APEA 3P Exam
Most common type of skin cancer in USA - verified answer Skin cancer
Most common type of skin cancer - verified answer basal cell carcinoma
basal cell carcinoma symptoms - verified answer Appearance varies; smooth, shiny bump, pink to
pearly white
Basal cell carcinoma common locations - verified answer cheeks, nose, face, neck, arms, back
basal cell carcinoma diagnosis gold standard - verified answer biopsy. if not an option, refer to
derm
Actinic keratosis - verified 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 - verified answer Biopsy.
if not an option, refer to derm
Actinic keratosis treatment gold standard - verified 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 - verified answer chronic red scaly rough textured lesion w/ irregular borders
crusting or bleeding may be present
Squamous cell carcinoma common locations - verified answer rims of ears, lips, nose, face and top
of hands
,precursor lesion to squamous cell cancer - verified answer actinic keratosis
squamous cell carcinoma diagnosis by? - verified answer biopsy gold standard. if biopsy is not an
option, refer to dermatology .
Risk factors for skin cancer(melanoma and both non-melanoma) - verified 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) - verified 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 - verified 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 - verified answer soft, round, wart-like growth that is light tan to black and
looks pasted on
asymptomatic &benign
Bacterial Meningitis Bacteria - verified answer Streptococcus pneumoniae- most common strain
Haemophilus influenzae
Neisseria meningitidis
Escherichia coli
*others
Bacterial meningitis symptoms (Classic Triad) - verified 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 - verified answer yes!
Treatment for Bacterial meningitis-patient - verified 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 - verified 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) - verified 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 - verified 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 - verified 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 - verified answer Give one dose of menactra or menveo
if never had either
, Rocky mountain spotted fever (RMSF) symptoms - verified 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) - verified answer R-Rash
M-Muscle aches (myalgia)
S-Stomach aches (nausea and vomiting)
F-Fever (>102 F)
Rocky Mountain Spotted Fever (RMSF): Located: - verified answer •Think "Rocky"- North Carolina,
Oklahoma, Arkansas, Tennessee, Missouri
Spring to Fall (April to September)
Rocky Mountain Spotted Fever (RMSF): DX - verified answer PCR assay by indirect
immunofluorescence antibody (IFA) assay for immunoglobulin G (IgG) for Rickettsia Rickettsii
Rocky Mountain Spotted Fever (RMSF): tx - verified 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 - verified answer 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
Most common type of skin cancer in USA - verified answer Skin cancer
Most common type of skin cancer - verified answer basal cell carcinoma
basal cell carcinoma symptoms - verified answer Appearance varies; smooth, shiny bump, pink to
pearly white
Basal cell carcinoma common locations - verified answer cheeks, nose, face, neck, arms, back
basal cell carcinoma diagnosis gold standard - verified answer biopsy. if not an option, refer to
derm
Actinic keratosis - verified 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 - verified answer Biopsy.
if not an option, refer to derm
Actinic keratosis treatment gold standard - verified 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 - verified answer chronic red scaly rough textured lesion w/ irregular borders
crusting or bleeding may be present
Squamous cell carcinoma common locations - verified answer rims of ears, lips, nose, face and top
of hands
,precursor lesion to squamous cell cancer - verified answer actinic keratosis
squamous cell carcinoma diagnosis by? - verified answer biopsy gold standard. if biopsy is not an
option, refer to dermatology .
Risk factors for skin cancer(melanoma and both non-melanoma) - verified 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) - verified 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 - verified 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 - verified answer soft, round, wart-like growth that is light tan to black and
looks pasted on
asymptomatic &benign
Bacterial Meningitis Bacteria - verified answer Streptococcus pneumoniae- most common strain
Haemophilus influenzae
Neisseria meningitidis
Escherichia coli
*others
Bacterial meningitis symptoms (Classic Triad) - verified 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 - verified answer yes!
Treatment for Bacterial meningitis-patient - verified 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 - verified 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) - verified 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 - verified 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 - verified 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 - verified answer Give one dose of menactra or menveo
if never had either
, Rocky mountain spotted fever (RMSF) symptoms - verified 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) - verified answer R-Rash
M-Muscle aches (myalgia)
S-Stomach aches (nausea and vomiting)
F-Fever (>102 F)
Rocky Mountain Spotted Fever (RMSF): Located: - verified answer •Think "Rocky"- North Carolina,
Oklahoma, Arkansas, Tennessee, Missouri
Spring to Fall (April to September)
Rocky Mountain Spotted Fever (RMSF): DX - verified answer PCR assay by indirect
immunofluorescence antibody (IFA) assay for immunoglobulin G (IgG) for Rickettsia Rickettsii
Rocky Mountain Spotted Fever (RMSF): tx - verified 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 - verified answer 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
