2025//2026 APEA PRE-PREDICTOR A
COMPREHENSSIVE SET OF QUESTIONS AND
EXPLANED ANSWERS 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? - ANSWERS: 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. -
ANSWERS: 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? - ANSWERS: 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? - ANSWERS: 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? - ANSWERS: 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
Page | 1
,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? - ANSWERS: 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? - ANSWERS: 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. -
ANSWERS: 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? - ANSWERS: 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? - ANSWERS: 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
Page | 2
, 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? - ANSWERS: 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? - ANSWERS: 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? - ANSWERS: 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? - ANSWERS:
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
Page | 3
COMPREHENSSIVE SET OF QUESTIONS AND
EXPLANED ANSWERS 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? - ANSWERS: 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. -
ANSWERS: 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? - ANSWERS: 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? - ANSWERS: 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? - ANSWERS: 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
Page | 1
,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? - ANSWERS: 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? - ANSWERS: 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. -
ANSWERS: 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? - ANSWERS: 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? - ANSWERS: 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
Page | 2
, 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? - ANSWERS: 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? - ANSWERS: 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? - ANSWERS: 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? - ANSWERS:
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
Page | 3
