"APEA Pre-Predictor CHEAT SHEET | Must-
Know Labs, Meds, Diagnoses & Management |
NP Exam Ready"
A 19-year-old man presents with a sudden onset of vomiting, headache, vision changes,
numbness and tingling of extremities, difficulty speaking, difficulty writing, loss of coordination,
and loss of balance. His past medical history is significant for sickle cell anemia. Physical exam
findings are consistent with acute cerebrovascular insufficiency. Early detection and prevention
of stroke in sickle cell anemia is now possible by using screening tests. What imaging modality is
recommended as a screening test for cerebrovascular disease/stroke in sickle cell disease (SCD)
patients? ✔✔answer✔✔Transcranial Doppler ultrasonography (TCD)
A 70-year-old woman presents with a 1-year history of short-term memory loss. She did not
seek medical attention earlier because she believed the memory loss to be age-related. Her
husband has also noticed that she is unable to perform her regular daily activities and is often
misplacing things. Recently, she was unable to get back home after her evening walk, and
neighbors brought her home. The husband also feels she has been acting strange lately, and she
is suspicious of her own son. Her past medical history is significant for hypertension and she has
been on medication for the past 3 years. On clinical examination, she appears conscious and
alert. Her vitals are PR- 70/min, BP120/74 mmHg. She is afebrile. What is your provisional
diagnosis? ✔✔answer✔✔AD
A 10-year-old boy is referred to you for being fidgety at school, though he makes good grades.
Prior history is unremarkable, and there has been no recent illness. The father had a similar
history as a child. While speaking with the patient, you notice that he clears his throat several
times per minute. Examination is otherwise normal, except for rapid, nonrhythmic jerking
movements of the face, neck, and shoulders while at rest. What is true of this patient's case?
✔✔answer✔✔Has a condition that clusters in families
,A 3-year-old girl presents with terrible head pain, increasing fever, and irritability. On
examination, you find the child febrile, 103o F, and she cries when you lift her head from the
examining table. The neck appears to be quite stiff when manipulated. You perform a lumbar
puncture. What findings would you expect if this child had bacterial meningitis?
✔✔answer✔✔Elevated protein
The mechanism of sumatriptan in migraine involves what neurotransmitter?
✔✔answer✔✔Serotonin (5HT1)
A 32-year-old woman presents several hours after a grand mal seizure. Her husband states that
a few days before the seizure she experiences headache, nausea, vomiting, fever, and "was not
herself". She is on glucocorticoid therapy due to a kidney transplant 1 year ago. On examination,
you find a lethargic, febrile (39 C), dysphasic patient; there is right-sided hemiparesis, and
meningeal signs are present, but detailed examination cannot be performed because of lack of
cooperation. Cerebrospinal analysis (CSF) shows normal opening pressure, xanthochromia,
mononuclear pleocytosis (100 white blood cells), elevated protein (100 mg/d), and a normal
serum to glucose ratio; EEG shows focal abnormalities over temporal lobes, and her CT is
normal. While waiting for the results of polymerase chain reaction, you start supportive care,
anticonvulsants, diuretics, and acyclovir. What factor guides you to the choice of acyclovir?
✔✔answer✔✔(EEG)
A 45-year-old man goes to a party and enjoys several glasses of an alcoholic cocktail. His past
medical history is significant for headaches. The drinks trigger a unilateral right-sided headache.
The headache is behind his right eye and spreads to his forehead. He also notices that his right
nostril has a watery discharge and his right eye is tearing. He describes the pain as if he were
"being stabbed in my eye". What kind of headache does he have? ✔✔answer✔✔Cluster HA
A patient presents with bilateral spastic paresis of his legs. His gait is noticeably stiff and his legs
are advanced slowly. He uses short steps and crosses his legs in front of the other as he
advances. What type of gait does he have? ✔✔answer✔✔Scissor gait
What condition is characterized by fine movements that are absent at rest, occur with activity,
and worsen as the target is neared? ✔✔answer✔✔Intention tremor
,A 23-year-old man presents after being thrown from a motorcycle onto a cement median. He is
awake and appears alert on exam. He believes that his helmet was knocked off at point of
impact, but he cannot recall the specifics of his crash. A head CT scan is consistent with a
cerebral contusion. What findings on a CT scan would you see with this diagnosis?
✔✔answer✔✔No cortical disruption, but tissue necrosis, edema, and punctate hemorrhages
What is the therapeutic window for using recombinant tissue plasminogen activator in acute
ischemic stroke? ✔✔answer✔✔3 hours
A 43-year-old woman presents for the evaluation of possible seizures. The patient was well until
the day of admission to the hospital. She works as a secretary at a law firm. She was having a
heated argument about work assignments with her supervisor when she slumped back in her
chair, became pale, and then had a 5-10 second spell of generalized tonic-clonic jerking. She
was placed on the floor, and she began to rouse after 15-30 seconds. What profile is best
correlated with the likelihood of pseudoseizures (psychogenic non-epileptic seizures) in patients
where pseudoseizures are a consideration? ✔✔answer✔✔Young (20 - 30 years old) women
with history of sexual abuse
A 42-year-old woman presents with a tremor that has become more bothersome lately. She
thinks it originally began as a mild tremor twelve years ago. It affects her hands more than her
head. It usually occurs when she moves her extremities. She drinks 1 or 2 alcoholic beverages
every day because alcohol seems to lessen the tremor. Her mother suffered from a similar
disorder. Her neurological exam is essentially normal other than a tremor of the hands and
head. What movement disorder does this patient have? ✔✔answer✔✔Essential tremor
A 42-year-old man presents following an episode of loss of consciousness. The patient was in
excellent health until the evening of admission; his wife found him unconscious on the concrete
deck surrounding their swimming pool. His swim trunks were fully wet and there was vomitus
on the deck near him. He regained consciousness in the ambulance, at which time he was
confused, and complained of severe generalized headache. Past medical history is positive for
well-treated hypertension, 2 packs per day smoking history of 24 years duration, occasional
social drinking, and a 2-month history of intermittent right ocular pain. The patient is identified
, as having an aneurysmal subarachnoid hemorrhage (SAH). What statement about this condition
is most valid? ✔✔answer✔✔The risk of rebleeding is highest in the first 6 to 24 hours after the
initial bleed
An unidentified motorcyclist is transported to the emergency department via helicopter from
the scene of a highway accident. According to eyewitnesses, he appears to have been trying to
avoid a piece of debris in the road; however, in doing so, he lost control of his bike and hit the
highway median. On arrival, the emergency medical team conducts a rapid assessment, and he
is assigned a Glascow Coma Score of 12. In addition to motor and verbal responsiveness, what
needs to be assessed in order to determine the patient's Glascow Coma Score?
✔✔answer✔✔Eye response
A 4-month-old infant presents for a well child check up. She was a spontaneous vaginal delivery
at 39.5 weeks without complications. The mother notes the baby has been more irritable and
has not been eating well. No cough or fever is described. There are no smokers at their home.
On exam, you note impaired extraocular movements, especially in the upward gaze, and a
bulging anterior fontanel. There is increased tone of the legs. Skin exam is normal. Similar to her
last visit, the length and weight are at the 50th percentile. The head circumference was formerly
at the 75th percentile and is now at the +99th percentile. What clinical diagnosis do you make
for this child? ✔✔answer✔✔Hydrocephalus
A 34-year-old man presents with a right-sided periorbital headache of 20 minutes duration. The
pain is described as excruciating and bore-like, and it is associated with tearing and redness of
the right eye, right eyelid swelling, and nasal congestion. The headaches have been occurring at
multiple times nearly daily over the past 2 weeks, and each episode lasts approximately 30 to
60 minutes. The pain is not relieved with acetaminophen or ibuprofen. There is no nausea,
vomiting, or photophobia. There is no history of amaurosis, visual scintillations, diplopia, focal
weakness, numbness, neck stiffness, or other common neurologic complaints. The patient has
had similar bouts of headaches over the past 5 years; the bouts typically last 3 to 4 weeks. What
is the most effective abortive therapy for this patient's headache? ✔✔answer✔✔Nasal O2
A 56-year-old man presents with weakness of his grip. On exam, the problem is bilateral. During
the next few office visits, you note the development of hyperactivity of his deep tendon reflexes
Know Labs, Meds, Diagnoses & Management |
NP Exam Ready"
A 19-year-old man presents with a sudden onset of vomiting, headache, vision changes,
numbness and tingling of extremities, difficulty speaking, difficulty writing, loss of coordination,
and loss of balance. His past medical history is significant for sickle cell anemia. Physical exam
findings are consistent with acute cerebrovascular insufficiency. Early detection and prevention
of stroke in sickle cell anemia is now possible by using screening tests. What imaging modality is
recommended as a screening test for cerebrovascular disease/stroke in sickle cell disease (SCD)
patients? ✔✔answer✔✔Transcranial Doppler ultrasonography (TCD)
A 70-year-old woman presents with a 1-year history of short-term memory loss. She did not
seek medical attention earlier because she believed the memory loss to be age-related. Her
husband has also noticed that she is unable to perform her regular daily activities and is often
misplacing things. Recently, she was unable to get back home after her evening walk, and
neighbors brought her home. The husband also feels she has been acting strange lately, and she
is suspicious of her own son. Her past medical history is significant for hypertension and she has
been on medication for the past 3 years. On clinical examination, she appears conscious and
alert. Her vitals are PR- 70/min, BP120/74 mmHg. She is afebrile. What is your provisional
diagnosis? ✔✔answer✔✔AD
A 10-year-old boy is referred to you for being fidgety at school, though he makes good grades.
Prior history is unremarkable, and there has been no recent illness. The father had a similar
history as a child. While speaking with the patient, you notice that he clears his throat several
times per minute. Examination is otherwise normal, except for rapid, nonrhythmic jerking
movements of the face, neck, and shoulders while at rest. What is true of this patient's case?
✔✔answer✔✔Has a condition that clusters in families
,A 3-year-old girl presents with terrible head pain, increasing fever, and irritability. On
examination, you find the child febrile, 103o F, and she cries when you lift her head from the
examining table. The neck appears to be quite stiff when manipulated. You perform a lumbar
puncture. What findings would you expect if this child had bacterial meningitis?
✔✔answer✔✔Elevated protein
The mechanism of sumatriptan in migraine involves what neurotransmitter?
✔✔answer✔✔Serotonin (5HT1)
A 32-year-old woman presents several hours after a grand mal seizure. Her husband states that
a few days before the seizure she experiences headache, nausea, vomiting, fever, and "was not
herself". She is on glucocorticoid therapy due to a kidney transplant 1 year ago. On examination,
you find a lethargic, febrile (39 C), dysphasic patient; there is right-sided hemiparesis, and
meningeal signs are present, but detailed examination cannot be performed because of lack of
cooperation. Cerebrospinal analysis (CSF) shows normal opening pressure, xanthochromia,
mononuclear pleocytosis (100 white blood cells), elevated protein (100 mg/d), and a normal
serum to glucose ratio; EEG shows focal abnormalities over temporal lobes, and her CT is
normal. While waiting for the results of polymerase chain reaction, you start supportive care,
anticonvulsants, diuretics, and acyclovir. What factor guides you to the choice of acyclovir?
✔✔answer✔✔(EEG)
A 45-year-old man goes to a party and enjoys several glasses of an alcoholic cocktail. His past
medical history is significant for headaches. The drinks trigger a unilateral right-sided headache.
The headache is behind his right eye and spreads to his forehead. He also notices that his right
nostril has a watery discharge and his right eye is tearing. He describes the pain as if he were
"being stabbed in my eye". What kind of headache does he have? ✔✔answer✔✔Cluster HA
A patient presents with bilateral spastic paresis of his legs. His gait is noticeably stiff and his legs
are advanced slowly. He uses short steps and crosses his legs in front of the other as he
advances. What type of gait does he have? ✔✔answer✔✔Scissor gait
What condition is characterized by fine movements that are absent at rest, occur with activity,
and worsen as the target is neared? ✔✔answer✔✔Intention tremor
,A 23-year-old man presents after being thrown from a motorcycle onto a cement median. He is
awake and appears alert on exam. He believes that his helmet was knocked off at point of
impact, but he cannot recall the specifics of his crash. A head CT scan is consistent with a
cerebral contusion. What findings on a CT scan would you see with this diagnosis?
✔✔answer✔✔No cortical disruption, but tissue necrosis, edema, and punctate hemorrhages
What is the therapeutic window for using recombinant tissue plasminogen activator in acute
ischemic stroke? ✔✔answer✔✔3 hours
A 43-year-old woman presents for the evaluation of possible seizures. The patient was well until
the day of admission to the hospital. She works as a secretary at a law firm. She was having a
heated argument about work assignments with her supervisor when she slumped back in her
chair, became pale, and then had a 5-10 second spell of generalized tonic-clonic jerking. She
was placed on the floor, and she began to rouse after 15-30 seconds. What profile is best
correlated with the likelihood of pseudoseizures (psychogenic non-epileptic seizures) in patients
where pseudoseizures are a consideration? ✔✔answer✔✔Young (20 - 30 years old) women
with history of sexual abuse
A 42-year-old woman presents with a tremor that has become more bothersome lately. She
thinks it originally began as a mild tremor twelve years ago. It affects her hands more than her
head. It usually occurs when she moves her extremities. She drinks 1 or 2 alcoholic beverages
every day because alcohol seems to lessen the tremor. Her mother suffered from a similar
disorder. Her neurological exam is essentially normal other than a tremor of the hands and
head. What movement disorder does this patient have? ✔✔answer✔✔Essential tremor
A 42-year-old man presents following an episode of loss of consciousness. The patient was in
excellent health until the evening of admission; his wife found him unconscious on the concrete
deck surrounding their swimming pool. His swim trunks were fully wet and there was vomitus
on the deck near him. He regained consciousness in the ambulance, at which time he was
confused, and complained of severe generalized headache. Past medical history is positive for
well-treated hypertension, 2 packs per day smoking history of 24 years duration, occasional
social drinking, and a 2-month history of intermittent right ocular pain. The patient is identified
, as having an aneurysmal subarachnoid hemorrhage (SAH). What statement about this condition
is most valid? ✔✔answer✔✔The risk of rebleeding is highest in the first 6 to 24 hours after the
initial bleed
An unidentified motorcyclist is transported to the emergency department via helicopter from
the scene of a highway accident. According to eyewitnesses, he appears to have been trying to
avoid a piece of debris in the road; however, in doing so, he lost control of his bike and hit the
highway median. On arrival, the emergency medical team conducts a rapid assessment, and he
is assigned a Glascow Coma Score of 12. In addition to motor and verbal responsiveness, what
needs to be assessed in order to determine the patient's Glascow Coma Score?
✔✔answer✔✔Eye response
A 4-month-old infant presents for a well child check up. She was a spontaneous vaginal delivery
at 39.5 weeks without complications. The mother notes the baby has been more irritable and
has not been eating well. No cough or fever is described. There are no smokers at their home.
On exam, you note impaired extraocular movements, especially in the upward gaze, and a
bulging anterior fontanel. There is increased tone of the legs. Skin exam is normal. Similar to her
last visit, the length and weight are at the 50th percentile. The head circumference was formerly
at the 75th percentile and is now at the +99th percentile. What clinical diagnosis do you make
for this child? ✔✔answer✔✔Hydrocephalus
A 34-year-old man presents with a right-sided periorbital headache of 20 minutes duration. The
pain is described as excruciating and bore-like, and it is associated with tearing and redness of
the right eye, right eyelid swelling, and nasal congestion. The headaches have been occurring at
multiple times nearly daily over the past 2 weeks, and each episode lasts approximately 30 to
60 minutes. The pain is not relieved with acetaminophen or ibuprofen. There is no nausea,
vomiting, or photophobia. There is no history of amaurosis, visual scintillations, diplopia, focal
weakness, numbness, neck stiffness, or other common neurologic complaints. The patient has
had similar bouts of headaches over the past 5 years; the bouts typically last 3 to 4 weeks. What
is the most effective abortive therapy for this patient's headache? ✔✔answer✔✔Nasal O2
A 56-year-old man presents with weakness of his grip. On exam, the problem is bilateral. During
the next few office visits, you note the development of hyperactivity of his deep tendon reflexes
