NR 603 APEA PREDICTOR EXAM ADVANCED CLINICAL
DIAGNOSIS AND PRACTICE ACROSS THE LIFESPAN
QUESTIONS & ANSWERS WITH RATIONALES – HIGH-
YIELD 360 LATEST 2026 REVIEW GUIDE
APEA Predictor Exam Sample Questions
1. A 32-year-old woman presents with sudden right lower quadrant pain, nausea, and low-
grade fever. Exam shows rebound tenderness. Most likely diagnosis?
A) Ovarian cyst rupture
B) Acute appendicitis
C) Ectopic pregnancy
D) Pelvic inflammatory disease
Correct Answer: B) Acute appendicitis
Rationale: Classic RLQ pain with rebound tenderness and systemic symptoms indicates appendicitis.
Other options may mimic, but location and signs point to appendicitis.
2. A 10-year-old child has fever, sore throat, and sandpaper-like rash on trunk. Causative
organism?
A) Staphylococcus aureus
B) Group A Streptococcus
C) Haemophilus influenzae
D) Epstein-Barr virus
Correct Answer: B) Group A Streptococcus
Rationale: Scarlet fever is caused by Group A Streptococcus; features include pharyngitis, fever, and
fine erythematous rash.
3. 58-year-old man with type 2 diabetes, polyuria, polydipsia, blurred vision. HbA1c 9.5%.
Next
step?
A) Observe and recheck labs in 3 months
B) Intensify glycemic control with lifestyle and meds
C) Start antibiotics
D) Schedule cardiac stress test
Correct Answer: B) Intensify glycemic control with lifestyle and meds
Rationale: HbA1c >9% indicates poor control; therapy must be intensified.
4. 25-year-old woman, 2 weeks postpartum, sudden dyspnea and pleuritic chest pain.
Most urgent consideration?
A) Asthma exacerbation
,B) Pulmonary embolism
C) Pneumonia
D) Myocardial infarction
Correct Answer: B) Pulmonary embolism
Rationale: Postpartum hypercoagulability + sudden dyspnea = high risk for PE.
5. 6-year-old
with fever, cough, coarse crackles, WBC 15,000/mm³. Empiric antibiotic for
community-acquired pneumonia?
A) Azithromycin
B) Amoxicillin
C) Ciprofloxacin
D) Trimethoprim-sulfamethoxazole
Correct Answer: B) Amoxicillin
Rationale: First-line empiric therapy in healthy children is amoxicillin.
6. 70-year-old man with crushing chest pain radiating to jaw, sweating, nausea. ECG
shows ST elevation in leads II, III, aVF. Next step?
A) Administer sublingual nitroglycerin and discharge
B) Emergent PCI
C) Oral beta-blocker only
D) Schedule stress test next week
Correct Answer: B) Emergent PCI
Rationale: ST-elevation MI (inferior wall) requires immediate reperfusion via PCI.
7. 45-year-old woman presents with fatigue, cold intolerance, constipation, and dry skin.
Labs show high TSH, low T4. Diagnosis?
A) Hyperthyroidism
B) Hypothyroidism
C) Cushing syndrome
D) Addison disease
Correct Answer: B) Hypothyroidism
Rationale: Classic symptoms with lab findings indicate primary hypothyroidism.
8. 22-year-old college student presents with dysuria, frequency, and urgency. Urine dip
shows leukocyte esterase positive. Most likely diagnosis?
A) Acute pyelonephritis
B) Cystitis
C) Interstitial nephritis
D) Urethral stricture
,Correct Answer: B) Cystitis
Rationale: Young female with dysuria and frequency, no systemic symptoms, consistent with
uncomplicated urinary tract infection.
9. A 60-year-old man with COPD develops worsening dyspnea, purulent sputum, and
fever. Best empiric antibiotic?
A) Amoxicillin
B) Levofloxacin
C) Vancomycin
D) Azithromycin
Correct Answer: B) Levofloxacin
Rationale: COPD exacerbation with suspected bacterial infection often requires respiratory
fluoroquinolone coverage.
10. 5-year-old child with sudden onset of difficulty breathing, inspiratory stridor, drooling,
and fever. Most likely diagnosis?
A) Croup
B) Epiglottitis
C) Asthma
D) Bronchiolitis
Correct Answer: B) Epiglottitis
Rationale: Drooling, stridor, and rapid onset suggest epiglottitis; airway management is priority.
11. A 55-year-old male with a history of hypertension presents with a sudden, severe
"thunderclap" headache, nausea, and photophobia. His blood pressure is 210/120
mmHg. What is the most likely diagnosis?
A) Migraine headache
B) Hypertensive emergency
C) Subarachnoid hemorrhage
D) Tension headache
Correct Answer: C) Subarachnoid hemorrhage
Rationale: A "thunderclap" headache (sudden and severe) is classic for subarachnoid hemorrhage
until proven otherwise. While the patient is hypertensive, the headache description is the key
diagnostic clue.
A 28-year-old woman presents with 3 days of dysuria, frequency, and
12.
suprapubic discomfort. She is afebrile. A urine dipstick is positive for leukocyte
esterase and nitrites. What is the first-line antibiotic treatment?
A) Ciprofloxacin 250 mg BID for 3 days
B) Nitrofurantoin 100 mg BID for 5 days
C) Amoxicillin-clavulanate 875 mg BID for 7 days
D) Doxycycline 100 mg BID for 7 days
, Correct Answer: B) Nitrofurantoin 100 mg BID for 5 days
Rationale: For uncomplicated cystitis in a young, healthy woman, the IDSA guidelines
recommend nitrofurantoin, TMP-SMX (if resistance is <20%), or fosfomycin as first-line agents.
Fluoroquinolones (like ciprofloxacin) are reserved for more complicated cases due to side effects
and resistance.
13. A 68-year-old man with a
40-pack-year smoking history presents with a new-onset
cough and hemoptysis. A chest X-ray shows a 3 cm hilar mass. What is the most
appropriate next step?
A) Prescribe a course of broad-spectrum antibiotics
B) Schedule a follow-up chest X-ray in 6 weeks
C) Refer for a CT scan of the chest
D) Order a pulmonary function test
Correct Answer: C) Refer for a CT scan of the chest
Rationale: A new lung nodule/mass in a high-risk patient (older, heavy smoker) with hemoptysis is
suspicious for lung cancer. The next step is further
characterization with a chest CT scan, which will guide the need for biopsy.
14. A16-year-old male is brought to the clinic by his mother for a sports physical. On
cardiac auscultation, you hear a mid-systolic click followed by a late systolic murmur at
the apex. Which maneuver would likely make the murmur louder?
A) Squatting
B) Handgrip
C) Valsalva maneuver (bearing down)
D) Lying flat
Correct Answer: C) Valsalva maneuver (bearing down)
Rationale: This describes mitral valve prolapse (MVP) with regurgitation. The murmur of MVP gets
louder with maneuvers that decrease left ventricular volume (like Valsalva or standing), as this
allows the prolapse to occur earlier and more prominently. Squatting increases venous return,
which increases ventricular volume and delays the prolapse, making the murmur softer.
15.A 75-year-old woman with a history of osteoporosis and GERD presents with acute
onset of severe epigastric pain radiating to her back. On exam, she is lying still and has
a rigid, board-like abdomen. What is the most likely diagnosis?
A) Acute cholecystitis
B) Perforatedpeptic ulcer
C) Acute pancreatitis
D) Gastroesophageal reflux
Correct Answer: B) Perforated peptic ulcer
Rationale: The combination of a rigid, board-like abdomen and severe, sudden- onset epigastric
pain is highly suggestive of a perforated viscus (like a peptic
ulcer), leading to peritonitis. Her GERD history is a risk factor. Acute pancreatitis pain often radiates
DIAGNOSIS AND PRACTICE ACROSS THE LIFESPAN
QUESTIONS & ANSWERS WITH RATIONALES – HIGH-
YIELD 360 LATEST 2026 REVIEW GUIDE
APEA Predictor Exam Sample Questions
1. A 32-year-old woman presents with sudden right lower quadrant pain, nausea, and low-
grade fever. Exam shows rebound tenderness. Most likely diagnosis?
A) Ovarian cyst rupture
B) Acute appendicitis
C) Ectopic pregnancy
D) Pelvic inflammatory disease
Correct Answer: B) Acute appendicitis
Rationale: Classic RLQ pain with rebound tenderness and systemic symptoms indicates appendicitis.
Other options may mimic, but location and signs point to appendicitis.
2. A 10-year-old child has fever, sore throat, and sandpaper-like rash on trunk. Causative
organism?
A) Staphylococcus aureus
B) Group A Streptococcus
C) Haemophilus influenzae
D) Epstein-Barr virus
Correct Answer: B) Group A Streptococcus
Rationale: Scarlet fever is caused by Group A Streptococcus; features include pharyngitis, fever, and
fine erythematous rash.
3. 58-year-old man with type 2 diabetes, polyuria, polydipsia, blurred vision. HbA1c 9.5%.
Next
step?
A) Observe and recheck labs in 3 months
B) Intensify glycemic control with lifestyle and meds
C) Start antibiotics
D) Schedule cardiac stress test
Correct Answer: B) Intensify glycemic control with lifestyle and meds
Rationale: HbA1c >9% indicates poor control; therapy must be intensified.
4. 25-year-old woman, 2 weeks postpartum, sudden dyspnea and pleuritic chest pain.
Most urgent consideration?
A) Asthma exacerbation
,B) Pulmonary embolism
C) Pneumonia
D) Myocardial infarction
Correct Answer: B) Pulmonary embolism
Rationale: Postpartum hypercoagulability + sudden dyspnea = high risk for PE.
5. 6-year-old
with fever, cough, coarse crackles, WBC 15,000/mm³. Empiric antibiotic for
community-acquired pneumonia?
A) Azithromycin
B) Amoxicillin
C) Ciprofloxacin
D) Trimethoprim-sulfamethoxazole
Correct Answer: B) Amoxicillin
Rationale: First-line empiric therapy in healthy children is amoxicillin.
6. 70-year-old man with crushing chest pain radiating to jaw, sweating, nausea. ECG
shows ST elevation in leads II, III, aVF. Next step?
A) Administer sublingual nitroglycerin and discharge
B) Emergent PCI
C) Oral beta-blocker only
D) Schedule stress test next week
Correct Answer: B) Emergent PCI
Rationale: ST-elevation MI (inferior wall) requires immediate reperfusion via PCI.
7. 45-year-old woman presents with fatigue, cold intolerance, constipation, and dry skin.
Labs show high TSH, low T4. Diagnosis?
A) Hyperthyroidism
B) Hypothyroidism
C) Cushing syndrome
D) Addison disease
Correct Answer: B) Hypothyroidism
Rationale: Classic symptoms with lab findings indicate primary hypothyroidism.
8. 22-year-old college student presents with dysuria, frequency, and urgency. Urine dip
shows leukocyte esterase positive. Most likely diagnosis?
A) Acute pyelonephritis
B) Cystitis
C) Interstitial nephritis
D) Urethral stricture
,Correct Answer: B) Cystitis
Rationale: Young female with dysuria and frequency, no systemic symptoms, consistent with
uncomplicated urinary tract infection.
9. A 60-year-old man with COPD develops worsening dyspnea, purulent sputum, and
fever. Best empiric antibiotic?
A) Amoxicillin
B) Levofloxacin
C) Vancomycin
D) Azithromycin
Correct Answer: B) Levofloxacin
Rationale: COPD exacerbation with suspected bacterial infection often requires respiratory
fluoroquinolone coverage.
10. 5-year-old child with sudden onset of difficulty breathing, inspiratory stridor, drooling,
and fever. Most likely diagnosis?
A) Croup
B) Epiglottitis
C) Asthma
D) Bronchiolitis
Correct Answer: B) Epiglottitis
Rationale: Drooling, stridor, and rapid onset suggest epiglottitis; airway management is priority.
11. A 55-year-old male with a history of hypertension presents with a sudden, severe
"thunderclap" headache, nausea, and photophobia. His blood pressure is 210/120
mmHg. What is the most likely diagnosis?
A) Migraine headache
B) Hypertensive emergency
C) Subarachnoid hemorrhage
D) Tension headache
Correct Answer: C) Subarachnoid hemorrhage
Rationale: A "thunderclap" headache (sudden and severe) is classic for subarachnoid hemorrhage
until proven otherwise. While the patient is hypertensive, the headache description is the key
diagnostic clue.
A 28-year-old woman presents with 3 days of dysuria, frequency, and
12.
suprapubic discomfort. She is afebrile. A urine dipstick is positive for leukocyte
esterase and nitrites. What is the first-line antibiotic treatment?
A) Ciprofloxacin 250 mg BID for 3 days
B) Nitrofurantoin 100 mg BID for 5 days
C) Amoxicillin-clavulanate 875 mg BID for 7 days
D) Doxycycline 100 mg BID for 7 days
, Correct Answer: B) Nitrofurantoin 100 mg BID for 5 days
Rationale: For uncomplicated cystitis in a young, healthy woman, the IDSA guidelines
recommend nitrofurantoin, TMP-SMX (if resistance is <20%), or fosfomycin as first-line agents.
Fluoroquinolones (like ciprofloxacin) are reserved for more complicated cases due to side effects
and resistance.
13. A 68-year-old man with a
40-pack-year smoking history presents with a new-onset
cough and hemoptysis. A chest X-ray shows a 3 cm hilar mass. What is the most
appropriate next step?
A) Prescribe a course of broad-spectrum antibiotics
B) Schedule a follow-up chest X-ray in 6 weeks
C) Refer for a CT scan of the chest
D) Order a pulmonary function test
Correct Answer: C) Refer for a CT scan of the chest
Rationale: A new lung nodule/mass in a high-risk patient (older, heavy smoker) with hemoptysis is
suspicious for lung cancer. The next step is further
characterization with a chest CT scan, which will guide the need for biopsy.
14. A16-year-old male is brought to the clinic by his mother for a sports physical. On
cardiac auscultation, you hear a mid-systolic click followed by a late systolic murmur at
the apex. Which maneuver would likely make the murmur louder?
A) Squatting
B) Handgrip
C) Valsalva maneuver (bearing down)
D) Lying flat
Correct Answer: C) Valsalva maneuver (bearing down)
Rationale: This describes mitral valve prolapse (MVP) with regurgitation. The murmur of MVP gets
louder with maneuvers that decrease left ventricular volume (like Valsalva or standing), as this
allows the prolapse to occur earlier and more prominently. Squatting increases venous return,
which increases ventricular volume and delays the prolapse, making the murmur softer.
15.A 75-year-old woman with a history of osteoporosis and GERD presents with acute
onset of severe epigastric pain radiating to her back. On exam, she is lying still and has
a rigid, board-like abdomen. What is the most likely diagnosis?
A) Acute cholecystitis
B) Perforatedpeptic ulcer
C) Acute pancreatitis
D) Gastroesophageal reflux
Correct Answer: B) Perforated peptic ulcer
Rationale: The combination of a rigid, board-like abdomen and severe, sudden- onset epigastric
pain is highly suggestive of a perforated viscus (like a peptic
ulcer), leading to peritonitis. Her GERD history is a risk factor. Acute pancreatitis pain often radiates
