New 2025/26 APEA 3P Review: Pharmacology,
Pathophysiology & Physical Assessment Practice
Questions
1.
A 55-year-old male presents with dyspnea on exertion, orthopnea, and ankle edema. On exam, you hear
an S3 heart sound. Which condition is most consistent with these findings?
A. Mitral stenosis
B. Left ventricular systolic heart failure
C. Pulmonary embolism
D. COPD exacerbation
Answer: B. Left ventricular systolic heart failure
Rationale: S3 (ventricular gallop) is associated with increased ventricular filling pressures and is a
hallmark of systolic heart failure. It indicates poor left ventricular compliance and volume overload.
2.
A 32-year-old woman reports a dry, hacking cough that developed after starting lisinopril. What is the
next best step?
A. Stop lisinopril and start losartan
B. Add a cough suppressant
C. Continue lisinopril and recheck in 1 month
D. Switch to hydrochlorothiazide
Answer: A. Stop lisinopril and start losartan
Rationale: ACE inhibitors can cause a persistent dry cough due to bradykinin accumulation. ARBs like
losartan do not have this side effect and are an appropriate substitution.
3.
A 65-year-old diabetic presents with lower extremity ulcers and decreased dorsalis pedis pulses. ABI =
0.6. What is the likely diagnosis?
A. Venous insufficiency
B. Peripheral artery disease (PAD)
C. Deep vein thrombosis
D. Cellulitis
Answer: B. Peripheral artery disease (PAD)
Rationale: ABI <0.9 confirms PAD. Patients typically present with intermittent claudication, diminished
pulses, and non-healing ulcers on pressure areas.
,4.
Which of the following murmurs is considered benign?
A. Aortic stenosis
B. Mitral valve prolapse
C. Physiologic murmur
D. Mitral regurgitation
Answer: C. Physiologic murmur
Rationale: Physiologic (innocent) murmurs are soft, short, and typically heard in young, healthy
individuals. They are not associated with structural heart disease.
5.
Which of the following is the gold standard for diagnosing Actinic Keratosis?
A. Skin scraping
B. Dermatoscopy
C. Biopsy
D. Wood’s lamp exam
Answer: C. Biopsy
Rationale: A biopsy confirms the diagnosis and distinguishes actinic keratosis from squamous cell
carcinoma.
6.
A 40-year-old woman presents with a unilateral dermatomal rash that began as pain and now has
vesicles. What is the best treatment?
A. Acyclovir started within 48–72 hours
B. Prednisone taper only
C. Topical antifungal
D. Amoxicillin 500 mg BID
Answer: A. Acyclovir started within 48–72 hours
Rationale: Herpes zoster (shingles) should be treated with antivirals within 72 hours of rash onset to
shorten duration and reduce postherpetic neuralgia.
7.
Which medication is contraindicated in pregnancy for meningococcal prophylaxis?
A. Rifampin
B. Ceftriaxone
C. Azithromycin
D. Doxycycline
Answer: A. Rifampin
, Rationale: Rifampin can cause teratogenic effects and is contraindicated during pregnancy. Ceftriaxone
is a safer alternative.
8.
A 70-year-old presents with a “pasted-on,” wart-like lesion on the back. It is tan, rough, and
asymptomatic. Diagnosis?
A. Melanoma
B. Seborrheic keratosis
C. Basal cell carcinoma
D. Actinic keratosis
Answer: B. Seborrheic keratosis
Rationale: Benign, common in the elderly, and described as “stuck-on” lesions. No malignant potential.
9.
Which of the following findings is most concerning for malignant melanoma?
A. Symmetric lesion with smooth border
B. Uniform color and <5mm
C. Asymmetry and variegated color
D. Soft, waxy surface
Answer: C. Asymmetry and variegated color
Rationale: The ABCDE rule—Asymmetry, Border irregularity, Color variation, Diameter >6mm,
Evolving—helps identify melanoma.
10.
Which of the following antibiotics can cause tendon rupture?
A. Azithromycin
B. Amoxicillin
C. Ciprofloxacin
D. Doxycycline
Answer: C. Ciprofloxacin
Rationale: Fluoroquinolones like ciprofloxacin can cause tendinopathy and tendon rupture, especially in
older adults and those on corticosteroids.
11.
A 68-year-old man with a history of COPD presents with an oxygen saturation of 89% on room air and
pCO₂ of 55 mmHg. What is the primary drive to breathe in this patient?
A. High CO₂ levels
B. Low O₂ levels
Pathophysiology & Physical Assessment Practice
Questions
1.
A 55-year-old male presents with dyspnea on exertion, orthopnea, and ankle edema. On exam, you hear
an S3 heart sound. Which condition is most consistent with these findings?
A. Mitral stenosis
B. Left ventricular systolic heart failure
C. Pulmonary embolism
D. COPD exacerbation
Answer: B. Left ventricular systolic heart failure
Rationale: S3 (ventricular gallop) is associated with increased ventricular filling pressures and is a
hallmark of systolic heart failure. It indicates poor left ventricular compliance and volume overload.
2.
A 32-year-old woman reports a dry, hacking cough that developed after starting lisinopril. What is the
next best step?
A. Stop lisinopril and start losartan
B. Add a cough suppressant
C. Continue lisinopril and recheck in 1 month
D. Switch to hydrochlorothiazide
Answer: A. Stop lisinopril and start losartan
Rationale: ACE inhibitors can cause a persistent dry cough due to bradykinin accumulation. ARBs like
losartan do not have this side effect and are an appropriate substitution.
3.
A 65-year-old diabetic presents with lower extremity ulcers and decreased dorsalis pedis pulses. ABI =
0.6. What is the likely diagnosis?
A. Venous insufficiency
B. Peripheral artery disease (PAD)
C. Deep vein thrombosis
D. Cellulitis
Answer: B. Peripheral artery disease (PAD)
Rationale: ABI <0.9 confirms PAD. Patients typically present with intermittent claudication, diminished
pulses, and non-healing ulcers on pressure areas.
,4.
Which of the following murmurs is considered benign?
A. Aortic stenosis
B. Mitral valve prolapse
C. Physiologic murmur
D. Mitral regurgitation
Answer: C. Physiologic murmur
Rationale: Physiologic (innocent) murmurs are soft, short, and typically heard in young, healthy
individuals. They are not associated with structural heart disease.
5.
Which of the following is the gold standard for diagnosing Actinic Keratosis?
A. Skin scraping
B. Dermatoscopy
C. Biopsy
D. Wood’s lamp exam
Answer: C. Biopsy
Rationale: A biopsy confirms the diagnosis and distinguishes actinic keratosis from squamous cell
carcinoma.
6.
A 40-year-old woman presents with a unilateral dermatomal rash that began as pain and now has
vesicles. What is the best treatment?
A. Acyclovir started within 48–72 hours
B. Prednisone taper only
C. Topical antifungal
D. Amoxicillin 500 mg BID
Answer: A. Acyclovir started within 48–72 hours
Rationale: Herpes zoster (shingles) should be treated with antivirals within 72 hours of rash onset to
shorten duration and reduce postherpetic neuralgia.
7.
Which medication is contraindicated in pregnancy for meningococcal prophylaxis?
A. Rifampin
B. Ceftriaxone
C. Azithromycin
D. Doxycycline
Answer: A. Rifampin
, Rationale: Rifampin can cause teratogenic effects and is contraindicated during pregnancy. Ceftriaxone
is a safer alternative.
8.
A 70-year-old presents with a “pasted-on,” wart-like lesion on the back. It is tan, rough, and
asymptomatic. Diagnosis?
A. Melanoma
B. Seborrheic keratosis
C. Basal cell carcinoma
D. Actinic keratosis
Answer: B. Seborrheic keratosis
Rationale: Benign, common in the elderly, and described as “stuck-on” lesions. No malignant potential.
9.
Which of the following findings is most concerning for malignant melanoma?
A. Symmetric lesion with smooth border
B. Uniform color and <5mm
C. Asymmetry and variegated color
D. Soft, waxy surface
Answer: C. Asymmetry and variegated color
Rationale: The ABCDE rule—Asymmetry, Border irregularity, Color variation, Diameter >6mm,
Evolving—helps identify melanoma.
10.
Which of the following antibiotics can cause tendon rupture?
A. Azithromycin
B. Amoxicillin
C. Ciprofloxacin
D. Doxycycline
Answer: C. Ciprofloxacin
Rationale: Fluoroquinolones like ciprofloxacin can cause tendinopathy and tendon rupture, especially in
older adults and those on corticosteroids.
11.
A 68-year-old man with a history of COPD presents with an oxygen saturation of 89% on room air and
pCO₂ of 55 mmHg. What is the primary drive to breathe in this patient?
A. High CO₂ levels
B. Low O₂ levels
