APEA Predictor Exam – NP Certification
Readiness Assessment Questions and
Answers |Graded A+).
Section 1: Advanced Physical Assessment (Questions 1–40)
Q1: A 58-year-old male presents with exertional chest pain. During cardiac auscultation, you
note a harsh crescendo-decrescendo systolic murmur at the right upper sternal border radiating
to the carotid arteries. The murmur decreases with handgrip. Which valvular lesion is most
likely?
A. Mitral regurgitation
B. Aortic stenosis [CORRECT]
C. Mitral stenosis
D. Hypertrophic cardiomyopathy
Correct Answer: B
Rationale: Best choice because a harsh systolic crescendo-decrescendo murmur at the right
upper sternal border with carotid radiation and decreased intensity with handgrip is
pathognomonic for aortic stenosis; handgrip increases afterload, which diminishes the murmur
of fixed obstruction.
Q2: A 42-year-old female reports progressive dyspnea on exertion. On cardiac auscultation, you
hear a low-pitched diastolic rumble at the apex with an opening snap. Which maneuver would
best accentuate this murmur?
A. Standing from squatting
B. Handgrip
C. Left lateral decubitus position [CORRECT]
D. Valsalva maneuver
Correct Answer: C
Rationale: Best choice because the left lateral decubitus position brings the apex closer to the
chest wall, enhancing low-frequency sounds such as the diastolic rumble of mitral stenosis.
,Q3: During abdominal examination of a 65-year-old male, you palpate a pulsatile midline mass
approximately 5 cm above the umbilicus. Which is the most appropriate next step?
A. Immediate surgical consultation
B. Abdominal ultrasound with aortic measurement [CORRECT]
C. CT abdomen without contrast
D. Observation with repeat exam in 6 months
Correct Answer: B
Rationale: Best choice because a pulsatile midline epigastric mass in an older male is highly
suggestive of abdominal aortic aneurysm, and ultrasound is the preferred initial screening and
diagnostic modality with accurate diameter measurement.
Q4: A 34-year-old patient presents with right upper quadrant pain. Murphy's sign is positive.
During the examination, the patient stops inspiration as the examiner palpates the right
subcostal area. What does this finding indicate?
A. Appendicitis
B. Acute cholecystitis [CORRECT]
C. Hepatitis
D. Peptic ulcer disease
Correct Answer: B
Rationale: Best choice because Murphy's sign—arrest of inspiration during right subcostal
palpation due to pain—is a classic physical finding for acute cholecystitis caused by an inflamed
gallbladder descending onto the examiner's hand.
Q5: A 72-year-old female is evaluated for gait instability. On neurologic examination, she has a
positive Romberg test. Which sensory deficit is most likely responsible?
A. Motor weakness
B. Proprioceptive loss [CORRECT]
C. Cerebellar dysfunction
D. Vestibular dysfunction
Correct Answer: B
Rationale: Best choice because the Romberg test specifically assesses proprioception; a positive
test (increased sway with eyes closed) indicates dorsal column or peripheral nerve pathology
affecting position sense.
,Q6: During musculoskeletal examination of a 28-year-old athlete, you perform the anterior
drawer test on the knee. The tibia translates anteriorly beyond normal limits. Which structure is
most likely injured?
A. Posterior cruciate ligament
B. Medial collateral ligament
C. Anterior cruciate ligament [CORRECT]
D. Lateral meniscus
Correct Answer: C
Rationale: Best choice because anterior drawer test assesses the integrity of the anterior
cruciate ligament; excessive anterior tibial translation indicates ACL disruption.
Q7: A 45-year-old male presents with shoulder pain. You perform the empty can test by
positioning the arm at 90 degrees of forward flexion with full internal rotation while resisting
downward pressure. Pain with this maneuver suggests pathology of which structure?
A. Biceps tendon
B. Subscapularis
C. Supraspinatus [CORRECT]
D. Infraspinatus
Correct Answer: C
Rationale: Best choice because the empty can test places maximal stress on the supraspinatus
tendon; pain with this maneuver indicates supraspinatus tendinopathy or tear.
Q8: A 55-year-old smoker presents with a non-healing ulcer on the lateral malleolus with a
punched-out appearance and minimal granulation tissue. Peripheral pulses are diminished.
Which type of ulcer is most consistent with this presentation?
A. Venous stasis ulcer
B. Arterial (ischemic) ulcer [CORRECT]
C. Neuropathic ulcer
D. Pressure injury
Correct Answer: B
Rationale: Best choice because arterial ulcers typically present over bony prominences such as
the lateral malleolus with a punched-out appearance, minimal granulation tissue, and
associated diminished pulses in patients with peripheral arterial disease.
, Q9: During HEENT examination of a 62-year-old male, you note a unilateral, pulsatile, bruit-like
tinnitus. Which diagnostic study is most appropriate?
A. Audiometry
B. Carotid duplex ultrasound
C. CT angiography of the head and neck [CORRECT]
D. MRI of the brain
Correct Answer: C
Rationale: Best choice because pulsatile tinnitus, especially when unilateral, requires evaluation
for vascular causes including carotid artery stenosis, arteriovenous malformations, or glomus
tumors; CT angiography provides comprehensive vascular assessment.
Q10: A 38-year-old female presents with a breast mass. On palpation, the mass is firm, irregular,
fixed to surrounding tissue, and non-tender. Which feature most strongly suggests malignancy?
A. Non-tender mass
B. Fixed to surrounding tissue [CORRECT]
C. Firm consistency
D. Irregular borders
Correct Answer: B
Rationale: Best choice because fixation to surrounding tissue or chest wall is a hallmark of
invasive breast cancer indicating local tissue invasion; while irregular borders and firmness are
suspicious, fixation carries the highest positive predictive value for malignancy.
Q11: A 28-year-old male presents with scrotal pain. On examination, you elevate the testis and
note pain relief. Which condition does this finding (Prehn's sign) suggest?
A. Testicular torsion
B. Epididymitis [CORRECT]
C. Varicocele
D. Hydrocele
Correct Answer: B
Rationale: Best choice because Prehn's sign—relief of pain with testicular elevation—is
characteristic of epididymitis; testicular torsion typically worsens with elevation.
Readiness Assessment Questions and
Answers |Graded A+).
Section 1: Advanced Physical Assessment (Questions 1–40)
Q1: A 58-year-old male presents with exertional chest pain. During cardiac auscultation, you
note a harsh crescendo-decrescendo systolic murmur at the right upper sternal border radiating
to the carotid arteries. The murmur decreases with handgrip. Which valvular lesion is most
likely?
A. Mitral regurgitation
B. Aortic stenosis [CORRECT]
C. Mitral stenosis
D. Hypertrophic cardiomyopathy
Correct Answer: B
Rationale: Best choice because a harsh systolic crescendo-decrescendo murmur at the right
upper sternal border with carotid radiation and decreased intensity with handgrip is
pathognomonic for aortic stenosis; handgrip increases afterload, which diminishes the murmur
of fixed obstruction.
Q2: A 42-year-old female reports progressive dyspnea on exertion. On cardiac auscultation, you
hear a low-pitched diastolic rumble at the apex with an opening snap. Which maneuver would
best accentuate this murmur?
A. Standing from squatting
B. Handgrip
C. Left lateral decubitus position [CORRECT]
D. Valsalva maneuver
Correct Answer: C
Rationale: Best choice because the left lateral decubitus position brings the apex closer to the
chest wall, enhancing low-frequency sounds such as the diastolic rumble of mitral stenosis.
,Q3: During abdominal examination of a 65-year-old male, you palpate a pulsatile midline mass
approximately 5 cm above the umbilicus. Which is the most appropriate next step?
A. Immediate surgical consultation
B. Abdominal ultrasound with aortic measurement [CORRECT]
C. CT abdomen without contrast
D. Observation with repeat exam in 6 months
Correct Answer: B
Rationale: Best choice because a pulsatile midline epigastric mass in an older male is highly
suggestive of abdominal aortic aneurysm, and ultrasound is the preferred initial screening and
diagnostic modality with accurate diameter measurement.
Q4: A 34-year-old patient presents with right upper quadrant pain. Murphy's sign is positive.
During the examination, the patient stops inspiration as the examiner palpates the right
subcostal area. What does this finding indicate?
A. Appendicitis
B. Acute cholecystitis [CORRECT]
C. Hepatitis
D. Peptic ulcer disease
Correct Answer: B
Rationale: Best choice because Murphy's sign—arrest of inspiration during right subcostal
palpation due to pain—is a classic physical finding for acute cholecystitis caused by an inflamed
gallbladder descending onto the examiner's hand.
Q5: A 72-year-old female is evaluated for gait instability. On neurologic examination, she has a
positive Romberg test. Which sensory deficit is most likely responsible?
A. Motor weakness
B. Proprioceptive loss [CORRECT]
C. Cerebellar dysfunction
D. Vestibular dysfunction
Correct Answer: B
Rationale: Best choice because the Romberg test specifically assesses proprioception; a positive
test (increased sway with eyes closed) indicates dorsal column or peripheral nerve pathology
affecting position sense.
,Q6: During musculoskeletal examination of a 28-year-old athlete, you perform the anterior
drawer test on the knee. The tibia translates anteriorly beyond normal limits. Which structure is
most likely injured?
A. Posterior cruciate ligament
B. Medial collateral ligament
C. Anterior cruciate ligament [CORRECT]
D. Lateral meniscus
Correct Answer: C
Rationale: Best choice because anterior drawer test assesses the integrity of the anterior
cruciate ligament; excessive anterior tibial translation indicates ACL disruption.
Q7: A 45-year-old male presents with shoulder pain. You perform the empty can test by
positioning the arm at 90 degrees of forward flexion with full internal rotation while resisting
downward pressure. Pain with this maneuver suggests pathology of which structure?
A. Biceps tendon
B. Subscapularis
C. Supraspinatus [CORRECT]
D. Infraspinatus
Correct Answer: C
Rationale: Best choice because the empty can test places maximal stress on the supraspinatus
tendon; pain with this maneuver indicates supraspinatus tendinopathy or tear.
Q8: A 55-year-old smoker presents with a non-healing ulcer on the lateral malleolus with a
punched-out appearance and minimal granulation tissue. Peripheral pulses are diminished.
Which type of ulcer is most consistent with this presentation?
A. Venous stasis ulcer
B. Arterial (ischemic) ulcer [CORRECT]
C. Neuropathic ulcer
D. Pressure injury
Correct Answer: B
Rationale: Best choice because arterial ulcers typically present over bony prominences such as
the lateral malleolus with a punched-out appearance, minimal granulation tissue, and
associated diminished pulses in patients with peripheral arterial disease.
, Q9: During HEENT examination of a 62-year-old male, you note a unilateral, pulsatile, bruit-like
tinnitus. Which diagnostic study is most appropriate?
A. Audiometry
B. Carotid duplex ultrasound
C. CT angiography of the head and neck [CORRECT]
D. MRI of the brain
Correct Answer: C
Rationale: Best choice because pulsatile tinnitus, especially when unilateral, requires evaluation
for vascular causes including carotid artery stenosis, arteriovenous malformations, or glomus
tumors; CT angiography provides comprehensive vascular assessment.
Q10: A 38-year-old female presents with a breast mass. On palpation, the mass is firm, irregular,
fixed to surrounding tissue, and non-tender. Which feature most strongly suggests malignancy?
A. Non-tender mass
B. Fixed to surrounding tissue [CORRECT]
C. Firm consistency
D. Irregular borders
Correct Answer: B
Rationale: Best choice because fixation to surrounding tissue or chest wall is a hallmark of
invasive breast cancer indicating local tissue invasion; while irregular borders and firmness are
suspicious, fixation carries the highest positive predictive value for malignancy.
Q11: A 28-year-old male presents with scrotal pain. On examination, you elevate the testis and
note pain relief. Which condition does this finding (Prehn's sign) suggest?
A. Testicular torsion
B. Epididymitis [CORRECT]
C. Varicocele
D. Hydrocele
Correct Answer: B
Rationale: Best choice because Prehn's sign—relief of pain with testicular elevation—is
characteristic of epididymitis; testicular torsion typically worsens with elevation.
