APEA 3P EXAM PREP GUIDE (2026/2027)
BOARD-STYLE QUESTIONS WITH
DETAILED ANSWERS AND RATIONALLES
GRADED A+
A 45-year-old patient with a BMI of 33 presents with velvety,
hyperpigmented plaques on the back of the neck. What is the
most appropriate next step in management?
A. Prescribe topical corticosteroids
B. Screen for insulin resistance and diabetes
C. Reassure the patient this is benign
D. Refer to dermatology
Correct Answer: B
Rationale: The described velvety, hyperpigmented plaques on
the posterior neck are classic for acanthosis nigricans, which is
strongly associated with insulin resistance, obesity, and type 2
diabetes mellitus. In an adult with an elevated BMI, the most
appropriate next step is to screen for underlying metabolic
abnormalities, including insulin resistance and diabetes. Treating
the skin findings alone or providing reassurance would miss the
underlying systemic condition that requires evaluation and
management.
Which of the following medications is contraindicated in
pregnancy due to teratogenic effects?
A. Metronidazole
B. Benzoyl peroxide
,C. Isotretinoin
D. Azithromycin
Answer: C Explanation: Isotretinoin (Accutane) is a category X
drug with known teratogenic effects. It requires two forms of
contraception and regular pregnancy testing
Rationale:Isotretinoin is a known potent teratogen and is
absolutely contraindicated in pregnancy. It is associated with
severe congenital malformations involving the central nervous
system, cardiovascular system, and craniofacial structures.
Because of this risk, strict pregnancy prevention protocols,
including dual contraception and routine pregnancy testing, are
mandated.
A patient presents with acute unilateral facial pain, tinnitus,
and gradual hearing loss. What is the most appropriate
diagnostic test?
A. CT of the head
B. Audiogram
C. MRI of the brain
D. Tympanometry
Answer: C Explanation: Acoustic neuroma (vestibular
schwannoma) is best diagnosed via MRI to visualize the tumor
compressing CN VIII and possibly CN V.
A patient with chronic papulopustular acne fails to respond
to topical retinoids. What is the next best step in
management?
A. Start Accutane
B. Add oral doxycycline
,C. Switch to a different topical
D. Refer to dermatology immediately
Answer: B Explanation: Moderate acne with papules and pustules
is treated with a combination of topical agents and oral antibiotics
like doxycycline.
Which heart murmur radiates to the carotids and poses a risk
of sudden cardiac death?
A. Mitral regurgitation
B. Aortic stenosis
C. Tricuspid regurgitation
D. Aortic regurgitation
Answer: B Explanation: Aortic stenosis is a systolic ejection
murmur that radiates to the neck and is associated with syncope
and sudden death.
A patient with recent sinus infection reports facial pain,
purulent nasal discharge, and fever. Which organism is most
likely?
A. Streptococcus pyogenes
B. Haemophilus influenzae
C. Staphylococcus aureus
D. Streptococcus pneumoniae
Answer: D Explanation: Streptococcus pneumoniae is the most
common bacterial cause of acute bacterial rhinosinusitis (ABRS).
A 70-year-old smoker presents with gradual, painless central
vision loss. What is the likely diagnosis?
A. Diabetic retinopathy
B. Retinal detachment
, C. Age-related macular degeneration
D. Cataracts
Answer: C Explanation: Macular degeneration causes central
vision loss and is common in elderly smokers. Peripheral vision is
preserved.
Which of the following drugs is known to cause angioedema
and a persistent dry cough? A. Atenolol B. Lisinopril C.
Hydrochlorothiazide D. Losartan
Answer: B Explanation: ACE inhibitors (like lisinopril) can cause
dry cough and angioedema due to bradykinin accumulation.
Which of the following diagnostic signs is associated with
meningitis?
A. Cullen's sign
B. McBurney's point tenderness
C. Brudzinski's sign
D. Murphy's sign
Explanation: Brudzinski's sign (hip/knee flexion when neck is
flexed) indicates meningeal irritation, commonly seen in
meningitis.
A child presents with a honey-colored crusted lesion on the
face. What is the most appropriate first-line treatment?
A. Oral cephalexin
B. Topical mupirocin
C. Oral clindamycin
D. Hydrocortisone cream
BOARD-STYLE QUESTIONS WITH
DETAILED ANSWERS AND RATIONALLES
GRADED A+
A 45-year-old patient with a BMI of 33 presents with velvety,
hyperpigmented plaques on the back of the neck. What is the
most appropriate next step in management?
A. Prescribe topical corticosteroids
B. Screen for insulin resistance and diabetes
C. Reassure the patient this is benign
D. Refer to dermatology
Correct Answer: B
Rationale: The described velvety, hyperpigmented plaques on
the posterior neck are classic for acanthosis nigricans, which is
strongly associated with insulin resistance, obesity, and type 2
diabetes mellitus. In an adult with an elevated BMI, the most
appropriate next step is to screen for underlying metabolic
abnormalities, including insulin resistance and diabetes. Treating
the skin findings alone or providing reassurance would miss the
underlying systemic condition that requires evaluation and
management.
Which of the following medications is contraindicated in
pregnancy due to teratogenic effects?
A. Metronidazole
B. Benzoyl peroxide
,C. Isotretinoin
D. Azithromycin
Answer: C Explanation: Isotretinoin (Accutane) is a category X
drug with known teratogenic effects. It requires two forms of
contraception and regular pregnancy testing
Rationale:Isotretinoin is a known potent teratogen and is
absolutely contraindicated in pregnancy. It is associated with
severe congenital malformations involving the central nervous
system, cardiovascular system, and craniofacial structures.
Because of this risk, strict pregnancy prevention protocols,
including dual contraception and routine pregnancy testing, are
mandated.
A patient presents with acute unilateral facial pain, tinnitus,
and gradual hearing loss. What is the most appropriate
diagnostic test?
A. CT of the head
B. Audiogram
C. MRI of the brain
D. Tympanometry
Answer: C Explanation: Acoustic neuroma (vestibular
schwannoma) is best diagnosed via MRI to visualize the tumor
compressing CN VIII and possibly CN V.
A patient with chronic papulopustular acne fails to respond
to topical retinoids. What is the next best step in
management?
A. Start Accutane
B. Add oral doxycycline
,C. Switch to a different topical
D. Refer to dermatology immediately
Answer: B Explanation: Moderate acne with papules and pustules
is treated with a combination of topical agents and oral antibiotics
like doxycycline.
Which heart murmur radiates to the carotids and poses a risk
of sudden cardiac death?
A. Mitral regurgitation
B. Aortic stenosis
C. Tricuspid regurgitation
D. Aortic regurgitation
Answer: B Explanation: Aortic stenosis is a systolic ejection
murmur that radiates to the neck and is associated with syncope
and sudden death.
A patient with recent sinus infection reports facial pain,
purulent nasal discharge, and fever. Which organism is most
likely?
A. Streptococcus pyogenes
B. Haemophilus influenzae
C. Staphylococcus aureus
D. Streptococcus pneumoniae
Answer: D Explanation: Streptococcus pneumoniae is the most
common bacterial cause of acute bacterial rhinosinusitis (ABRS).
A 70-year-old smoker presents with gradual, painless central
vision loss. What is the likely diagnosis?
A. Diabetic retinopathy
B. Retinal detachment
, C. Age-related macular degeneration
D. Cataracts
Answer: C Explanation: Macular degeneration causes central
vision loss and is common in elderly smokers. Peripheral vision is
preserved.
Which of the following drugs is known to cause angioedema
and a persistent dry cough? A. Atenolol B. Lisinopril C.
Hydrochlorothiazide D. Losartan
Answer: B Explanation: ACE inhibitors (like lisinopril) can cause
dry cough and angioedema due to bradykinin accumulation.
Which of the following diagnostic signs is associated with
meningitis?
A. Cullen's sign
B. McBurney's point tenderness
C. Brudzinski's sign
D. Murphy's sign
Explanation: Brudzinski's sign (hip/knee flexion when neck is
flexed) indicates meningeal irritation, commonly seen in
meningitis.
A child presents with a honey-colored crusted lesion on the
face. What is the most appropriate first-line treatment?
A. Oral cephalexin
B. Topical mupirocin
C. Oral clindamycin
D. Hydrocortisone cream
