APEA PREDICTOR TEST 1 ALL 150 QUESTIONS AND
CORRECT ANSWERS 2025
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
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
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
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
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
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
,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
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
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
A 64-year-old woman presents for evaluation of myxedema. She is experiencing
constipation, headaches, weakness, fatigue, lethargy, somnolence, cold
intolerance, decreased sweating, paresthesias, arthralgias, and muscle cramps.
She has dry, coarse skin. Her face and extremities are swollen, and her voice is
coarse. What gait abnormality would you most likely expect to see in this
patient? - ANSWER-Myopathic
A 28-year-old man presents following a motor vehicle accident 20 minutes prior.
He states that it was just a "fender bender," but he feels he might have whiplash.
His neck is stiff and sore, and he has developed numbness and tingling on the
, medial surface of his right arm and into his right fourth and fifth digits. On
physical examination, his bicep strength is +5/5 on the left and +5/5 on the right.
His biceps tendon reflex is 2+ on the left and 2+ on the right. In addition, his
triceps tendon reflex is 2+ on the left and 2+ on the right. His grip strength on the
right is diminished as compared to the left. The remainder of the physical exam is
normal. Based on the above presentation, what is the cervical nerve root most
likely affected? - ANSWER-C8
A 32-year-old woman starts to notice that she is having difficulty brushing her
hair. She also notices that her eyes are extremely tired after reading the evening
newspaper. One night, her husband comments that she has droopy eyelids. She is
relieved the next morning when her eyelids appear normal. Her condition
deteriorates, and she has weakness and fatigability to the point that she finally
sees her family doctor. On history, she denies pain. Her physical exam
demonstrates weakness in her limbs. Her deep tendon reflexes are within normal
limits. Her doctor wants to run a diagnostic test by injecting a drug. What is the
most likely diagnosis? - ANSWER-MG
A 32-year-old man presents with a 2-day history of high fever and progressive,
severe, headaches. It is associated with blurred vision and increasing confusion.
Results of drug screening are negative, and his urinalysis is normal. The lumbar
puncture results are as follows: Cerebrospinal pressure Increased Protein level 180
mg/dL Glucose 92 mg/dL White blood cell count 116 per microliter (all
lymphocytes) Red blood cell count 80 per microliter Gram-staining results White
blood cells with no organisms Oligoclonal bands Absent IgG index Normal. An
MRI scan of the brain demonstrates low-density lesions in the brain; they
represent areas of gross demyelination. What is the most likely diagnosis? -
ANSWER-HSV encephalitis
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
CORRECT ANSWERS 2025
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
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
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
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
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
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
,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
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
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
A 64-year-old woman presents for evaluation of myxedema. She is experiencing
constipation, headaches, weakness, fatigue, lethargy, somnolence, cold
intolerance, decreased sweating, paresthesias, arthralgias, and muscle cramps.
She has dry, coarse skin. Her face and extremities are swollen, and her voice is
coarse. What gait abnormality would you most likely expect to see in this
patient? - ANSWER-Myopathic
A 28-year-old man presents following a motor vehicle accident 20 minutes prior.
He states that it was just a "fender bender," but he feels he might have whiplash.
His neck is stiff and sore, and he has developed numbness and tingling on the
, medial surface of his right arm and into his right fourth and fifth digits. On
physical examination, his bicep strength is +5/5 on the left and +5/5 on the right.
His biceps tendon reflex is 2+ on the left and 2+ on the right. In addition, his
triceps tendon reflex is 2+ on the left and 2+ on the right. His grip strength on the
right is diminished as compared to the left. The remainder of the physical exam is
normal. Based on the above presentation, what is the cervical nerve root most
likely affected? - ANSWER-C8
A 32-year-old woman starts to notice that she is having difficulty brushing her
hair. She also notices that her eyes are extremely tired after reading the evening
newspaper. One night, her husband comments that she has droopy eyelids. She is
relieved the next morning when her eyelids appear normal. Her condition
deteriorates, and she has weakness and fatigability to the point that she finally
sees her family doctor. On history, she denies pain. Her physical exam
demonstrates weakness in her limbs. Her deep tendon reflexes are within normal
limits. Her doctor wants to run a diagnostic test by injecting a drug. What is the
most likely diagnosis? - ANSWER-MG
A 32-year-old man presents with a 2-day history of high fever and progressive,
severe, headaches. It is associated with blurred vision and increasing confusion.
Results of drug screening are negative, and his urinalysis is normal. The lumbar
puncture results are as follows: Cerebrospinal pressure Increased Protein level 180
mg/dL Glucose 92 mg/dL White blood cell count 116 per microliter (all
lymphocytes) Red blood cell count 80 per microliter Gram-staining results White
blood cells with no organisms Oligoclonal bands Absent IgG index Normal. An
MRI scan of the brain demonstrates low-density lesions in the brain; they
represent areas of gross demyelination. What is the most likely diagnosis? -
ANSWER-HSV encephalitis
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
