APEA PRE-PREDICTOR 2026/2027 – COMPLETE
100-QUESTION EXAM
Section 1: Cardiovascular (Questions 1–10)
1. A 58-year-old male with hypertension reports midsternal chest pressure with
exertion, relieved by rest. What is the most likely diagnosis?
A. Unstable angina
B. Stable angina
C. Prinzmetal angina
D. Pericarditis
Answer: B – Stable angina
Rationale: Stable angina is provoked by exertion/emotional stress, relieved by
rest or nitroglycerin, and follows a predictable pattern. Unstable angina occurs at
rest or increases in frequency. Prinzmetal’s is vasospastic. Pericarditis is pleuritic,
positional.
2. An S3 heart sound is best heard with the bell of the stethoscope at the apex
in left lateral decubitus. It most likely indicates:
A. Aortic stenosis
B. Heart failure
C. Mitral valve prolapse
D. Pulmonary hypertension
Answer: B – Heart failure
Rationale: S3 (“ventricular gallop”) occurs in volume overload states like
,systolic HF, also late pregnancy, but in adults >40 suggests pathology. S4 suggests
diastolic dysfunction or hypertrophy.
3. Which ECG finding is most specific for digoxin toxicity?
A. Prolonged PR interval
B. ST-segment depression with scooping
C. Ventricular bigeminy
D. Atrial tachycardia with block
Answer: D – Atrial tachycardia with block
Rationale: Atrial tachycardia with variable AV block is nearly diagnostic for
digoxin toxicity. Scooped ST (digitalis effect) is not toxic. Ventricular bigeminy and
prolonged PR can occur but are less specific.
4. A 72-year-old with sudden onset of severe tearing chest pain radiating to the
back has a blood pressure of 100/60 in right arm and 140/90 in left arm. Most
likely diagnosis:
A. Myocardial infarction
B. Pulmonary embolism
C. Aortic dissection
D. Musculoskeletal pain
Answer: C – Aortic dissection
Rationale: Asymmetric BPs, tearing pain radiating to back → Type A aortic
dissection until proven otherwise. CXR may show widened mediastinum; CT
angiography is definitive.
5. First-line pharmacotherapy for chronic stable angina is:
A. Aspirin + metoprolol
B. Aspirin + amlodipine
C. Nitroglycerin PRN only
D. Ranexa monotherapy
,Answer: A – Aspirin + metoprolol
*Rationale: Beta-blockers (metoprolol) reduce myocardial O2 demand,
improve survival post-MI. Aspirin for antiplatelet effect. Add nitroglycerin PRN.
Amlodipine second-line.*
6. Ankle-brachial index (ABI) >1.4 suggests:
A. Normal
B. Mild peripheral artery disease
C. Severe PAD
D. Non-compressible calcified vessels
Answer: D – Non-compressible calcified vessels
Rationale: ABI >1.4 seen in medial calcinosis (diabetes, CKD). PAD is ABI <0.90.
Severe PAD <0.50.
7. What murmur increases with squatting and decreases with
standing/Valsalva?
A. Aortic stenosis
B. Mitral regurgitation
C. Hypertrophic cardiomyopathy
D. Mitral stenosis
Answer: C – Hypertrophic cardiomyopathy
Rationale: HCM murmur increases with decreased preload (standing) and
decreases with increased preload (squatting). Opposite for AS and MR.
8. Most common cause of right-sided heart failure is:
A. Pulmonary hypertension
B. COPD
C. Left-sided heart failure
D. Tricuspid regurgitation
, Answer: C – Left-sided heart failure
Rationale: Left HF increases pulmonary pressures, causing RV strain → right
HF. Cor pulmonale (COPD, PH) is another cause but less common overall.
9. Which medication for heart failure with reduced ejection fraction (HFrEF)
provides the greatest mortality reduction?
A. Furosemide
B. Digoxin
C. Sacubitril/valsartan
D. Hydralazine + isosorbide dinitrate
Answer: C – Sacubitril/valsartan
*Rationale: PARADIGM-HF trial showed superior mortality reduction over
enalapril. Also GDMT includes BB, MRA, SGLT2i.*
10. A 65-year-old with new-onset atrial fibrillation, CHA₂DS₂-VASc score of 4, no
contraindications. Best anticoagulant:
A. Aspirin 81 mg daily
B. Clopidogrel
C. Warfarin or DOAC
D. No anticoagulation
Answer: C – Warfarin or DOAC
*Rationale: CHA₂DS₂-VASc ≥2 in men, ≥3 in women → oral anticoagulation.
DOACs preferred unless mechanical valve or moderate-severe mitral stenosis.*
Section 2: Pulmonary (11–20)
11. A 45-year-old with asthma has daytime symptoms 2-3x/week, nighttime
awakenings 1x/week, FEV1 80% predicted. GINA step:
A. Step 1
B. Step 2
100-QUESTION EXAM
Section 1: Cardiovascular (Questions 1–10)
1. A 58-year-old male with hypertension reports midsternal chest pressure with
exertion, relieved by rest. What is the most likely diagnosis?
A. Unstable angina
B. Stable angina
C. Prinzmetal angina
D. Pericarditis
Answer: B – Stable angina
Rationale: Stable angina is provoked by exertion/emotional stress, relieved by
rest or nitroglycerin, and follows a predictable pattern. Unstable angina occurs at
rest or increases in frequency. Prinzmetal’s is vasospastic. Pericarditis is pleuritic,
positional.
2. An S3 heart sound is best heard with the bell of the stethoscope at the apex
in left lateral decubitus. It most likely indicates:
A. Aortic stenosis
B. Heart failure
C. Mitral valve prolapse
D. Pulmonary hypertension
Answer: B – Heart failure
Rationale: S3 (“ventricular gallop”) occurs in volume overload states like
,systolic HF, also late pregnancy, but in adults >40 suggests pathology. S4 suggests
diastolic dysfunction or hypertrophy.
3. Which ECG finding is most specific for digoxin toxicity?
A. Prolonged PR interval
B. ST-segment depression with scooping
C. Ventricular bigeminy
D. Atrial tachycardia with block
Answer: D – Atrial tachycardia with block
Rationale: Atrial tachycardia with variable AV block is nearly diagnostic for
digoxin toxicity. Scooped ST (digitalis effect) is not toxic. Ventricular bigeminy and
prolonged PR can occur but are less specific.
4. A 72-year-old with sudden onset of severe tearing chest pain radiating to the
back has a blood pressure of 100/60 in right arm and 140/90 in left arm. Most
likely diagnosis:
A. Myocardial infarction
B. Pulmonary embolism
C. Aortic dissection
D. Musculoskeletal pain
Answer: C – Aortic dissection
Rationale: Asymmetric BPs, tearing pain radiating to back → Type A aortic
dissection until proven otherwise. CXR may show widened mediastinum; CT
angiography is definitive.
5. First-line pharmacotherapy for chronic stable angina is:
A. Aspirin + metoprolol
B. Aspirin + amlodipine
C. Nitroglycerin PRN only
D. Ranexa monotherapy
,Answer: A – Aspirin + metoprolol
*Rationale: Beta-blockers (metoprolol) reduce myocardial O2 demand,
improve survival post-MI. Aspirin for antiplatelet effect. Add nitroglycerin PRN.
Amlodipine second-line.*
6. Ankle-brachial index (ABI) >1.4 suggests:
A. Normal
B. Mild peripheral artery disease
C. Severe PAD
D. Non-compressible calcified vessels
Answer: D – Non-compressible calcified vessels
Rationale: ABI >1.4 seen in medial calcinosis (diabetes, CKD). PAD is ABI <0.90.
Severe PAD <0.50.
7. What murmur increases with squatting and decreases with
standing/Valsalva?
A. Aortic stenosis
B. Mitral regurgitation
C. Hypertrophic cardiomyopathy
D. Mitral stenosis
Answer: C – Hypertrophic cardiomyopathy
Rationale: HCM murmur increases with decreased preload (standing) and
decreases with increased preload (squatting). Opposite for AS and MR.
8. Most common cause of right-sided heart failure is:
A. Pulmonary hypertension
B. COPD
C. Left-sided heart failure
D. Tricuspid regurgitation
, Answer: C – Left-sided heart failure
Rationale: Left HF increases pulmonary pressures, causing RV strain → right
HF. Cor pulmonale (COPD, PH) is another cause but less common overall.
9. Which medication for heart failure with reduced ejection fraction (HFrEF)
provides the greatest mortality reduction?
A. Furosemide
B. Digoxin
C. Sacubitril/valsartan
D. Hydralazine + isosorbide dinitrate
Answer: C – Sacubitril/valsartan
*Rationale: PARADIGM-HF trial showed superior mortality reduction over
enalapril. Also GDMT includes BB, MRA, SGLT2i.*
10. A 65-year-old with new-onset atrial fibrillation, CHA₂DS₂-VASc score of 4, no
contraindications. Best anticoagulant:
A. Aspirin 81 mg daily
B. Clopidogrel
C. Warfarin or DOAC
D. No anticoagulation
Answer: C – Warfarin or DOAC
*Rationale: CHA₂DS₂-VASc ≥2 in men, ≥3 in women → oral anticoagulation.
DOACs preferred unless mechanical valve or moderate-severe mitral stenosis.*
Section 2: Pulmonary (11–20)
11. A 45-year-old with asthma has daytime symptoms 2-3x/week, nighttime
awakenings 1x/week, FEV1 80% predicted. GINA step:
A. Step 1
B. Step 2
