Page |1
APEA PRE-PREDICTOR EXAM Original Practice Questions with
Answers & Rationales
SECTION 1: CARDIOVASCULAR
1. A 65-year-old patient presents with chest pain that occurs
with exertion and is relieved by rest. The pain is described as
pressure-like, substernal, and radiates to the left arm. The most
likely diagnosis is:
A) Unstable angina
B) Stable angina
C) Myocardial infarction
D) Pericarditis
Answer: B
Rationale: Stable angina is predictable, occurs with exertion, is
relieved by rest or nitroglycerin, and has a consistent pattern.
Unstable angina occurs at rest or with increasing
frequency/severity. MI pain is prolonged and not relieved by
rest. Pericarditis pain is sharp and improved by leaning forward.
2. Which cardiac biomarker is the MOST specific and sensitive
for myocardial infarction?
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A) CK-MB
B) Myoglobin
C) Troponin I or T
D) LDH
Answer: C
Rationale: Cardiac troponins (I and T) are the most specific and
sensitive biomarkers for myocardial injury. They rise within 3–6
hours and remain elevated for 7–14 days.
3. The first-line treatment for a patient presenting with acute
STEMI within 90 minutes of arrival is:
A) Thrombolytics only
B) Percutaneous coronary intervention (PCI)
C) Coronary artery bypass grafting
D) Observation only
Answer: B
Rationale: PCI (primary angioplasty) is the preferred
reperfusion strategy for STEMI when it can be performed within
90 minutes of first medical contact. Thrombolytics are used
when PCI is not available within that window.
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4. A patient with atrial fibrillation has a CHA₂DS₂-VASc score of
4. The appropriate management is:
A) Aspirin only
B) No anticoagulation needed
C) Oral anticoagulation (DOAC or warfarin)
D) Clopidogrel only
Answer: C
Rationale: A CHA₂DS₂-VASc score of ≥ 2 in men (≥ 3 in women)
indicates significant stroke risk warranting oral anticoagulation.
Score of 4 clearly requires anticoagulation.
5. Which medication class is CONTRAINDICATED in patients with
heart failure with reduced ejection fraction (HFrEF)?
A) ACE inhibitors
B) Beta blockers
C) Non-dihydropyridine calcium channel blockers (verapamil,
diltiazem)
D) Diuretics
Answer: C
Rationale: Non-dihydropyridine calcium channel blockers have
negative inotropic effects and can worsen heart failure. They
should be avoided in HFrEF. ACE inhibitors, beta blockers
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(carvedilol, metoprolol succinate, bisoprolol), and diuretics are
standard therapy.
6. The hallmark finding of pericarditis on physical examination
is:
A) A diastolic murmur
B) A pericardial friction rub
C) An S3 gallop
D) A systolic ejection click
Answer: B
Rationale: A pericardial friction rub is the classic physical
finding in pericarditis, caused by inflamed pericardial layers
rubbing together. It is best heard at the left lower sternal
border.
7. A patient presents with sudden onset of severe "tearing"
chest pain radiating to the back. Blood pressure in the right arm
is 180/100 mm Hg and in the left arm is 140/80 mm Hg. The
most likely diagnosis is:
A) Myocardial infarction
B) Aortic dissection
C) Pulmonary embolism
D) Tension pneumothorax
APEA PRE-PREDICTOR EXAM Original Practice Questions with
Answers & Rationales
SECTION 1: CARDIOVASCULAR
1. A 65-year-old patient presents with chest pain that occurs
with exertion and is relieved by rest. The pain is described as
pressure-like, substernal, and radiates to the left arm. The most
likely diagnosis is:
A) Unstable angina
B) Stable angina
C) Myocardial infarction
D) Pericarditis
Answer: B
Rationale: Stable angina is predictable, occurs with exertion, is
relieved by rest or nitroglycerin, and has a consistent pattern.
Unstable angina occurs at rest or with increasing
frequency/severity. MI pain is prolonged and not relieved by
rest. Pericarditis pain is sharp and improved by leaning forward.
2. Which cardiac biomarker is the MOST specific and sensitive
for myocardial infarction?
, Page |2
A) CK-MB
B) Myoglobin
C) Troponin I or T
D) LDH
Answer: C
Rationale: Cardiac troponins (I and T) are the most specific and
sensitive biomarkers for myocardial injury. They rise within 3–6
hours and remain elevated for 7–14 days.
3. The first-line treatment for a patient presenting with acute
STEMI within 90 minutes of arrival is:
A) Thrombolytics only
B) Percutaneous coronary intervention (PCI)
C) Coronary artery bypass grafting
D) Observation only
Answer: B
Rationale: PCI (primary angioplasty) is the preferred
reperfusion strategy for STEMI when it can be performed within
90 minutes of first medical contact. Thrombolytics are used
when PCI is not available within that window.
, Page |3
4. A patient with atrial fibrillation has a CHA₂DS₂-VASc score of
4. The appropriate management is:
A) Aspirin only
B) No anticoagulation needed
C) Oral anticoagulation (DOAC or warfarin)
D) Clopidogrel only
Answer: C
Rationale: A CHA₂DS₂-VASc score of ≥ 2 in men (≥ 3 in women)
indicates significant stroke risk warranting oral anticoagulation.
Score of 4 clearly requires anticoagulation.
5. Which medication class is CONTRAINDICATED in patients with
heart failure with reduced ejection fraction (HFrEF)?
A) ACE inhibitors
B) Beta blockers
C) Non-dihydropyridine calcium channel blockers (verapamil,
diltiazem)
D) Diuretics
Answer: C
Rationale: Non-dihydropyridine calcium channel blockers have
negative inotropic effects and can worsen heart failure. They
should be avoided in HFrEF. ACE inhibitors, beta blockers
, Page |4
(carvedilol, metoprolol succinate, bisoprolol), and diuretics are
standard therapy.
6. The hallmark finding of pericarditis on physical examination
is:
A) A diastolic murmur
B) A pericardial friction rub
C) An S3 gallop
D) A systolic ejection click
Answer: B
Rationale: A pericardial friction rub is the classic physical
finding in pericarditis, caused by inflamed pericardial layers
rubbing together. It is best heard at the left lower sternal
border.
7. A patient presents with sudden onset of severe "tearing"
chest pain radiating to the back. Blood pressure in the right arm
is 180/100 mm Hg and in the left arm is 140/80 mm Hg. The
most likely diagnosis is:
A) Myocardial infarction
B) Aortic dissection
C) Pulmonary embolism
D) Tension pneumothorax
