NEWEST APEA PRE-PREDICTOR ACTUAL EXAM QUESTIONS WITH
CORRECT DETAILED ANSWERS 2025-2026
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
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
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
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)
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
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
,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
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
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
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
Radiculopathy due to nerve root compression occurs most commonly at which
nerve root within the brachial plexus? - ANSWER-C7
A 48-year-old woman presents with new-onset headache that she describes as
nonspecific, worse on awakening, intermittent throughout the day but can
worsen with bending over or coughing. Her husband reports that she has not
been herself since the headaches started about 4 to 6 weeks ago. Which of the
following tests would be best for determining the etiology of her presenting
symptoms? - ANSWER-Contrast MRI
A 19-year-old woman presents to the emergency department complaining of
headache. The headaches are generalized and increasing in intensity. They
have not responded to over-the-counter (OTC) medications. She complains of
approximately 1 week of blurred vision, intermittent diplopia, and vague
dizziness. Her medical history includes obesity and acne. She takes Accutane
and oral contraceptives. She is found to have bilateral papilledema, visual acuity
of 20/30 on physical examination, and a normal MRI of the brain. The next most
appropriate step would be - ANSWER-LP
You have determined that a multiple sclerosis patient with relapsing-remitting
disease has not returned to her baseline functional status with her most recent
exacerbations, despite her returning to baseline with exacerbations for many
years. Her exam also reveals residual neurologic dysfunction. Which of the
following multiple sclerosis clinical types would you classify this patient within? -
ANSWER-Secondary progressive
CORRECT DETAILED ANSWERS 2025-2026
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
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
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
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)
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
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
,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
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
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
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
Radiculopathy due to nerve root compression occurs most commonly at which
nerve root within the brachial plexus? - ANSWER-C7
A 48-year-old woman presents with new-onset headache that she describes as
nonspecific, worse on awakening, intermittent throughout the day but can
worsen with bending over or coughing. Her husband reports that she has not
been herself since the headaches started about 4 to 6 weeks ago. Which of the
following tests would be best for determining the etiology of her presenting
symptoms? - ANSWER-Contrast MRI
A 19-year-old woman presents to the emergency department complaining of
headache. The headaches are generalized and increasing in intensity. They
have not responded to over-the-counter (OTC) medications. She complains of
approximately 1 week of blurred vision, intermittent diplopia, and vague
dizziness. Her medical history includes obesity and acne. She takes Accutane
and oral contraceptives. She is found to have bilateral papilledema, visual acuity
of 20/30 on physical examination, and a normal MRI of the brain. The next most
appropriate step would be - ANSWER-LP
You have determined that a multiple sclerosis patient with relapsing-remitting
disease has not returned to her baseline functional status with her most recent
exacerbations, despite her returning to baseline with exacerbations for many
years. Her exam also reveals residual neurologic dysfunction. Which of the
following multiple sclerosis clinical types would you classify this patient within? -
ANSWER-Secondary progressive
