APEA 3P EXAM QUESTIONS AND
ANSWERS WITH VERIFIED SOLUTIONS
2024
Most common type of skin cancer in USA - ANSWER Skin cancer
Most common type of skin cancer - ANSWER basal cell carcinoma
basal cell carcinoma symptoms - ANSWER Appearance varies; smooth, shiny bump, pink to pearly white
Basal cell carcinoma common locations - ANSWER cheeks, nose, face, neck, arms, back
basal cell carcinoma diagnosis gold standard - ANSWER biopsy. if not an option, refer to derm
Actinic keratosis - ANSWER 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 - ANSWER Biopsy.
if not an option, refer to derm
Actinic keratosis treatment gold standard - ANSWER 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 - ANSWER chronic red scaly rough textured lesion w/ irregular borders
crusting or bleeding may be present
Squamous cell carcinoma common locations - ANSWER rims of ears, lips, nose, face and top of hands
,precursor lesion to squamous cell cancer - ANSWER actinic keratosis
squamous cell carcinoma diagnosis by? - ANSWER biopsy gold standard. if biopsy is not an option, refer
to dermatology .
Risk factors for skin cancer(melanoma and both non-melanoma) - ANSWER Blistering 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) - ANSWER 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 - ANSWER 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
seborrheic keratosis - ANSWER soft, round, wart-like growth that is light tan to black and looks pasted on
asymptomatic &benign
Bacterial Meningitis Bacteria - ANSWER Streptococcus pneumoniae- most common strain
Haemophilus influenzae
Neisseria meningitidis
Escherichia coli
*others
,Bacterial meningitis symptoms (Classic Triad) - ANSWER 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 - ANSWER yes!
Treatment for Bacterial meningitis-patient - ANSWER 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 - ANSWER 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) - 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
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) - ANSWER R-Rash
M-Muscle aches (myalgia)
S-Stomach aches (nausea and vomiting)
F-Fever (>102 F)
Rocky Mountain Spotted Fever (RMSF): Located: - ANSWER •Think "Rocky"- North Carolina, Oklahoma,
Arkansas, Tennessee, Missouri
Spring to Fall (April to September)
Rocky Mountain Spotted Fever (RMSF): DX - ANSWER PCR assay by indirect immunofluorescence
antibody (IFA) assay for immunoglobulin G (IgG) for Rickettsia Rickettsii
Rocky Mountain Spotted Fever (RMSF): tx - ANSWER 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 - ANSWER Usually appears in 7-14 days after being
bitten by a deer tick; range 3-30 days
ANSWERS WITH VERIFIED SOLUTIONS
2024
Most common type of skin cancer in USA - ANSWER Skin cancer
Most common type of skin cancer - ANSWER basal cell carcinoma
basal cell carcinoma symptoms - ANSWER Appearance varies; smooth, shiny bump, pink to pearly white
Basal cell carcinoma common locations - ANSWER cheeks, nose, face, neck, arms, back
basal cell carcinoma diagnosis gold standard - ANSWER biopsy. if not an option, refer to derm
Actinic keratosis - ANSWER 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 - ANSWER Biopsy.
if not an option, refer to derm
Actinic keratosis treatment gold standard - ANSWER 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 - ANSWER chronic red scaly rough textured lesion w/ irregular borders
crusting or bleeding may be present
Squamous cell carcinoma common locations - ANSWER rims of ears, lips, nose, face and top of hands
,precursor lesion to squamous cell cancer - ANSWER actinic keratosis
squamous cell carcinoma diagnosis by? - ANSWER biopsy gold standard. if biopsy is not an option, refer
to dermatology .
Risk factors for skin cancer(melanoma and both non-melanoma) - ANSWER Blistering 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) - ANSWER 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 - ANSWER 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
seborrheic keratosis - ANSWER soft, round, wart-like growth that is light tan to black and looks pasted on
asymptomatic &benign
Bacterial Meningitis Bacteria - ANSWER Streptococcus pneumoniae- most common strain
Haemophilus influenzae
Neisseria meningitidis
Escherichia coli
*others
,Bacterial meningitis symptoms (Classic Triad) - ANSWER 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 - ANSWER yes!
Treatment for Bacterial meningitis-patient - ANSWER 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 - ANSWER 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) - 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
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) - ANSWER R-Rash
M-Muscle aches (myalgia)
S-Stomach aches (nausea and vomiting)
F-Fever (>102 F)
Rocky Mountain Spotted Fever (RMSF): Located: - ANSWER •Think "Rocky"- North Carolina, Oklahoma,
Arkansas, Tennessee, Missouri
Spring to Fall (April to September)
Rocky Mountain Spotted Fever (RMSF): DX - ANSWER PCR assay by indirect immunofluorescence
antibody (IFA) assay for immunoglobulin G (IgG) for Rickettsia Rickettsii
Rocky Mountain Spotted Fever (RMSF): tx - ANSWER 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 - ANSWER Usually appears in 7-14 days after being
bitten by a deer tick; range 3-30 days
