Page 1 of 36
“ APEA PRE-PREDICTOR “ LATEST 2025 EXAM
UPDATED 2025 – 2026 SOLVED QUESTIONS &
ANSWERS VERIFIED 100% GRADED A+ (LATEST
VERSION)
APEA PRE-PREDICTOR
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?
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.
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?
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?
Epidural hematoma
, Page 2 of 36
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?
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?
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?
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.
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?
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
, Page 3 of 36
reflexes. A lumbar puncture is performed to confirm the diagnosis. What
cerebrospinal fluid (CSF) finding is most likely?
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?
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?
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?
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
, Page 4 of 36
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?
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?
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?
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.
What medication would be most appropriate for this patient's likely diagnosis?
Gabapentin
A 46-year-old man recently recovered from a bout of influenza, and he now
presents due to an 8-hour history of right-sided facial paralysis. He is having
trouble closing his right eye, cannot raise his right eyebrow, and cannot smile
with the right side of his mouth. What medication(s) should this patient be
started on?
Prednisone 60 mg PO daily plus acyclovir 400mg PO 5 times daily
A 4-month-old febrile infant presents with loss of appetite, irritability, seizures,
focal sensory and motor deficits, and an acute petechial rash. On physical
examination, a bulging fontanelle is noted; rectal temperature is 102.8°F. What
study would be most important in this child's evaluation?
CSF analysis
A 46-year-old man presents with severe insomnia and anxiety. While
hospitalized, an overnight polysomnogram was performed over 2 consecutive
nights. Sleep latency was 60 minutes; REM latency was 45 minutes. He reports
feeling paresthesias deep within his legs while lying in bed, especially while
falling asleep. He denies recent illness or illicit drug use. His physical exam
“ APEA PRE-PREDICTOR “ LATEST 2025 EXAM
UPDATED 2025 – 2026 SOLVED QUESTIONS &
ANSWERS VERIFIED 100% GRADED A+ (LATEST
VERSION)
APEA PRE-PREDICTOR
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?
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.
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?
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?
Epidural hematoma
, Page 2 of 36
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?
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?
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?
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.
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?
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
, Page 3 of 36
reflexes. A lumbar puncture is performed to confirm the diagnosis. What
cerebrospinal fluid (CSF) finding is most likely?
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?
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?
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?
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
, Page 4 of 36
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?
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?
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?
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.
What medication would be most appropriate for this patient's likely diagnosis?
Gabapentin
A 46-year-old man recently recovered from a bout of influenza, and he now
presents due to an 8-hour history of right-sided facial paralysis. He is having
trouble closing his right eye, cannot raise his right eyebrow, and cannot smile
with the right side of his mouth. What medication(s) should this patient be
started on?
Prednisone 60 mg PO daily plus acyclovir 400mg PO 5 times daily
A 4-month-old febrile infant presents with loss of appetite, irritability, seizures,
focal sensory and motor deficits, and an acute petechial rash. On physical
examination, a bulging fontanelle is noted; rectal temperature is 102.8°F. What
study would be most important in this child's evaluation?
CSF analysis
A 46-year-old man presents with severe insomnia and anxiety. While
hospitalized, an overnight polysomnogram was performed over 2 consecutive
nights. Sleep latency was 60 minutes; REM latency was 45 minutes. He reports
feeling paresthesias deep within his legs while lying in bed, especially while
falling asleep. He denies recent illness or illicit drug use. His physical exam
