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