APEA PREDICTOR TEST 1
EXAMINATION COMPLETE QUESTIONS AND DETAILED
SOLUTIONS
LATEST UPDATE THIS YEAR JUST RELEASED
Question 1: A colleague asks you to provide a neurosurgical
consultation on a 75-year-old man. The consultation request form
informs you that, "This man is having difficulty tolerating his
medications as well as difficulty with his day-to-day activities".
Your colleague wants to know if neurosurgery could help the
patient's neurologic disorder. As a prudent provider, you plan to
visit this man prior to recommending or denying definitive surgery.
For what disorder may neurosurgery become a reasonable
therapeutic option?
Answer:
Parkinson's
Question 2: A 5-year-old girl was hit by a slow moving car when
she ran into the street while playing tag. She hit her head and had a
brief period of loss of consciousness along with a few superficial
scrapes and bruises. She was placed in cervical spine precautions
and brought to the ED where cervical spine radiographs were read
as negative. What transient symptoms immediately after injury
suggest the presence of spinal cord injury without radiographic
abnormality?
Answer:
Lightning sensation down the spine with neck movement
,Question 3: A 22-year-old woman presents with an 8-hour history of
headache and vomiting. She resides in a college dormitory; she
has no remarkable travel history, and reports eating food from a
street vendor 24 hours before becoming ill. The patient is lethargic
and disoriented. On examination, she is found to have a
temperature of 38.5° C and a petechial rash on her legs. Gram stain
of exudate from a skin lesion shows Gram-negative diplococci. A
lumbar puncture is performed; the cerebral spinal fluid (CSF)
reveals a leukocyte count of 5/µL consisting of primarily
neutrophils. A Gram stain of CSF is negative for bacteria. What is
the most likely diagnosis?
Answer:
Meningococcemia
Question 4: A 45-year-old woman presents with a 1-month history
of double vision, tripping, urinary incontinence, and restless legs;
the symptoms are accompagnied by weakness, numbness, and
tingling sensations. She denies any headaches, difficulty with
speech, or memory impairment. Her physical examination does not
demonstrate impairments in mental status, speech, or memory. Her
muscular strength is 2+ bilaterally in the upper and lower
extremities, although it is diminished from a previous exam 1 year
ago. Deep tendon reflexes are also diminished compared to 1 year
ago. What is the most likely diagnosis?
Answer:
MS
Question 5: A 12-year-old girl presents with a 3-day history of
progressive dysarthria, dysphagia, and weakness. The patient was
well until 3 days ago, when she developed the onset and
subsequent gradual worsening of dysarthria. She attributed this to
,a sore throat, which she had about 2 weeks before. Three days
prior to presentation, she had the onset of mild dysphagia, which
occurred primarily with liquids. 24 hours prior to presentation, she
developed weakness in both upper extremities; the weakness
worsened and began to involve the lower extremities. This limb
weakness was not worsened by activity, but it was not improved by
rest. She developed tingling in her toes 24 hours prior to
presentation. When she became unable to walk without assistance
(on the day of presentation), she decided to seek medical care.
Computed tomography of the brain, with and without contrast, is
negative. What is the most likely diagnosis?
Answer:
GBS
Question 6: A 55-year-old man with a history of heavy alcohol use
presents for treatment of an infected gash in his hand. He is not
currently intoxicated. His clothes fit loosely, and he mentions that
he thinks he has lost weight since becoming homeless earlier in
the year. In preparation for giving him antibiotics, he receives an
intravenous infusion of 5% dextrose solution. 2 hours later, he is
confused and ataxic, with bilateral 6th nerve palsies (intranuclear
ophthalmoplegia) and nystagmus. What is the patient most likely
exhibiting?
Answer:
Wernicke encepahlopathy
Question 7: A 34-year-old woman, an immigrant from South
America, presents with an acute onset of chest palpitations and
shortness of breath. The patient also gives a 1-week history of
fever, fatigue, and weakness. Echocardiography reveals that her
heart is dramatically increased in size. Electrocardiogram (EKG)
, shows low voltage QRS with atrioventricular (AV) conduction
abnormality. It is determined that she has Chagas' disease. What is
a complication that occurs during the acute phase of this patient's
condition?
Answer:
meningoencephalitis
Question 8: A 15-month-old toddler presents with sudden onset of
generalized tonic and clonic convulsions for the last 30 minutes.
There is no history of trauma, fever, vomiting, or irritability prior to
the onset of convulsions. This is the first episode of seizure, and
there is no history of convulsions in the family. Birth history,
neonatal period, and developmental milestones are normal.
Question After initial stabilization by securing the airway,
oxygenation, and controlling the acute convulsion, what is the
investigation of choice for the above child?
Answer:
CT scan of head
Question 9: A 40-year-old man presents with a 3-week history of a
daily headache that awakens him from sleep. The headaches occur
around the left eye. He notes that the left eye waters and his left
nostril gets stuffy with each headache. What is the most likely
diagnosis?
Answer:
Cluster HA
Question 10: A 64-year-old woman presents for evaluation of
myxedema. She is experiencing constipation, headaches,
EXAMINATION COMPLETE QUESTIONS AND DETAILED
SOLUTIONS
LATEST UPDATE THIS YEAR JUST RELEASED
Question 1: A colleague asks you to provide a neurosurgical
consultation on a 75-year-old man. The consultation request form
informs you that, "This man is having difficulty tolerating his
medications as well as difficulty with his day-to-day activities".
Your colleague wants to know if neurosurgery could help the
patient's neurologic disorder. As a prudent provider, you plan to
visit this man prior to recommending or denying definitive surgery.
For what disorder may neurosurgery become a reasonable
therapeutic option?
Answer:
Parkinson's
Question 2: A 5-year-old girl was hit by a slow moving car when
she ran into the street while playing tag. She hit her head and had a
brief period of loss of consciousness along with a few superficial
scrapes and bruises. She was placed in cervical spine precautions
and brought to the ED where cervical spine radiographs were read
as negative. What transient symptoms immediately after injury
suggest the presence of spinal cord injury without radiographic
abnormality?
Answer:
Lightning sensation down the spine with neck movement
,Question 3: A 22-year-old woman presents with an 8-hour history of
headache and vomiting. She resides in a college dormitory; she
has no remarkable travel history, and reports eating food from a
street vendor 24 hours before becoming ill. The patient is lethargic
and disoriented. On examination, she is found to have a
temperature of 38.5° C and a petechial rash on her legs. Gram stain
of exudate from a skin lesion shows Gram-negative diplococci. A
lumbar puncture is performed; the cerebral spinal fluid (CSF)
reveals a leukocyte count of 5/µL consisting of primarily
neutrophils. A Gram stain of CSF is negative for bacteria. What is
the most likely diagnosis?
Answer:
Meningococcemia
Question 4: A 45-year-old woman presents with a 1-month history
of double vision, tripping, urinary incontinence, and restless legs;
the symptoms are accompagnied by weakness, numbness, and
tingling sensations. She denies any headaches, difficulty with
speech, or memory impairment. Her physical examination does not
demonstrate impairments in mental status, speech, or memory. Her
muscular strength is 2+ bilaterally in the upper and lower
extremities, although it is diminished from a previous exam 1 year
ago. Deep tendon reflexes are also diminished compared to 1 year
ago. What is the most likely diagnosis?
Answer:
MS
Question 5: A 12-year-old girl presents with a 3-day history of
progressive dysarthria, dysphagia, and weakness. The patient was
well until 3 days ago, when she developed the onset and
subsequent gradual worsening of dysarthria. She attributed this to
,a sore throat, which she had about 2 weeks before. Three days
prior to presentation, she had the onset of mild dysphagia, which
occurred primarily with liquids. 24 hours prior to presentation, she
developed weakness in both upper extremities; the weakness
worsened and began to involve the lower extremities. This limb
weakness was not worsened by activity, but it was not improved by
rest. She developed tingling in her toes 24 hours prior to
presentation. When she became unable to walk without assistance
(on the day of presentation), she decided to seek medical care.
Computed tomography of the brain, with and without contrast, is
negative. What is the most likely diagnosis?
Answer:
GBS
Question 6: A 55-year-old man with a history of heavy alcohol use
presents for treatment of an infected gash in his hand. He is not
currently intoxicated. His clothes fit loosely, and he mentions that
he thinks he has lost weight since becoming homeless earlier in
the year. In preparation for giving him antibiotics, he receives an
intravenous infusion of 5% dextrose solution. 2 hours later, he is
confused and ataxic, with bilateral 6th nerve palsies (intranuclear
ophthalmoplegia) and nystagmus. What is the patient most likely
exhibiting?
Answer:
Wernicke encepahlopathy
Question 7: A 34-year-old woman, an immigrant from South
America, presents with an acute onset of chest palpitations and
shortness of breath. The patient also gives a 1-week history of
fever, fatigue, and weakness. Echocardiography reveals that her
heart is dramatically increased in size. Electrocardiogram (EKG)
, shows low voltage QRS with atrioventricular (AV) conduction
abnormality. It is determined that she has Chagas' disease. What is
a complication that occurs during the acute phase of this patient's
condition?
Answer:
meningoencephalitis
Question 8: A 15-month-old toddler presents with sudden onset of
generalized tonic and clonic convulsions for the last 30 minutes.
There is no history of trauma, fever, vomiting, or irritability prior to
the onset of convulsions. This is the first episode of seizure, and
there is no history of convulsions in the family. Birth history,
neonatal period, and developmental milestones are normal.
Question After initial stabilization by securing the airway,
oxygenation, and controlling the acute convulsion, what is the
investigation of choice for the above child?
Answer:
CT scan of head
Question 9: A 40-year-old man presents with a 3-week history of a
daily headache that awakens him from sleep. The headaches occur
around the left eye. He notes that the left eye waters and his left
nostril gets stuffy with each headache. What is the most likely
diagnosis?
Answer:
Cluster HA
Question 10: A 64-year-old woman presents for evaluation of
myxedema. She is experiencing constipation, headaches,
