APEA 3P EXAM CORRECT ANSWERS AND
QUESTIONS .
Most common type of skin cancer in USA - CorreCt Answers -Skin cancer
Symptoms: Sore throat with tonsillitis. May have whitish tonsillar exudates
• Posterior lymphadenopathy • Severe fatigue present for many weeks •
Maculopapular rash • Hepatomegaly and or splenomegaly
Classic Triad: Fever, Pharyngitis, Lymphadenopathy
Dx: • Monospot (heterophile antibody)
Treatment: Symptomatic • Rest • Avoid contact sports and heavy lifting for
at least 4-6 weeks.
A Ruptured spleen is a rare but serious sequela of mono
May do an abdominal US to clear patient for sports
Test Tip: If the patient has strep throat and mono, avoid using Amoxicillin
as the antibiotic of choice. The patient may develop a rash with this drug.
Macrolides are a good option (Clarithromycin). Levofloxacin works as well
but it is overkill
Strep Throat:Cause, symptoms, TX - CorreCt Answers -Cause:
,• Group A streptococcal bacteria (Streptococcus pyogenes)• Most common
cause of sore throat is viral (rhinovirus, adenovirus, RSV)
• Strep is most common in school-aged children
SX:
• Abrupt onset of fever, sore throat, and pain on swallowing
• Absence of viral symptoms (coryza, cough, hoarseness, runny nose, watery
eyes)
• Tender anterior cervical lymphadenopathy • Scarlatiniform rash
(sandpaper rash) • Children:
May have abdominal pain and diarrhea
TX: First line-Pencillin V or amoxicillin suspension immediate or XR QD
x10 days
ANAPHYLAXIS HX: z pack or clindamycin
Strep Throat, Nonpuruluent SSTI Risks - CorreCt Answers -o Rheumatic
fever, scarlet fever, acute poststreptococcal glomerulonephritis,
poststreptococcal reactive arthritis (develops within 1 month after strep)
Strep throat, purulent risks - CorreCt Answers -• Suppurative (Pus):
Tonsillopharyngeal abscess, cellulitis, OM, sinusitis
Strep throat • Centor Criteria: - CorreCt Answers -• Be able to connect
Centor Criteria with Strep Throat
Fever (1 point)
Anterior cervical lymphadenopathy (1 point)
,Tonsillar exudate (1 point)
Absence of cough (1 point)
Age 3-14 (1 point)
Age 15-44 (0 points)
Age >44 (-1 point)
Score of 0-1 unlikely need to test for strep; score of 3-4 confirm with rapid
strep test
Hypertension Retinopathy - CorreCt Answers -Cotton wool, Retinal
arterioles constriction
• Copper/silver wire arterioles
• AV nicking (mild retinopathy)
• Retinal Hemorrhages
Diabetic Retinopathy: - CorreCt Answers -damage to the retina as a
complication of uncontrolled diabetes
Symptoms:
• Cotton wool spots (moderate retinopathy)
• Micro-aneurysms
• Neovascularization
Koplik's Spots - CorreCt Answers -Symptoms:
• "Clusters of small size red papules with white centers in the buccal
mucosa by lower molars"
• Caused by Rubeola (Measles) o Rubeola and Koplik's have an "O"
, • Fever, conjunctivitis, coryza, cough
• Morbilliform rash
Hear Murmurs: Gold standard DX - CorreCt Answers -Echocardiography
(TEE)
Systolic murmurs occur when? - CorreCt Answers -During S1
mitral regurgitation - CorreCt Answers -Radiates to axilla
5th intercostal space (ICS) by mid clavicular line (MCL), apex, apical area
Aortic Stenosis (mid systolic ejection): - CorreCt Answers -Radiates to
neck!
Higher risk of sudden death • Location:
oAortic area, 2nd ICS by right upper sternum; at the base of the heart by
the right upper sternum; base of heart on the right side of sternum
Diastolic murmurs occur when - CorreCt Answers -S2 Heart sound
diastolic murmurs are always - CorreCt Answers -PATHOLOGICAL-
indicative of heart disease
Mitral stenosis (Mid/late diastolic) - CorreCt Answers -Afib most common
risk-emboli risk
narrowing of the mitral valve
Only murmur you listen to with your Bell
QUESTIONS .
Most common type of skin cancer in USA - CorreCt Answers -Skin cancer
Symptoms: Sore throat with tonsillitis. May have whitish tonsillar exudates
• Posterior lymphadenopathy • Severe fatigue present for many weeks •
Maculopapular rash • Hepatomegaly and or splenomegaly
Classic Triad: Fever, Pharyngitis, Lymphadenopathy
Dx: • Monospot (heterophile antibody)
Treatment: Symptomatic • Rest • Avoid contact sports and heavy lifting for
at least 4-6 weeks.
A Ruptured spleen is a rare but serious sequela of mono
May do an abdominal US to clear patient for sports
Test Tip: If the patient has strep throat and mono, avoid using Amoxicillin
as the antibiotic of choice. The patient may develop a rash with this drug.
Macrolides are a good option (Clarithromycin). Levofloxacin works as well
but it is overkill
Strep Throat:Cause, symptoms, TX - CorreCt Answers -Cause:
,• Group A streptococcal bacteria (Streptococcus pyogenes)• Most common
cause of sore throat is viral (rhinovirus, adenovirus, RSV)
• Strep is most common in school-aged children
SX:
• Abrupt onset of fever, sore throat, and pain on swallowing
• Absence of viral symptoms (coryza, cough, hoarseness, runny nose, watery
eyes)
• Tender anterior cervical lymphadenopathy • Scarlatiniform rash
(sandpaper rash) • Children:
May have abdominal pain and diarrhea
TX: First line-Pencillin V or amoxicillin suspension immediate or XR QD
x10 days
ANAPHYLAXIS HX: z pack or clindamycin
Strep Throat, Nonpuruluent SSTI Risks - CorreCt Answers -o Rheumatic
fever, scarlet fever, acute poststreptococcal glomerulonephritis,
poststreptococcal reactive arthritis (develops within 1 month after strep)
Strep throat, purulent risks - CorreCt Answers -• Suppurative (Pus):
Tonsillopharyngeal abscess, cellulitis, OM, sinusitis
Strep throat • Centor Criteria: - CorreCt Answers -• Be able to connect
Centor Criteria with Strep Throat
Fever (1 point)
Anterior cervical lymphadenopathy (1 point)
,Tonsillar exudate (1 point)
Absence of cough (1 point)
Age 3-14 (1 point)
Age 15-44 (0 points)
Age >44 (-1 point)
Score of 0-1 unlikely need to test for strep; score of 3-4 confirm with rapid
strep test
Hypertension Retinopathy - CorreCt Answers -Cotton wool, Retinal
arterioles constriction
• Copper/silver wire arterioles
• AV nicking (mild retinopathy)
• Retinal Hemorrhages
Diabetic Retinopathy: - CorreCt Answers -damage to the retina as a
complication of uncontrolled diabetes
Symptoms:
• Cotton wool spots (moderate retinopathy)
• Micro-aneurysms
• Neovascularization
Koplik's Spots - CorreCt Answers -Symptoms:
• "Clusters of small size red papules with white centers in the buccal
mucosa by lower molars"
• Caused by Rubeola (Measles) o Rubeola and Koplik's have an "O"
, • Fever, conjunctivitis, coryza, cough
• Morbilliform rash
Hear Murmurs: Gold standard DX - CorreCt Answers -Echocardiography
(TEE)
Systolic murmurs occur when? - CorreCt Answers -During S1
mitral regurgitation - CorreCt Answers -Radiates to axilla
5th intercostal space (ICS) by mid clavicular line (MCL), apex, apical area
Aortic Stenosis (mid systolic ejection): - CorreCt Answers -Radiates to
neck!
Higher risk of sudden death • Location:
oAortic area, 2nd ICS by right upper sternum; at the base of the heart by
the right upper sternum; base of heart on the right side of sternum
Diastolic murmurs occur when - CorreCt Answers -S2 Heart sound
diastolic murmurs are always - CorreCt Answers -PATHOLOGICAL-
indicative of heart disease
Mitral stenosis (Mid/late diastolic) - CorreCt Answers -Afib most common
risk-emboli risk
narrowing of the mitral valve
Only murmur you listen to with your Bell
