APEA 3P Exam
Common Dermatological Conditions
Skin Cancer
Basal Cell Carcinoma (BCC)
Prevalence: Most common type of skin cancer overall and in the USA.
Symptoms: Appearance varies; typically a smooth, shiny bump, pink to pearly white.
Common Locations: Cheeks, nose, face, neck, arms, and back.
Diagnosis (Gold Standard): Biopsy. If not feasible, refer to dermatology.
Actinic Keratosis (AK)
Significance: Precursor to squamous cell carcinoma.
Symptoms: Numerous dry, round, and pink to red lesions with a rough and scaly texture.
o Does not heal.
o Slow-growing in sun-exposed areas.
Diagnosis (Gold Standard): Biopsy. If not feasible, refer to dermatology.
Treatment (Gold Standard):
o Small lesions: Cryotherapy.
o Numerous lesions: 5-FU (5-fluorouracil), also known as Efudex.
Important Note: 5-FU causes skin to ooze, crust, scab, and become red. Wear
sunscreen diligently!
Squamous Cell Carcinoma (SCC)
Symptoms: Chronic red, scaly, rough-textured lesion with irregular borders. Crusting or
bleeding may be present.
Common Locations: Rims of ears, lips, nose, face, and top of hands.
Precursor Lesion: Actinic keratosis.
Diagnosis (Gold Standard): Biopsy. If not feasible, refer to dermatology.
Risk Factors for Skin Cancer (Melanoma and Non-Melanoma)
Blistering sunburn as a child.
History of sunburns.
Light skin.
Chronic exposure to UV light (sunlight/tanning beds).
Presence of moles.
Family history of skin cancer.
,Melanoma
Symptoms (ABCDE):
o Asymmetry: Uneven shape or texture.
o Border: Irregular, notched, or blurred.
o Color: Variegated colors (black, blue, dark to light brown).
o Diameter: Size greater than 6 mm (size of a pencil eraser or larger).
o Evolving: Changes in color, size, or shape; may be itchy.
Acral Lentiginous Melanoma
Prevalence: Most common type of melanoma in dark-skinned individuals (Blacks & Asians).
Key Features: Look for longitudinal brown to black bands under the nailbed. Also consider
changing spots or moles on the palms or soles of the feet.
Seborrheic Keratosis
Symptoms: Soft, round, wart-like growth, light tan to black, appearing "pasted on."
Significance: Asymptomatic and benign.
Infectious Skin Conditions
Bacterial Meningitis
Causative Bacteria:
o Streptococcus pneumoniae: Most common strain.
o Haemophilus influenzae.
o Neisseria meningitidis.
o Escherichia coli.
o Other bacteria.
Symptoms (Classic Triad):
o High fever.
o Nuchal rigidity (stiff neck).
o Rapid change in mental status with headache.
o Erythematous spot-like rash (petechiae) or ecchymosis to purple-colored lesions
(purpura) which are non-blanchable.
Reportable Disease: Yes!
Treatment - Patient:
o IV antibiotics ASAP.
o Respiratory/droplet isolation for the first 24-48 hours.
o Hydration (low maintenance after initial fluid correction).
o Maintain ventilation and reduce increased intracranial pressure if present (dexamethasone,
mannitol).
, o Low stimulation environment.
o Treat complications and support family.
Treatment - Close Contacts:
o Treat with rifampin 600 mg q 12 hours x 2 days.
o Important Notes: Rifampin changes urine color to reddish-orange and can stain contacts.
Avoid rifampin in pregnancy.
Signs of Meningeal Irritation:
o Brudzinski's Sign: Patient supine, raise the back of the head and flex chin towards chest.
Positive if patient automatically bends both hips.
o Kernig's Sign: Patient supine, flex hips and knees to 90 degrees, then slowly
straighten/extend the legs. Positive if patient complains of pain during leg extension.
Meningococcal Vaccine (MCV4):
o Age 11-19: One dose of Menactra or Menveo. If primary dose given at age 12 or younger,
give a booster at age 16-18.
o Age 19-21: One dose of Menactra or Menveo if never vaccinated.
Rocky Mountain Spotted Fever (RMSF)
Symptoms:
o Fever, chills, nausea, vomiting, myalgia, arthralgia.
o Rash (2-5 days later): Petechial rash on forearms, ankles, and wrists, spreading towards
the trunk and becoming generalized. May develop on palms and soles. Rash develops
inwards.
Mnemonic (RMSF):
o Rash
o Muscle aches (myalgia)
o Stomach aches (nausea and vomiting)
o Fever (>102°F)
Geographic Location: North Carolina, Oklahoma, Arkansas, Tennessee, Missouri.
Season: Spring to Fall (April to September).
Diagnosis: PCR assay or indirect immunofluorescence antibody (IFA) assay for immunoglobulin
G (IgG) for Rickettsia rickettsii.
Treatment: Doxycycline 100 mg every 12 hours x 7-10 days is always first-line for all ages.
Can be fatal if not treated within the first 5 days.
Erythema Migrans (Early Lyme Disease)
Symptoms:
o Usually appears 7-14 days after a deer tick bite (range 3-30 days).
o Target bull's-eye rash: Hot to touch with a rough texture, expanding red rash with central
clearing.
o Common Locations: Belt line, axillary area, behind the knees, and groin area.
Common Dermatological Conditions
Skin Cancer
Basal Cell Carcinoma (BCC)
Prevalence: Most common type of skin cancer overall and in the USA.
Symptoms: Appearance varies; typically a smooth, shiny bump, pink to pearly white.
Common Locations: Cheeks, nose, face, neck, arms, and back.
Diagnosis (Gold Standard): Biopsy. If not feasible, refer to dermatology.
Actinic Keratosis (AK)
Significance: Precursor to squamous cell carcinoma.
Symptoms: Numerous dry, round, and pink to red lesions with a rough and scaly texture.
o Does not heal.
o Slow-growing in sun-exposed areas.
Diagnosis (Gold Standard): Biopsy. If not feasible, refer to dermatology.
Treatment (Gold Standard):
o Small lesions: Cryotherapy.
o Numerous lesions: 5-FU (5-fluorouracil), also known as Efudex.
Important Note: 5-FU causes skin to ooze, crust, scab, and become red. Wear
sunscreen diligently!
Squamous Cell Carcinoma (SCC)
Symptoms: Chronic red, scaly, rough-textured lesion with irregular borders. Crusting or
bleeding may be present.
Common Locations: Rims of ears, lips, nose, face, and top of hands.
Precursor Lesion: Actinic keratosis.
Diagnosis (Gold Standard): Biopsy. If not feasible, refer to dermatology.
Risk Factors for Skin Cancer (Melanoma and Non-Melanoma)
Blistering sunburn as a child.
History of sunburns.
Light skin.
Chronic exposure to UV light (sunlight/tanning beds).
Presence of moles.
Family history of skin cancer.
,Melanoma
Symptoms (ABCDE):
o Asymmetry: Uneven shape or texture.
o Border: Irregular, notched, or blurred.
o Color: Variegated colors (black, blue, dark to light brown).
o Diameter: Size greater than 6 mm (size of a pencil eraser or larger).
o Evolving: Changes in color, size, or shape; may be itchy.
Acral Lentiginous Melanoma
Prevalence: Most common type of melanoma in dark-skinned individuals (Blacks & Asians).
Key Features: Look for longitudinal brown to black bands under the nailbed. Also consider
changing spots or moles on the palms or soles of the feet.
Seborrheic Keratosis
Symptoms: Soft, round, wart-like growth, light tan to black, appearing "pasted on."
Significance: Asymptomatic and benign.
Infectious Skin Conditions
Bacterial Meningitis
Causative Bacteria:
o Streptococcus pneumoniae: Most common strain.
o Haemophilus influenzae.
o Neisseria meningitidis.
o Escherichia coli.
o Other bacteria.
Symptoms (Classic Triad):
o High fever.
o Nuchal rigidity (stiff neck).
o Rapid change in mental status with headache.
o Erythematous spot-like rash (petechiae) or ecchymosis to purple-colored lesions
(purpura) which are non-blanchable.
Reportable Disease: Yes!
Treatment - Patient:
o IV antibiotics ASAP.
o Respiratory/droplet isolation for the first 24-48 hours.
o Hydration (low maintenance after initial fluid correction).
o Maintain ventilation and reduce increased intracranial pressure if present (dexamethasone,
mannitol).
, o Low stimulation environment.
o Treat complications and support family.
Treatment - Close Contacts:
o Treat with rifampin 600 mg q 12 hours x 2 days.
o Important Notes: Rifampin changes urine color to reddish-orange and can stain contacts.
Avoid rifampin in pregnancy.
Signs of Meningeal Irritation:
o Brudzinski's Sign: Patient supine, raise the back of the head and flex chin towards chest.
Positive if patient automatically bends both hips.
o Kernig's Sign: Patient supine, flex hips and knees to 90 degrees, then slowly
straighten/extend the legs. Positive if patient complains of pain during leg extension.
Meningococcal Vaccine (MCV4):
o Age 11-19: One dose of Menactra or Menveo. If primary dose given at age 12 or younger,
give a booster at age 16-18.
o Age 19-21: One dose of Menactra or Menveo if never vaccinated.
Rocky Mountain Spotted Fever (RMSF)
Symptoms:
o Fever, chills, nausea, vomiting, myalgia, arthralgia.
o Rash (2-5 days later): Petechial rash on forearms, ankles, and wrists, spreading towards
the trunk and becoming generalized. May develop on palms and soles. Rash develops
inwards.
Mnemonic (RMSF):
o Rash
o Muscle aches (myalgia)
o Stomach aches (nausea and vomiting)
o Fever (>102°F)
Geographic Location: North Carolina, Oklahoma, Arkansas, Tennessee, Missouri.
Season: Spring to Fall (April to September).
Diagnosis: PCR assay or indirect immunofluorescence antibody (IFA) assay for immunoglobulin
G (IgG) for Rickettsia rickettsii.
Treatment: Doxycycline 100 mg every 12 hours x 7-10 days is always first-line for all ages.
Can be fatal if not treated within the first 5 days.
Erythema Migrans (Early Lyme Disease)
Symptoms:
o Usually appears 7-14 days after a deer tick bite (range 3-30 days).
o Target bull's-eye rash: Hot to touch with a rough texture, expanding red rash with central
clearing.
o Common Locations: Belt line, axillary area, behind the knees, and groin area.
