APEA PRE-PREDICTOR
APEA PRE-PREDICTOR EXAM STUDY GUIDE
QUESTIONS AND ANSWERS 2025
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? - Correct Ans-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.
- Correct Ans-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? - Correct Ans-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? - Correct Ans-
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? - Correct Ans-Infection
1|Page
,APEA PRE-PREDICTOR
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? - Correct Ans-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? - Correct Ans-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. - Correct Ans-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? - Correct Ans-Bell's Palsy
2|Page
,APEA PRE-PREDICTOR
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? - Correct Ans-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? - Correct Ans-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? - Correct Ans-
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
3|Page
, APEA PRE-PREDICTOR
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? -
Correct Ans-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? - Correct Ans-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? - Correct Ans-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? - Correct Ans-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
4|Page
APEA PRE-PREDICTOR EXAM STUDY GUIDE
QUESTIONS AND ANSWERS 2025
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? - Correct Ans-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.
- Correct Ans-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? - Correct Ans-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? - Correct Ans-
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? - Correct Ans-Infection
1|Page
,APEA PRE-PREDICTOR
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? - Correct Ans-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? - Correct Ans-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. - Correct Ans-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? - Correct Ans-Bell's Palsy
2|Page
,APEA PRE-PREDICTOR
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? - Correct Ans-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? - Correct Ans-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? - Correct Ans-
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
3|Page
, APEA PRE-PREDICTOR
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? -
Correct Ans-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? - Correct Ans-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? - Correct Ans-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? - Correct Ans-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
4|Page
