APEA 3P Exam
Most common type of skin cancer in USA Skin cancer
Most common type of skin cancer basal cell carcinoma
basal cell carcinoma symptoms Appearance varies; smooth, shiny bump, pink to pearly white
Basal cell carcinoma common locations cheeks, nose, face, neck, arms, back
basal cell carcinoma diagnosis gold standard biopsy. if not an option, refer to derm
Actinic keratosis Precursor 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 Biopsy.
if not an option, refer to derm
Actinic keratosis treatment gold standard small- 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 chronic red scaly rough textured lesion w/ irregular borders
crusting or bleeding may be present
Squamous cell carcinoma common locations rims of ears, lips, nose, face and top of hands
precursor lesion to squamous cell cancer actinic keratosis
squamous cell carcinoma diagnosis by? biopsy gold standard. if biopsy is not an option, refer to dermatology .
Risk factors for skin cancer(melanoma and both non- Blistering sunburn as a child, history of sunburns, light skin, chronic exposure to
melanoma) UV light (sunlight/tanning beds), moles, family hx for skin cancer
Melanoma symptoms (ABCDE) asymmetry (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 Most 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
, APEA 3P Exam
seborrheic keratosis soft, round, wart-like growth that is light tan to black and looks pasted on
asymptomatic &benign
Bacterial Meningitis Bacteria Streptococcus pneumoniae- most common strain
Haemophilus influenzae
Neisseria meningitidis
Escherichia coli
*others
Bacterial meningitis symptoms (Classic Triad) High 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 yes!
Treatment for Bacterial meningitis-patient 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 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) Tests 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 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 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 Give one dose of menactra or menveo if never had either
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)
, APEA 3P Exam
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)
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
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)
Most common type of skin cancer in USA Skin cancer
Most common type of skin cancer basal cell carcinoma
basal cell carcinoma symptoms Appearance varies; smooth, shiny bump, pink to pearly white
Basal cell carcinoma common locations cheeks, nose, face, neck, arms, back
basal cell carcinoma diagnosis gold standard biopsy. if not an option, refer to derm
Actinic keratosis Precursor 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 Biopsy.
if not an option, refer to derm
Actinic keratosis treatment gold standard small- 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 chronic red scaly rough textured lesion w/ irregular borders
crusting or bleeding may be present
Squamous cell carcinoma common locations rims of ears, lips, nose, face and top of hands
precursor lesion to squamous cell cancer actinic keratosis
squamous cell carcinoma diagnosis by? biopsy gold standard. if biopsy is not an option, refer to dermatology .
Risk factors for skin cancer(melanoma and both non- Blistering sunburn as a child, history of sunburns, light skin, chronic exposure to
melanoma) UV light (sunlight/tanning beds), moles, family hx for skin cancer
Melanoma symptoms (ABCDE) asymmetry (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 Most 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
, APEA 3P Exam
seborrheic keratosis soft, round, wart-like growth that is light tan to black and looks pasted on
asymptomatic &benign
Bacterial Meningitis Bacteria Streptococcus pneumoniae- most common strain
Haemophilus influenzae
Neisseria meningitidis
Escherichia coli
*others
Bacterial meningitis symptoms (Classic Triad) High 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 yes!
Treatment for Bacterial meningitis-patient 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 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) Tests 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 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 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 Give one dose of menactra or menveo if never had either
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)
, APEA 3P Exam
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)
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
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)
