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APEA PRE-PREDICTOR TEST EXAM||
QUESTIONS AND 100% CORRECT ANSWERS
ALREADY GRADED A+|| LATEST AND
COMPLETE UPDATE WITH VERIFIED
SOLUTIONS GUARANTEED PASS!!!
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
,2|Page
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 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? - ANSWER: 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? - ANSWER:
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. - ANSWER: Toxoplasma
encephalitis
,3|Page
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? - ANSWER: Bell's Palsy
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? - ANSWER: 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? -
ANSWER: 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
, 4|Page
investigations, what is the most appropriate next step? - ANSWER: 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 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? -
ANSWER: 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? -
ANSWER: 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
APEA PRE-PREDICTOR TEST EXAM||
QUESTIONS AND 100% CORRECT ANSWERS
ALREADY GRADED A+|| LATEST AND
COMPLETE UPDATE WITH VERIFIED
SOLUTIONS GUARANTEED PASS!!!
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
,2|Page
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 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? - ANSWER: 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? - ANSWER:
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. - ANSWER: Toxoplasma
encephalitis
,3|Page
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? - ANSWER: Bell's Palsy
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? - ANSWER: 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? -
ANSWER: 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
, 4|Page
investigations, what is the most appropriate next step? - ANSWER: 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 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? -
ANSWER: 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? -
ANSWER: 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
