APEA 3P Exam Test Bank - Version 2
QUESTION 1
A 67-year-old male with a history of type 2 diabetes presents with a
2-day history of fever, chills, and productive cough with purulent
sputum. Chest X-ray reveals a cavitary lesion in the right upper
lobe. Which of the following is the most likely causative organism?
A. Streptococcus pneumoniae
B. Mycobacterium tuberculosis
C. Klebsiella pneumoniae
D. Staphylococcus aureus
Correct Answer: C
Rationale: Klebsiella pneumoniae is a common cause of
community-acquired pneumonia in patients with underlying
conditions such as diabetes mellitus, alcoholism, or chronic lung
disease. It is classically associated with upper lobe cavitary lesions
and "currant jelly" sputum. Streptococcus pneumoniae typically
causes lobar consolidation without cavitation. Mycobacterium
tuberculosis can cause cavitary lesions but typically has a more
indolent course. Staphylococcus aureus can cause cavitary
pneumonia but is more commonly associated with post-influenza
or hematogenous spread.
,QUESTION 2
A 52-year-old female presents with complaints of progressive
shortness of breath, orthopnea, and a chronic cough. On cardiac
auscultation, a low-pitched, rumbling diastolic murmur is heard at
the apex with presystolic accentuation. Which of the following is
the most likely valvular abnormality?
A. Mitral stenosis
B. Mitral regurgitation
C. Aortic stenosis
D. Aortic regurgitation
Correct Answer: A
Rationale: Mitral stenosis produces a low-pitched, rumbling
diastolic murmur best heard at the apex with the patient in the left
lateral decubitus position. Presystolic accentuation occurs due to
atrial contraction pushing blood through the narrowed valve. Mitral
regurgitation produces a holosystolic murmur. Aortic stenosis
produces a systolic ejection murmur. Aortic regurgitation produces
a diastolic decrescendo murmur.
QUESTION 3
A 35-year-old man presents with acute onset of severe, colicky
abdominal pain, nausea, and vomiting. He has a history of prior
abdominal surgery. On examination, abdominal distension and
,high-pitched bowel sounds are noted. Which of the following is the
most likely diagnosis?
A. Acute pancreatitis
B. Small bowel obstruction
C. Perforated peptic ulcer
D. Acute cholecystitis
Correct Answer: B
Rationale: Small bowel obstruction typically presents with acute
onset of colicky abdominal pain, nausea, vomiting, abdominal
distension, and high-pitched bowel sounds. The history of prior
abdominal surgery is a significant risk factor due to adhesive
disease. Acute pancreatitis presents with epigastric pain radiating
to the back. Perforated peptic ulcer presents with sudden, severe,
diffuse abdominal pain. Acute cholecystitis presents with right
upper quadrant pain.
QUESTION 4
A 45-year-old female presents with a 3-month history of
progressive fatigue, weight loss, and night sweats. Physical
examination reveals splenomegaly and generalized
lymphadenopathy. Laboratory findings show anemia and
thrombocytopenia. Which of the following is the most appropriate
diagnostic test?
A. Lymph node biopsy
B. Bone marrow biopsy
, C. CT scan of the chest, abdomen, and pelvis
D. Serum protein electrophoresis
Correct Answer: A
Rationale: This patient's presentation—fatigue, weight loss, night
sweats, splenomegaly, generalized lymphadenopathy, and
cytopenias—is concerning for lymphoma. Lymph node biopsy is the
gold standard for diagnosis. Bone marrow biopsy may be
performed for staging. CT scan is useful for staging after diagnosis.
Serum protein electrophoresis is used for multiple myeloma.
QUESTION 5
A 62-year-old male presents with a 6-month history of progressive
dysphagia to solids, heartburn, and regurgitation of undigested
food. Esophagogastroduodenoscopy reveals a distal esophageal
stricture with biopsy showing intestinal metaplasia. Which of the
following is the most appropriate management?
A. Proton pump inhibitor therapy
B. Endoscopic dilation
C. Surgical resection
D. Surveillance endoscopy
Correct Answer: A
Rationale: This patient has Barrett's esophagus with stricture
formation. Proton pump inhibitor therapy is the mainstay of
treatment to reduce acid reflux and prevent progression.
Endoscopic dilation may be needed for the stricture but does not
QUESTION 1
A 67-year-old male with a history of type 2 diabetes presents with a
2-day history of fever, chills, and productive cough with purulent
sputum. Chest X-ray reveals a cavitary lesion in the right upper
lobe. Which of the following is the most likely causative organism?
A. Streptococcus pneumoniae
B. Mycobacterium tuberculosis
C. Klebsiella pneumoniae
D. Staphylococcus aureus
Correct Answer: C
Rationale: Klebsiella pneumoniae is a common cause of
community-acquired pneumonia in patients with underlying
conditions such as diabetes mellitus, alcoholism, or chronic lung
disease. It is classically associated with upper lobe cavitary lesions
and "currant jelly" sputum. Streptococcus pneumoniae typically
causes lobar consolidation without cavitation. Mycobacterium
tuberculosis can cause cavitary lesions but typically has a more
indolent course. Staphylococcus aureus can cause cavitary
pneumonia but is more commonly associated with post-influenza
or hematogenous spread.
,QUESTION 2
A 52-year-old female presents with complaints of progressive
shortness of breath, orthopnea, and a chronic cough. On cardiac
auscultation, a low-pitched, rumbling diastolic murmur is heard at
the apex with presystolic accentuation. Which of the following is
the most likely valvular abnormality?
A. Mitral stenosis
B. Mitral regurgitation
C. Aortic stenosis
D. Aortic regurgitation
Correct Answer: A
Rationale: Mitral stenosis produces a low-pitched, rumbling
diastolic murmur best heard at the apex with the patient in the left
lateral decubitus position. Presystolic accentuation occurs due to
atrial contraction pushing blood through the narrowed valve. Mitral
regurgitation produces a holosystolic murmur. Aortic stenosis
produces a systolic ejection murmur. Aortic regurgitation produces
a diastolic decrescendo murmur.
QUESTION 3
A 35-year-old man presents with acute onset of severe, colicky
abdominal pain, nausea, and vomiting. He has a history of prior
abdominal surgery. On examination, abdominal distension and
,high-pitched bowel sounds are noted. Which of the following is the
most likely diagnosis?
A. Acute pancreatitis
B. Small bowel obstruction
C. Perforated peptic ulcer
D. Acute cholecystitis
Correct Answer: B
Rationale: Small bowel obstruction typically presents with acute
onset of colicky abdominal pain, nausea, vomiting, abdominal
distension, and high-pitched bowel sounds. The history of prior
abdominal surgery is a significant risk factor due to adhesive
disease. Acute pancreatitis presents with epigastric pain radiating
to the back. Perforated peptic ulcer presents with sudden, severe,
diffuse abdominal pain. Acute cholecystitis presents with right
upper quadrant pain.
QUESTION 4
A 45-year-old female presents with a 3-month history of
progressive fatigue, weight loss, and night sweats. Physical
examination reveals splenomegaly and generalized
lymphadenopathy. Laboratory findings show anemia and
thrombocytopenia. Which of the following is the most appropriate
diagnostic test?
A. Lymph node biopsy
B. Bone marrow biopsy
, C. CT scan of the chest, abdomen, and pelvis
D. Serum protein electrophoresis
Correct Answer: A
Rationale: This patient's presentation—fatigue, weight loss, night
sweats, splenomegaly, generalized lymphadenopathy, and
cytopenias—is concerning for lymphoma. Lymph node biopsy is the
gold standard for diagnosis. Bone marrow biopsy may be
performed for staging. CT scan is useful for staging after diagnosis.
Serum protein electrophoresis is used for multiple myeloma.
QUESTION 5
A 62-year-old male presents with a 6-month history of progressive
dysphagia to solids, heartburn, and regurgitation of undigested
food. Esophagogastroduodenoscopy reveals a distal esophageal
stricture with biopsy showing intestinal metaplasia. Which of the
following is the most appropriate management?
A. Proton pump inhibitor therapy
B. Endoscopic dilation
C. Surgical resection
D. Surveillance endoscopy
Correct Answer: A
Rationale: This patient has Barrett's esophagus with stricture
formation. Proton pump inhibitor therapy is the mainstay of
treatment to reduce acid reflux and prevent progression.
Endoscopic dilation may be needed for the stricture but does not
