APEA 3P PREDICTOR EXAM PREP QUESTIONS AND ANSWERS
GuArAntEEd SuccESS with ExPErt
VErifiEd Q&A
◉ Cataracts: Symptoms & Screening. Answer: Symptoms: Elderly with night vision
issues
Difficulty with glare (headlights when driving at night or sunlight)
Halos around lights
Screening: Red Reflex Test o If cataracts are present the red reflex will be missing from
the affected eye(s)
Normal is a reddish-orange glow
If no glow, dull, or white; the reflection is abnormal
◉ Age-Related Macular Degeneration: Symptoms & Treatment. Answer: Symptoms:
Painless loss of "central vision" reports straight lines appear curved
Periphery is preserved
Leading cause of blindness in the elderly and more common in smokers
Treatment: Give Amsler grid or refer to ophthalmologist if Amsler grid is not an option
◉ Retinal Detachment: Symptoms & Treatment. Answer: Symptoms:
Sudden onset of floaters
Looking through the curtain
Flashes of light
Painless
Treatment: ER STAT
◉ Dacryocystitis: background& symptoms & treatment. Answer: Background: Infection
of lacrimal sac/tear duct usually caused by blockage
Common in infants, adults over 40 also have higher risk of developing
Symptoms: Thick eye discharge, pain, redness/swelling/warmth of lower eyelid, watery
eye/excess tearing
Treatment: Lacrimal sac massage (downward toward mouth) 2-3 times daily; systemic
antibiotics 7-10 days
,◉ Allergic Rhinitis: Background & symptoms & treatment. Answer: Background:
Inflammatory changes of nasal mucosa due to allergies
Atopic family history (asthma, eczema)
May have seasonal or daily symptoms
Symptoms: Chronic nasal congestion with clear mucus discharge or post nasal drip
Itchy nose, Frequent sneezing, Coughing worsens when supine due to post nasal drip,
Blue-tinged or pale boggy (spongy) nasal turbinate's
Treatment: • First Line: Nasal steroid sprays (Fluticasone - Flonase) BID, triamcinolone
(Nasacort Allergy) 1-2 sprays QD • Antihistamine
Azelastine (Astelin) QD-BID • Decongestants Pseudoephedrine PRN.
Avoid in infants and children • Avoid triggers
◉ Epistaxis (Nosebleed): Background & Treatment. Answer: Background: Anterior
nosebleed more common. Caused by bleeding at Kisselbach's plexus
Treatment: Have the pt. blow their nose first
Apply two sprays of topical nasal decongestant (Afrin). Pinch alae tightly against nasal
septum and hold for 10 minutes
◉ Meniere's Disease: Symptoms. Answer: Vertigo
Hearing loss
Tinnitus
◉ Meniere's Disease Mnemonic: VAST. Answer: Vertigo (Episodic)
Aural (auditory) fullness
Sensorineural Hearing Loss (Fluctuating)
Tinnitus (Subjective)
◉ Meniere's Disease Treatment. Answer: Usually, self-limiting. Treat acute attacks
Antihistamines for vertigo
Meclizine, dimenhydrinate
Antiemetics for nausea/vomiting o Promethazine, prochlorperazine
◉ Acoustic Neuroma (Vestibular Schwannoma): Symptoms/DX/TX. Answer: Symptoms:
Ages 30-60
Gradual onset, one-sided
Sensorineural hearing loss, tinnitus that is insidious; CN 8
Facial numbness and pain if it compresses CN 5
Dx: Order an MRI o Benign tumor of CN 8 causing sensorineural hearing loss and
tinnitus.
, If it compresses on CN 5 will have facial numbness and pain
Treatment: Surgery
◉ Cholesteatoma symptoms and treatment. Answer: Symptoms:
Cauliflower
Foul-smell
Hearing loss (typically conductive unless it's way inner than can have sensorineural)
If erodes bones in face affects CN VII
Treatment: SURGERY
◉ Battle Sign (Basilar Skull Fracture):. Answer: Bruising behind the ear (mastoid area)
appear within 1-3 days after trauma
Parietal bone is most fractured. Linear fracture most common
leaking of clear fluid from nose and eyes, raccoon eyes
Look for clear, golden serous discharge from the ear or nose
treat immediately-Refer to ER
◉ Benign Paroxysmal Positional Vertigo (BPPV): Symptoms & DX & Treatment.
Answer: Symptoms: Vertigo lasting <1 minute caused by sudden head movements and
position changes
May lose balance and fall
Due to calcium carbonate crystals (otoconia) being trapped in the semicircular canals
Dx: Gold Standard: Dix-Hallpike
Epley Maneuver in clinic or at home by pt
Test won't ask how to conduct treatment just be able to associated Epley with BPPV
◉ Vestibular Neuritis and Labyrinthitis: Cause/ Symptoms/ TX. Answer: Viral
infection/Inflammation
Symptoms: Sudden/rapid onset of severe vertigo with nausea/vomiting for 1-2 days and
then symptoms lessen • Sensorineural hearing loss and tinnitus
Treatment: Ondansetron (Zofran)
Methylprednisolone taper
GuArAntEEd SuccESS with ExPErt
VErifiEd Q&A
◉ Cataracts: Symptoms & Screening. Answer: Symptoms: Elderly with night vision
issues
Difficulty with glare (headlights when driving at night or sunlight)
Halos around lights
Screening: Red Reflex Test o If cataracts are present the red reflex will be missing from
the affected eye(s)
Normal is a reddish-orange glow
If no glow, dull, or white; the reflection is abnormal
◉ Age-Related Macular Degeneration: Symptoms & Treatment. Answer: Symptoms:
Painless loss of "central vision" reports straight lines appear curved
Periphery is preserved
Leading cause of blindness in the elderly and more common in smokers
Treatment: Give Amsler grid or refer to ophthalmologist if Amsler grid is not an option
◉ Retinal Detachment: Symptoms & Treatment. Answer: Symptoms:
Sudden onset of floaters
Looking through the curtain
Flashes of light
Painless
Treatment: ER STAT
◉ Dacryocystitis: background& symptoms & treatment. Answer: Background: Infection
of lacrimal sac/tear duct usually caused by blockage
Common in infants, adults over 40 also have higher risk of developing
Symptoms: Thick eye discharge, pain, redness/swelling/warmth of lower eyelid, watery
eye/excess tearing
Treatment: Lacrimal sac massage (downward toward mouth) 2-3 times daily; systemic
antibiotics 7-10 days
,◉ Allergic Rhinitis: Background & symptoms & treatment. Answer: Background:
Inflammatory changes of nasal mucosa due to allergies
Atopic family history (asthma, eczema)
May have seasonal or daily symptoms
Symptoms: Chronic nasal congestion with clear mucus discharge or post nasal drip
Itchy nose, Frequent sneezing, Coughing worsens when supine due to post nasal drip,
Blue-tinged or pale boggy (spongy) nasal turbinate's
Treatment: • First Line: Nasal steroid sprays (Fluticasone - Flonase) BID, triamcinolone
(Nasacort Allergy) 1-2 sprays QD • Antihistamine
Azelastine (Astelin) QD-BID • Decongestants Pseudoephedrine PRN.
Avoid in infants and children • Avoid triggers
◉ Epistaxis (Nosebleed): Background & Treatment. Answer: Background: Anterior
nosebleed more common. Caused by bleeding at Kisselbach's plexus
Treatment: Have the pt. blow their nose first
Apply two sprays of topical nasal decongestant (Afrin). Pinch alae tightly against nasal
septum and hold for 10 minutes
◉ Meniere's Disease: Symptoms. Answer: Vertigo
Hearing loss
Tinnitus
◉ Meniere's Disease Mnemonic: VAST. Answer: Vertigo (Episodic)
Aural (auditory) fullness
Sensorineural Hearing Loss (Fluctuating)
Tinnitus (Subjective)
◉ Meniere's Disease Treatment. Answer: Usually, self-limiting. Treat acute attacks
Antihistamines for vertigo
Meclizine, dimenhydrinate
Antiemetics for nausea/vomiting o Promethazine, prochlorperazine
◉ Acoustic Neuroma (Vestibular Schwannoma): Symptoms/DX/TX. Answer: Symptoms:
Ages 30-60
Gradual onset, one-sided
Sensorineural hearing loss, tinnitus that is insidious; CN 8
Facial numbness and pain if it compresses CN 5
Dx: Order an MRI o Benign tumor of CN 8 causing sensorineural hearing loss and
tinnitus.
, If it compresses on CN 5 will have facial numbness and pain
Treatment: Surgery
◉ Cholesteatoma symptoms and treatment. Answer: Symptoms:
Cauliflower
Foul-smell
Hearing loss (typically conductive unless it's way inner than can have sensorineural)
If erodes bones in face affects CN VII
Treatment: SURGERY
◉ Battle Sign (Basilar Skull Fracture):. Answer: Bruising behind the ear (mastoid area)
appear within 1-3 days after trauma
Parietal bone is most fractured. Linear fracture most common
leaking of clear fluid from nose and eyes, raccoon eyes
Look for clear, golden serous discharge from the ear or nose
treat immediately-Refer to ER
◉ Benign Paroxysmal Positional Vertigo (BPPV): Symptoms & DX & Treatment.
Answer: Symptoms: Vertigo lasting <1 minute caused by sudden head movements and
position changes
May lose balance and fall
Due to calcium carbonate crystals (otoconia) being trapped in the semicircular canals
Dx: Gold Standard: Dix-Hallpike
Epley Maneuver in clinic or at home by pt
Test won't ask how to conduct treatment just be able to associated Epley with BPPV
◉ Vestibular Neuritis and Labyrinthitis: Cause/ Symptoms/ TX. Answer: Viral
infection/Inflammation
Symptoms: Sudden/rapid onset of severe vertigo with nausea/vomiting for 1-2 days and
then symptoms lessen • Sensorineural hearing loss and tinnitus
Treatment: Ondansetron (Zofran)
Methylprednisolone taper
