12. XII. GI - Duodenal Ulcer Pain Worse Night Relieved Food NSAID H. pylori Epigastric Triple Therapy Clarithromycin Amoxicillin PPI Quadruple
Bismuth Metronidazole Tetracycline
13. XIII. Practice Questions - Each Asked Like Real APEA Predictor Exam - Original Questions
14. XIV. Answer Key with Correct Answers & Complete Solutions - Graded A+
,APEA PREDICTOR TEST BANK - PRACTICE QUESTIONS - EACH QUESTION ASKED LIKE REAL EXAM
Based on APEA Predictor Blueprint - Adult, Women's Health, Pediatrics, Pharmacology, Cardiology, Endocrine, Psych, Infectious Disease. High Yield.
1. A 55-year-old male with diabetes, HTN, presents with chest pain exertional, relieved rest, SOB, diaphoresis. EKG shows ST depression. What is
next step?
A. Give antacid
B. Discharge home
C. Unstable angina/NSTEMI - admit, aspirin, heparin, troponin, EKG monitoring, cardiology consult, risk stratification TIMI, avoid nitrates if hypotensive, no
stress test acutely
D. Only reassurance
Answer: C
Rationale: Exertional chest pain relieved rest ST depression unstable angina/NSTEMI admit aspirin heparin troponin monitoring cardiology risk stratification.
2. A 60-year-old with heart failure with reduced ejection fraction 30%, on lisinopril, metoprolol, furosemide. What additional medication improves
mortality?
A. No additional
B. Stop ACE
C. Add NSAID
D. Add aldosterone antagonist eplerenone or spironolactone if K <5 creatinine <2.5 NYHA II-IV, also consider ARNI sacubitril-valsartan instead ACE, SGLT2
inhibitor dapagliflozin - all improve mortality HFrEF
Answer: D
Rationale: HFrEF EF 30% on ACE beta blocker diuretic add aldosterone antagonist eplerenone spironolactone if K <5 creatinine <2.5 NYHA II-IV also ARNI
sacubitril-valsartan SGLT2 dapagliflozin improve mortality.
3. A 55-year-old female with postmenopausal bleeding, endometrial thickness 8 mm on ultrasound. Next step?
A. Reassure
B. No biopsy
C. Postmenopausal bleeding always concerning - endometrial biopsy to rule out endometrial cancer - thickness >4-5 mm postmenopausal bleeding requires
biopsy
D. Only repeat ultrasound
Answer: C
Rationale: Postmenopausal bleeding concerning endometrial cancer endometrial thickness >4-5 mm requires biopsy endometrial biopsy.
4. A 65-year-old male with atrial fibrillation on warfarin presents with INR 4.5 and no bleeding. What is management?
A. Increase warfarin
B. No action
C. Give FFP immediately
D. Hold warfarin, consider low dose oral vitamin K 2.5 mg if high risk, recheck INR, assess bleeding risk, review diet drug interactions - INR 4.5 no bleeding hold
1-2 doses
Answer: D
Rationale: INR 4.5 no bleeding hold warfarin 1-2 doses consider low dose vitamin K 2.5 mg oral if high bleeding risk, recheck INR, assess diet drugs.
5. A 55-year-old female with postmenopausal bleeding, endometrial thickness 8 mm on ultrasound. Next step?
A. Postmenopausal bleeding always concerning - endometrial biopsy to rule out endometrial cancer - thickness >4-5 mm postmenopausal bleeding requires
biopsy
B. Only repeat ultrasound
C. No biopsy
D. Reassure
Answer: A
Rationale: Postmenopausal bleeding concerning endometrial cancer endometrial thickness >4-5 mm requires biopsy endometrial biopsy.
6. A 55-year-old male with diabetes, HTN, presents with chest pain exertional, relieved rest, SOB, diaphoresis. EKG shows ST depression. What is
next step?
A. Discharge home
B. Only reassurance
C. Unstable angina/NSTEMI - admit, aspirin, heparin, troponin, EKG monitoring, cardiology consult, risk stratification TIMI, avoid nitrates if hypotensive, no
stress test acutely
D. Give antacid
Answer: C
Rationale: Exertional chest pain relieved rest ST depression unstable angina/NSTEMI admit aspirin heparin troponin monitoring cardiology risk stratification.
7. A 25-year-old with sore throat, fever, exudates, anterior cervical lymphadenopathy, no cough, Centor criteria. Next step?
A. Centor criteria sore throat fever exudates anterior cervical lymphadenopathy no cough age - if 3-4 criteria test rapid strep - if positive treat penicillin
amoxicillin
B. No antibiotics
C. Only supportive
D. No test
Answer: A
Rationale: Centor criteria strep sore throat fever exudates anterior cervical lymphadenopathy no cough age - if 3-4 test rapid strep positive treat penicillin
amoxicillin.
,8. A 65-year-old male with atrial fibrillation on warfarin presents with INR 4.5 and no bleeding. What is management?
A. Give FFP immediately
B. Hold warfarin, consider low dose oral vitamin K 2.5 mg if high risk, recheck INR, assess bleeding risk, review diet drug interactions - INR 4.5 no bleeding hold
1-2 doses
C. Increase warfarin
D. No action
Answer: B
Rationale: INR 4.5 no bleeding hold warfarin 1-2 doses consider low dose vitamin K 2.5 mg oral if high bleeding risk, recheck INR, assess diet drugs.
9. A 25-year-old with sore throat, fever, exudates, anterior cervical lymphadenopathy, no cough, Centor criteria. Next step?
A. No antibiotics
B. Centor criteria sore throat fever exudates anterior cervical lymphadenopathy no cough age - if 3-4 criteria test rapid strep - if positive treat penicillin
amoxicillin
C. No test
D. Only supportive
Answer: B
Rationale: Centor criteria strep sore throat fever exudates anterior cervical lymphadenopathy no cough age - if 3-4 test rapid strep positive treat penicillin
amoxicillin.
10. A patient with asthma uses albuterol daily, nighttime symptoms 2x/week, FEV1 75%. Classification and treatment?
A. Mild persistent - symptoms >2 days/week but <daily, nighttime 3-4/month, FEV1 >=80%? Actually mild persistent symptoms >2 days/week <daily nighttime
3-4/month FEV1 >=80, moderate persistent daily nighttime >1/week FEV1 60-80 - this case moderate persistent daily albuterol nighttime 2/week FEV1 75%
moderate persistent - add low dose ICS
B. No asthma
C. Mild intermittent
D. Severe
Answer: A
Rationale: Asthma classification mild intermittent symptoms <=2 days/week nighttime <=2/month FEV1 >=80, mild persistent >2 days/week <daily nighttime
3-4/month FEV1 >=80, moderate persistent daily nighttime >1/week FEV1 60-80, severe continuous nighttime frequent FEV1 <60 - treatment ICS stepwise.
11. A 60-year-old with osteoarthritis knee pain worse with activity, morning stiffness <30 min, crepitus, no systemic symptoms. Treatment?
A. Only surgery
B. No treatment
C. OA knee - nonpharmacologic weight loss PT exercise, pharmacologic acetaminophen topical NSAIDs oral NSAIDs if no contraindications, intra-articular
steroids, no systemic inflammation - vs RA morning stiffness >30 min systemic symmetric small joints
D. Only opioids
Answer: C
Rationale: OA knee pain worse activity morning stiffness <30 min crepitus no systemic weight loss PT acetaminophen topical NSAIDs oral NSAIDs
intra-articular steroids vs RA >30 min systemic symmetric small joints.
12. A 18-month-old with fever, drooling, tripod position, muffled voice, stridor. Diagnosis?
A. Epiglottitis - Hib, medical emergency, drooling tripod muffled voice stridor fever - do not examine throat, secure airway ENT anesthesia, ceftriaxone
B. No emergency
C. Asthma
D. Croup
Answer: A
Rationale: Epiglottitis Hib emergency drooling tripod muffled voice stridor fever do not examine throat secure airway ceftriaxone.
13. A patient with asthma uses albuterol daily, nighttime symptoms 2x/week, FEV1 75%. Classification and treatment?
A. Mild persistent - symptoms >2 days/week but <daily, nighttime 3-4/month, FEV1 >=80%? Actually mild persistent symptoms >2 days/week <daily nighttime
3-4/month FEV1 >=80, moderate persistent daily nighttime >1/week FEV1 60-80 - this case moderate persistent daily albuterol nighttime 2/week FEV1 75%
moderate persistent - add low dose ICS
B. Mild intermittent
C. No asthma
D. Severe
Answer: A
Rationale: Asthma classification mild intermittent symptoms <=2 days/week nighttime <=2/month FEV1 >=80, mild persistent >2 days/week <daily nighttime
3-4/month FEV1 >=80, moderate persistent daily nighttime >1/week FEV1 60-80, severe continuous nighttime frequent FEV1 <60 - treatment ICS stepwise.
14. A 70-year-old with new confusion, urinary incontinence, gait disturbance, CT shows enlarged ventricles. Diagnosis?
A. Alzheimer
B. Parkinson
C. Normal pressure hydrocephalus - triad wet wobbly wacky - confusion incontinence gait disturbance enlarged ventricles - treat VP shunt
D. No disease
Answer: C
Rationale: Normal pressure hydrocephalus triad confusion incontinence gait disturbance wet wobbly wacky enlarged ventricles treat VP shunt.
15. A newborn with yellow skin day 2, bilirubin 12 mg/dL. Type of jaundice?
A. Physiologic jaundice - appears after 24 hours, bilirubin <12-15, no hemolysis, normal exam - pathologic if <24 hours bilirubin >15 rapid rise hemolysis
B. No jaundice
C. Always pathologic
, D. Pathologic
Answer: A
Rationale: Physiologic jaundice appears after 24 hours bilirubin <12-15 no hemolysis normal exam pathologic <24 hours >15 rapid rise hemolysis.
16. A 60-year-old with heart failure with reduced ejection fraction 30%, on lisinopril, metoprolol, furosemide. What additional medication improves
mortality?
A. No additional
B. Stop ACE
C. Add NSAID
D. Add aldosterone antagonist eplerenone or spironolactone if K <5 creatinine <2.5 NYHA II-IV, also consider ARNI sacubitril-valsartan instead ACE, SGLT2
inhibitor dapagliflozin - all improve mortality HFrEF
Answer: D
Rationale: HFrEF EF 30% on ACE beta blocker diuretic add aldosterone antagonist eplerenone spironolactone if K <5 creatinine <2.5 NYHA II-IV also ARNI
sacubitril-valsartan SGLT2 dapagliflozin improve mortality.
17. A 60-year-old with heart failure with reduced ejection fraction 30%, on lisinopril, metoprolol, furosemide. What additional medication improves
mortality?
A. No additional
B. Add aldosterone antagonist eplerenone or spironolactone if K <5 creatinine <2.5 NYHA II-IV, also consider ARNI sacubitril-valsartan instead ACE, SGLT2
inhibitor dapagliflozin - all improve mortality HFrEF
C. Stop ACE
D. Add NSAID
Answer: B
Rationale: HFrEF EF 30% on ACE beta blocker diuretic add aldosterone antagonist eplerenone spironolactone if K <5 creatinine <2.5 NYHA II-IV also ARNI
sacubitril-valsartan SGLT2 dapagliflozin improve mortality.
18. A 60-year-old with heart failure with reduced ejection fraction 30%, on lisinopril, metoprolol, furosemide. What additional medication improves
mortality?
A. Add aldosterone antagonist eplerenone or spironolactone if K <5 creatinine <2.5 NYHA II-IV, also consider ARNI sacubitril-valsartan instead ACE, SGLT2
inhibitor dapagliflozin - all improve mortality HFrEF
B. Stop ACE
C. Add NSAID
D. No additional
Answer: A
Rationale: HFrEF EF 30% on ACE beta blocker diuretic add aldosterone antagonist eplerenone spironolactone if K <5 creatinine <2.5 NYHA II-IV also ARNI
sacubitril-valsartan SGLT2 dapagliflozin improve mortality.
19. A 30-year-old pregnant female at 28 weeks presents with headache, visual changes, BP 160/100, proteinuria 2+, edema. What is diagnosis?
A. Gestational HTN only
B. Chronic HTN
C. Preeclampsia - BP >=140/90 after 20 weeks plus proteinuria >=300 mg or protein/creatinine >=0.3 or severe features headache visual changes platelets
<100K creatinine >1.1 LFTs twice normal pulmonary edema - severe preeclampsia if BP >=160/110 headache visual
D. No disease
Answer: C
Rationale: Preeclampsia BP >=140/90 after 20 weeks proteinuria >=300 mg or protein/creatinine >=0.3 or severe features headache visual changes platelets
<100K creatinine >1.1 LFTs 2x normal pulmonary edema. Severe if BP >=160/110 headache visual etc. Manage magnesium sulfate delivery.
20. A patient on lithium presents with tremor, polyuria, polydipsia, weight gain, hypothyroidism. What monitoring is required?
A. Only lithium level
B. No monitoring
C. No TSH
D. Lithium monitoring - lithium level 0.6-1.2, TSH baseline 6 months, creatinine BUN, electrolytes, pregnancy test, signs toxicity tremor confusion ataxia -
narrow therapeutic index, hydration
Answer: D
Rationale: Lithium narrow therapeutic index monitoring lithium level 0.6-1.2 TSH baseline 6 months creatinine BUN electrolytes toxicity tremor confusion ataxia
hydration.
21. A 60-year-old with heart failure with reduced ejection fraction 30%, on lisinopril, metoprolol, furosemide. What additional medication improves
mortality?
A. Add aldosterone antagonist eplerenone or spironolactone if K <5 creatinine <2.5 NYHA II-IV, also consider ARNI sacubitril-valsartan instead ACE, SGLT2
inhibitor dapagliflozin - all improve mortality HFrEF
B. Stop ACE
C. No additional
D. Add NSAID
Answer: A
Rationale: HFrEF EF 30% on ACE beta blocker diuretic add aldosterone antagonist eplerenone spironolactone if K <5 creatinine <2.5 NYHA II-IV also ARNI
sacubitril-valsartan SGLT2 dapagliflozin improve mortality.
22. A 50-year-old with major depressive disorder started sertraline 2 weeks ago reports worsening agitation, insomnia, suicidal ideation. What is
action?
A. Continue same dose
B. No concern
