APEA 3P Predictor Exam
2026/2027|| 200 High-Yield Practice
Questions with Detailed Rationales
Graded A+ Guaranteed Pass
1. An 80-year-old patient is evaluated for recent episodes of
incontinence and confusion, which are unusual for him. He has also
become increasingly forgetful over the past two weeks. Which
medication might be responsible for these symptoms?
• A) Ibuprofen
• B) Tagamet (cimetidine)
• C) Lisinopril
• D) Metformin
Correct Answer: B) Tagamet (cimetidine)
Rationale: Cimetidine is a histamine-2 receptor antagonist that can cross
the blood-brain barrier. In elderly patients, this can lead to central
nervous system side effects, including confusion, cognitive changes, and
delirium. These symptoms can often be mistaken for dementia or a new
neurological condition .
2. A patient presents with a 3-week history of hoarseness.
Laryngoscopy reveals a unilateral vocal cord paralysis. The patient
has a 30-pack-year smoking history. What is the most appropriate
next step?
• A) Referral for speech therapy
• B) CT of the neck and chest
• C) Trial of voice rest
• D) Reassurance and follow-up
Correct Answer: B) CT of the neck and chest
,Rationale: In a patient with a significant smoking history, new-onset
unilateral vocal cord paralysis is a concerning red flag for malignancy.
The left recurrent laryngeal nerve, which innervates the vocal cords, has a
longer course through the chest and can be affected by a lung mass.
Imaging of the neck and chest is necessary to rule out a tumor .
3. A 15-year-old high school student reports a mild sore throat, low-
grade fever, malaise, fatigue, and loss of appetite that have
persisted for about 3 weeks. The NP suspects mononucleosis. Which
intervention is LEAST appropriate?
• A) Palpate the lymph nodes and spleen
• B) Examine the posterior oropharynx for petechiae
• C) Obtain a CBC, throat culture, and heterophil antibody test
• D) Obtain a urinalysis and serum for LFTs and amylase
Correct Answer: D) Obtain a urinalysis and serum for LFTs and
amylase
Rationale: The evaluation for infectious mononucleosis typically involves
a physical exam to assess for lymphadenopathy and splenomegaly, and
testing such as a CBC and heterophile antibody test. While liver function
tests may be indicated in some cases, a urinalysis and amylase are not
routine first-line assessments for uncomplicated suspected EBV
mononucleosis .
4. A 72-year-old female presents with a 3-month history of
progressive memory loss, difficulty with complex tasks, and
personality changes. She has difficulty naming objects. What is the
most likely diagnosis?
• A) Alzheimer disease
• B) Vascular dementia
• C) Frontotemporal dementia
• D) Lewy body dementia
Correct Answer: A) Alzheimer disease
Rationale: Alzheimer's disease typically presents with a gradual onset of
memory loss, executive dysfunction, and language difficulties like
,anomia (difficulty naming objects). While other dementias have
distinctive features, this combination of symptoms is classic for
Alzheimer's disease .
5. A 1-month-old infant is brought in with reported recurrent
diarrhea, screaming, and drawing up of the legs followed by periods
of lethargy. On physical examination, a "sausage-like" mass is
palpated in the upper right quadrant of the distended abdomen.
What is the most likely diagnosis?
• A) Intussusception
• B) Volvulus
• C) Crohn's disease
• D) Foreign body in the GI tract
Correct Answer: A) Intussusception
Rationale: This presentation is classic for intussusception, a condition
where one part of the intestine telescopes into another. It is
characterized by paroxysmal, severe abdominal pain that causes the
infant to draw up their legs and scream, often followed by periods of
lethargy. A palpable "sausage-shaped" mass in the right upper quadrant
is a key clinical finding
6. A 68-year-old female presents with a 4-week history of fatigue,
unintentional weight loss, and early satiety. She also reports vague
abdominal discomfort. Physical exam reveals splenomegaly. What is
the most likely diagnosis?
• A) Gastric cancer
• B) Chronic lymphocytic leukemia
• C) Myelofibrosis
• D) Lymphoma
Correct Answer: D) Lymphoma
Rationale: Lymphoma often presents with "B symptoms" (fever, night
sweats, weight loss), early satiety, and splenomegaly from extensive
, intra-abdominal disease. Chronic lymphocytic leukemia can also cause
splenomegaly but is often asymptomatic in early stages. Myelofibrosis
causes massive splenomegaly but is typically accompanied by anemia
and abnormal blood film findings .
7. A 58-year-old male with a history of hypertension and diabetes
presents with a 2-day history of dyspnea on exertion and
orthopnea. He has bilateral lower extremity edema and jugular
venous distention (JVD). What is the most likely diagnosis?
• A) Heart failure
• B) COPD exacerbation
• C) Pulmonary embolism
• D) Pneumonia
Correct Answer: A) Heart failure
Rationale: Orthopnea, dyspnea on exertion, edema, and JVD are classic
signs of heart failure. Hypertension and diabetes are significant risk
factors. A COPD exacerbation would more likely present with wheezing
and prolonged expiration. Pulmonary embolism typically presents with
pleuritic chest pain and hypoxia. Pneumonia would usually involve fever
and productive cough .
8. A 35-year-old female presents with a 2-week history of a
nonproductive cough, low-grade fever, and malaise. She reports
exposure to a coworker with a similar illness. What is the most likely
diagnosis?
• A) Pneumococcal pneumonia
2026/2027|| 200 High-Yield Practice
Questions with Detailed Rationales
Graded A+ Guaranteed Pass
1. An 80-year-old patient is evaluated for recent episodes of
incontinence and confusion, which are unusual for him. He has also
become increasingly forgetful over the past two weeks. Which
medication might be responsible for these symptoms?
• A) Ibuprofen
• B) Tagamet (cimetidine)
• C) Lisinopril
• D) Metformin
Correct Answer: B) Tagamet (cimetidine)
Rationale: Cimetidine is a histamine-2 receptor antagonist that can cross
the blood-brain barrier. In elderly patients, this can lead to central
nervous system side effects, including confusion, cognitive changes, and
delirium. These symptoms can often be mistaken for dementia or a new
neurological condition .
2. A patient presents with a 3-week history of hoarseness.
Laryngoscopy reveals a unilateral vocal cord paralysis. The patient
has a 30-pack-year smoking history. What is the most appropriate
next step?
• A) Referral for speech therapy
• B) CT of the neck and chest
• C) Trial of voice rest
• D) Reassurance and follow-up
Correct Answer: B) CT of the neck and chest
,Rationale: In a patient with a significant smoking history, new-onset
unilateral vocal cord paralysis is a concerning red flag for malignancy.
The left recurrent laryngeal nerve, which innervates the vocal cords, has a
longer course through the chest and can be affected by a lung mass.
Imaging of the neck and chest is necessary to rule out a tumor .
3. A 15-year-old high school student reports a mild sore throat, low-
grade fever, malaise, fatigue, and loss of appetite that have
persisted for about 3 weeks. The NP suspects mononucleosis. Which
intervention is LEAST appropriate?
• A) Palpate the lymph nodes and spleen
• B) Examine the posterior oropharynx for petechiae
• C) Obtain a CBC, throat culture, and heterophil antibody test
• D) Obtain a urinalysis and serum for LFTs and amylase
Correct Answer: D) Obtain a urinalysis and serum for LFTs and
amylase
Rationale: The evaluation for infectious mononucleosis typically involves
a physical exam to assess for lymphadenopathy and splenomegaly, and
testing such as a CBC and heterophile antibody test. While liver function
tests may be indicated in some cases, a urinalysis and amylase are not
routine first-line assessments for uncomplicated suspected EBV
mononucleosis .
4. A 72-year-old female presents with a 3-month history of
progressive memory loss, difficulty with complex tasks, and
personality changes. She has difficulty naming objects. What is the
most likely diagnosis?
• A) Alzheimer disease
• B) Vascular dementia
• C) Frontotemporal dementia
• D) Lewy body dementia
Correct Answer: A) Alzheimer disease
Rationale: Alzheimer's disease typically presents with a gradual onset of
memory loss, executive dysfunction, and language difficulties like
,anomia (difficulty naming objects). While other dementias have
distinctive features, this combination of symptoms is classic for
Alzheimer's disease .
5. A 1-month-old infant is brought in with reported recurrent
diarrhea, screaming, and drawing up of the legs followed by periods
of lethargy. On physical examination, a "sausage-like" mass is
palpated in the upper right quadrant of the distended abdomen.
What is the most likely diagnosis?
• A) Intussusception
• B) Volvulus
• C) Crohn's disease
• D) Foreign body in the GI tract
Correct Answer: A) Intussusception
Rationale: This presentation is classic for intussusception, a condition
where one part of the intestine telescopes into another. It is
characterized by paroxysmal, severe abdominal pain that causes the
infant to draw up their legs and scream, often followed by periods of
lethargy. A palpable "sausage-shaped" mass in the right upper quadrant
is a key clinical finding
6. A 68-year-old female presents with a 4-week history of fatigue,
unintentional weight loss, and early satiety. She also reports vague
abdominal discomfort. Physical exam reveals splenomegaly. What is
the most likely diagnosis?
• A) Gastric cancer
• B) Chronic lymphocytic leukemia
• C) Myelofibrosis
• D) Lymphoma
Correct Answer: D) Lymphoma
Rationale: Lymphoma often presents with "B symptoms" (fever, night
sweats, weight loss), early satiety, and splenomegaly from extensive
, intra-abdominal disease. Chronic lymphocytic leukemia can also cause
splenomegaly but is often asymptomatic in early stages. Myelofibrosis
causes massive splenomegaly but is typically accompanied by anemia
and abnormal blood film findings .
7. A 58-year-old male with a history of hypertension and diabetes
presents with a 2-day history of dyspnea on exertion and
orthopnea. He has bilateral lower extremity edema and jugular
venous distention (JVD). What is the most likely diagnosis?
• A) Heart failure
• B) COPD exacerbation
• C) Pulmonary embolism
• D) Pneumonia
Correct Answer: A) Heart failure
Rationale: Orthopnea, dyspnea on exertion, edema, and JVD are classic
signs of heart failure. Hypertension and diabetes are significant risk
factors. A COPD exacerbation would more likely present with wheezing
and prolonged expiration. Pulmonary embolism typically presents with
pleuritic chest pain and hypoxia. Pneumonia would usually involve fever
and productive cough .
8. A 35-year-old female presents with a 2-week history of a
nonproductive cough, low-grade fever, and malaise. She reports
exposure to a coworker with a similar illness. What is the most likely
diagnosis?
• A) Pneumococcal pneumonia
