1|Page
APEA PREDICTOR EXAM QUESTIONS & ANSWERS 2026–2027 |
120 PRACTICE QS WITH RATIONALES,100% CORRECT
ALREADY GRADED A+
1.
A 42-year-old woman presents with fatigue, pallor, and spoon-shaped nails.
Labs reveal Hgb 9.5 g/dL, MCV 72 fL, ferritin 8 ng/mL. What is the most
likely diagnosis?
A) Iron-deficiency anemia
B) Vitamin B12 deficiency
C) Anemia of chronic disease
D) Thalassemia minor
Answer: A) Iron-deficiency anemia
Rationale: Microcytic anemia (low MCV) with low ferritin confirms iron
deficiency. Spoon nails (koilonychia) is a classic finding.
2.
A 67-year-old man with a history of smoking presents with new-onset
hematuria. Which diagnostic test is most appropriate first?
A) Renal biopsy
B) CT urogram
C) Cystoscopy
D) Urinalysis with microscopy
Answer: D) Urinalysis with microscopy
Rationale: Always start with the least invasive test. UA can help distinguish
infection, proteinuria, or red cell casts. Cystoscopy and imaging follow if
suspicion for bladder cancer remains.
3.
Which antibiotic is first-line therapy for acute uncomplicated cystitis in
women?
A) Amoxicillin
B) Ciprofloxacin
C) Nitrofurantoin
,2|Page
D) Cephalexin
Answer: C) Nitrofurantoin
Rationale: Nitrofurantoin (5 days) or TMP-SMX (3 days if resistance <20%)
are first-line. Fluoroquinolones are reserved for complicated cases.
4.
A 55-year-old woman reports palpitations and heat intolerance. On exam, she
has a diffusely enlarged thyroid and brisk reflexes. Which lab confirms the
diagnosis?
A) Low TSH, high free T4
B) High TSH, low free T4
C) Low TSH, low T4
D) High TSH, high T4
Answer: A) Low TSH, high free T4
Rationale: Primary hyperthyroidism suppresses TSH while elevating T4.
5.
A 68-year-old man with hypertension presents with sudden, tearing chest pain
radiating to his back. BP is 210/110. What is the most likely diagnosis?
A) Acute coronary syndrome
B) Pulmonary embolism
C) Aortic dissection
D) Pericarditis
Answer: C) Aortic dissection
Rationale: Severe tearing pain radiating to the back with hypertension
strongly suggests aortic dissection.
6.
A 32-year-old pregnant woman (28 weeks) presents with dysuria and
frequency. Which antibiotic is safest?
A) Ciprofloxacin
B) Trimethoprim-sulfamethoxazole
C) Nitrofurantoin
D) Doxycycline
Answer: C) Nitrofurantoin
Rationale: Nitrofurantoin is safe in pregnancy (except near term).
,3|Page
Fluoroquinolones and tetracyclines are contraindicated.
7.
Which vaccine is recommended for adults age 65 and older regardless of prior
vaccination history?
A) Hepatitis B
B) Pneumococcal conjugate (PCV20 or PCV15)
C) MMR
D) Varicella
Answer: B) Pneumococcal conjugate (PCV20 or PCV15)
Rationale: Current CDC guidelines recommend PCV20 (or PCV15 followed
by PPSV23) for all adults ≥65.
8.
A 23-year-old woman presents with lower abdominal pain, fever, cervical
motion tenderness, and purulent cervical discharge. What is the best
treatment?
A) Oral azithromycin only
B) IM ceftriaxone plus doxycycline
C) Oral metronidazole alone
D) IV vancomycin
Answer: B) IM ceftriaxone plus doxycycline
Rationale: Pelvic inflammatory disease is treated with ceftriaxone
(gonorrhea) plus doxycycline (chlamydia), sometimes adding metronidazole.
9.
Which antihypertensive is first-line in a patient with type 2 diabetes and
albuminuria?
A) Beta-blocker
B) Thiazide diuretic
C) ACE inhibitor
D) Calcium channel blocker
Answer: C) ACE inhibitor
Rationale: ACE inhibitors protect kidney function in diabetics with
proteinuria.
, 4|Page
10.
A 74-year-old woman presents with resting tremor, bradykinesia, and
shuffling gait. What is the most likely diagnosis?
A) Alzheimer’s disease
B) Parkinson’s disease
C) Essential tremor
D) Myasthenia gravis
Answer: B) Parkinson’s disease
Rationale: Classic triad = resting tremor, rigidity, bradykinesia.
11.
A 19-year-old male presents with fever, sore throat, and posterior cervical
lymphadenopathy. Monospot is positive. Which is the most likely causative
agent?
A) CMV
B) EBV
C) HIV
D) Streptococcus pyogenes
Answer: B) EBV
Rationale: Epstein-Barr virus causes infectious mononucleosis with posterior
cervical adenopathy.
12.
Which condition presents with a wide pulse pressure, bounding pulses, and a
diastolic decrescendo murmur?
A) Aortic regurgitation
B) Mitral stenosis
C) Tricuspid regurgitation
D) Aortic stenosis
Answer: A) Aortic regurgitation
Rationale: Aortic regurgitation causes wide pulse pressure and bounding
“water-hammer” pulses.
13.
A 45-year-old man presents with epigastric pain worse after meals and
improved with antacids. What is the best first test?
APEA PREDICTOR EXAM QUESTIONS & ANSWERS 2026–2027 |
120 PRACTICE QS WITH RATIONALES,100% CORRECT
ALREADY GRADED A+
1.
A 42-year-old woman presents with fatigue, pallor, and spoon-shaped nails.
Labs reveal Hgb 9.5 g/dL, MCV 72 fL, ferritin 8 ng/mL. What is the most
likely diagnosis?
A) Iron-deficiency anemia
B) Vitamin B12 deficiency
C) Anemia of chronic disease
D) Thalassemia minor
Answer: A) Iron-deficiency anemia
Rationale: Microcytic anemia (low MCV) with low ferritin confirms iron
deficiency. Spoon nails (koilonychia) is a classic finding.
2.
A 67-year-old man with a history of smoking presents with new-onset
hematuria. Which diagnostic test is most appropriate first?
A) Renal biopsy
B) CT urogram
C) Cystoscopy
D) Urinalysis with microscopy
Answer: D) Urinalysis with microscopy
Rationale: Always start with the least invasive test. UA can help distinguish
infection, proteinuria, or red cell casts. Cystoscopy and imaging follow if
suspicion for bladder cancer remains.
3.
Which antibiotic is first-line therapy for acute uncomplicated cystitis in
women?
A) Amoxicillin
B) Ciprofloxacin
C) Nitrofurantoin
,2|Page
D) Cephalexin
Answer: C) Nitrofurantoin
Rationale: Nitrofurantoin (5 days) or TMP-SMX (3 days if resistance <20%)
are first-line. Fluoroquinolones are reserved for complicated cases.
4.
A 55-year-old woman reports palpitations and heat intolerance. On exam, she
has a diffusely enlarged thyroid and brisk reflexes. Which lab confirms the
diagnosis?
A) Low TSH, high free T4
B) High TSH, low free T4
C) Low TSH, low T4
D) High TSH, high T4
Answer: A) Low TSH, high free T4
Rationale: Primary hyperthyroidism suppresses TSH while elevating T4.
5.
A 68-year-old man with hypertension presents with sudden, tearing chest pain
radiating to his back. BP is 210/110. What is the most likely diagnosis?
A) Acute coronary syndrome
B) Pulmonary embolism
C) Aortic dissection
D) Pericarditis
Answer: C) Aortic dissection
Rationale: Severe tearing pain radiating to the back with hypertension
strongly suggests aortic dissection.
6.
A 32-year-old pregnant woman (28 weeks) presents with dysuria and
frequency. Which antibiotic is safest?
A) Ciprofloxacin
B) Trimethoprim-sulfamethoxazole
C) Nitrofurantoin
D) Doxycycline
Answer: C) Nitrofurantoin
Rationale: Nitrofurantoin is safe in pregnancy (except near term).
,3|Page
Fluoroquinolones and tetracyclines are contraindicated.
7.
Which vaccine is recommended for adults age 65 and older regardless of prior
vaccination history?
A) Hepatitis B
B) Pneumococcal conjugate (PCV20 or PCV15)
C) MMR
D) Varicella
Answer: B) Pneumococcal conjugate (PCV20 or PCV15)
Rationale: Current CDC guidelines recommend PCV20 (or PCV15 followed
by PPSV23) for all adults ≥65.
8.
A 23-year-old woman presents with lower abdominal pain, fever, cervical
motion tenderness, and purulent cervical discharge. What is the best
treatment?
A) Oral azithromycin only
B) IM ceftriaxone plus doxycycline
C) Oral metronidazole alone
D) IV vancomycin
Answer: B) IM ceftriaxone plus doxycycline
Rationale: Pelvic inflammatory disease is treated with ceftriaxone
(gonorrhea) plus doxycycline (chlamydia), sometimes adding metronidazole.
9.
Which antihypertensive is first-line in a patient with type 2 diabetes and
albuminuria?
A) Beta-blocker
B) Thiazide diuretic
C) ACE inhibitor
D) Calcium channel blocker
Answer: C) ACE inhibitor
Rationale: ACE inhibitors protect kidney function in diabetics with
proteinuria.
, 4|Page
10.
A 74-year-old woman presents with resting tremor, bradykinesia, and
shuffling gait. What is the most likely diagnosis?
A) Alzheimer’s disease
B) Parkinson’s disease
C) Essential tremor
D) Myasthenia gravis
Answer: B) Parkinson’s disease
Rationale: Classic triad = resting tremor, rigidity, bradykinesia.
11.
A 19-year-old male presents with fever, sore throat, and posterior cervical
lymphadenopathy. Monospot is positive. Which is the most likely causative
agent?
A) CMV
B) EBV
C) HIV
D) Streptococcus pyogenes
Answer: B) EBV
Rationale: Epstein-Barr virus causes infectious mononucleosis with posterior
cervical adenopathy.
12.
Which condition presents with a wide pulse pressure, bounding pulses, and a
diastolic decrescendo murmur?
A) Aortic regurgitation
B) Mitral stenosis
C) Tricuspid regurgitation
D) Aortic stenosis
Answer: A) Aortic regurgitation
Rationale: Aortic regurgitation causes wide pulse pressure and bounding
“water-hammer” pulses.
13.
A 45-year-old man presents with epigastric pain worse after meals and
improved with antacids. What is the best first test?
