APEA 3P Exam Questions And Answers
Most common type of skin cancer in USA - Correct Answer - Skin cancer
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Most common type of skin cancer - Correct Answer - basal cell carcinoma
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basal cell carcinoma symptoms - Correct Answer -
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Appearance varies; smooth, shiny bump, pink to pearly white
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Basal cell carcinoma common locations - Correct Answer - cheeks, nose, face, neck, arms, back
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basal cell carcinoma diagnosis gold standard - Correct Answer - biopsy. if not an option, refer to derm
d d d d d d d d d d d d d d d d d
Actinic keratosis - Correct Answer - Precursor to squamous cell carcinoma
d d d d d d d d d d
numerous dry, round and pink to red lesions w/ rough and scaly texture
d d d d d d d d d d d d
--> does not heal, slow growing in sun exposed areas
d d d d d d d d d
Actinic keratosis diagnosis gold standard - Correct Answer - Biopsy.
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if not an option, refer to derm
d d d d d d
Actinic keratosis treatment gold standard - Correct Answer - small- cryotherapy
d d d d d d d d d d
large- number 5-FU (5-flouracil aka efudex). 5-FU medication Causes skin to ooze, crust, scab and be red
d d d d d d d d d d d d d d d d d
**5-flouracil/ efudex-wear sunscreen!!** d d
squamous cell cancer - Correct Answer - chronic red scaly rough textured lesion w/ irregular borders
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crusting or bleeding may be present d d d d d
Squamous cell carcinoma common locations - Correct Answer -
d d d d d d d d
rims of ears, lips, nose, face and top of hands
d d d d d d d d d d
precursor lesion to squamous cell cancer - Correct Answer - actinic keratosis
d d d d d d d d d d d
squamous cell carcinoma diagnosis by? - Correct Answer -
d d d d d d d d
biopsy gold standard. if biopsy is not an option, refer to dermatology .
d d d d d d d d d d d d d
Risk factors for skin cancer(melanoma and both non-melanoma) - Correct Answer -
d d d d d d d d d d d
Blistering sunburn as a child, history of sunburns, light skin, chronic exposure to UV light (sunlight/
d d d d d d d d d d d d d d d d
tanning beds), moles, family hx for skin cancer
d d d d d d d
Melanoma symptoms (ABCDE) - Correct Answer - asymmetry (shape/uneven texture)
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border (irregular/notched/blurred)
d
color (variegated colors from black, blue, dark to light brown)
d d d d d d d d d
,diameter (size >6mm size of pencil eraser or larger)d d d d d d d d
evolving (changes in color/size/shape) d d d
may be itchy d d
Acral lengtiginous melanoma - Correct Answer -
d d d d d d
Most common type of melanoma in dark skinned individuals (blacks & asians)
d d d d d d d d d d d d
--
> look for longitudinal brown to black bands under the nailbed. a changing spot or mole in the palms, or the
d d d d d d d d d d d d d d d d d d d d d
soles of the feet d d d
seborrheic keratosis - Correct Answer - soft, round, wart-
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like growth that is light tan to black and looks pasted on
d d d d d d d d d d d
asymptomatic &benign d
Bacterial Meningitis Bacteria - Correct Answer - Streptococcus pneumoniae- most common strain
d d d d d d d d d d d d
Haemophilus influenzae d
Neisseria meningitidis d
Escherichia coli d
*others
Bacterial meningitis symptoms (Classic Triad) - Correct Answer - High fever
d d d d d d d d d d
Nuchal rigidity d
rapid change in mental status w/ headache
d d d d d d d
Triad=neck up d
erythematous spot-like rash (petechiae) ecchymosis to purple-colored lesions (purpura) which are non-
d d d d d d d d d d d
blanchable
Is bacterial meningitis a reportable disease - Correct Answer - yes!
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Treatment for Bacterial meningitis-patient - Correct Answer - IV Abx ASAP, resp/droplet iso for first 24-
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48 hrs, hydrate (low maintenance after initial fluid correction), Maintain ventilation and reduce increased i
d d d d d d d d d d d d d d
ntra cranial pressure if present (dexamethosone(to reduce inflammation, mannitol to diurese the brain), lo
d d d d d d d d d d d d d
w stim environment, tx complications that may arrive and support family
d d d d d d d d d d
Treatment for bacterial meningitis-close encounter - Correct Answer -
d d d d d d d d
Close contacts should be treated w/ rifampin 600 mg q 12 hours x 2 days
d d d d d d d d d d d d d d d
**Rifampin changes urine color to reddish orange and can stain contacts
d d d d d d d d d d
**AVOID RIFAMPIN IN PREGNANCY d d d
,Brudzinkski sign (meningeal irritation) - Correct Answer - Tests for meningeal irritation
d d d d d d d d d d d
Patient supine, raise BACK of head and flex chin towards chest
d d d d d d d d d d
+ result if pt automatically beds both hips
d d d d d d d
--Brudzinski and back of head start with B as well as bends--
d d d d d d d d d d d
Kernig's sign - Correct Answer - Tests for meningeal irritation
d d d d d d d d d
patient supine. flex patients hips and knees in a right angle, then slowly straighten/extend the legs up
d d d d d d d d d d d d d d d d d
+ result if when the patient complains of pain during extension of leg
d d d d d d d d d d d d
MCV4 (meningococcal vaccine) Age 11-19 - Correct Answer - Give one dose of menactra or menveo
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primary dose given age 12 or younger give a booster at age 16-18
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MCV4 (meningococcal vaccine) Age 19-21 - Correct Answer -
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Give one dose of menactra or menveo if never had either
d d d d d d d d d d d
Rocky mountain spotted fever (RMSF) symptoms - Correct Answer - Fever
d d d d d d d d d d
chills
N/V
myalgia
arthralgia
2-
5 days later develop petechial rash on forearms, ankles, and wrists that spreads towards trunk and become
d d d d d d d d d d d d d d d d
s generalised. sometimes rash develops on palms and soles
d d d d d d d d
**RASH DEVELOPS INWARDS** d d
RMSF pneumonic (RMSF) - Correct Answer - R-Rash
d d d d d d d d
d M-Muscle aches (myalgia) d d d
d S-Stomach aches (nausea and vomiting) d d d d d
d F-Fever (>102 F) d d
Rocky Mountain Spotted Fever (RMSF): Located: - Correct Answer - •Think "Rocky"-
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North Carolina, Oklahoma, Arkansas, Tennessee, Missouri
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d Spring to Fall (April to September)
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Rocky Mountain Spotted Fever (RMSF): DX - Correct Answer -
d d d d d d d d d
dPCR assay by indirect immunofluorescence antibody (IFA) assay for immunoglobulin G (IgG) for Rickettsia R
d d d d d d d d d d d d d d
ickettsii
Rocky Mountain Spotted Fever (RMSF): tx - Correct Answer - Doxycycline is always first line for all ages
d d d d d d d d d d d d d d d d d d
, 100 mg every 12 hours x 7-10 days
d d d d d d d d
d Can be fatal if not treated within the first 5 days
d d d d d d d d d d
Erythema Migrans (early Lyme disease): Symptoms - Correct Answer - Usually appears in 7-
d d d d d d d d d d d d d
14 days after being bitten by a deer tick; range 3-30 days
d d d d d d d d d d d d
Target bull's- d
eye Rash is hot to touch with rough texture. Expanding red rash with central clearing • Common locations ar
d d d d d d d d d d d d d d d d d d
e belt line, axillary area, behind the knees, and groin area • Positive for flu like symptoms. Lesions and rash r
d d d d d d d d d d d d d d d d d d d d
esolve within a few weeks with or without treatment
d d d d d d d d
Erythema Migrans (early Lyme disease): DX - Correct Answer -d d d d d d d d d
Dx: • First step is enzyme immunoassay (EIA) also knows as ELISA if negative no further testing needed. If po
d d d d d d d d d d d d d d d d d d d d
sitive confirm with Western Blot test (aka indirect immunofluorescence assay (IFA) for Borrelia Burgdorferi
d d d d d d d d d d d d d d
1. Enzyme immunoassay
d d
2. western blot test (immunoflurorescence assay/ IFA)
d d d d d d d
Exam Tip: E before I d d d d
Will have increased ESR
d d d
Erythema Migrans (early Lyme disease): TX - Correct Answer - Doxycycline is always first line for all ages
d d d d d d d d d d d d d d d d d d
100 mg BID x 10-21 days
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Remove ticks by grasping with tweezers or forceps close to the skin and pulling gently with steady pressure.
d d d d d d d d d d d d d d d d d d
After removing the tick, clean area with rubbing alcohol, iodine scrub, or soap and water. Dispose of the tick
d d d d d d d d d d d d d d d d d d
by flushing it into the toilet
d d d d d d
Tick repellant skin use - Correct Answer - DEET
d d d d d d d d
Tick repellant clothing use - Correct Answer - Permethrin
d d d d d d d d
Brown Recluse Spider Bite: SX - Correct Answer -
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• Fever, chills • Nausea and Vomiting • Located in the arms, upper legs, or the trunk • Bitten area becomes s
d d d d d d d d d d d d d d d d d d d d d d
wollen, red, and tender, or can be painless • Blisters appear within 24-
d d d d d d d d d d d d
48 hours • Necrotic in center, which kills the tissue
d d d d d d d d d
**can be painless d d
Brown Recluse Spider Bite treatment - Correct Answer -
d d d d d d d d
Treatment: • Ice packs to wound as the cold inactivates the toxin • Treat like cellulitis of the skin • Antibioti
d d d d d d d d d d d d d d d d d d d d d
c ointment at first and watch
d d d d d
Most common type of skin cancer in USA - Correct Answer - Skin cancer
d d d d d d d d d d d d d
Most common type of skin cancer - Correct Answer - basal cell carcinoma
d d d d d d d d d d d d
basal cell carcinoma symptoms - Correct Answer -
d d d d d d d
Appearance varies; smooth, shiny bump, pink to pearly white
d d d d d d d d d
Basal cell carcinoma common locations - Correct Answer - cheeks, nose, face, neck, arms, back
d d d d d d d d d d d d d d
basal cell carcinoma diagnosis gold standard - Correct Answer - biopsy. if not an option, refer to derm
d d d d d d d d d d d d d d d d d
Actinic keratosis - Correct Answer - Precursor to squamous cell carcinoma
d d d d d d d d d d
numerous dry, round and pink to red lesions w/ rough and scaly texture
d d d d d d d d d d d d
--> does not heal, slow growing in sun exposed areas
d d d d d d d d d
Actinic keratosis diagnosis gold standard - Correct Answer - Biopsy.
d d d d d d d d d
if not an option, refer to derm
d d d d d d
Actinic keratosis treatment gold standard - Correct Answer - small- cryotherapy
d d d d d d d d d d
large- number 5-FU (5-flouracil aka efudex). 5-FU medication Causes skin to ooze, crust, scab and be red
d d d d d d d d d d d d d d d d d
**5-flouracil/ efudex-wear sunscreen!!** d d
squamous cell cancer - Correct Answer - chronic red scaly rough textured lesion w/ irregular borders
d d d d d d d d d d d d d d d
crusting or bleeding may be present d d d d d
Squamous cell carcinoma common locations - Correct Answer -
d d d d d d d d
rims of ears, lips, nose, face and top of hands
d d d d d d d d d d
precursor lesion to squamous cell cancer - Correct Answer - actinic keratosis
d d d d d d d d d d d
squamous cell carcinoma diagnosis by? - Correct Answer -
d d d d d d d d
biopsy gold standard. if biopsy is not an option, refer to dermatology .
d d d d d d d d d d d d d
Risk factors for skin cancer(melanoma and both non-melanoma) - Correct Answer -
d d d d d d d d d d d
Blistering sunburn as a child, history of sunburns, light skin, chronic exposure to UV light (sunlight/
d d d d d d d d d d d d d d d d
tanning beds), moles, family hx for skin cancer
d d d d d d d
Melanoma symptoms (ABCDE) - Correct Answer - asymmetry (shape/uneven texture)
d d d d d d d d d
border (irregular/notched/blurred)
d
color (variegated colors from black, blue, dark to light brown)
d d d d d d d d d
,diameter (size >6mm size of pencil eraser or larger)d d d d d d d d
evolving (changes in color/size/shape) d d d
may be itchy d d
Acral lengtiginous melanoma - Correct Answer -
d d d d d d
Most common type of melanoma in dark skinned individuals (blacks & asians)
d d d d d d d d d d d d
--
> look for longitudinal brown to black bands under the nailbed. a changing spot or mole in the palms, or the
d d d d d d d d d d d d d d d d d d d d d
soles of the feet d d d
seborrheic keratosis - Correct Answer - soft, round, wart-
d d d d d d d d
like growth that is light tan to black and looks pasted on
d d d d d d d d d d d
asymptomatic &benign d
Bacterial Meningitis Bacteria - Correct Answer - Streptococcus pneumoniae- most common strain
d d d d d d d d d d d d
Haemophilus influenzae d
Neisseria meningitidis d
Escherichia coli d
*others
Bacterial meningitis symptoms (Classic Triad) - Correct Answer - High fever
d d d d d d d d d d
Nuchal rigidity d
rapid change in mental status w/ headache
d d d d d d d
Triad=neck up d
erythematous spot-like rash (petechiae) ecchymosis to purple-colored lesions (purpura) which are non-
d d d d d d d d d d d
blanchable
Is bacterial meningitis a reportable disease - Correct Answer - yes!
d d d d d d d d d d
Treatment for Bacterial meningitis-patient - Correct Answer - IV Abx ASAP, resp/droplet iso for first 24-
d d d d d d d d d d d d d d d
48 hrs, hydrate (low maintenance after initial fluid correction), Maintain ventilation and reduce increased i
d d d d d d d d d d d d d d
ntra cranial pressure if present (dexamethosone(to reduce inflammation, mannitol to diurese the brain), lo
d d d d d d d d d d d d d
w stim environment, tx complications that may arrive and support family
d d d d d d d d d d
Treatment for bacterial meningitis-close encounter - Correct Answer -
d d d d d d d d
Close contacts should be treated w/ rifampin 600 mg q 12 hours x 2 days
d d d d d d d d d d d d d d d
**Rifampin changes urine color to reddish orange and can stain contacts
d d d d d d d d d d
**AVOID RIFAMPIN IN PREGNANCY d d d
,Brudzinkski sign (meningeal irritation) - Correct Answer - Tests for meningeal irritation
d d d d d d d d d d d
Patient supine, raise BACK of head and flex chin towards chest
d d d d d d d d d d
+ result if pt automatically beds both hips
d d d d d d d
--Brudzinski and back of head start with B as well as bends--
d d d d d d d d d d d
Kernig's sign - Correct Answer - Tests for meningeal irritation
d d d d d d d d d
patient supine. flex patients hips and knees in a right angle, then slowly straighten/extend the legs up
d d d d d d d d d d d d d d d d d
+ result if when the patient complains of pain during extension of leg
d d d d d d d d d d d d
MCV4 (meningococcal vaccine) Age 11-19 - Correct Answer - Give one dose of menactra or menveo
d d d d d d d d d d d d d d d
primary dose given age 12 or younger give a booster at age 16-18
d d d d d d d d d d d d
MCV4 (meningococcal vaccine) Age 19-21 - Correct Answer -
d d d d d d d d
Give one dose of menactra or menveo if never had either
d d d d d d d d d d d
Rocky mountain spotted fever (RMSF) symptoms - Correct Answer - Fever
d d d d d d d d d d
chills
N/V
myalgia
arthralgia
2-
5 days later develop petechial rash on forearms, ankles, and wrists that spreads towards trunk and become
d d d d d d d d d d d d d d d d
s generalised. sometimes rash develops on palms and soles
d d d d d d d d
**RASH DEVELOPS INWARDS** d d
RMSF pneumonic (RMSF) - Correct Answer - R-Rash
d d d d d d d d
d M-Muscle aches (myalgia) d d d
d S-Stomach aches (nausea and vomiting) d d d d d
d F-Fever (>102 F) d d
Rocky Mountain Spotted Fever (RMSF): Located: - Correct Answer - •Think "Rocky"-
d d d d d d d d d d d
North Carolina, Oklahoma, Arkansas, Tennessee, Missouri
d d d d d d d
d Spring to Fall (April to September)
d d d d d
Rocky Mountain Spotted Fever (RMSF): DX - Correct Answer -
d d d d d d d d d
dPCR assay by indirect immunofluorescence antibody (IFA) assay for immunoglobulin G (IgG) for Rickettsia R
d d d d d d d d d d d d d d
ickettsii
Rocky Mountain Spotted Fever (RMSF): tx - Correct Answer - Doxycycline is always first line for all ages
d d d d d d d d d d d d d d d d d d
, 100 mg every 12 hours x 7-10 days
d d d d d d d d
d Can be fatal if not treated within the first 5 days
d d d d d d d d d d
Erythema Migrans (early Lyme disease): Symptoms - Correct Answer - Usually appears in 7-
d d d d d d d d d d d d d
14 days after being bitten by a deer tick; range 3-30 days
d d d d d d d d d d d d
Target bull's- d
eye Rash is hot to touch with rough texture. Expanding red rash with central clearing • Common locations ar
d d d d d d d d d d d d d d d d d d
e belt line, axillary area, behind the knees, and groin area • Positive for flu like symptoms. Lesions and rash r
d d d d d d d d d d d d d d d d d d d d
esolve within a few weeks with or without treatment
d d d d d d d d
Erythema Migrans (early Lyme disease): DX - Correct Answer -d d d d d d d d d
Dx: • First step is enzyme immunoassay (EIA) also knows as ELISA if negative no further testing needed. If po
d d d d d d d d d d d d d d d d d d d d
sitive confirm with Western Blot test (aka indirect immunofluorescence assay (IFA) for Borrelia Burgdorferi
d d d d d d d d d d d d d d
1. Enzyme immunoassay
d d
2. western blot test (immunoflurorescence assay/ IFA)
d d d d d d d
Exam Tip: E before I d d d d
Will have increased ESR
d d d
Erythema Migrans (early Lyme disease): TX - Correct Answer - Doxycycline is always first line for all ages
d d d d d d d d d d d d d d d d d d
100 mg BID x 10-21 days
d d d d d d
Remove ticks by grasping with tweezers or forceps close to the skin and pulling gently with steady pressure.
d d d d d d d d d d d d d d d d d d
After removing the tick, clean area with rubbing alcohol, iodine scrub, or soap and water. Dispose of the tick
d d d d d d d d d d d d d d d d d d
by flushing it into the toilet
d d d d d d
Tick repellant skin use - Correct Answer - DEET
d d d d d d d d
Tick repellant clothing use - Correct Answer - Permethrin
d d d d d d d d
Brown Recluse Spider Bite: SX - Correct Answer -
d d d d d d d d
• Fever, chills • Nausea and Vomiting • Located in the arms, upper legs, or the trunk • Bitten area becomes s
d d d d d d d d d d d d d d d d d d d d d d
wollen, red, and tender, or can be painless • Blisters appear within 24-
d d d d d d d d d d d d
48 hours • Necrotic in center, which kills the tissue
d d d d d d d d d
**can be painless d d
Brown Recluse Spider Bite treatment - Correct Answer -
d d d d d d d d
Treatment: • Ice packs to wound as the cold inactivates the toxin • Treat like cellulitis of the skin • Antibioti
d d d d d d d d d d d d d d d d d d d d d
c ointment at first and watch
d d d d d
