Page 1 of 118
APEA PRE-PREDICTOR 2026 EXAM WITH VERIFIED
ANSWERS DETAILED RATIONALES GRADED A+
APEA Pre-Predictor 2026
SECTION 1: ASSESSMENT — HISTORY & PHYSICAL EXAMINATION (Questions 1–30)
1. A 15-year-old high school student presents with a mild sore throat and low-grade fever that
has persisted for about 3 weeks. She reports general malaise, fatigue, and loss of appetite.
The NP suspects mononucleosis. Which physical examination finding is most consistent with
this diagnosis?
A) White patches on the tonsils
B) Posterior cervical lymphadenopathy
C) Strawberry tongue
D) Koplik spots
Answer: B) Posterior cervical lymphadenopathy
Rationale: Infectious mononucleosis classically presents with posterior cervical
lymphadenopathy, fever, sore throat, and fatigue. White patches on the tonsils suggest
streptococcal pharyngitis. Strawberry tongue is seen in scarlet fever and Kawasaki disease.
Koplik spots are associated with measles.
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,Page 2 of 118
2. A 70-year-old male patient complains of a bright red-colored spot in his left eye for 2 days.
He denies eye pain, visual changes, or headaches. He has a new onset of cough from a recent
viral upper respiratory infection. The only medicine he is on is Bayer aspirin, 1 tablet a day.
Which of the following is most likely?
A) Corneal abrasion
B) Acute bacterial conjunctivitis
C) Acute uveitis
D) Subconjunctival hemorrhage
Answer: D) Subconjunctival hemorrhage
Rationale: Bright red blood in a sharply defined area surrounded by normal-appearing
conjunctiva indicates subconjunctival hemorrhage. It is typically painless and resolves
spontaneously. Aspirin use and coughing increase risk. Corneal abrasion causes pain and
tearing. Bacterial conjunctivitis causes discharge and irritation. Uveitis causes pain and
photophobia.
3. The mother of a 12-month-old infant reports that her child had a high fever for several
days, which spontaneously resolved. After the fever resolved, the child developed a
maculopapular rash. Which of the following is the most likely diagnosis?
A) Fifth Disease (erythema infectiosum)
B) Roseola infantum (exanthema subitum)
C) Varicella
D) Infantile maculopapular rashes
Answer: B) Roseola infantum (exanthema subitum)
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Rationale: Roseola infantum is characterized by high fever lasting 3–5 days that resolves
abruptly, followed by a maculopapular rash. Fifth disease presents with a "slapped cheek" rash.
Varicella presents with vesicles in different stages of healing.
4. A woman is being evaluated by the nurse practitioner for complaints of dyspareunia. A
microscopy slide reveals a large number of atrophic squamous epithelial cells. The vaginal pH
is 4.0. There are very few leukocytes and no RBCs seen on the wet smear. Which of the
following is most likely?
A) Atrophic vaginitis
B) Bacterial vaginosis
C) Trichomoniasis
D) This is a normal finding
Answer: A) Atrophic vaginitis
Rationale: Symptoms of atrophic vaginitis include painful intercourse, atrophic squamous
epithelial cells, and a decrease in pH. Vaginal atrophy is caused by lack of or imbalance of
estrogen. Normal vaginal pH is 4.0–5.0 (acidic). Bacterial vaginosis presents with clue cells and
elevated pH. Trichomoniasis presents with motile trichomonads and elevated pH.
5. The most common type of skin malignancy is:
A) Squamous cell cancer
B) Basal skin cancer
C) Melanoma
D) Dysplastic nevi
Answer: B) Basal skin cancer
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Rationale: Basal cell carcinoma is several times more common than squamous cell carcinoma
according to the NIH. It is the most common type of skin cancer, typically presenting as a pearly
nodule or non-healing sore.
6. Koplik's spots are associated with:
A) Poxvirus infections
B) Measles
C) Kawasaki's disease
D) Reye's syndrome
Answer: B) Measles
Rationale: Koplik's spots are small white lesions on the buccal mucosa that appear before the
measles rash. They are pathognomonic for measles (rubeola).
7. In the majority of children, the first permanent teeth start to erupt at the age of 6 years.
Which of the following are the first permanent teeth to erupt in this time period?
A) First molars
B) Second molars
C) Lower or upper incisors
D) Canines
Answer: A) First molars
Rationale: The first permanent molars typically erupt around age 6, often before any primary
teeth are lost. They are commonly referred to as the "6-year molars."
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APEA PRE-PREDICTOR 2026 EXAM WITH VERIFIED
ANSWERS DETAILED RATIONALES GRADED A+
APEA Pre-Predictor 2026
SECTION 1: ASSESSMENT — HISTORY & PHYSICAL EXAMINATION (Questions 1–30)
1. A 15-year-old high school student presents with a mild sore throat and low-grade fever that
has persisted for about 3 weeks. She reports general malaise, fatigue, and loss of appetite.
The NP suspects mononucleosis. Which physical examination finding is most consistent with
this diagnosis?
A) White patches on the tonsils
B) Posterior cervical lymphadenopathy
C) Strawberry tongue
D) Koplik spots
Answer: B) Posterior cervical lymphadenopathy
Rationale: Infectious mononucleosis classically presents with posterior cervical
lymphadenopathy, fever, sore throat, and fatigue. White patches on the tonsils suggest
streptococcal pharyngitis. Strawberry tongue is seen in scarlet fever and Kawasaki disease.
Koplik spots are associated with measles.
1|Page
,Page 2 of 118
2. A 70-year-old male patient complains of a bright red-colored spot in his left eye for 2 days.
He denies eye pain, visual changes, or headaches. He has a new onset of cough from a recent
viral upper respiratory infection. The only medicine he is on is Bayer aspirin, 1 tablet a day.
Which of the following is most likely?
A) Corneal abrasion
B) Acute bacterial conjunctivitis
C) Acute uveitis
D) Subconjunctival hemorrhage
Answer: D) Subconjunctival hemorrhage
Rationale: Bright red blood in a sharply defined area surrounded by normal-appearing
conjunctiva indicates subconjunctival hemorrhage. It is typically painless and resolves
spontaneously. Aspirin use and coughing increase risk. Corneal abrasion causes pain and
tearing. Bacterial conjunctivitis causes discharge and irritation. Uveitis causes pain and
photophobia.
3. The mother of a 12-month-old infant reports that her child had a high fever for several
days, which spontaneously resolved. After the fever resolved, the child developed a
maculopapular rash. Which of the following is the most likely diagnosis?
A) Fifth Disease (erythema infectiosum)
B) Roseola infantum (exanthema subitum)
C) Varicella
D) Infantile maculopapular rashes
Answer: B) Roseola infantum (exanthema subitum)
2|Page
,Page 3 of 118
Rationale: Roseola infantum is characterized by high fever lasting 3–5 days that resolves
abruptly, followed by a maculopapular rash. Fifth disease presents with a "slapped cheek" rash.
Varicella presents with vesicles in different stages of healing.
4. A woman is being evaluated by the nurse practitioner for complaints of dyspareunia. A
microscopy slide reveals a large number of atrophic squamous epithelial cells. The vaginal pH
is 4.0. There are very few leukocytes and no RBCs seen on the wet smear. Which of the
following is most likely?
A) Atrophic vaginitis
B) Bacterial vaginosis
C) Trichomoniasis
D) This is a normal finding
Answer: A) Atrophic vaginitis
Rationale: Symptoms of atrophic vaginitis include painful intercourse, atrophic squamous
epithelial cells, and a decrease in pH. Vaginal atrophy is caused by lack of or imbalance of
estrogen. Normal vaginal pH is 4.0–5.0 (acidic). Bacterial vaginosis presents with clue cells and
elevated pH. Trichomoniasis presents with motile trichomonads and elevated pH.
5. The most common type of skin malignancy is:
A) Squamous cell cancer
B) Basal skin cancer
C) Melanoma
D) Dysplastic nevi
Answer: B) Basal skin cancer
3|Page
, Page 4 of 118
Rationale: Basal cell carcinoma is several times more common than squamous cell carcinoma
according to the NIH. It is the most common type of skin cancer, typically presenting as a pearly
nodule or non-healing sore.
6. Koplik's spots are associated with:
A) Poxvirus infections
B) Measles
C) Kawasaki's disease
D) Reye's syndrome
Answer: B) Measles
Rationale: Koplik's spots are small white lesions on the buccal mucosa that appear before the
measles rash. They are pathognomonic for measles (rubeola).
7. In the majority of children, the first permanent teeth start to erupt at the age of 6 years.
Which of the following are the first permanent teeth to erupt in this time period?
A) First molars
B) Second molars
C) Lower or upper incisors
D) Canines
Answer: A) First molars
Rationale: The first permanent molars typically erupt around age 6, often before any primary
teeth are lost. They are commonly referred to as the "6-year molars."
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