APEA PREDICTOR EXAM BLUEPRINT 2026 | 120 COMPREHENSIVE PRACTICE
QUESTIONS AND ANSWERS WITH RATIONALES
SECTION 1: ADVANCED PHYSICAL ASSESSMENT (Questions 1–30)
1. A 58-year-old male with type 2 diabetes reports burning foot pain that is
worse at night. Exam reveals diminished pinprick sensation distal to the
ankles and absent Achilles reflexes. What is the most likely diagnosis?
A) Peripheral artery disease
B) Lumbar radiculopathy
C) Diabetic peripheral neuropathy
D) Vitamin B12 deficiency
Answer C: – Diabetic peripheral neuropathy
Rationale: Distal symmetric polyneuropathy in diabetes presents with burning
pain, nocturnal exacerbation, loss of sensation, and areflexia. Peripheral
artery disease would present with claudication and diminished pulses. Lumbar
,radiculopathy typically causes unilateral, dermatomal pain. Vitamin B12
deficiency can cause neuropathy but is less common in this context. ---
2. A 70-year-old woman reports progressive forgetfulness over 2 years. Exam
reveals difficulty with word finding, apraxia, and agnosia. MMSE is 22/30.
There is no fluctuation in cognition. What is the most likely diagnosis?
A) Alzheimer's disease
B) Lewy body dementia
C) Frontotemporal dementia
D) Vascular dementia
Answer A: – Alzheimer's disease
Rationale: Alzheimer's disease presents with gradual onset of memory loss,
word-finding difficulty, apraxia, and agnosia without fluctuation. Lewy body
dementia features fluctuating cognition and visual hallucinations.
Frontotemporal dementia typically presents with personality changes and
behavioral symptoms. Vascular dementia has stepwise deterioration. ---
3. A 32-year-old man has sudden onset of severe, tearing chest pain
radiating to the back. BP is 160/90 in the right arm and 100/60 in the left
arm. What is the most likely diagnosis?
A) Myocardial infarction
,B) Pulmonary embolism
C) Aortic dissection
D) Pericarditis
Answer C: – Aortic dissection
Rationale: Aortic dissection presents with tearing chest pain and asymmetric
blood pressures between arms. Myocardial infarction typically presents with
pressure-type pain. Pulmonary embolism presents with pleuritic chest pain
and dyspnea. Pericarditis pain is positional and relieved by leaning forward. ---
4. A 45-year-old woman has BP 152/96 mmHg on two visits. She has no
comorbidities. According to ACC/AHA guidelines, what is the first step in
management?
A) Start amlodipine 5 mg daily
B) Start lisinopril 10 mg daily
C) Recommend DASH diet and exercise for 4–6 months
D) Order renal artery duplex ultrasound
Answer C: – Recommend DASH diet and exercise for 4–6 months
Rationale: Stage 2 hypertension without comorbidities or target organ
damage should first receive therapeutic lifestyle changes for 4–6 months
before initiating pharmacotherapy. ---
, 5. A 68-year-old woman with osteoporosis on alendronate for 5 years
develops severe thigh and groin pain. X-ray shows transverse cortical
thickening. What is the most likely diagnosis?
A) Osteosarcoma
B) Atypical femoral fracture precursor
C) Paget's disease
D) Osteomalacia
Answer B: – Atypical femoral fracture precursor
Rationale: Atypical femoral fractures are associated with prolonged
bisphosphonate use (alendronate) and present with prodromal thigh/groin
pain and characteristic X-ray findings. ---
6. A patient presents with a triangular thickening of the bulbar conjunctiva
across the outer surface of the cornea. This condition is termed:
A) Pinguecula
B) Pterygium
C) Corneal ulcer
D) Conjunctivitis
Answer B: – Pterygium
Rationale: Pterygium is a triangular thickening of the bulbar conjunctiva that
extends across the cornea. Pinguecula is a yellowish raised area on the
QUESTIONS AND ANSWERS WITH RATIONALES
SECTION 1: ADVANCED PHYSICAL ASSESSMENT (Questions 1–30)
1. A 58-year-old male with type 2 diabetes reports burning foot pain that is
worse at night. Exam reveals diminished pinprick sensation distal to the
ankles and absent Achilles reflexes. What is the most likely diagnosis?
A) Peripheral artery disease
B) Lumbar radiculopathy
C) Diabetic peripheral neuropathy
D) Vitamin B12 deficiency
Answer C: – Diabetic peripheral neuropathy
Rationale: Distal symmetric polyneuropathy in diabetes presents with burning
pain, nocturnal exacerbation, loss of sensation, and areflexia. Peripheral
artery disease would present with claudication and diminished pulses. Lumbar
,radiculopathy typically causes unilateral, dermatomal pain. Vitamin B12
deficiency can cause neuropathy but is less common in this context. ---
2. A 70-year-old woman reports progressive forgetfulness over 2 years. Exam
reveals difficulty with word finding, apraxia, and agnosia. MMSE is 22/30.
There is no fluctuation in cognition. What is the most likely diagnosis?
A) Alzheimer's disease
B) Lewy body dementia
C) Frontotemporal dementia
D) Vascular dementia
Answer A: – Alzheimer's disease
Rationale: Alzheimer's disease presents with gradual onset of memory loss,
word-finding difficulty, apraxia, and agnosia without fluctuation. Lewy body
dementia features fluctuating cognition and visual hallucinations.
Frontotemporal dementia typically presents with personality changes and
behavioral symptoms. Vascular dementia has stepwise deterioration. ---
3. A 32-year-old man has sudden onset of severe, tearing chest pain
radiating to the back. BP is 160/90 in the right arm and 100/60 in the left
arm. What is the most likely diagnosis?
A) Myocardial infarction
,B) Pulmonary embolism
C) Aortic dissection
D) Pericarditis
Answer C: – Aortic dissection
Rationale: Aortic dissection presents with tearing chest pain and asymmetric
blood pressures between arms. Myocardial infarction typically presents with
pressure-type pain. Pulmonary embolism presents with pleuritic chest pain
and dyspnea. Pericarditis pain is positional and relieved by leaning forward. ---
4. A 45-year-old woman has BP 152/96 mmHg on two visits. She has no
comorbidities. According to ACC/AHA guidelines, what is the first step in
management?
A) Start amlodipine 5 mg daily
B) Start lisinopril 10 mg daily
C) Recommend DASH diet and exercise for 4–6 months
D) Order renal artery duplex ultrasound
Answer C: – Recommend DASH diet and exercise for 4–6 months
Rationale: Stage 2 hypertension without comorbidities or target organ
damage should first receive therapeutic lifestyle changes for 4–6 months
before initiating pharmacotherapy. ---
, 5. A 68-year-old woman with osteoporosis on alendronate for 5 years
develops severe thigh and groin pain. X-ray shows transverse cortical
thickening. What is the most likely diagnosis?
A) Osteosarcoma
B) Atypical femoral fracture precursor
C) Paget's disease
D) Osteomalacia
Answer B: – Atypical femoral fracture precursor
Rationale: Atypical femoral fractures are associated with prolonged
bisphosphonate use (alendronate) and present with prodromal thigh/groin
pain and characteristic X-ray findings. ---
6. A patient presents with a triangular thickening of the bulbar conjunctiva
across the outer surface of the cornea. This condition is termed:
A) Pinguecula
B) Pterygium
C) Corneal ulcer
D) Conjunctivitis
Answer B: – Pterygium
Rationale: Pterygium is a triangular thickening of the bulbar conjunctiva that
extends across the cornea. Pinguecula is a yellowish raised area on the
