APEA 3P RATED CERTIFICATION EVALUATION QUESTIONS AND
ANSWERS
⩥ Acne: Severe. Answer: painful indurated nodule, cysts, abscesses,
pustules
Accutane- check Liver function tests (LFTS)
must use 2 forms of contraceptives, monthly pregnancy testing
only prescribe 1 month supply of medication
Usually, will refer to Dermatology
⩥ Topical retinoid side effects. Answer: Irritation, dry skin, flaking, redness
during first 4 weeks due to increase in skin turnover
After washing face wait 30 minutes before applying medication to help
minimize irritation
⩥ Acne medications to avoid in pregnancy (category X &C). Answer:
Category X: Topical tazarotene (Tazorac), Accutane
Category C: Topical retinoids (tretinoin, adapalene)
⩥ Acne Rosacea. Answer: Symptoms: • Chronic small acne like
papules/pustules, and telangiectasias around nose, mouth, and chin
symmetrically
,Treatment: First line: o (Avoid triggers of flushing (EtOH, excessive sun,
spicy foods)
Metro gel or Azelex gel QD-BID
Low dose Tetracycline 250 mg QID or doxycycline 100 mg QD if gel not
effective or the patient has pustular/ocular rosacea
⩥ Psoriasis. Answer: Symptoms: • Inherited condition (atopy)
Pruritic erythematous plaques
Fine silvery-white scales with pitted fingernails
Occurs on scalp, elbows, knees, sacrum, and intergluteal folds (extensor
surfaces)
Migratory arthritis
⩥ Psoriasis treatment. Answer: Treatment: • Topical steroids o Seven
classes of steroids 10 o Avoid class I-III on children, and sensitive skin
(face, groin, etc.) o Class I- super potent o Class VII least potent • Tar preps
(mild cases) • Anti-TNF (severe cases) or immunologics o Methotrexate,
cyclosporine, etanercept, adalimumab
⩥ Koebner phenomenon:. Answer: New psoriatic plaques form over skin
trauma
⩥ Auspitz sign:. Answer: Pinpoint bleeding when plaques are removed
⩥ Atopic Dermatitis (Eczema):. Answer: Inherited condition (atopy)
Extremely itchy
On neck, and hands as well as other flexural folds
An IgE condition
Small vesicles (MVP- macule, vesicle, papule all are <1 CM all others ≥1
CM) that rupture leaving painful, bright-red, weepy lesions
,Will become lichenified from itching
⩥ Atopic dermatitis (eczema) treatment. Answer: First Line: o Topical
steroids and emollients
Avoid hot water/soaps
Can take oral antihistamines to help with itching
Avoid wool clothes
⩥ Contact Dermatitis. Answer: An inflammation of the skin caused by
having contact with certain chemicals or substances; many of these
substances are used in cosmetology.
It is very pruritic, and usually there is no lichenification. Lesions evolve into
vesicular bullae that easily rupture leaving bright-red moist areas that are
painful
⩥ Contact dermatitis Treatment:. Answer: • First Line: o Stop exposure to
substance • Topical steroids QD to BID x 1-2 weeks • Consider referral to
allergist for patch testing
⩥ Scabies. Answer: Pruritic rash located in the interdigital webs of the
hands, axillae, breasts, buttock folds, waist, scrotum, and penis • Severe
generalized itching that is worse at bedtime • Family member will have
same symptoms
o Apply cream to skin from neck to soles of feet. Leave on for at least 8-14
hours then rinse off. Repeat in 1 week o Scabies never go to scalp! o Treat
everyone. Wash sheets and all other items in house in hot water
--Scabies never go to scalp
TREAT EVERYONE
⩥ Pityriasis Rosea: Symptoms. Answer: May be itchy
, Herald patch appears 2 weeks before full breakout
Christmas tree pattern
Rash on the hands or soles of the feet
⩥ Brudzinkski sign (meningeal irritation). Answer: 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. Answer: 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. Answer: 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. Answer: Give one dose of
menactra or menveo if never had either
⩥ Rocky mountain spotted fever (RMSF) symptoms. Answer: Fever
chills
N/V
myalgia
arthralgia
ANSWERS
⩥ Acne: Severe. Answer: painful indurated nodule, cysts, abscesses,
pustules
Accutane- check Liver function tests (LFTS)
must use 2 forms of contraceptives, monthly pregnancy testing
only prescribe 1 month supply of medication
Usually, will refer to Dermatology
⩥ Topical retinoid side effects. Answer: Irritation, dry skin, flaking, redness
during first 4 weeks due to increase in skin turnover
After washing face wait 30 minutes before applying medication to help
minimize irritation
⩥ Acne medications to avoid in pregnancy (category X &C). Answer:
Category X: Topical tazarotene (Tazorac), Accutane
Category C: Topical retinoids (tretinoin, adapalene)
⩥ Acne Rosacea. Answer: Symptoms: • Chronic small acne like
papules/pustules, and telangiectasias around nose, mouth, and chin
symmetrically
,Treatment: First line: o (Avoid triggers of flushing (EtOH, excessive sun,
spicy foods)
Metro gel or Azelex gel QD-BID
Low dose Tetracycline 250 mg QID or doxycycline 100 mg QD if gel not
effective or the patient has pustular/ocular rosacea
⩥ Psoriasis. Answer: Symptoms: • Inherited condition (atopy)
Pruritic erythematous plaques
Fine silvery-white scales with pitted fingernails
Occurs on scalp, elbows, knees, sacrum, and intergluteal folds (extensor
surfaces)
Migratory arthritis
⩥ Psoriasis treatment. Answer: Treatment: • Topical steroids o Seven
classes of steroids 10 o Avoid class I-III on children, and sensitive skin
(face, groin, etc.) o Class I- super potent o Class VII least potent • Tar preps
(mild cases) • Anti-TNF (severe cases) or immunologics o Methotrexate,
cyclosporine, etanercept, adalimumab
⩥ Koebner phenomenon:. Answer: New psoriatic plaques form over skin
trauma
⩥ Auspitz sign:. Answer: Pinpoint bleeding when plaques are removed
⩥ Atopic Dermatitis (Eczema):. Answer: Inherited condition (atopy)
Extremely itchy
On neck, and hands as well as other flexural folds
An IgE condition
Small vesicles (MVP- macule, vesicle, papule all are <1 CM all others ≥1
CM) that rupture leaving painful, bright-red, weepy lesions
,Will become lichenified from itching
⩥ Atopic dermatitis (eczema) treatment. Answer: First Line: o Topical
steroids and emollients
Avoid hot water/soaps
Can take oral antihistamines to help with itching
Avoid wool clothes
⩥ Contact Dermatitis. Answer: An inflammation of the skin caused by
having contact with certain chemicals or substances; many of these
substances are used in cosmetology.
It is very pruritic, and usually there is no lichenification. Lesions evolve into
vesicular bullae that easily rupture leaving bright-red moist areas that are
painful
⩥ Contact dermatitis Treatment:. Answer: • First Line: o Stop exposure to
substance • Topical steroids QD to BID x 1-2 weeks • Consider referral to
allergist for patch testing
⩥ Scabies. Answer: Pruritic rash located in the interdigital webs of the
hands, axillae, breasts, buttock folds, waist, scrotum, and penis • Severe
generalized itching that is worse at bedtime • Family member will have
same symptoms
o Apply cream to skin from neck to soles of feet. Leave on for at least 8-14
hours then rinse off. Repeat in 1 week o Scabies never go to scalp! o Treat
everyone. Wash sheets and all other items in house in hot water
--Scabies never go to scalp
TREAT EVERYONE
⩥ Pityriasis Rosea: Symptoms. Answer: May be itchy
, Herald patch appears 2 weeks before full breakout
Christmas tree pattern
Rash on the hands or soles of the feet
⩥ Brudzinkski sign (meningeal irritation). Answer: 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. Answer: 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. Answer: 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. Answer: Give one dose of
menactra or menveo if never had either
⩥ Rocky mountain spotted fever (RMSF) symptoms. Answer: Fever
chills
N/V
myalgia
arthralgia
