3P APEA /APEA 3P EXAM AND STUDYGUIDE 2024 precursor lesion to squamous cell cancer - ANSWERactinic keratosis
ACTUAL EXAM COMPLETE 350 QUESTIONS AND squamous cell carcinoma diagnosis by? - ANSWERbiopsy gold standard. if biopsy is
CORRECT ANSWERS (VERIFIED ANSWERS) not an option, refer to dermatology .
|ALREADY GRADED A+||BRAND NEW VERSION!! Risk factors for skin cancer(melanoma and both non-melanoma) - ANSWERBlistering
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) - ANSWERasymmetry (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)
Most common type of skin cancer in USA - ANSWERSkin cancer may be itchy
Most common type of skin cancer - ANSWERbasal cell carcinoma Acral lengtiginous melanoma - ANSWERMost common type of melanoma in dark
skinned individuals (blacks & asians)
basal cell carcinoma symptoms - ANSWERAppearance varies; smooth, shiny bump, --> look for longitudinal brown to black bands under the nailbed. a changing spot or
pink to pearly white mole in the palms, or the soles of the feet
Basal cell carcinoma common locations - ANSWERcheeks, nose, face, neck, arms, seborrheic keratosis - ANSWERsoft, round, wart-like growth that is light tan to black and
back looks pasted on
asymptomatic &benign
basal cell carcinoma diagnosis gold standard - ANSWERbiopsy. if not an option, refer to
derm Bacterial Meningitis Bacteria - ANSWERStreptococcus pneumoniae- most common
strain
Actinic keratosis - ANSWERPrecursor to squamous cell carcinoma Haemophilus influenzae
numerous dry, round and pink to red lesions w/ rough and scaly texture Neisseria meningitidis
--> does not heal, slow growing in sun exposed areas Escherichia coli
*others
Actinic keratosis diagnosis gold standard - ANSWERBiopsy.
if not an option, refer to derm Bacterial meningitis symptoms (Classic Triad) - ANSWERHigh fever
Nuchal rigidity
Actinic keratosis treatment gold standard - ANSWERsmall- cryotherapy rapid change in mental status w/ headache
large- number 5-FU (5-flouracil aka efudex). 5-FU medication Causes skin to ooze, Triad=neck up
crust, scab and be red erythematous spot-like rash (petechiae) ecchymosis to purple-colored lesions (purpura)
**5-flouracil/ efudex-wear sunscreen!!** which are non-blanchable
squamous cell cancer - ANSWERchronic red scaly rough textured lesion w/ irregular Is bacterial meningitis a reportable disease - ANSWERyes!
borders
crusting or bleeding may be present Treatment for Bacterial meningitis-patient - ANSWERIV Abx ASAP, resp/droplet iso for
first 24-48 hrs, hydrate (low maintenance after initial fluid correction), Maintain
Squamous cell carcinoma common locations - ANSWERrims of ears, lips, nose, face ventilation and reduce increased intra cranial pressure if present (dexamethosone(to
and top of hands
,reduce inflammation, mannitol to diurese the brain), low stim environment, tx Rocky Mountain Spotted Fever (RMSF): DX - ANSWERPCR assay by indirect
complications that may arrive and support family immunofluorescence antibody (IFA) assay for immunoglobulin G (IgG) for Rickettsia
Rickettsii
Treatment for bacterial meningitis-close encounter - ANSWERClose contacts should be
treated w/ rifampin 600 mg q 12 hours x 2 days Rocky Mountain Spotted Fever (RMSF): tx - ANSWERDoxycycline is always first line for
**Rifampin changes urine color to reddish orange and can stain contacts all ages
100 mg every 12 hours x 7-10 days
**AVOID RIFAMPIN IN PREGNANCY Can be fatal if not treated within the first 5 days
Brudzinkski sign (meningeal irritation) - ANSWERTests for meningeal irritation Erythema Migrans (early Lyme disease): Symptoms - ANSWERUsually appears in 7-14
Patient supine, raise BACK of head and flex chin towards chest days after being bitten by a deer tick; range 3-30 days
+ result if pt automatically beds both hips Target bull's-eye Rash is hot to touch with rough texture. Expanding red rash with
--Brudzinski and back of head start with B as well as bends-- 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
Kernig's sign - ANSWERTests for meningeal irritation with or without treatment
patient supine. flex patients hips and knees in a right angle, then slowly
straighten/extend the legs up Erythema Migrans (early Lyme disease): DX - ANSWERDx: • First step is enzyme
+ result if when the patient complains of pain during extension of leg 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
MCV4 (meningococcal vaccine) Age 11-19 - ANSWERGive one dose of menactra or Borrelia Burgdorferi
menveo
primary dose given age 12 or younger give a booster at age 16-18 1. Enzyme immunoassay
2. western blot test (immunoflurorescence assay/ IFA)
MCV4 (meningococcal vaccine) Age 19-21 - ANSWERGive one dose of menactra or Exam Tip: E before I
menveo if never had either
Will have increased ESR
Rocky mountain spotted fever (RMSF) symptoms - ANSWERFever
chills Erythema Migrans (early Lyme disease): TX - ANSWERDoxycycline is always first line
N/V for all ages
myalgia 100 mg BID x 10-21 days
arthralgia
2-5 days later develop petechial rash on forearms, ankles, and wrists that spreads Remove ticks by grasping with tweezers or forceps close to the skin and pulling gently
towards trunk and becomes generalised. sometimes rash develops on palms and soles with steady pressure. After removing the tick, clean area with rubbing alcohol, iodine
**RASH DEVELOPS INWARDS** scrub, or soap and water. Dispose of the tick by flushing it into the toilet
RMSF pneumonic (RMSF) - ANSWERR-Rash Tick repellant skin use - ANSWERDEET
M-Muscle aches (myalgia)
S-Stomach aches (nausea and vomiting) Tick repellant clothing use - ANSWERPermethrin
F-Fever (>102 F)
Brown Recluse Spider Bite: SX - ANSWER• Fever, chills • Nausea and Vomiting •
Rocky Mountain Spotted Fever (RMSF): Located: - ANSWER•Think "Rocky"- North Located in the arms, upper legs, or the trunk • Bitten area becomes swollen, red, and
Carolina, Oklahoma, Arkansas, Tennessee, Missouri tender, or can be painless • Blisters appear within 24-48 hours • Necrotic in center,
Spring to Fall (April to September) which kills the tissue
**can be painless
, Brown Recluse Spider Bite treatment - ANSWERTreatment: • Ice packs to wound as the Rule of 9's - ANSWERHead and neck = 9%
cold inactivates the toxin • Treat like cellulitis of the skin • Antibiotic ointment at first and Upper Ex = 9% each
watch Lower Ex = 9% each
Front trunk = 18%
Skin lesions - ANSWERprimary skin lesions Back trunk = 18%
Macule Vesicle Papule MVP Size: <1 CM
Rule of 9's =-child leg - ANSWERChlid one leg=13.5%
Macule - ANSWERFlat, nonpalpable, but visually distinct areas on the skin surface with One leg adult =18%
color different from the person's normal skin; less than 1 cm
FRECKLE Rule of 9's =child head - ANSWERChild head- 18% (half of adult %)
Vesicle - ANSWERelevated, raised lesion filled with serous fluid (herpetic lesions) First degree (superficial): - ANSWERRed to bright red skin and tenderness/pain
Papule - ANSWERpalpable solid lesion (acne, moles) second-degree (partial-thickness) burns - ANSWERPainful red skin, bullae (blisters),
reddened/weepy skin
primary skin lesions >1cm in size - ANSWERNodule --> BLISTERS START AT SECOND DEGREE
Plaque
Bullae (Blister) third-degree (full-thickness) burns - ANSWERPain sensation absent. Pale/white color,
Pustule charred skin, leather-like texture
Wheal
Criteria for Burn Center Referral: - ANSWERFace, hands, feet, genitals, major joints
Nodule - ANSWERraised solid lesion (BCC) Electrical burns, lightning burns
Partial thickness burns >10% of total body surface area
Plaque - ANSWERsolid raised lesion with flat top (psoriasis) Third degree burns in any age group
Bulla/Bullae - ANSWERelevated superficial blister filled with serous fluid (2nd degree If pt. has a Sulfa allergy and can't use Silvadene what is the alternative? -
burn, impetigo) ANSWERBacitracin, Polysporin/Triple antibiotic cream or ointment
Pustule - ANSWERcircumscribed elevated lesion containing pus (acne pustules) Cellulitis - ANSWERBacteria (Gram Positive):
Streptococcus (beta hemolytic strep), Staph aureus (MRSA)
Secondary Skin Lesions-Lichenification - ANSWERthickening of the epidermis with
exaggeration of normal skin due to chronic skin itching (eczema) Cellulitis Symptoms: - ANSWERDiffused pink to red colored skin, warm to touch, and
may become abscessed
Secondary skin lesions- Scale - ANSWERflaking skin (psoriasis) If red streaks radiating from infection it has spread to lymph nodes (lymphangitis)
Usually within the deep dermis and is poorly demarcated (poor boundaries)
Secondary skin condition-crust - ANSWERdried exudate (impetigo) Most common location is the lower legs
Secondary skin condition-ulceration - ANSWEReroding of epidermis and dermis (if deep -->If pt. has DM and develops cellulitis watch for osteomyelitis
can involve subcutaneous tissue)
Cellulitis treatment - ANSWERFirst line: Abscess/cellulitis is I&D (if <5 cm no PO
Secondary skin condition-scar - ANSWERpermanent fibrotic change following damage antibiotic needed) • Check for tetanus vaccine status
to dermis (surgical scars) Nonpurulent: Cephalexin (Keflex) 500 mg or Dicloxacillin q 6 hours for 5-10 days
Purulent (MRSA): Wound culture o Follow up in 48 hours Bactrim BS BID x 10 days o If
Secondary skin condition-keloids/hypertrophic scars - ANSWERovergrowth of scar you suspect osteomyelitis order an MRI
tissue (more common in Black and Asian descent) If allergic to Penicillin: Azithromycin (Z-Pack x 5 days)
ACTUAL EXAM COMPLETE 350 QUESTIONS AND squamous cell carcinoma diagnosis by? - ANSWERbiopsy gold standard. if biopsy is
CORRECT ANSWERS (VERIFIED ANSWERS) not an option, refer to dermatology .
|ALREADY GRADED A+||BRAND NEW VERSION!! Risk factors for skin cancer(melanoma and both non-melanoma) - ANSWERBlistering
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) - ANSWERasymmetry (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)
Most common type of skin cancer in USA - ANSWERSkin cancer may be itchy
Most common type of skin cancer - ANSWERbasal cell carcinoma Acral lengtiginous melanoma - ANSWERMost common type of melanoma in dark
skinned individuals (blacks & asians)
basal cell carcinoma symptoms - ANSWERAppearance varies; smooth, shiny bump, --> look for longitudinal brown to black bands under the nailbed. a changing spot or
pink to pearly white mole in the palms, or the soles of the feet
Basal cell carcinoma common locations - ANSWERcheeks, nose, face, neck, arms, seborrheic keratosis - ANSWERsoft, round, wart-like growth that is light tan to black and
back looks pasted on
asymptomatic &benign
basal cell carcinoma diagnosis gold standard - ANSWERbiopsy. if not an option, refer to
derm Bacterial Meningitis Bacteria - ANSWERStreptococcus pneumoniae- most common
strain
Actinic keratosis - ANSWERPrecursor to squamous cell carcinoma Haemophilus influenzae
numerous dry, round and pink to red lesions w/ rough and scaly texture Neisseria meningitidis
--> does not heal, slow growing in sun exposed areas Escherichia coli
*others
Actinic keratosis diagnosis gold standard - ANSWERBiopsy.
if not an option, refer to derm Bacterial meningitis symptoms (Classic Triad) - ANSWERHigh fever
Nuchal rigidity
Actinic keratosis treatment gold standard - ANSWERsmall- cryotherapy rapid change in mental status w/ headache
large- number 5-FU (5-flouracil aka efudex). 5-FU medication Causes skin to ooze, Triad=neck up
crust, scab and be red erythematous spot-like rash (petechiae) ecchymosis to purple-colored lesions (purpura)
**5-flouracil/ efudex-wear sunscreen!!** which are non-blanchable
squamous cell cancer - ANSWERchronic red scaly rough textured lesion w/ irregular Is bacterial meningitis a reportable disease - ANSWERyes!
borders
crusting or bleeding may be present Treatment for Bacterial meningitis-patient - ANSWERIV Abx ASAP, resp/droplet iso for
first 24-48 hrs, hydrate (low maintenance after initial fluid correction), Maintain
Squamous cell carcinoma common locations - ANSWERrims of ears, lips, nose, face ventilation and reduce increased intra cranial pressure if present (dexamethosone(to
and top of hands
,reduce inflammation, mannitol to diurese the brain), low stim environment, tx Rocky Mountain Spotted Fever (RMSF): DX - ANSWERPCR assay by indirect
complications that may arrive and support family immunofluorescence antibody (IFA) assay for immunoglobulin G (IgG) for Rickettsia
Rickettsii
Treatment for bacterial meningitis-close encounter - ANSWERClose contacts should be
treated w/ rifampin 600 mg q 12 hours x 2 days Rocky Mountain Spotted Fever (RMSF): tx - ANSWERDoxycycline is always first line for
**Rifampin changes urine color to reddish orange and can stain contacts all ages
100 mg every 12 hours x 7-10 days
**AVOID RIFAMPIN IN PREGNANCY Can be fatal if not treated within the first 5 days
Brudzinkski sign (meningeal irritation) - ANSWERTests for meningeal irritation Erythema Migrans (early Lyme disease): Symptoms - ANSWERUsually appears in 7-14
Patient supine, raise BACK of head and flex chin towards chest days after being bitten by a deer tick; range 3-30 days
+ result if pt automatically beds both hips Target bull's-eye Rash is hot to touch with rough texture. Expanding red rash with
--Brudzinski and back of head start with B as well as bends-- 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
Kernig's sign - ANSWERTests for meningeal irritation with or without treatment
patient supine. flex patients hips and knees in a right angle, then slowly
straighten/extend the legs up Erythema Migrans (early Lyme disease): DX - ANSWERDx: • First step is enzyme
+ result if when the patient complains of pain during extension of leg 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
MCV4 (meningococcal vaccine) Age 11-19 - ANSWERGive one dose of menactra or Borrelia Burgdorferi
menveo
primary dose given age 12 or younger give a booster at age 16-18 1. Enzyme immunoassay
2. western blot test (immunoflurorescence assay/ IFA)
MCV4 (meningococcal vaccine) Age 19-21 - ANSWERGive one dose of menactra or Exam Tip: E before I
menveo if never had either
Will have increased ESR
Rocky mountain spotted fever (RMSF) symptoms - ANSWERFever
chills Erythema Migrans (early Lyme disease): TX - ANSWERDoxycycline is always first line
N/V for all ages
myalgia 100 mg BID x 10-21 days
arthralgia
2-5 days later develop petechial rash on forearms, ankles, and wrists that spreads Remove ticks by grasping with tweezers or forceps close to the skin and pulling gently
towards trunk and becomes generalised. sometimes rash develops on palms and soles with steady pressure. After removing the tick, clean area with rubbing alcohol, iodine
**RASH DEVELOPS INWARDS** scrub, or soap and water. Dispose of the tick by flushing it into the toilet
RMSF pneumonic (RMSF) - ANSWERR-Rash Tick repellant skin use - ANSWERDEET
M-Muscle aches (myalgia)
S-Stomach aches (nausea and vomiting) Tick repellant clothing use - ANSWERPermethrin
F-Fever (>102 F)
Brown Recluse Spider Bite: SX - ANSWER• Fever, chills • Nausea and Vomiting •
Rocky Mountain Spotted Fever (RMSF): Located: - ANSWER•Think "Rocky"- North Located in the arms, upper legs, or the trunk • Bitten area becomes swollen, red, and
Carolina, Oklahoma, Arkansas, Tennessee, Missouri tender, or can be painless • Blisters appear within 24-48 hours • Necrotic in center,
Spring to Fall (April to September) which kills the tissue
**can be painless
, Brown Recluse Spider Bite treatment - ANSWERTreatment: • Ice packs to wound as the Rule of 9's - ANSWERHead and neck = 9%
cold inactivates the toxin • Treat like cellulitis of the skin • Antibiotic ointment at first and Upper Ex = 9% each
watch Lower Ex = 9% each
Front trunk = 18%
Skin lesions - ANSWERprimary skin lesions Back trunk = 18%
Macule Vesicle Papule MVP Size: <1 CM
Rule of 9's =-child leg - ANSWERChlid one leg=13.5%
Macule - ANSWERFlat, nonpalpable, but visually distinct areas on the skin surface with One leg adult =18%
color different from the person's normal skin; less than 1 cm
FRECKLE Rule of 9's =child head - ANSWERChild head- 18% (half of adult %)
Vesicle - ANSWERelevated, raised lesion filled with serous fluid (herpetic lesions) First degree (superficial): - ANSWERRed to bright red skin and tenderness/pain
Papule - ANSWERpalpable solid lesion (acne, moles) second-degree (partial-thickness) burns - ANSWERPainful red skin, bullae (blisters),
reddened/weepy skin
primary skin lesions >1cm in size - ANSWERNodule --> BLISTERS START AT SECOND DEGREE
Plaque
Bullae (Blister) third-degree (full-thickness) burns - ANSWERPain sensation absent. Pale/white color,
Pustule charred skin, leather-like texture
Wheal
Criteria for Burn Center Referral: - ANSWERFace, hands, feet, genitals, major joints
Nodule - ANSWERraised solid lesion (BCC) Electrical burns, lightning burns
Partial thickness burns >10% of total body surface area
Plaque - ANSWERsolid raised lesion with flat top (psoriasis) Third degree burns in any age group
Bulla/Bullae - ANSWERelevated superficial blister filled with serous fluid (2nd degree If pt. has a Sulfa allergy and can't use Silvadene what is the alternative? -
burn, impetigo) ANSWERBacitracin, Polysporin/Triple antibiotic cream or ointment
Pustule - ANSWERcircumscribed elevated lesion containing pus (acne pustules) Cellulitis - ANSWERBacteria (Gram Positive):
Streptococcus (beta hemolytic strep), Staph aureus (MRSA)
Secondary Skin Lesions-Lichenification - ANSWERthickening of the epidermis with
exaggeration of normal skin due to chronic skin itching (eczema) Cellulitis Symptoms: - ANSWERDiffused pink to red colored skin, warm to touch, and
may become abscessed
Secondary skin lesions- Scale - ANSWERflaking skin (psoriasis) If red streaks radiating from infection it has spread to lymph nodes (lymphangitis)
Usually within the deep dermis and is poorly demarcated (poor boundaries)
Secondary skin condition-crust - ANSWERdried exudate (impetigo) Most common location is the lower legs
Secondary skin condition-ulceration - ANSWEReroding of epidermis and dermis (if deep -->If pt. has DM and develops cellulitis watch for osteomyelitis
can involve subcutaneous tissue)
Cellulitis treatment - ANSWERFirst line: Abscess/cellulitis is I&D (if <5 cm no PO
Secondary skin condition-scar - ANSWERpermanent fibrotic change following damage antibiotic needed) • Check for tetanus vaccine status
to dermis (surgical scars) Nonpurulent: Cephalexin (Keflex) 500 mg or Dicloxacillin q 6 hours for 5-10 days
Purulent (MRSA): Wound culture o Follow up in 48 hours Bactrim BS BID x 10 days o If
Secondary skin condition-keloids/hypertrophic scars - ANSWERovergrowth of scar you suspect osteomyelitis order an MRI
tissue (more common in Black and Asian descent) If allergic to Penicillin: Azithromycin (Z-Pack x 5 days)
