APEA PRE-PREDICTOR
EXAMINATION COMPLETE QUESTIONS AND DETAILED
SOLUTIONS
LATEST UPDATE THIS YEAR JUST RELEASED
Question 1: Apea Pre-Predictor Actual Exam A 75-year-old
African-American man has a past medical history that is significant
for severe and uncontrolled hypertension; he is brought into the
emergency room by his family due to a 30-minute history of change
of mental status. The patient had just climbed stairs when he first
developed a headache that has become progressive; it is
associated with nausea, non-bilious vomiting, and unilateral upper
and lower extremity numbness. His physical exam reveals an alert
and oriented times zero patient. He is afebrile, with a blood
pressure of 185/108 mm Hg, and there is nuchal rigidity. His
neurological exam notes contralateral sensory loss, contralateral
hemiparesis, gaze paresis, homonymous hemianopia, and miosis.
A CT scan without contrast was performed, and it is shown in the
image. What medication would be most appropriate in this patient?
Answer:
Nicardipine
Question 2: You have completed comprehensive testing on an
80-year-old woman, and the diagnosis is dementia of the
Alzheimer's type. You believe she is in the very early stages of the
disease and want to try a medication to possibly slow disease
progression. What drug may be an effective treatment?
Answer:
Donepezil (Aricept)
,Question 3: A 12-month-old girl presents with her parents after a
3-day history of intermittent episodes of strange behavior. A
neurologist is consulted because the parents are concerned she is
having some form of seizure activity. Her health history includes 2
episodes of otitis media, but she is otherwise healthy. Her initial
vital signs and physical exam by the emergency room staff are all
normal. What description of the infant's strange behavior would
lead the neurologist to suspect a diagnosis of simple partial
seizures?
Answer:
Eye deviation with facial twitching that lasts 1-2 minutes
Question 4: A 24-year-old man presents with head trauma received
in a motor vehicle accident (MVA) 30 minutes ago. Paramedics
relate loss of consciousness for 1 minute, with a complete
recovery. At the initial evaluation, the physical exam reveals a
patient with a Glasgow Coma Scale (GCS) of 12, right hemiparesis,
and a left fixed dilated pupil. What is the most probable finding in
the brain CT scan?
Answer:
Lt epidural hematoma
Question 5: A 40-year-old man presents to the emergency
department with severe pain in his left eye, decreased vision,
nausea, and abdominal pain. On examination, the patient's left
pupil is moderately dilated and nonreactive. The cornea is
"steamy" in appearance and generally the eye is red. What do you
suspect is the cause?
Answer:
acute angle closure glaucoma
,Question 6: A 48-year-old HIV positive man starts to develop
headaches. At first, he attributes the headaches to stress. However,
they persist and become worse over the next few weeks. He
develops nausea and vomiting, and he thinks he has a fever. He
starts to become confused, so he seeks medical attention. On
physical examination, his temperature is 100°F. He has signs of
meningeal irritation. A lumbar puncture is performed, and there is
an elevation of his CSF pressure. Cerebrospinal fluid is sent to the
lab. The CSF is centrifuged. A drop of India ink is placed on the
slide along with a drop of the spun CSF. The India ink test is
positive. What diagnostic sign may be found in this patient?
Answer:
Kernig's sign
Question 7: A 25-year-old woman is seeking medical attention
because she is concerned about a genetic disease that is running
in her family. Both her father and her paternal grandfather are
affected. Her 50-year-old father has suffered for several years with
coordination difficulties, chorea, decline in cognitive ability, and
aggressive outbursts. His symptoms are getting progressively
worse. This patient has a 50% chance of developing what disorder?
Answer:
Huntington Disease
Question 8: A 35-year-old man presents with paralysis and
confusion. His wife states her husband had been working in the
yard about 3 days prior to presentation and suddenly began to not
feel well. She states that it has progressed to the point where he
appears quite confused, is extremely agitated, and does not seem
to be able to close his right eye completely or smile on the right
, side of his face. The patient has a rash on the right arm that does
not seem to be pruritic. Physical examination of the patient reveals
findings of altered mental status, a cranial nerve palsy of the facial
nerve (cranial nerve VII), exaggerated deep tendon reflexes, and the
presence of a maculopapular rash on the right forearm. What is the
most likely source of this patient's condition?
Answer:
west nile virus
Question 9: A 66-year-old woman is brought to the emergency
room by her daughter; the patient is becoming incoherent and
confused. She was in good health until early that morning when
she reported having a headache. She is not a known hypertensive
or diabetic, and she is not on any medications. On examination,
she is well-nourished, has a fever, and is disorientated to time,
space, and person. Brudzinski's sign is positive. What would you
expect to find on examination of her cerebrospinal fluid (CSF)?
Answer:
CSF pressure 250 mm H2O, cells 2000/uL with predominant neutrophils
Question 10: A 72-year-old man presents with the inability to
comprehend spoken language. His speech is fluent and has a
normal cadence and rhythm; however, when he talks, it is
gibberish. He frequently substitutes one word for another. What is
this phenomenon called?
Answer:
paraphasia
EXAMINATION COMPLETE QUESTIONS AND DETAILED
SOLUTIONS
LATEST UPDATE THIS YEAR JUST RELEASED
Question 1: Apea Pre-Predictor Actual Exam A 75-year-old
African-American man has a past medical history that is significant
for severe and uncontrolled hypertension; he is brought into the
emergency room by his family due to a 30-minute history of change
of mental status. The patient had just climbed stairs when he first
developed a headache that has become progressive; it is
associated with nausea, non-bilious vomiting, and unilateral upper
and lower extremity numbness. His physical exam reveals an alert
and oriented times zero patient. He is afebrile, with a blood
pressure of 185/108 mm Hg, and there is nuchal rigidity. His
neurological exam notes contralateral sensory loss, contralateral
hemiparesis, gaze paresis, homonymous hemianopia, and miosis.
A CT scan without contrast was performed, and it is shown in the
image. What medication would be most appropriate in this patient?
Answer:
Nicardipine
Question 2: You have completed comprehensive testing on an
80-year-old woman, and the diagnosis is dementia of the
Alzheimer's type. You believe she is in the very early stages of the
disease and want to try a medication to possibly slow disease
progression. What drug may be an effective treatment?
Answer:
Donepezil (Aricept)
,Question 3: A 12-month-old girl presents with her parents after a
3-day history of intermittent episodes of strange behavior. A
neurologist is consulted because the parents are concerned she is
having some form of seizure activity. Her health history includes 2
episodes of otitis media, but she is otherwise healthy. Her initial
vital signs and physical exam by the emergency room staff are all
normal. What description of the infant's strange behavior would
lead the neurologist to suspect a diagnosis of simple partial
seizures?
Answer:
Eye deviation with facial twitching that lasts 1-2 minutes
Question 4: A 24-year-old man presents with head trauma received
in a motor vehicle accident (MVA) 30 minutes ago. Paramedics
relate loss of consciousness for 1 minute, with a complete
recovery. At the initial evaluation, the physical exam reveals a
patient with a Glasgow Coma Scale (GCS) of 12, right hemiparesis,
and a left fixed dilated pupil. What is the most probable finding in
the brain CT scan?
Answer:
Lt epidural hematoma
Question 5: A 40-year-old man presents to the emergency
department with severe pain in his left eye, decreased vision,
nausea, and abdominal pain. On examination, the patient's left
pupil is moderately dilated and nonreactive. The cornea is
"steamy" in appearance and generally the eye is red. What do you
suspect is the cause?
Answer:
acute angle closure glaucoma
,Question 6: A 48-year-old HIV positive man starts to develop
headaches. At first, he attributes the headaches to stress. However,
they persist and become worse over the next few weeks. He
develops nausea and vomiting, and he thinks he has a fever. He
starts to become confused, so he seeks medical attention. On
physical examination, his temperature is 100°F. He has signs of
meningeal irritation. A lumbar puncture is performed, and there is
an elevation of his CSF pressure. Cerebrospinal fluid is sent to the
lab. The CSF is centrifuged. A drop of India ink is placed on the
slide along with a drop of the spun CSF. The India ink test is
positive. What diagnostic sign may be found in this patient?
Answer:
Kernig's sign
Question 7: A 25-year-old woman is seeking medical attention
because she is concerned about a genetic disease that is running
in her family. Both her father and her paternal grandfather are
affected. Her 50-year-old father has suffered for several years with
coordination difficulties, chorea, decline in cognitive ability, and
aggressive outbursts. His symptoms are getting progressively
worse. This patient has a 50% chance of developing what disorder?
Answer:
Huntington Disease
Question 8: A 35-year-old man presents with paralysis and
confusion. His wife states her husband had been working in the
yard about 3 days prior to presentation and suddenly began to not
feel well. She states that it has progressed to the point where he
appears quite confused, is extremely agitated, and does not seem
to be able to close his right eye completely or smile on the right
, side of his face. The patient has a rash on the right arm that does
not seem to be pruritic. Physical examination of the patient reveals
findings of altered mental status, a cranial nerve palsy of the facial
nerve (cranial nerve VII), exaggerated deep tendon reflexes, and the
presence of a maculopapular rash on the right forearm. What is the
most likely source of this patient's condition?
Answer:
west nile virus
Question 9: A 66-year-old woman is brought to the emergency
room by her daughter; the patient is becoming incoherent and
confused. She was in good health until early that morning when
she reported having a headache. She is not a known hypertensive
or diabetic, and she is not on any medications. On examination,
she is well-nourished, has a fever, and is disorientated to time,
space, and person. Brudzinski's sign is positive. What would you
expect to find on examination of her cerebrospinal fluid (CSF)?
Answer:
CSF pressure 250 mm H2O, cells 2000/uL with predominant neutrophils
Question 10: A 72-year-old man presents with the inability to
comprehend spoken language. His speech is fluent and has a
normal cadence and rhythm; however, when he talks, it is
gibberish. He frequently substitutes one word for another. What is
this phenomenon called?
Answer:
paraphasia
