APEA PRE-PREDICTOR FINAL EXAM 2024/2025 WITH
QUESTIONS AND VERIFIED CORRECT ANSWERS/ ALREADY
GRADED A++
In myasthenia gravis, weakness is a result of insufficient acetylcholine
transmission at the neuromuscular junction; however, weakness can also
occur with overdosing of the cholinergic medications used to treat
myasthenia. What symptom helps differentiate a myasthenic crisis from a
cholinergic crisis? - ANSWER Muscle fasciculations
A 74-year-old man presents after his wife witnessed him grab his head in
pain and fall to the floor. He has not regained consciousness. His current
blood pressure is 150/96 mm Hg, and his heart rate is 65 bpm. Emergent
head CT shows a subarachnoid hemorrhage. - ANSWER Nimodipine
(CCB)
A 75-year-old man is involved in a motor vehicle accident and strikes his
forehead on the windshield. He complains of neck pain and severe burning
in his shoulders and arms. His physical examination reveals weakness of
his upper extremities. What type of spinal cord injury does this patient
have? - ANSWER central cord syndrome
A 37-year-old man fell from a ladder as he finished hanging the Christmas
lights on his house. The right side of his head hit the alley cement, and he
lost consciousness for about 1 minute; he woke up with a headache, but he
had no other complaints. A few hours later, the patient is brought to the
emergency room by his neighbor because of an intense headache,
confusion, and left hand hemiparesis. On examination, the patient has a
bruise located over the right temporal region, mydriasis, and right deviation
of the right eye, papilledema, and left extensor plantar response. An
emergency CT scan of the head without contrast reveals a lens-shaped
hyper-density under the right temporal bone with mass effect and edema.
What is the most likely diagnosis? - ANSWER Epidural hematoma
A 1-year-old boy presents with increasing lethargy. He is barely responsive,
and his parents deny any trauma or injury. What is the most common
cause of nontraumatic altered levels of consciousness? - ANSWER
Infection
,A 44-year-old man starts to notice that his eyelids are drooping. Some time
afterwards, his jaw becomes weak. He has difficulty swallowing and also
experiences weakness in his limbs. He is quite embarrassed when he eats
because he must use his hand to help support his jaw. His weakness gets
progressively worse. Finally, he seeks medical attention. His physical
examination demonstrates the weakness in his limbs; however, no sensory
defects are present. A Tensilon test is done and is positive. His doctor is
concerned about an associated malignancy. What is the underlying
pathology of this disease? - ANSWER Antibodies to the acetylcholine
receptor
A 31-year-old woman presents with a purpural rash covering her arms,
legs, and abdomen. She also has fever, chills, nausea, abdominal
tenderness, tachycardia, and generalized myalgias. Prior to the
development of the rash, the patient noted that she had a headache,
cough, and sore throat. Laboratory studies were positive for Gram-negative
diplococci in the blood, along with thrombocytopenia and an elevation in
PMNs. Urinalysis showed blood, protein, and casts. The patient denies any
foreign travel and does not have any sick contacts. However, she does
work part time as a nurse in a local hospital. The patient is diagnosed with
Meningococcemia; she is admitted to the hospital and placed in respiratory
isolation. What major course of therapy should this patient receive? -
ANSWER Antibiotics
A 54-year-old man presents after having a generalized seizure. The patient
is HIV positive, but he has been unable to afford antiretroviral therapy since
losing his job 2 years ago. Other than cachexia, the physical exam is
unremarkable. Upon further inquiry, the patient also notes that he has
become short- tempered and hypercritical; at times, he seems confused.
An MRI of the brain is performed, and it reveals several cortical ring-
enhancing lesions. - ANSWER Toxoplasma encephalitis
A 37-year-old woman presents to her GP surgery with a history of right-
sided facial weakness and peri-auricular discomfort since she awoke this
morning. She is afebrile. What is the most likely diagnosis? - ANSWER
Bell's Palsy
A 62-year-old man presents with vision problems and difficulty swallowing.
Over the last week, he has had a constellation of symptoms; they began
with numbness and tingling in his feet and progressed to weakness that
,now affects both lower and upper extremities. Within the last day, he has
started to notice difficulty swallowing and double vision. He also feels it is
difficult for him to take a big breath. His past medical history is
noncontributory, and he takes no medications. Exam reveals bilateral
absence of patellar and ulnar reflexes. A lumbar puncture is performed to
confirm the diagnosis. What cerebrospinal fluid (CSF) finding is most likely?
- ANSWER Elevated CSF proteins
A 70-year-old woman is brought to your attention by her family because of
the slowly progressive gait disorder, the impairment of mental function, and
urinary incontinence. About 1 year ago, she started having weakness and
tiredness in her legs, followed by unsteadiness; her steps became shorter
and shorter, and she also experienced unexplained backward falls. She is
becoming emotionally indifferent, inattentive, and her actions and thinking
have became "dull". Over the past month, she has started having urinary
urgency and involuntary leaking of urine. What is most likely the best
method of treating the patient's urinary problems? - ANSWER
Ventriculoperitoneal shunt
A 5-month-old male infant presents after a seizure involving all 4 limbs. His
mother tells you that he was born full term without any complications, and
he was well until 2 days ago when he developed a fever. He vomited
multiple times yesterday and was irritable. He was given antipyretic
medication for his fever. He has no known allergies. On physical exam, his
temperature is 102.7 F, and his pulse is 154/min; BP is 90/50 mmHg, and
RR is 20/min. He is lethargic, pale, and focal neurological deficits are
present. His anterior fontanel is bulging. You suspect that he has bacterial
meningitis. After drawing blood samples for investigations, what is the most
appropriate next step? - ANSWER intravenous empirical antibiotics
A 12-year-old girl presents with a 3-day history of progressive dysarthria,
dysphagia, and weakness. The patient was well until 3 days prior to
admission to the hospital; at that time, she developed the onset and
subsequent gradual worsening of dysarthria. She attributed the dysarthria
to a sore throat that she had had about 2 weeks earlier. 3 days prior to
admission, she also had the onset of mild dysphagia; it mostly occurred
with liquids. 24 hours prior to admission, she developed weakness in both
upper extremities, which increased and began to involve the lower
extremities. This limb weakness was neither worsened by activity nor
improved by rest. A nerve conduction study reveals a moderate degree of
, mostly motor demyelinating peripheral neuropathy, highly suggestive of
Guillain- Barre. What statement best describes the patient's prognosis? -
ANSWER Her rapidly evolving clinical course indicates a poor prognosis
A 45-year-old African American man with no significant past medical history
presents with a 1-hour history of left retroorbital headache. It is described
as excruciating, stabbing, sharp, and lancinating; it is rated as severe in
intensity. He denies any preceding infections, nausea, vomiting,
photophobia, or osmophobia; he also denies fever, chills, stiff neck, focal
weakness, numbness, tingling, vision, hearing, gait, or speech changes. He
recalls a similar episode several months ago; it lasted about a week, and it
dissipated without complications. His physical exam is remarkable for
painful distress, lacrimation with conjunctival injection, nasal congestion,
rhinorrhea, left ocular miosis, and left forehead diaphoretic flushing. What
pharmacologic agent is the most beneficial for this patient at this time? -
ANSWER Sumatriptan
A 48-year-old woman presents after a seizure. Prior to the seizure, she
experienced confusion and disorientation preceded by nausea, vomiting,
and blurred vision. Symptoms appeared after working for several hours in
the garden under the sun. Her medical history is significant for the
presence of schizophrenia, for which she takes chlorpromazine at bedtime.
Her temperature is 41 C; BUN and creatinine are elevated; and there is
neutrophilia, hemoconcentration, and lactic acidosis. You think that the
event is possibly drug related. What is the most likely diagnosis? -
ANSWER Heat stroke
A 17-year-old adolescent male presents with unexplained neurological
symptoms. His liver is enlarged on palpation, and he has other symptoms
of hepatitis. Blood work reveals depressed ceruloplasmin levels. An
ophthalmological examination reveals Kayser-Fleischer rings. What is the
most likely diagnosis? - ANSWER Wilson's Disease
A 62-year-old woman presents with excruciating pain, burning, and swelling
in her left forearm and wrist. She reports that symptoms initially began with
a fracture 4 months ago. The fracture was casted, and the patient was told
it had healed well with cast removal at 8 weeks. She is frustrated because
her symptoms have persisted and worsened, rather than improving, as she
was told they would.
QUESTIONS AND VERIFIED CORRECT ANSWERS/ ALREADY
GRADED A++
In myasthenia gravis, weakness is a result of insufficient acetylcholine
transmission at the neuromuscular junction; however, weakness can also
occur with overdosing of the cholinergic medications used to treat
myasthenia. What symptom helps differentiate a myasthenic crisis from a
cholinergic crisis? - ANSWER Muscle fasciculations
A 74-year-old man presents after his wife witnessed him grab his head in
pain and fall to the floor. He has not regained consciousness. His current
blood pressure is 150/96 mm Hg, and his heart rate is 65 bpm. Emergent
head CT shows a subarachnoid hemorrhage. - ANSWER Nimodipine
(CCB)
A 75-year-old man is involved in a motor vehicle accident and strikes his
forehead on the windshield. He complains of neck pain and severe burning
in his shoulders and arms. His physical examination reveals weakness of
his upper extremities. What type of spinal cord injury does this patient
have? - ANSWER central cord syndrome
A 37-year-old man fell from a ladder as he finished hanging the Christmas
lights on his house. The right side of his head hit the alley cement, and he
lost consciousness for about 1 minute; he woke up with a headache, but he
had no other complaints. A few hours later, the patient is brought to the
emergency room by his neighbor because of an intense headache,
confusion, and left hand hemiparesis. On examination, the patient has a
bruise located over the right temporal region, mydriasis, and right deviation
of the right eye, papilledema, and left extensor plantar response. An
emergency CT scan of the head without contrast reveals a lens-shaped
hyper-density under the right temporal bone with mass effect and edema.
What is the most likely diagnosis? - ANSWER Epidural hematoma
A 1-year-old boy presents with increasing lethargy. He is barely responsive,
and his parents deny any trauma or injury. What is the most common
cause of nontraumatic altered levels of consciousness? - ANSWER
Infection
,A 44-year-old man starts to notice that his eyelids are drooping. Some time
afterwards, his jaw becomes weak. He has difficulty swallowing and also
experiences weakness in his limbs. He is quite embarrassed when he eats
because he must use his hand to help support his jaw. His weakness gets
progressively worse. Finally, he seeks medical attention. His physical
examination demonstrates the weakness in his limbs; however, no sensory
defects are present. A Tensilon test is done and is positive. His doctor is
concerned about an associated malignancy. What is the underlying
pathology of this disease? - ANSWER Antibodies to the acetylcholine
receptor
A 31-year-old woman presents with a purpural rash covering her arms,
legs, and abdomen. She also has fever, chills, nausea, abdominal
tenderness, tachycardia, and generalized myalgias. Prior to the
development of the rash, the patient noted that she had a headache,
cough, and sore throat. Laboratory studies were positive for Gram-negative
diplococci in the blood, along with thrombocytopenia and an elevation in
PMNs. Urinalysis showed blood, protein, and casts. The patient denies any
foreign travel and does not have any sick contacts. However, she does
work part time as a nurse in a local hospital. The patient is diagnosed with
Meningococcemia; she is admitted to the hospital and placed in respiratory
isolation. What major course of therapy should this patient receive? -
ANSWER Antibiotics
A 54-year-old man presents after having a generalized seizure. The patient
is HIV positive, but he has been unable to afford antiretroviral therapy since
losing his job 2 years ago. Other than cachexia, the physical exam is
unremarkable. Upon further inquiry, the patient also notes that he has
become short- tempered and hypercritical; at times, he seems confused.
An MRI of the brain is performed, and it reveals several cortical ring-
enhancing lesions. - ANSWER Toxoplasma encephalitis
A 37-year-old woman presents to her GP surgery with a history of right-
sided facial weakness and peri-auricular discomfort since she awoke this
morning. She is afebrile. What is the most likely diagnosis? - ANSWER
Bell's Palsy
A 62-year-old man presents with vision problems and difficulty swallowing.
Over the last week, he has had a constellation of symptoms; they began
with numbness and tingling in his feet and progressed to weakness that
,now affects both lower and upper extremities. Within the last day, he has
started to notice difficulty swallowing and double vision. He also feels it is
difficult for him to take a big breath. His past medical history is
noncontributory, and he takes no medications. Exam reveals bilateral
absence of patellar and ulnar reflexes. A lumbar puncture is performed to
confirm the diagnosis. What cerebrospinal fluid (CSF) finding is most likely?
- ANSWER Elevated CSF proteins
A 70-year-old woman is brought to your attention by her family because of
the slowly progressive gait disorder, the impairment of mental function, and
urinary incontinence. About 1 year ago, she started having weakness and
tiredness in her legs, followed by unsteadiness; her steps became shorter
and shorter, and she also experienced unexplained backward falls. She is
becoming emotionally indifferent, inattentive, and her actions and thinking
have became "dull". Over the past month, she has started having urinary
urgency and involuntary leaking of urine. What is most likely the best
method of treating the patient's urinary problems? - ANSWER
Ventriculoperitoneal shunt
A 5-month-old male infant presents after a seizure involving all 4 limbs. His
mother tells you that he was born full term without any complications, and
he was well until 2 days ago when he developed a fever. He vomited
multiple times yesterday and was irritable. He was given antipyretic
medication for his fever. He has no known allergies. On physical exam, his
temperature is 102.7 F, and his pulse is 154/min; BP is 90/50 mmHg, and
RR is 20/min. He is lethargic, pale, and focal neurological deficits are
present. His anterior fontanel is bulging. You suspect that he has bacterial
meningitis. After drawing blood samples for investigations, what is the most
appropriate next step? - ANSWER intravenous empirical antibiotics
A 12-year-old girl presents with a 3-day history of progressive dysarthria,
dysphagia, and weakness. The patient was well until 3 days prior to
admission to the hospital; at that time, she developed the onset and
subsequent gradual worsening of dysarthria. She attributed the dysarthria
to a sore throat that she had had about 2 weeks earlier. 3 days prior to
admission, she also had the onset of mild dysphagia; it mostly occurred
with liquids. 24 hours prior to admission, she developed weakness in both
upper extremities, which increased and began to involve the lower
extremities. This limb weakness was neither worsened by activity nor
improved by rest. A nerve conduction study reveals a moderate degree of
, mostly motor demyelinating peripheral neuropathy, highly suggestive of
Guillain- Barre. What statement best describes the patient's prognosis? -
ANSWER Her rapidly evolving clinical course indicates a poor prognosis
A 45-year-old African American man with no significant past medical history
presents with a 1-hour history of left retroorbital headache. It is described
as excruciating, stabbing, sharp, and lancinating; it is rated as severe in
intensity. He denies any preceding infections, nausea, vomiting,
photophobia, or osmophobia; he also denies fever, chills, stiff neck, focal
weakness, numbness, tingling, vision, hearing, gait, or speech changes. He
recalls a similar episode several months ago; it lasted about a week, and it
dissipated without complications. His physical exam is remarkable for
painful distress, lacrimation with conjunctival injection, nasal congestion,
rhinorrhea, left ocular miosis, and left forehead diaphoretic flushing. What
pharmacologic agent is the most beneficial for this patient at this time? -
ANSWER Sumatriptan
A 48-year-old woman presents after a seizure. Prior to the seizure, she
experienced confusion and disorientation preceded by nausea, vomiting,
and blurred vision. Symptoms appeared after working for several hours in
the garden under the sun. Her medical history is significant for the
presence of schizophrenia, for which she takes chlorpromazine at bedtime.
Her temperature is 41 C; BUN and creatinine are elevated; and there is
neutrophilia, hemoconcentration, and lactic acidosis. You think that the
event is possibly drug related. What is the most likely diagnosis? -
ANSWER Heat stroke
A 17-year-old adolescent male presents with unexplained neurological
symptoms. His liver is enlarged on palpation, and he has other symptoms
of hepatitis. Blood work reveals depressed ceruloplasmin levels. An
ophthalmological examination reveals Kayser-Fleischer rings. What is the
most likely diagnosis? - ANSWER Wilson's Disease
A 62-year-old woman presents with excruciating pain, burning, and swelling
in her left forearm and wrist. She reports that symptoms initially began with
a fracture 4 months ago. The fracture was casted, and the patient was told
it had healed well with cast removal at 8 weeks. She is frustrated because
her symptoms have persisted and worsened, rather than improving, as she
was told they would.
