Ultimate APEA 3P 2026/2027 Exam
Prep Bundle – 4 Real Exams,
Answer Key, and Complete Study
Guide for Success Graded A+
Question 1
A 64-year-old male with CKD Stage 3B (eGFR 38 mL/min) and chronic
gout presents with an acute flare of his right first MTP joint. Which is
the most appropriate first-line treatment?
A) High-dose Indomethacin
B) Colchicine 1.2 mg followed by 0.6 mg one hour later
C) Intra-articular or systemic Corticosteroids ✓
D) Allopurinol titrated rapidly up to 300 mg daily
Rationale: NSAIDs are contraindicated in CKD with eGFR <40 due to
nephrotoxicity. Colchicine is highly toxic in severe renal impairment.
Corticosteroids are the safest option for acute flare termination in renal
impairment. Allopurinol should not be initiated during an acute flare .
Question 2
A 28-year-old female at 26 weeks gestation has a fundal height of 30
cm and AFI of 26 cm (polyhydramnios). What is the most likely
etiology?
,A) Maternal preeclampsia
B) Fetal renal agenesis
C) Undiagnosed maternal gestational diabetes ✓
D) Fetal intrauterine growth restriction (IUGR)
Rationale: Polyhydramnios (AFI >24-25 cm) is heavily associated with
gestational diabetes. Elevated maternal glucose crosses the placenta,
causing fetal hyperglycemia and osmotic polyuria that increases amniotic
fluid volume. Fetal renal agenesis causes oligohydramnios, not
polyhydramnios .
Question 3
A 45-year-old female presents with non-productive cough, fatigue,
and erythema nodosum on her shins. CXR shows bilateral hilar
adenopathy. What biopsy finding confirms the suspected disease?
A) Caseating granulomas with central necrosis
B) Non-caseating granulomas containing epithelioid cells ✓
C) Interstitial fibrosis with honeycombing
D) Acid-fast bacilli
Rationale: This classic presentation (bilateral hilar adenopathy + erythema
nodosum + dry cough) is sarcoidosis. The histological hallmark is non-
caseating granulomas. Caseating granulomas with central necrosis suggest
tuberculosis .
Question 4
,A 22-year-old male presents with headache, photophobia, and stiff
neck. When his neck is passively flexed, he involuntarily flexes his hips
and knees. How should this be documented?
A) Positive Kernig's sign
B) Positive Babinski reflex
C) Positive Brudzinski's sign ✓
D) Positive Murphy's sign
Rationale: Involuntary flexion of hips and knees in response to passive
neck flexion is a positive Brudzinski's sign—a hallmark of meningeal
irritation. Kernig's sign is pain with knee extension while the hip is flexed at
90 degrees .
Question 5
A patient on warfarin presents with an elevated INR between 4.5 and
10 with no bleeding. What is the appropriate management?
A) Administer IV Vitamin K
B) Hold the next 1-2 doses of Warfarin, monitor INR closely, and
resume at a lower dose ✓
C) Transfuse fresh frozen plasma immediately
D) Continue current dose and add Vitamin K
Rationale: For INR 4.5-10 without bleeding, guidelines recommend holding
1-2 doses of warfarin and monitoring INR. IV Vitamin K is reserved for life-
threatening bleeding. FFP is for active severe hemorrhage .
Question 6
, A 72-year-old male with prostate cancer history presents with
progressive lower back pain worse at night, relieved by sitting, with
unintentional weight loss. What is the most appropriate initial
diagnostic study?
A) Lumbar spine radiographs
B) MRI of the spine ✓
C) Bone scan
D) CBC and ESR
Rationale: Night pain + weight loss + cancer history suggests spinal
metastasis. MRI is the gold standard for evaluating suspected spinal
metastasis—it provides superior soft tissue contrast to visualize the spinal
cord and epidural space. Plain radiographs are less sensitive for early bony
metastasis .
Question 7
A 55-year-old male with hypertension and diabetes presents with a
tender, erythematous, swollen right great toe after a meal of red meat
and alcohol. Joint aspiration reveals needle-shaped, negatively
birefringent crystals. What is the most appropriate initial
pharmacologic therapy?
A) Allopurinol
B) Colchicine
C) Indomethacin (NSAID) ✓
D) Prednisone
Rationale: This is an acute gout flare confirmed by monosodium urate
crystals. First-line therapy without contraindications is an NSAID. Colchicine
must be given early with a narrow therapeutic window. Prednisone is for
Prep Bundle – 4 Real Exams,
Answer Key, and Complete Study
Guide for Success Graded A+
Question 1
A 64-year-old male with CKD Stage 3B (eGFR 38 mL/min) and chronic
gout presents with an acute flare of his right first MTP joint. Which is
the most appropriate first-line treatment?
A) High-dose Indomethacin
B) Colchicine 1.2 mg followed by 0.6 mg one hour later
C) Intra-articular or systemic Corticosteroids ✓
D) Allopurinol titrated rapidly up to 300 mg daily
Rationale: NSAIDs are contraindicated in CKD with eGFR <40 due to
nephrotoxicity. Colchicine is highly toxic in severe renal impairment.
Corticosteroids are the safest option for acute flare termination in renal
impairment. Allopurinol should not be initiated during an acute flare .
Question 2
A 28-year-old female at 26 weeks gestation has a fundal height of 30
cm and AFI of 26 cm (polyhydramnios). What is the most likely
etiology?
,A) Maternal preeclampsia
B) Fetal renal agenesis
C) Undiagnosed maternal gestational diabetes ✓
D) Fetal intrauterine growth restriction (IUGR)
Rationale: Polyhydramnios (AFI >24-25 cm) is heavily associated with
gestational diabetes. Elevated maternal glucose crosses the placenta,
causing fetal hyperglycemia and osmotic polyuria that increases amniotic
fluid volume. Fetal renal agenesis causes oligohydramnios, not
polyhydramnios .
Question 3
A 45-year-old female presents with non-productive cough, fatigue,
and erythema nodosum on her shins. CXR shows bilateral hilar
adenopathy. What biopsy finding confirms the suspected disease?
A) Caseating granulomas with central necrosis
B) Non-caseating granulomas containing epithelioid cells ✓
C) Interstitial fibrosis with honeycombing
D) Acid-fast bacilli
Rationale: This classic presentation (bilateral hilar adenopathy + erythema
nodosum + dry cough) is sarcoidosis. The histological hallmark is non-
caseating granulomas. Caseating granulomas with central necrosis suggest
tuberculosis .
Question 4
,A 22-year-old male presents with headache, photophobia, and stiff
neck. When his neck is passively flexed, he involuntarily flexes his hips
and knees. How should this be documented?
A) Positive Kernig's sign
B) Positive Babinski reflex
C) Positive Brudzinski's sign ✓
D) Positive Murphy's sign
Rationale: Involuntary flexion of hips and knees in response to passive
neck flexion is a positive Brudzinski's sign—a hallmark of meningeal
irritation. Kernig's sign is pain with knee extension while the hip is flexed at
90 degrees .
Question 5
A patient on warfarin presents with an elevated INR between 4.5 and
10 with no bleeding. What is the appropriate management?
A) Administer IV Vitamin K
B) Hold the next 1-2 doses of Warfarin, monitor INR closely, and
resume at a lower dose ✓
C) Transfuse fresh frozen plasma immediately
D) Continue current dose and add Vitamin K
Rationale: For INR 4.5-10 without bleeding, guidelines recommend holding
1-2 doses of warfarin and monitoring INR. IV Vitamin K is reserved for life-
threatening bleeding. FFP is for active severe hemorrhage .
Question 6
, A 72-year-old male with prostate cancer history presents with
progressive lower back pain worse at night, relieved by sitting, with
unintentional weight loss. What is the most appropriate initial
diagnostic study?
A) Lumbar spine radiographs
B) MRI of the spine ✓
C) Bone scan
D) CBC and ESR
Rationale: Night pain + weight loss + cancer history suggests spinal
metastasis. MRI is the gold standard for evaluating suspected spinal
metastasis—it provides superior soft tissue contrast to visualize the spinal
cord and epidural space. Plain radiographs are less sensitive for early bony
metastasis .
Question 7
A 55-year-old male with hypertension and diabetes presents with a
tender, erythematous, swollen right great toe after a meal of red meat
and alcohol. Joint aspiration reveals needle-shaped, negatively
birefringent crystals. What is the most appropriate initial
pharmacologic therapy?
A) Allopurinol
B) Colchicine
C) Indomethacin (NSAID) ✓
D) Prednisone
Rationale: This is an acute gout flare confirmed by monosodium urate
crystals. First-line therapy without contraindications is an NSAID. Colchicine
must be given early with a narrow therapeutic window. Prednisone is for
