APEA 3P ACTUAL EXAM UPDATED
2024 WITH ANSWERS
FEVI less than 80% predicted
FEV1/FVC ratio of <0.7 is diagnostic for COPD
#1 risk factor for COPD - CORRECT ANSWERSsmoking
COPD gold guidelines - CORRECT ANSWERSAnticholinergics are first line for COPD
(ipratropium/Atrovent)
chronic bronchitis - CORRECT ANSWERSProductive cough that occurs >3
months/year for 2 consecutive years --> dirty-chest appearance on CXR
Typically are "blue bloaters" (overweight and cyanotic)
***Clinical Diagnosis***
common side effect of ACE inhibitors - CORRECT ANSWERSDry cough.
Increased potassium levels in the blood (hyperkalemia)
Fatigue.
Dizziness from blood pressure going too low.
Headaches.
Loss of taste.
Most common type of skin cancer in USA - CORRECT ANSWERSSkin cancer
Most common type of skin cancer - CORRECT ANSWERSbasal cell carcinoma
basal cell carcinoma symptoms - CORRECT ANSWERSAppearance varies; smooth,
shiny bump, pink to pearly white
Basal cell carcinoma common locations - CORRECT ANSWERScheeks, nose, face,
neck, arms, back
basal cell carcinoma diagnosis gold standard - CORRECT ANSWERSbiopsy. if not an
option, refer to derm
Actinic keratosis - CORRECT ANSWERSPrecursor to squamous cell carcinoma
numerous dry, round and pink to red lesions w/ rough and scaly texture
,--> does not heal, slow growing in sun exposed areas
Actinic keratosis diagnosis gold standard - CORRECT ANSWERSBiopsy.
if not an option, refer to derm
Actinic keratosis treatment gold standard - CORRECT ANSWERSsmall- cryotherapy
large- number 5-FU (5-flouracil aka efudex). 5-FU medication Causes skin to ooze,
crust, scab and be red
**5-flouracil/ efudex-wear sunscreen!!**
squamous cell cancer - CORRECT ANSWERSchronic red scaly rough textured lesion
w/ irregular borders
crusting or bleeding may be present
Squamous cell carcinoma common locations - CORRECT ANSWERSrims of ears, lips,
nose, face and top of hands
precursor lesion to squamous cell cancer - CORRECT ANSWERSactinic keratosis
squamous cell carcinoma diagnosis by? - CORRECT ANSWERSbiopsy gold standard.
if biopsy is not an option, refer to dermatology .
Risk factors for skin cancer(melanoma and both non-melanoma) - CORRECT
ANSWERSBlistering sunburn as a child, history of sunburns, light skin, chronic
exposure to UV light (sunlight/tanning beds), moles, family hx for skin cancer
Melanoma symptoms (ABCDE) - CORRECT ANSWERSasymmetry (shape/uneven
texture)
border (irregular/notched/blurred)
color (variegated colors from black, blue, dark to light brown)
diameter (size >6mm size of pencil eraser or larger)
evolving (changes in color/size/shape)
may be itchy
Acral lengtiginous melanoma - CORRECT ANSWERSMost common type of melanoma
in dark skinned individuals (blacks & asians)
--> look for longitudinal brown to black bands under the nailbed. a changing spot or
mole in the palms, or the soles of the feet
seborrheic keratosis - CORRECT ANSWERSsoft, round, wart-like growth that is light
tan to black and looks pasted on
asymptomatic &benign
Bacterial Meningitis Bacteria - CORRECT ANSWERSStreptococcus pneumoniae- most
common strain
Haemophilus influenzae
, Neisseria meningitidis
Escherichia coli
*others
Bacterial meningitis symptoms (Classic Triad) - CORRECT ANSWERSHigh fever
Nuchal rigidity
rapid change in mental status w/ headache
Triad=neck up
erythematous spot-like rash (petechiae) ecchymosis to purple-colored lesions (purpura)
which are non-blanchable
Is bacterial meningitis a reportable disease - CORRECT ANSWERSyes!
Treatment for Bacterial meningitis-patient - CORRECT ANSWERSIV 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 - CORRECT ANSWERSClose
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) - CORRECT ANSWERSTests for meningeal
irritation
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 - CORRECT ANSWERSTests 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 - CORRECT ANSWERSGive 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 - CORRECT ANSWERSGive one dose of
menactra or menveo if never had either
Rocky mountain spotted fever (RMSF) symptoms - CORRECT ANSWERSFever
chills
N/V
2024 WITH ANSWERS
FEVI less than 80% predicted
FEV1/FVC ratio of <0.7 is diagnostic for COPD
#1 risk factor for COPD - CORRECT ANSWERSsmoking
COPD gold guidelines - CORRECT ANSWERSAnticholinergics are first line for COPD
(ipratropium/Atrovent)
chronic bronchitis - CORRECT ANSWERSProductive cough that occurs >3
months/year for 2 consecutive years --> dirty-chest appearance on CXR
Typically are "blue bloaters" (overweight and cyanotic)
***Clinical Diagnosis***
common side effect of ACE inhibitors - CORRECT ANSWERSDry cough.
Increased potassium levels in the blood (hyperkalemia)
Fatigue.
Dizziness from blood pressure going too low.
Headaches.
Loss of taste.
Most common type of skin cancer in USA - CORRECT ANSWERSSkin cancer
Most common type of skin cancer - CORRECT ANSWERSbasal cell carcinoma
basal cell carcinoma symptoms - CORRECT ANSWERSAppearance varies; smooth,
shiny bump, pink to pearly white
Basal cell carcinoma common locations - CORRECT ANSWERScheeks, nose, face,
neck, arms, back
basal cell carcinoma diagnosis gold standard - CORRECT ANSWERSbiopsy. if not an
option, refer to derm
Actinic keratosis - CORRECT ANSWERSPrecursor to squamous cell carcinoma
numerous dry, round and pink to red lesions w/ rough and scaly texture
,--> does not heal, slow growing in sun exposed areas
Actinic keratosis diagnosis gold standard - CORRECT ANSWERSBiopsy.
if not an option, refer to derm
Actinic keratosis treatment gold standard - CORRECT ANSWERSsmall- cryotherapy
large- number 5-FU (5-flouracil aka efudex). 5-FU medication Causes skin to ooze,
crust, scab and be red
**5-flouracil/ efudex-wear sunscreen!!**
squamous cell cancer - CORRECT ANSWERSchronic red scaly rough textured lesion
w/ irregular borders
crusting or bleeding may be present
Squamous cell carcinoma common locations - CORRECT ANSWERSrims of ears, lips,
nose, face and top of hands
precursor lesion to squamous cell cancer - CORRECT ANSWERSactinic keratosis
squamous cell carcinoma diagnosis by? - CORRECT ANSWERSbiopsy gold standard.
if biopsy is not an option, refer to dermatology .
Risk factors for skin cancer(melanoma and both non-melanoma) - CORRECT
ANSWERSBlistering sunburn as a child, history of sunburns, light skin, chronic
exposure to UV light (sunlight/tanning beds), moles, family hx for skin cancer
Melanoma symptoms (ABCDE) - CORRECT ANSWERSasymmetry (shape/uneven
texture)
border (irregular/notched/blurred)
color (variegated colors from black, blue, dark to light brown)
diameter (size >6mm size of pencil eraser or larger)
evolving (changes in color/size/shape)
may be itchy
Acral lengtiginous melanoma - CORRECT ANSWERSMost common type of melanoma
in dark skinned individuals (blacks & asians)
--> look for longitudinal brown to black bands under the nailbed. a changing spot or
mole in the palms, or the soles of the feet
seborrheic keratosis - CORRECT ANSWERSsoft, round, wart-like growth that is light
tan to black and looks pasted on
asymptomatic &benign
Bacterial Meningitis Bacteria - CORRECT ANSWERSStreptococcus pneumoniae- most
common strain
Haemophilus influenzae
, Neisseria meningitidis
Escherichia coli
*others
Bacterial meningitis symptoms (Classic Triad) - CORRECT ANSWERSHigh fever
Nuchal rigidity
rapid change in mental status w/ headache
Triad=neck up
erythematous spot-like rash (petechiae) ecchymosis to purple-colored lesions (purpura)
which are non-blanchable
Is bacterial meningitis a reportable disease - CORRECT ANSWERSyes!
Treatment for Bacterial meningitis-patient - CORRECT ANSWERSIV 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 - CORRECT ANSWERSClose
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) - CORRECT ANSWERSTests for meningeal
irritation
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 - CORRECT ANSWERSTests 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 - CORRECT ANSWERSGive 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 - CORRECT ANSWERSGive one dose of
menactra or menveo if never had either
Rocky mountain spotted fever (RMSF) symptoms - CORRECT ANSWERSFever
chills
N/V
