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 conjunctiva that does not cross the cornea. Corneal ulcers have
epithelial defects. Conjunctivitis presents with injection and discharge. ---
7. Where should the uterine fundus be palpable at 12 weeks gestation?
A) Above the umbilicus
B) At the level of the symphysis pubis
C) Halfway between the symphysis and umbilicus
D) At the umbilicus
Answer B: – At the level of the symphysis pubis
Rationale: At 12 weeks gestation, the uterine fundus is palpable at the level of the symphysis pubis. It
reaches halfway to the umbilicus at 16 weeks and the umbilicus at 20 weeks. ---
8. A 40-year-old carpenter presents with a triangular thickening of the bulbar conjunctiva across the
outer surface of the cornea. What is this condition called?
A) Pinguecula
B) Pterygium
C) Corneal pannus
D) Arcus senilis
Answer B: – Pterygium
Rationale: Pterygium is a triangular, fleshy growth of conjunctival tissue that extends onto the cornea,
commonly seen in individuals with UV exposure (e.g., carpenters). Pinguecula does not cross the cornea. ---
9. Which group of lymph nodes is located on the medial surface of the arm approximately 3 cm above
the elbow?
A) Axillary nodes
B) Inguinal nodes
C) Epitrochlear nodes
, D) Cervical nodes
j j
Answer C: – Epitrochlear nodes j j j j
Rationale: The epitrochlear nodes are located on the medial surface of the arm approximately 3 cm above the
j j j j j j j j j j j j j j j j j
j elbow. They are palpable in certain conditions such as infections of the hand or forearm. ---
j j j j j j j j j j j j j j j
10. A 50-year-old male has a nontender, enlarged scrotum. What condition should the NP suspect?
j j j j j j j j j j j j j j
A) Testicular torsion
j j
B) Epididymitis
j
C) Hydrocele
j
D) Varicocele
j
Answer C: – Hydrocele j j j
Rationale: A nontender, enlarged scrotum in a 50-year-old male is most consistent with a hydrocele. Testicular
j j j j j j j j j j j j j j j
j torsion presents with acute severe pain. Epididymitis is typically tender. Varicocele presents as a "bag of
j j j j j j j j j j j j j j j
j worms" and is more common on the left. ---
j j j j j j j j
11. Ophthalmoscopic exam of a 40-year-old carpenter reveals a triangular thickening of the bulbar
j j j j j j j j j j j j j
j conjunctiva across the outer surface of the cornea. This condition is termed:
j j j j j j j j j j j
A) Pinguecula
j
B) Pterygium
j
C) Conjunctival cyst
j j
D) Scleritis
j
Answer B: – Pterygium j j j
Rationale: Pterygium is a degenerative condition of the conjunctiva that grows across the cornea, associated
j j j j j j j j j j j j j j
j with UV exposure. Pinguecula is a similar growth but does not extend across the cornea. ---
j j j j j j j j j j j j j j j
12. An elderly patient has been diagnosed with a cataract. What structure in the eye has become
j j j j j j j j j j j j j j j j
j diseased?
A) Cornea
j
B) Retina
j
C) Lens
j
D) Optic nerve
j j
Answer C: – Lens j j j
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 conjunctiva that does not cross the cornea. Corneal ulcers have
epithelial defects. Conjunctivitis presents with injection and discharge. ---
7. Where should the uterine fundus be palpable at 12 weeks gestation?
A) Above the umbilicus
B) At the level of the symphysis pubis
C) Halfway between the symphysis and umbilicus
D) At the umbilicus
Answer B: – At the level of the symphysis pubis
Rationale: At 12 weeks gestation, the uterine fundus is palpable at the level of the symphysis pubis. It
reaches halfway to the umbilicus at 16 weeks and the umbilicus at 20 weeks. ---
8. A 40-year-old carpenter presents with a triangular thickening of the bulbar conjunctiva across the
outer surface of the cornea. What is this condition called?
A) Pinguecula
B) Pterygium
C) Corneal pannus
D) Arcus senilis
Answer B: – Pterygium
Rationale: Pterygium is a triangular, fleshy growth of conjunctival tissue that extends onto the cornea,
commonly seen in individuals with UV exposure (e.g., carpenters). Pinguecula does not cross the cornea. ---
9. Which group of lymph nodes is located on the medial surface of the arm approximately 3 cm above
the elbow?
A) Axillary nodes
B) Inguinal nodes
C) Epitrochlear nodes
, D) Cervical nodes
j j
Answer C: – Epitrochlear nodes j j j j
Rationale: The epitrochlear nodes are located on the medial surface of the arm approximately 3 cm above the
j j j j j j j j j j j j j j j j j
j elbow. They are palpable in certain conditions such as infections of the hand or forearm. ---
j j j j j j j j j j j j j j j
10. A 50-year-old male has a nontender, enlarged scrotum. What condition should the NP suspect?
j j j j j j j j j j j j j j
A) Testicular torsion
j j
B) Epididymitis
j
C) Hydrocele
j
D) Varicocele
j
Answer C: – Hydrocele j j j
Rationale: A nontender, enlarged scrotum in a 50-year-old male is most consistent with a hydrocele. Testicular
j j j j j j j j j j j j j j j
j torsion presents with acute severe pain. Epididymitis is typically tender. Varicocele presents as a "bag of
j j j j j j j j j j j j j j j
j worms" and is more common on the left. ---
j j j j j j j j
11. Ophthalmoscopic exam of a 40-year-old carpenter reveals a triangular thickening of the bulbar
j j j j j j j j j j j j j
j conjunctiva across the outer surface of the cornea. This condition is termed:
j j j j j j j j j j j
A) Pinguecula
j
B) Pterygium
j
C) Conjunctival cyst
j j
D) Scleritis
j
Answer B: – Pterygium j j j
Rationale: Pterygium is a degenerative condition of the conjunctiva that grows across the cornea, associated
j j j j j j j j j j j j j j
j with UV exposure. Pinguecula is a similar growth but does not extend across the cornea. ---
j j j j j j j j j j j j j j j
12. An elderly patient has been diagnosed with a cataract. What structure in the eye has become
j j j j j j j j j j j j j j j j
j diseased?
A) Cornea
j
B) Retina
j
C) Lens
j
D) Optic nerve
j j
Answer C: – Lens j j j
