Apea Pre-Predictor Actual Exam Newest 2025
APEA PRE-PREDICTOR ACTUAL EXAM NEWEST 2025 ACTUAL
EXAM COMPLETE 150 QUESTIONS AND CORRECT ANSWERS
(VERIFIED ANSWERS) |ALREADY GRADED A+
A 32-year-old man presents with a severe headache; he has had 2 similar headaches within the
past week. He describes a burning, 'hot poker'-type of pain located primarily behind his right
eye. He notes that his eye waters profusely with the headache; in addition, his nose is initially
congested, then it starts running. Only his right side is affected. The headache is so severe that
he cannot work or sleep through it, and he is unable to concentrate on anything else. The
headaches have been unresponsive to over- the-counter pain medications. The episodes seem
to last about 1 hour. He denies any other symptoms. This patient has no chronic medical
conditions, and he takes no regular medications. What is the most likely underlying
pathophysiology of this patient's condition? - ANSWER-Increased trigeminal nerve and
parasympathetic activity, leading to vasodilation
A 73-year-old man presents after a 15-minute episode of right eye vision loss, which he
described as being "like a shade being pulled down". What diagnostic test is most likely to be
abnormal? - ANSWER-Carotid ultrasound
A 42-year-old man presents to the emergency department with a severe headache. He has been
getting several of these headaches recently and has tried all over-the-counter pain relievers and
headache medicines with no relief. His current headache started 15 minutes ago. He describes
the pain as located next to and behind his left eye and "stabbing/excruciating" in nature. He
feels like his left eye tears up profusely with these headaches. He denies recent stressors that
may have caused his headaches. On physical exam, the patient appears slightly agitated and
appears uncomfortable. Which of the following aspects of patient history would be most
consistent with this patient's suspected condition? - ANSWER-Rhinorrhea associated with HA
A 66-year-old English teacher is in the hospital. Her neurologist gives her a magazine to read,
and she is unable to do so. What is this phenomenon called? - ANSWER-Alexia
1|Page
, Apea Pre-Predictor Actual Exam Newest 2025
A 35-year-old man presents with unusual sensations in his legs. He describes the sensation as an
uncomfortable crawly sensation deep within his legs. If he tries to ignore them, the feeling
worsens. He has brief relief with movement, but the feelings return as soon as he is still again.
He was given a trial of a benzodiazepine to take at bedtime, but it did not really help. In
addition, he complains of being sleepy during the day as a result of the medication. He also
tried leg massages and exercise without much relief. The patient denies snoring, vivid dreams,
or cataplexy. He states that he has a depressed mood and reduced energy and concentration,
but he denies suicidal ideation. His physical exam is normal. Complete blood cell count and
chemistry panels are normal. Question What is true regarding the patient's condition? -
ANSWER-An abnormal electrical impulse conduction study is frequently seen
A 70-year-old man presents with memory loss that has been worsening over the past few
months. He also has history of slurred speech and walking difficulty. There is a history of getting
lost in familiar surroundings. His history is also significant for a stroke 2 years ago. On
examination, there are focal neurological signs including plantar response, gait abnormalities,
exaggeration of deep tendon reflexes, and weakness of the right lower limb. Brain imaging
studies show multiple large-vessel infarcts and extensive periventricular white matter lesion.
What is indicated by evidence of relevant cerebrovascular disease? - ANSWER-Vascular
dementia
A 60-year-old man presents for evaluation of loss of recent and remote memory, psychomotor
slowing, and difficulty with complex tasks. On exam, the patient also shows some tremor tics,
dystonia, and impaired coordination. Family history reveals he had 2 brothers who both died of
a strange "movement" disorder. What is the provisional diagnosis? - ANSWER-Huntington's
disease
A 9-year-old boy presents to a neurologist's office accompanied by his mother. She reports that
he has had 3 episodes of what she thinks are seizures. She describes these episodes in detail to
the neurologist. What would lead the neurologist to consider the diagnosis of tonic-clonic
seizures? - ANSWER-Sudden loss of consciousness with convulsions and confusion that lasts
about 15 minutes each time, then resolves spontaneously
A 32-year-old man is admitted to the hospital following loss of consciousness. The patient had
been ill with fever and headache for several days, then developed double vision, confusion, and
2|Page
, Apea Pre-Predictor Actual Exam Newest 2025
loss of consciousness. He has been otherwise healthy with no past medical conditions. Imaging
reveals edema of the frontal lobe. Which virus most commonly causes the patient's infection? -
ANSWER-HSV
A 44-year-old man presents after an episode what is described as "passing out". He has a past
medical history of hypertension, diabetes mellitus type II, and osteoarthritis. Earlier in the day,
the patient visited his primary care physician for routine blood work. During his blood draw, the
patient had an acute onset of syncope. The patient never had such an episode before. Vital
signs upon presentation are as follows: BP 124/82 mmHg, P 88 beats/min, R14/min. EKG is
within normal limits. Cardiovascular examination reveals a normal S1 and S2, with no rubs,
murmurs, or gallops. The patient is being treated with atenolol and hydrochlorothiazide for his
hypertension. His blood sugar is 96 mg/dl. What is the most likely cause of the patient's
syncope? - ANSWER-Vasovagal syncope
The girl's mother states that there are times when the patient does not seem to be paying
attention to what the mother is saying. Shortly after these "episodes", the child engages in
conversation without any problem; therefore, the mother did not think the episodes were an
issue. There is no concern about other abnormal behavior or discipline issues at home or at
school. What is the most likely diagnosis? - ANSWER-Petit mal (absence) seizures
A 45-year-old secretary presents with a 1-month history of paresthesias on the medial aspect of
her right hand. She has no neck pain or shoulder pain, but she has had some difficulty typing
with the right hand. Neurological exam reveals diminished sensation to pain and light touch on
the medial aspect of the palmar and dorsal surfaces of the hand to the wrist, the 5th finger, and
the medial aspect of the ring finger. Mild weakness of the right abductor minimi digiti is
present, but the other intrinsic hand muscles are of normal strength. The remainder of the
neurological exam is normal. - ANSWER-Compressive ulnar neuropathy at the elbow
A 52-year-old woman presents with a 1-year history of bilateral shaking in her hands. The
shaking tends to worsen when she is using her hands, and her symptoms improve when she
drinks a glass of wine on the weekends. Her 82- year-old mother also has a similar shaking in
her hands which developed when she was in her 50s. What is the most likely diagnosis? -
ANSWER-Essential tremor
3|Page
, Apea Pre-Predictor Actual Exam Newest 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? - ANSWER-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. - ANSWER-
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? - ANSWER-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? - ANSWER-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? - ANSWER-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
4|Page
APEA PRE-PREDICTOR ACTUAL EXAM NEWEST 2025 ACTUAL
EXAM COMPLETE 150 QUESTIONS AND CORRECT ANSWERS
(VERIFIED ANSWERS) |ALREADY GRADED A+
A 32-year-old man presents with a severe headache; he has had 2 similar headaches within the
past week. He describes a burning, 'hot poker'-type of pain located primarily behind his right
eye. He notes that his eye waters profusely with the headache; in addition, his nose is initially
congested, then it starts running. Only his right side is affected. The headache is so severe that
he cannot work or sleep through it, and he is unable to concentrate on anything else. The
headaches have been unresponsive to over- the-counter pain medications. The episodes seem
to last about 1 hour. He denies any other symptoms. This patient has no chronic medical
conditions, and he takes no regular medications. What is the most likely underlying
pathophysiology of this patient's condition? - ANSWER-Increased trigeminal nerve and
parasympathetic activity, leading to vasodilation
A 73-year-old man presents after a 15-minute episode of right eye vision loss, which he
described as being "like a shade being pulled down". What diagnostic test is most likely to be
abnormal? - ANSWER-Carotid ultrasound
A 42-year-old man presents to the emergency department with a severe headache. He has been
getting several of these headaches recently and has tried all over-the-counter pain relievers and
headache medicines with no relief. His current headache started 15 minutes ago. He describes
the pain as located next to and behind his left eye and "stabbing/excruciating" in nature. He
feels like his left eye tears up profusely with these headaches. He denies recent stressors that
may have caused his headaches. On physical exam, the patient appears slightly agitated and
appears uncomfortable. Which of the following aspects of patient history would be most
consistent with this patient's suspected condition? - ANSWER-Rhinorrhea associated with HA
A 66-year-old English teacher is in the hospital. Her neurologist gives her a magazine to read,
and she is unable to do so. What is this phenomenon called? - ANSWER-Alexia
1|Page
, Apea Pre-Predictor Actual Exam Newest 2025
A 35-year-old man presents with unusual sensations in his legs. He describes the sensation as an
uncomfortable crawly sensation deep within his legs. If he tries to ignore them, the feeling
worsens. He has brief relief with movement, but the feelings return as soon as he is still again.
He was given a trial of a benzodiazepine to take at bedtime, but it did not really help. In
addition, he complains of being sleepy during the day as a result of the medication. He also
tried leg massages and exercise without much relief. The patient denies snoring, vivid dreams,
or cataplexy. He states that he has a depressed mood and reduced energy and concentration,
but he denies suicidal ideation. His physical exam is normal. Complete blood cell count and
chemistry panels are normal. Question What is true regarding the patient's condition? -
ANSWER-An abnormal electrical impulse conduction study is frequently seen
A 70-year-old man presents with memory loss that has been worsening over the past few
months. He also has history of slurred speech and walking difficulty. There is a history of getting
lost in familiar surroundings. His history is also significant for a stroke 2 years ago. On
examination, there are focal neurological signs including plantar response, gait abnormalities,
exaggeration of deep tendon reflexes, and weakness of the right lower limb. Brain imaging
studies show multiple large-vessel infarcts and extensive periventricular white matter lesion.
What is indicated by evidence of relevant cerebrovascular disease? - ANSWER-Vascular
dementia
A 60-year-old man presents for evaluation of loss of recent and remote memory, psychomotor
slowing, and difficulty with complex tasks. On exam, the patient also shows some tremor tics,
dystonia, and impaired coordination. Family history reveals he had 2 brothers who both died of
a strange "movement" disorder. What is the provisional diagnosis? - ANSWER-Huntington's
disease
A 9-year-old boy presents to a neurologist's office accompanied by his mother. She reports that
he has had 3 episodes of what she thinks are seizures. She describes these episodes in detail to
the neurologist. What would lead the neurologist to consider the diagnosis of tonic-clonic
seizures? - ANSWER-Sudden loss of consciousness with convulsions and confusion that lasts
about 15 minutes each time, then resolves spontaneously
A 32-year-old man is admitted to the hospital following loss of consciousness. The patient had
been ill with fever and headache for several days, then developed double vision, confusion, and
2|Page
, Apea Pre-Predictor Actual Exam Newest 2025
loss of consciousness. He has been otherwise healthy with no past medical conditions. Imaging
reveals edema of the frontal lobe. Which virus most commonly causes the patient's infection? -
ANSWER-HSV
A 44-year-old man presents after an episode what is described as "passing out". He has a past
medical history of hypertension, diabetes mellitus type II, and osteoarthritis. Earlier in the day,
the patient visited his primary care physician for routine blood work. During his blood draw, the
patient had an acute onset of syncope. The patient never had such an episode before. Vital
signs upon presentation are as follows: BP 124/82 mmHg, P 88 beats/min, R14/min. EKG is
within normal limits. Cardiovascular examination reveals a normal S1 and S2, with no rubs,
murmurs, or gallops. The patient is being treated with atenolol and hydrochlorothiazide for his
hypertension. His blood sugar is 96 mg/dl. What is the most likely cause of the patient's
syncope? - ANSWER-Vasovagal syncope
The girl's mother states that there are times when the patient does not seem to be paying
attention to what the mother is saying. Shortly after these "episodes", the child engages in
conversation without any problem; therefore, the mother did not think the episodes were an
issue. There is no concern about other abnormal behavior or discipline issues at home or at
school. What is the most likely diagnosis? - ANSWER-Petit mal (absence) seizures
A 45-year-old secretary presents with a 1-month history of paresthesias on the medial aspect of
her right hand. She has no neck pain or shoulder pain, but she has had some difficulty typing
with the right hand. Neurological exam reveals diminished sensation to pain and light touch on
the medial aspect of the palmar and dorsal surfaces of the hand to the wrist, the 5th finger, and
the medial aspect of the ring finger. Mild weakness of the right abductor minimi digiti is
present, but the other intrinsic hand muscles are of normal strength. The remainder of the
neurological exam is normal. - ANSWER-Compressive ulnar neuropathy at the elbow
A 52-year-old woman presents with a 1-year history of bilateral shaking in her hands. The
shaking tends to worsen when she is using her hands, and her symptoms improve when she
drinks a glass of wine on the weekends. Her 82- year-old mother also has a similar shaking in
her hands which developed when she was in her 50s. What is the most likely diagnosis? -
ANSWER-Essential tremor
3|Page
, Apea Pre-Predictor Actual Exam Newest 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? - ANSWER-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. - ANSWER-
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? - ANSWER-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? - ANSWER-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? - ANSWER-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
4|Page
