APEA 3P EXAM
1. A patient with chronic kidney disease presents with hyperkalemia. Which
medication is contraindicated?
A. Lisinopril
B. Furosemide
C. Sodium polystyrene sulfonate
D. Calcium gluconate
Answer: A. Lisinopril
Rationale: ACE inhibitors like Lisinopril can worsen hyperkalemia and should be
avoided in patients with high potassium levels.
2. Which physical exam finding is most consistent with aortic stenosis?
A. Bounding pulses
B. Systolic murmur at the right 2nd intercostal space
C. Diastolic murmur at the left sternal border
D. Displaced PMI
Answer: B. Systolic murmur at the right 2nd intercostal space
Rationale: Classic sign of aortic stenosis includes a systolic murmur best heard at the
right upper sternal border.
3. A patient with asthma is prescribed a long-acting beta-agonist. Which co-
prescription is required?
A. Antihistamine
B. Inhaled corticosteroid
C. Leukotriene receptor antagonist
D. Theophylline
,Answer: B. Inhaled corticosteroid
Rationale: LABAs must be used with inhaled corticosteroids to reduce asthma-
related deaths.
4. Which cranial nerve controls facial expression?
A. CN V
B. CN VII
C. CN IX
D. CN X
Answer: B. CN VII
Rationale: Cranial Nerve VII (Facial) controls muscles of facial expression.
5. Which of the following drugs is a calcium channel blocker?
A. Lisinopril
B. Atenolol
C. Amlodipine
D. Losartan
Answer: C. Amlodipine
Rationale: Amlodipine is a dihydropyridine calcium channel blocker.
6. A patient on warfarin has an INR of 6.2 with no bleeding. What is the appropriate
action?
A. Give Vitamin K IV
B. Continue dose and recheck in 2 days
C. Hold warfarin and give oral Vitamin K
D. Increase warfarin dose
Answer: C. Hold warfarin and give oral Vitamin K
Rationale: For INR >6 without bleeding, oral Vitamin K is recommended.
7. Which test confirms mononucleosis?
A. Rapid strep
B. Monospot test
,C. ANA
D. ESR
Answer: B. Monospot test
Rationale: Monospot test detects heterophile antibodies associated with EBV
infection.
8. What is the first-line treatment for otitis media?
A. Amoxicillin
B. Azithromycin
C. Ciprofloxacin
D. Doxycycline
Answer: A. Amoxicillin
Rationale: Amoxicillin is the first-line agent unless allergy is present.
9. A positive McMurray test indicates:
A. ACL tear
B. MCL sprain
C. Meniscal tear
D. Patellar dislocation
Answer: C. Meniscal tear
Rationale: The McMurray test assesses for meniscal injury in the knee.
10. What electrolyte abnormality is expected in Addison’s disease?
A. Hypernatremia
B. Hyperkalemia
C. Hypokalemia
D. Hypocalcemia
Answer: B. Hyperkalemia
Rationale: Adrenal insufficiency leads to decreased aldosterone, causing sodium loss
and potassium retention.
11. What is a common side effect of SSRIs?
, A. Hypertension
B. Sedation
C. Sexual dysfunction
D. Bradycardia
Answer: C. Sexual dysfunction
Rationale: SSRIs frequently cause decreased libido and anorgasmia.
12. A 62-year-old smoker has a new cough and weight loss. What is the next step?
A. Chest X-ray
B. Spirometry
C. Trial of antibiotics
D. Inhaled bronchodilator
Answer: A. Chest X-ray
Rationale: Cancer must be ruled out in older smokers with systemic symptoms.
13. Which antihypertensive is safest during pregnancy?
A. Lisinopril
B. Methyldopa
C. Losartan
D. Hydrochlorothiazide
Answer: B. Methyldopa
Rationale: Methyldopa is preferred in pregnancy due to safety profile.
14. What is the most specific sign of appendicitis?
A. Murphy’s sign
B. McBurney's point tenderness
C. Rovsing’s sign
D. Obturator sign
Answer: B. McBurney's point tenderness
Rationale: This is the classic localized pain found in appendicitis.
15. What heart sound is associated with heart failure?
1. A patient with chronic kidney disease presents with hyperkalemia. Which
medication is contraindicated?
A. Lisinopril
B. Furosemide
C. Sodium polystyrene sulfonate
D. Calcium gluconate
Answer: A. Lisinopril
Rationale: ACE inhibitors like Lisinopril can worsen hyperkalemia and should be
avoided in patients with high potassium levels.
2. Which physical exam finding is most consistent with aortic stenosis?
A. Bounding pulses
B. Systolic murmur at the right 2nd intercostal space
C. Diastolic murmur at the left sternal border
D. Displaced PMI
Answer: B. Systolic murmur at the right 2nd intercostal space
Rationale: Classic sign of aortic stenosis includes a systolic murmur best heard at the
right upper sternal border.
3. A patient with asthma is prescribed a long-acting beta-agonist. Which co-
prescription is required?
A. Antihistamine
B. Inhaled corticosteroid
C. Leukotriene receptor antagonist
D. Theophylline
,Answer: B. Inhaled corticosteroid
Rationale: LABAs must be used with inhaled corticosteroids to reduce asthma-
related deaths.
4. Which cranial nerve controls facial expression?
A. CN V
B. CN VII
C. CN IX
D. CN X
Answer: B. CN VII
Rationale: Cranial Nerve VII (Facial) controls muscles of facial expression.
5. Which of the following drugs is a calcium channel blocker?
A. Lisinopril
B. Atenolol
C. Amlodipine
D. Losartan
Answer: C. Amlodipine
Rationale: Amlodipine is a dihydropyridine calcium channel blocker.
6. A patient on warfarin has an INR of 6.2 with no bleeding. What is the appropriate
action?
A. Give Vitamin K IV
B. Continue dose and recheck in 2 days
C. Hold warfarin and give oral Vitamin K
D. Increase warfarin dose
Answer: C. Hold warfarin and give oral Vitamin K
Rationale: For INR >6 without bleeding, oral Vitamin K is recommended.
7. Which test confirms mononucleosis?
A. Rapid strep
B. Monospot test
,C. ANA
D. ESR
Answer: B. Monospot test
Rationale: Monospot test detects heterophile antibodies associated with EBV
infection.
8. What is the first-line treatment for otitis media?
A. Amoxicillin
B. Azithromycin
C. Ciprofloxacin
D. Doxycycline
Answer: A. Amoxicillin
Rationale: Amoxicillin is the first-line agent unless allergy is present.
9. A positive McMurray test indicates:
A. ACL tear
B. MCL sprain
C. Meniscal tear
D. Patellar dislocation
Answer: C. Meniscal tear
Rationale: The McMurray test assesses for meniscal injury in the knee.
10. What electrolyte abnormality is expected in Addison’s disease?
A. Hypernatremia
B. Hyperkalemia
C. Hypokalemia
D. Hypocalcemia
Answer: B. Hyperkalemia
Rationale: Adrenal insufficiency leads to decreased aldosterone, causing sodium loss
and potassium retention.
11. What is a common side effect of SSRIs?
, A. Hypertension
B. Sedation
C. Sexual dysfunction
D. Bradycardia
Answer: C. Sexual dysfunction
Rationale: SSRIs frequently cause decreased libido and anorgasmia.
12. A 62-year-old smoker has a new cough and weight loss. What is the next step?
A. Chest X-ray
B. Spirometry
C. Trial of antibiotics
D. Inhaled bronchodilator
Answer: A. Chest X-ray
Rationale: Cancer must be ruled out in older smokers with systemic symptoms.
13. Which antihypertensive is safest during pregnancy?
A. Lisinopril
B. Methyldopa
C. Losartan
D. Hydrochlorothiazide
Answer: B. Methyldopa
Rationale: Methyldopa is preferred in pregnancy due to safety profile.
14. What is the most specific sign of appendicitis?
A. Murphy’s sign
B. McBurney's point tenderness
C. Rovsing’s sign
D. Obturator sign
Answer: B. McBurney's point tenderness
Rationale: This is the classic localized pain found in appendicitis.
15. What heart sound is associated with heart failure?
