NSG 6998 APEA Predictor Exam
ACTUAL EXAM 2026/2027 | NSG
6998 APEA Predictor | Verified Q&A |
Pass Guaranteed - A+ Graded
Domain 1 – Assessment & Diagnosis (Questions 1–40)
Q1: A 68-year-old female presents with acute onset of severe, tearing chest pain radiating to the
interscapular region. Her blood pressure is 170/95 mmHg in the right arm and 110/70 mmHg in the left
arm. What is the most likely diagnosis?
A. Acute myocardial infarction
B. Pulmonary embolism
C. Aortic dissection [CORRECT]
D. Musculoskeletal chest pain
Correct Answer: C
Rationale: Acute aortic dissection classically presents with tearing chest or back pain and pulse/blood
pressure differential between arms (asymmetry), requiring immediate imaging (CT angiography).
Q2: A 55-year-old male presents with a new systolic murmur heard best at the right upper sternal
border, radiating to the carotid arteries. The murmur is harsh and crescendo-decrescendo. What is the
most likely diagnosis?
A. Mitral regurgitation
B. Aortic stenosis [CORRECT]
C. Mitral stenosis
D. Tricuspid regurgitation
Correct Answer: B
Rationale: A harsh, crescendo-decrescendo systolic murmur at the right upper sternal border radiating
to the carotids is the classic presentation of aortic stenosis, caused by turbulent blood flow across a
narrowed aortic valve.
,Q3: A 45-year-old female has a breast lump palpated in the upper outer quadrant. It is firm, mobile, and
well-circumscribed. What is the most appropriate next step?
A. Reassurance and observation
B. Diagnostic mammography and ultrasound [CORRECT]
C. Core needle biopsy immediately
D. Excisional biopsy without imaging
Correct Answer: B
Rationale: For a palpable breast mass in a woman over 30, diagnostic mammography with targeted
ultrasound is the appropriate initial imaging workup to characterize the lesion before biopsy; imaging
guides the biopsy approach.
Q4: A 62-year-old male with hypertension has a blood pressure of 156/94 mmHg at two separate visits.
According to the 2025 ACC/AHA guidelines, what is his BP classification?
A. Normal
B. Elevated
C. Stage 1 hypertension
D. Stage 2 hypertension [CORRECT]
Correct Answer: D
Rationale: The 2025 ACC/AHA guidelines classify BP ≥140/90 mmHg as Stage 2 hypertension; this
patient's BP of 156/94 meets the Stage 2 criteria, requiring lifestyle modifications plus pharmacologic
therapy.
Q5: A 50-year-old female presents with fatigue, weight gain, constipation, and cold intolerance. Her TSH
is 12.5 mIU/L (normal 0.4-4.0). What is the most likely diagnosis?
A. Hyperthyroidism
B. Primary hypothyroidism [CORRECT]
C. Secondary hypothyroidism
D. Thyroid storm
Correct Answer: B
Rationale: Elevated TSH with low or low-normal T4 indicates primary hypothyroidism due to thyroid
gland dysfunction; the clinical symptoms of fatigue, weight gain, constipation, and cold intolerance are
classic for hypothyroidism.
,Q6: A 35-year-old male has a positive fecal occult blood test (FOBT). What is the most appropriate next
step?
A. Repeat FOBT in 1 year
B. Colonoscopy [CORRECT]
C. Sigmoidoscopy
D. CT colonography
Correct Answer: B
Rationale: A positive fecal occult blood test requires follow-up with colonoscopy to evaluate for
colorectal cancer or advanced adenomas; repeating the test or using less sensitive modalities delays
diagnosis.
Q7: A 28-year-old female presents with dysuria, frequency, and urgency. Urinalysis shows 15 WBC/hpf
and positive nitrites. What is the most likely diagnosis?
A. Pyelonephritis
B. Uncomplicated cystitis [CORRECT]
C. Interstitial cystitis
D. Urethritis
Correct Answer: B
Rationale: Dysuria, frequency, urgency, pyuria, and positive nitrites in a non-pregnant woman without
fever or flank pain indicate uncomplicated cystitis; first-line treatment is nitrofurantoin or trimethoprim-
sulfamethoxazole.
Q8: A 70-year-old male reports decreased vision in his right eye described as a "curtain coming down."
What is the most likely diagnosis?
A. Cataract
B. Retinal detachment [CORRECT]
C. Glaucoma
D. Macular degeneration
Correct Answer: B
Rationale: The description of a "curtain" or "shade" coming down over vision is the classic presentation
of retinal detachment, a true ophthalmologic emergency requiring immediate evaluation and surgical
repair.
, Q9: A 42-year-old female has a painless thyroid nodule. TSH is normal. What is the most appropriate
next step?
A. Observation only
B. Thyroid ultrasound and fine needle aspiration if indicated [CORRECT]
C. Thyroidectomy
D. Radioactive iodine uptake scan
Correct Answer: B
Rationale: For a thyroid nodule with normal TSH, ultrasound is the initial imaging of choice to
characterize the nodule; fine needle aspiration is indicated for nodules with suspicious ultrasound
features or size >1 cm.
Q10: A 60-year-old male presents with acute onset of right-sided weakness and aphasia. What is the
first priority?
A. CT head without contrast [CORRECT]
B. MRI brain
C. Lumbar puncture
D. Carotid ultrasound
Correct Answer: A
Rationale: For acute stroke symptoms, non-contrast CT head is the first imaging priority to differentiate
ischemic stroke from hemorrhagic stroke, as this determines whether thrombolytic therapy is
appropriate.
Q11: A 38-year-old female has a Pap smear showing ASC-US (atypical squamous cells of undetermined
significance). HPV testing is negative. What is the recommended follow-up?
A. Immediate colposcopy
B. Repeat cytology in 3 years [CORRECT]
C. Repeat cytology in 1 year
D. HPV testing in 6 months
Correct Answer: B
Rationale: For ASC-US with negative HPV testing (co-testing), the patient can return to routine screening
with cytology in 3 years, as the risk of CIN 3+ is very low; immediate colposcopy is not indicated.
Q12: A 55-year-old male with diabetes has a foot ulcer on the plantar surface of the first metatarsal
head. The ulcer is painless, surrounded by callus, and probes to bone. What is the most likely diagnosis?
ACTUAL EXAM 2026/2027 | NSG
6998 APEA Predictor | Verified Q&A |
Pass Guaranteed - A+ Graded
Domain 1 – Assessment & Diagnosis (Questions 1–40)
Q1: A 68-year-old female presents with acute onset of severe, tearing chest pain radiating to the
interscapular region. Her blood pressure is 170/95 mmHg in the right arm and 110/70 mmHg in the left
arm. What is the most likely diagnosis?
A. Acute myocardial infarction
B. Pulmonary embolism
C. Aortic dissection [CORRECT]
D. Musculoskeletal chest pain
Correct Answer: C
Rationale: Acute aortic dissection classically presents with tearing chest or back pain and pulse/blood
pressure differential between arms (asymmetry), requiring immediate imaging (CT angiography).
Q2: A 55-year-old male presents with a new systolic murmur heard best at the right upper sternal
border, radiating to the carotid arteries. The murmur is harsh and crescendo-decrescendo. What is the
most likely diagnosis?
A. Mitral regurgitation
B. Aortic stenosis [CORRECT]
C. Mitral stenosis
D. Tricuspid regurgitation
Correct Answer: B
Rationale: A harsh, crescendo-decrescendo systolic murmur at the right upper sternal border radiating
to the carotids is the classic presentation of aortic stenosis, caused by turbulent blood flow across a
narrowed aortic valve.
,Q3: A 45-year-old female has a breast lump palpated in the upper outer quadrant. It is firm, mobile, and
well-circumscribed. What is the most appropriate next step?
A. Reassurance and observation
B. Diagnostic mammography and ultrasound [CORRECT]
C. Core needle biopsy immediately
D. Excisional biopsy without imaging
Correct Answer: B
Rationale: For a palpable breast mass in a woman over 30, diagnostic mammography with targeted
ultrasound is the appropriate initial imaging workup to characterize the lesion before biopsy; imaging
guides the biopsy approach.
Q4: A 62-year-old male with hypertension has a blood pressure of 156/94 mmHg at two separate visits.
According to the 2025 ACC/AHA guidelines, what is his BP classification?
A. Normal
B. Elevated
C. Stage 1 hypertension
D. Stage 2 hypertension [CORRECT]
Correct Answer: D
Rationale: The 2025 ACC/AHA guidelines classify BP ≥140/90 mmHg as Stage 2 hypertension; this
patient's BP of 156/94 meets the Stage 2 criteria, requiring lifestyle modifications plus pharmacologic
therapy.
Q5: A 50-year-old female presents with fatigue, weight gain, constipation, and cold intolerance. Her TSH
is 12.5 mIU/L (normal 0.4-4.0). What is the most likely diagnosis?
A. Hyperthyroidism
B. Primary hypothyroidism [CORRECT]
C. Secondary hypothyroidism
D. Thyroid storm
Correct Answer: B
Rationale: Elevated TSH with low or low-normal T4 indicates primary hypothyroidism due to thyroid
gland dysfunction; the clinical symptoms of fatigue, weight gain, constipation, and cold intolerance are
classic for hypothyroidism.
,Q6: A 35-year-old male has a positive fecal occult blood test (FOBT). What is the most appropriate next
step?
A. Repeat FOBT in 1 year
B. Colonoscopy [CORRECT]
C. Sigmoidoscopy
D. CT colonography
Correct Answer: B
Rationale: A positive fecal occult blood test requires follow-up with colonoscopy to evaluate for
colorectal cancer or advanced adenomas; repeating the test or using less sensitive modalities delays
diagnosis.
Q7: A 28-year-old female presents with dysuria, frequency, and urgency. Urinalysis shows 15 WBC/hpf
and positive nitrites. What is the most likely diagnosis?
A. Pyelonephritis
B. Uncomplicated cystitis [CORRECT]
C. Interstitial cystitis
D. Urethritis
Correct Answer: B
Rationale: Dysuria, frequency, urgency, pyuria, and positive nitrites in a non-pregnant woman without
fever or flank pain indicate uncomplicated cystitis; first-line treatment is nitrofurantoin or trimethoprim-
sulfamethoxazole.
Q8: A 70-year-old male reports decreased vision in his right eye described as a "curtain coming down."
What is the most likely diagnosis?
A. Cataract
B. Retinal detachment [CORRECT]
C. Glaucoma
D. Macular degeneration
Correct Answer: B
Rationale: The description of a "curtain" or "shade" coming down over vision is the classic presentation
of retinal detachment, a true ophthalmologic emergency requiring immediate evaluation and surgical
repair.
, Q9: A 42-year-old female has a painless thyroid nodule. TSH is normal. What is the most appropriate
next step?
A. Observation only
B. Thyroid ultrasound and fine needle aspiration if indicated [CORRECT]
C. Thyroidectomy
D. Radioactive iodine uptake scan
Correct Answer: B
Rationale: For a thyroid nodule with normal TSH, ultrasound is the initial imaging of choice to
characterize the nodule; fine needle aspiration is indicated for nodules with suspicious ultrasound
features or size >1 cm.
Q10: A 60-year-old male presents with acute onset of right-sided weakness and aphasia. What is the
first priority?
A. CT head without contrast [CORRECT]
B. MRI brain
C. Lumbar puncture
D. Carotid ultrasound
Correct Answer: A
Rationale: For acute stroke symptoms, non-contrast CT head is the first imaging priority to differentiate
ischemic stroke from hemorrhagic stroke, as this determines whether thrombolytic therapy is
appropriate.
Q11: A 38-year-old female has a Pap smear showing ASC-US (atypical squamous cells of undetermined
significance). HPV testing is negative. What is the recommended follow-up?
A. Immediate colposcopy
B. Repeat cytology in 3 years [CORRECT]
C. Repeat cytology in 1 year
D. HPV testing in 6 months
Correct Answer: B
Rationale: For ASC-US with negative HPV testing (co-testing), the patient can return to routine screening
with cytology in 3 years, as the risk of CIN 3+ is very low; immediate colposcopy is not indicated.
Q12: A 55-year-old male with diabetes has a foot ulcer on the plantar surface of the first metatarsal
head. The ulcer is painless, surrounded by callus, and probes to bone. What is the most likely diagnosis?
