APEA PREDICTOR EXAM
COMPREHENSIVE REVIEW 2026/2027
1. A 65-year-old patient presents with a harsh systolic crescendo-decrescendo murmur heard
best at the second intercostal space, right sternal border, radiating to the carotids. What is
the most likely diagnosis?
A. Mitral Regurgitation
B. Mitral Stenosis
C. Aortic Stenosis
D. Aortic Regurgitation
Answer: C
Conceptual Explanation: Aortic stenosis is characterized by a systolic murmur at the right
upper sternal border that radiates to the neck. Mitral regurgitation is a holosystolic
murmur at the apex radiating to the axilla.
2. Which of the following is the first-line treatment for a 45-year-old patient with newly
diagnosed Type 2 Diabetes and an initial HbA1c of 7.5%?
A. Metformin
B. Glipizide
,C. Insulin Glargine
D. Pioglitazone
Answer: A
Conceptual Explanation: According to ADA guidelines, Metformin is the preferred initial
pharmacologic agent for the treatment of type 2 diabetes unless contraindicated.
3. A patient with a history of hypertension presents with a blood pressure of 155/95 mmHg.
The patient is already taking Lisinopril 20mg. Which laboratory value is most important to
monitor after increasing the dose?
A. Serum Sodium
B. Liver Enzymes
C. Serum Potassium
D. Serum Calcium
Answer: C
Conceptual Explanation: ACE inhibitors like Lisinopril can cause hyperkalemia and
decreased renal function; therefore, potassium and creatinine levels must be monitored.
4. A 24-year-old female presents with a ‘strawberry cervix’ and a malodorous, frothy,
yellowish-green vaginal discharge. What is the gold standard for diagnosis?
A. Wet Prep/Microscopy
B. NAAT (Nucleic Acid Amplification Test)
, C. Whiff Test
D. Vaginal pH
Answer: B
Conceptual Explanation: While microscopy may show motile trichomonads, NAAT is the
most sensitive and specific test (gold standard) for Trichomonas vaginalis.
5. Which physical exam finding is most indicative of acute cholecystitis?
A. Rovsing Sign
B. Psoas Sign
C. McBurney’s Point tenderness
D. Murphy’s Sign
Answer: D
Conceptual Explanation: Murphy’s sign (inspiratory arrest on deep palpation of the RUQ)
is highly suggestive of acute cholecystitis. The others are signs of appendicitis.
6. A 60-year-old male smoker presents with a persistent cough and a 10lb weight loss. A chest
X-ray shows a hilar mass. Which type of lung cancer is most associated with smoking and
central airway location?
A. Adenocarcinoma
B. Squamous cell carcinoma
C. Large cell carcinoma
COMPREHENSIVE REVIEW 2026/2027
1. A 65-year-old patient presents with a harsh systolic crescendo-decrescendo murmur heard
best at the second intercostal space, right sternal border, radiating to the carotids. What is
the most likely diagnosis?
A. Mitral Regurgitation
B. Mitral Stenosis
C. Aortic Stenosis
D. Aortic Regurgitation
Answer: C
Conceptual Explanation: Aortic stenosis is characterized by a systolic murmur at the right
upper sternal border that radiates to the neck. Mitral regurgitation is a holosystolic
murmur at the apex radiating to the axilla.
2. Which of the following is the first-line treatment for a 45-year-old patient with newly
diagnosed Type 2 Diabetes and an initial HbA1c of 7.5%?
A. Metformin
B. Glipizide
,C. Insulin Glargine
D. Pioglitazone
Answer: A
Conceptual Explanation: According to ADA guidelines, Metformin is the preferred initial
pharmacologic agent for the treatment of type 2 diabetes unless contraindicated.
3. A patient with a history of hypertension presents with a blood pressure of 155/95 mmHg.
The patient is already taking Lisinopril 20mg. Which laboratory value is most important to
monitor after increasing the dose?
A. Serum Sodium
B. Liver Enzymes
C. Serum Potassium
D. Serum Calcium
Answer: C
Conceptual Explanation: ACE inhibitors like Lisinopril can cause hyperkalemia and
decreased renal function; therefore, potassium and creatinine levels must be monitored.
4. A 24-year-old female presents with a ‘strawberry cervix’ and a malodorous, frothy,
yellowish-green vaginal discharge. What is the gold standard for diagnosis?
A. Wet Prep/Microscopy
B. NAAT (Nucleic Acid Amplification Test)
, C. Whiff Test
D. Vaginal pH
Answer: B
Conceptual Explanation: While microscopy may show motile trichomonads, NAAT is the
most sensitive and specific test (gold standard) for Trichomonas vaginalis.
5. Which physical exam finding is most indicative of acute cholecystitis?
A. Rovsing Sign
B. Psoas Sign
C. McBurney’s Point tenderness
D. Murphy’s Sign
Answer: D
Conceptual Explanation: Murphy’s sign (inspiratory arrest on deep palpation of the RUQ)
is highly suggestive of acute cholecystitis. The others are signs of appendicitis.
6. A 60-year-old male smoker presents with a persistent cough and a 10lb weight loss. A chest
X-ray shows a hilar mass. Which type of lung cancer is most associated with smoking and
central airway location?
A. Adenocarcinoma
B. Squamous cell carcinoma
C. Large cell carcinoma
