APEA 3P Exam Latest Updated 2024
Rocky mountain spotted fever (RMSF) symptoms - 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**
RMSF pneumonic (RMSF) - R-Rash
M-Muscle aches (myalgia)
S-Stomach aches (nausea and vomiting)
F-Fever (>102 F)
Rocky Mountain Spotted Fever (RMSF): Located: - •Think "Rocky"- North Carolina,
Oklahoma, Arkansas, Tennessee, Missouri
Spring to Fall (April to September)
1|Page
,Rocky Mountain Spotted Fever (RMSF): DX - PCR assay by indirect
immunofluorescence antibody (IFA) assay for immunoglobulin G (IgG) for
Rickettsia Rickettsii
Rocky Mountain Spotted Fever (RMSF): tx - 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 - 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 • Positive for flu like symptoms. Lesions and rash resolve within a
few weeks with or without treatment
Erythema Migrans (early Lyme disease): DX - 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)
2|Page
,Exam Tip: E before I
Will have increased ESR
Erythema Migrans (early Lyme disease): TX - 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 - DEET
Tick repellant clothing use - Permethrin
Brown Recluse Spider Bite: SX - • Fever, chills • Nausea and Vomiting • Located in
the arms, upper legs, or the trunk • Bitten area becomes swollen, red, and tender,
or can be painless • Blisters appear within 24-48 hours • Necrotic in center,
which kills the tissue
**can be painless
3|Page
, Brown Recluse Spider Bite treatment - Treatment: • Ice packs to wound as the
cold inactivates the toxin • Treat like cellulitis of the skin • Antibiotic ointment at
first and watch
Skin lesions - primary skin lesions
Macule Vesicle Papule MVP Size: <1 CM
Macule - Flat, nonpalpable, but visually distinct areas on the skin surface with
color different from the person's normal skin; less than 1 cm
FRECKLE
Vesicle - elevated, raised lesion filled with serous fluid (herpetic lesions)
Papule - palpable solid lesion (acne, moles)
primary skin lesions >1cm in size - Nodule
Plaque
Bullae (Blister)
Pustule
Wheal
4|Page
Rocky mountain spotted fever (RMSF) symptoms - 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**
RMSF pneumonic (RMSF) - R-Rash
M-Muscle aches (myalgia)
S-Stomach aches (nausea and vomiting)
F-Fever (>102 F)
Rocky Mountain Spotted Fever (RMSF): Located: - •Think "Rocky"- North Carolina,
Oklahoma, Arkansas, Tennessee, Missouri
Spring to Fall (April to September)
1|Page
,Rocky Mountain Spotted Fever (RMSF): DX - PCR assay by indirect
immunofluorescence antibody (IFA) assay for immunoglobulin G (IgG) for
Rickettsia Rickettsii
Rocky Mountain Spotted Fever (RMSF): tx - 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 - 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 • Positive for flu like symptoms. Lesions and rash resolve within a
few weeks with or without treatment
Erythema Migrans (early Lyme disease): DX - 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)
2|Page
,Exam Tip: E before I
Will have increased ESR
Erythema Migrans (early Lyme disease): TX - 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 - DEET
Tick repellant clothing use - Permethrin
Brown Recluse Spider Bite: SX - • Fever, chills • Nausea and Vomiting • Located in
the arms, upper legs, or the trunk • Bitten area becomes swollen, red, and tender,
or can be painless • Blisters appear within 24-48 hours • Necrotic in center,
which kills the tissue
**can be painless
3|Page
, Brown Recluse Spider Bite treatment - Treatment: • Ice packs to wound as the
cold inactivates the toxin • Treat like cellulitis of the skin • Antibiotic ointment at
first and watch
Skin lesions - primary skin lesions
Macule Vesicle Papule MVP Size: <1 CM
Macule - Flat, nonpalpable, but visually distinct areas on the skin surface with
color different from the person's normal skin; less than 1 cm
FRECKLE
Vesicle - elevated, raised lesion filled with serous fluid (herpetic lesions)
Papule - palpable solid lesion (acne, moles)
primary skin lesions >1cm in size - Nodule
Plaque
Bullae (Blister)
Pustule
Wheal
4|Page
