1|Page
APEA 3P EXAM newest 2026,2027 WITH
CORRECT ACTUAL QUESTIONS AND
CORRECTLY WELL DEFINED ANSWERS
LATEST ALREADY GRADED A+
Is bacterial meningitis a reportable disease - --ANS---yes!
Treatment for Bacterial meningitis-patient - --ANS---IV Abx ASAP, resp/droplet iso for first 24-
48 hrs, hydrate (low maintenance after initial fluid correction), Maintain ventilation and reduce
increased intra cranial pressure if present (dexamethosone(to reduce inflammation, mannitol to
diurese the brain), low stim environment, tx complications that may arrive and support family
Treatment for bacterial meningitis-close encounter - --ANS---Close contacts should be treated w/
rifampin 600 mg q 12 hours x 2 days
**Rifampin changes urine color to reddish orange and can stain contacts
**AVOID RIFAMPIN IN PREGNANCY
Brudzinkski sign (meningeal irritation) - --ANS---Tests for meningeal irritation
,2|Page
Patient supine, raise BACK of head and flex chin towards chest
+ result if pt automatically beds both hips
--Brudzinski and back of head start with B as well as bends--
Kernig's sign - --ANS---Tests for meningeal irritation
patient supine. flex patients hips and knees in a right angle, then slowly straighten/extend the
legs up
+ result if when the patient complains of pain during extension of leg
MCV4 (meningococcal vaccine) Age 11-19 - --ANS---Give one dose of menactra or menveo
primary dose given age 12 or younger give a booster at age 16-18
MCV4 (meningococcal vaccine) Age 19-21 - --ANS---Give one dose of menactra or menveo if
never had either
Rocky mountain spotted fever (RMSF) symptoms - --ANS---Fever
chills
N/V
myalgia
arthralgia
2-5 days later develop petechial rash on forearms, ankles, and wrists that spreads towards trunk
and becomes generalised. sometimes rash develops on palms and soles
**RASH DEVELOPS INWARDS**
,3|Page
RMSF pneumonic (RMSF) - --ANS---R-Rash
M-Muscle aches (myalgia)
S-Stomach aches (nausea and vomiting)
F-Fever (>102 F)
Rocky Mountain Spotted Fever (RMSF): Located: - --ANS---•Think "Rocky"- North Carolina,
Oklahoma, Arkansas, Tennessee, Missouri
Spring to Fall (April to September)
Rocky Mountain Spotted Fever (RMSF): DX - --ANS---PCR assay by indirect
immunofluorescence antibody (IFA) assay for immunoglobulin G (IgG) for Rickettsia Rickettsii
Rocky Mountain Spotted Fever (RMSF): tx - --ANS---Doxycycline is always first line for all
ages
100 mg every 12 hours x 7-10 days
Can be fatal if not treated within the first 5 days
Erythema Migrans (early Lyme disease): Symptoms - --ANS---Usually appears in 7-14 days
after being bitten by a deer tick; range 3-30 days
Target bull's-eye Rash is hot to touch with rough texture. Expanding red rash with central
clearing • Common locations are belt line, axillary area, behind the knees, and groin area •
, 4|Page
Positive for flu like symptoms. Lesions and rash resolve within a few weeks with or without
treatment
Erythema Migrans (early Lyme disease): DX - --ANS---Dx: • First step is enzyme immunoassay
(EIA) also knows as ELISA if negative no further testing needed. If positive confirm with
Western Blot test (aka indirect immunofluorescence assay (IFA) for Borrelia Burgdorferi
1. Enzyme immunoassay
2. western blot test (immunoflurorescence assay/ IFA)
Exam Tip: E before I
Will have increased ESR
Erythema Migrans (early Lyme disease): TX - --ANS---Doxycycline is always first line for all
ages
100 mg BID x 10-21 days
Remove ticks by grasping with tweezers or forceps close to the skin and pulling gently with
steady pressure. After removing the tick, clean area with rubbing alcohol, iodine scrub, or soap
and water. Dispose of the tick by flushing it into the toilet
Tick repellant skin use - --ANS---DEET
APEA 3P EXAM newest 2026,2027 WITH
CORRECT ACTUAL QUESTIONS AND
CORRECTLY WELL DEFINED ANSWERS
LATEST ALREADY GRADED A+
Is bacterial meningitis a reportable disease - --ANS---yes!
Treatment for Bacterial meningitis-patient - --ANS---IV Abx ASAP, resp/droplet iso for first 24-
48 hrs, hydrate (low maintenance after initial fluid correction), Maintain ventilation and reduce
increased intra cranial pressure if present (dexamethosone(to reduce inflammation, mannitol to
diurese the brain), low stim environment, tx complications that may arrive and support family
Treatment for bacterial meningitis-close encounter - --ANS---Close contacts should be treated w/
rifampin 600 mg q 12 hours x 2 days
**Rifampin changes urine color to reddish orange and can stain contacts
**AVOID RIFAMPIN IN PREGNANCY
Brudzinkski sign (meningeal irritation) - --ANS---Tests for meningeal irritation
,2|Page
Patient supine, raise BACK of head and flex chin towards chest
+ result if pt automatically beds both hips
--Brudzinski and back of head start with B as well as bends--
Kernig's sign - --ANS---Tests for meningeal irritation
patient supine. flex patients hips and knees in a right angle, then slowly straighten/extend the
legs up
+ result if when the patient complains of pain during extension of leg
MCV4 (meningococcal vaccine) Age 11-19 - --ANS---Give one dose of menactra or menveo
primary dose given age 12 or younger give a booster at age 16-18
MCV4 (meningococcal vaccine) Age 19-21 - --ANS---Give one dose of menactra or menveo if
never had either
Rocky mountain spotted fever (RMSF) symptoms - --ANS---Fever
chills
N/V
myalgia
arthralgia
2-5 days later develop petechial rash on forearms, ankles, and wrists that spreads towards trunk
and becomes generalised. sometimes rash develops on palms and soles
**RASH DEVELOPS INWARDS**
,3|Page
RMSF pneumonic (RMSF) - --ANS---R-Rash
M-Muscle aches (myalgia)
S-Stomach aches (nausea and vomiting)
F-Fever (>102 F)
Rocky Mountain Spotted Fever (RMSF): Located: - --ANS---•Think "Rocky"- North Carolina,
Oklahoma, Arkansas, Tennessee, Missouri
Spring to Fall (April to September)
Rocky Mountain Spotted Fever (RMSF): DX - --ANS---PCR assay by indirect
immunofluorescence antibody (IFA) assay for immunoglobulin G (IgG) for Rickettsia Rickettsii
Rocky Mountain Spotted Fever (RMSF): tx - --ANS---Doxycycline is always first line for all
ages
100 mg every 12 hours x 7-10 days
Can be fatal if not treated within the first 5 days
Erythema Migrans (early Lyme disease): Symptoms - --ANS---Usually appears in 7-14 days
after being bitten by a deer tick; range 3-30 days
Target bull's-eye Rash is hot to touch with rough texture. Expanding red rash with central
clearing • Common locations are belt line, axillary area, behind the knees, and groin area •
, 4|Page
Positive for flu like symptoms. Lesions and rash resolve within a few weeks with or without
treatment
Erythema Migrans (early Lyme disease): DX - --ANS---Dx: • First step is enzyme immunoassay
(EIA) also knows as ELISA if negative no further testing needed. If positive confirm with
Western Blot test (aka indirect immunofluorescence assay (IFA) for Borrelia Burgdorferi
1. Enzyme immunoassay
2. western blot test (immunoflurorescence assay/ IFA)
Exam Tip: E before I
Will have increased ESR
Erythema Migrans (early Lyme disease): TX - --ANS---Doxycycline is always first line for all
ages
100 mg BID x 10-21 days
Remove ticks by grasping with tweezers or forceps close to the skin and pulling gently with
steady pressure. After removing the tick, clean area with rubbing alcohol, iodine scrub, or soap
and water. Dispose of the tick by flushing it into the toilet
Tick repellant skin use - --ANS---DEET
