Advanced Practice Education Associates (APEA) 3P Comprehensive
Certification Exam – Complete High-Stakes Study and
Practice Guide | 100% Verified Questions with Detailed Answers &
Rationales Covering Advanced Pathophysiology, Pharmacology, and
Physical Assessment (3P) for Nurse Practitioner (NP) Board Exam
Mastery
APEA 3P Exam
Most Common Type of Skin Cancer in the USA
Answer: Basal Cell Carcinoma
Rationale: Basal cell carcinoma (BCC) accounts for ~80% of all skin cancers in the U.S. It
arises from basal cells in the epidermis due to chronic UV exposure. It grows slowly and rarely
metastasizes, making it less deadly but still destructive locally.
Basal Cell Carcinoma (BCC) – Symptoms
Answer: Appearance varies; smooth, shiny bump, pink to pearly white
Rationale: The typical presentation is a pearly or waxy nodule with visible telangiectasia (small
blood vessels). Over time, the lesion may ulcerate or bleed (“rodent ulcer”).
Basal Cell Carcinoma – Common Locations
Answer: Cheeks, nose, face, neck, arms, back
Rationale: BCC develops in areas of chronic sun exposure—especially on the face and upper
body, where UV light damages DNA in basal cells.
Basal Cell Carcinoma – Gold Standard Diagnosis
Answer: Biopsy (refer to dermatology if not an option)
Rationale: A skin biopsy provides histologic confirmation by identifying nests of basaloid cells.
Referral ensures accurate diagnosis and treatment.
,Actinic Keratosis
Answer: Precursor to squamous cell carcinoma
Rationale: Chronic UV exposure causes dysplasia of keratinocytes, leading to actinic keratosis
(AK), which may progress to squamous cell carcinoma (SCC) if untreated.
Actinic Keratosis – Classic Appearance
Answer: Numerous dry, round, pink to red lesions with rough, scaly texture; slow-growing, non-
healing
Rationale: AK lesions often feel like sandpaper. Persistent non-healing lesions on sun-exposed
areas should raise concern for precancerous changes.
Actinic Keratosis – Gold Standard Diagnosis
Answer: Biopsy (refer to dermatology if not possible)
Rationale: A biopsy confirms keratinocyte atypia confined to the epidermis, distinguishing AK
from early invasive SCC.
Actinic Keratosis – Gold Standard Treatment
Answer:
Small lesions → Cryotherapy
Large/multiple lesions → Topical 5-Fluorouracil (5-FU / Efudex)
Rationale: 5-FU destroys precancerous cells by inhibiting DNA synthesis. The resulting
redness, crusting, and oozing indicate effective treatment. Sunscreen use is critical to
prevent recurrence.
Squamous Cell Carcinoma (SCC)
Answer: Chronic red, scaly, rough lesion with irregular borders, sometimes crusting or bleeding
Rationale: SCC arises from keratinocytes in the epidermis and can invade deeper tissues, unlike
AK. Lesions may ulcerate or become painful.
Squamous Cell Carcinoma – Common Locations
,Answer: Rims of ears, lips, nose, face, top of hands
Rationale: These sun-exposed areas are prone to UV-induced mutations leading to SCC
formation.
Precursor Lesion to SCC
Answer: Actinic keratosis
Rationale: Approximately 10% of untreated AK lesions may progress to SCC, emphasizing
early detection and management.
Squamous Cell Carcinoma – Gold Standard Diagnosis
Answer: Biopsy (refer to dermatology if not possible)
Rationale: Biopsy identifies keratin pearls and atypical squamous cells invading the dermis.
Risk Factors for Skin Cancer (Melanoma & Non-Melanoma)
Answer: Blistering sunburns in childhood, fair skin, chronic UV exposure, moles, family history
of skin cancer
Rationale: UV-induced DNA mutations accumulate over time, especially in individuals with fair
skin or genetic susceptibility.
Melanoma – ABCDE Symptoms
Answer:
A: Asymmetry
B: Border irregularity
C: Color variation
D: Diameter >6 mm
E: Evolution (change in size/shape/color)
Rationale: These features indicate malignant transformation of melanocytes. Early
recognition is critical because melanoma metastasizes quickly.
Acral Lentiginous Melanoma
, Answer: Most common melanoma in dark-skinned individuals (Black & Asian populations);
found on palms, soles, or under nails
Rationale: Unlike other melanomas linked to UV exposure, this variant occurs in less pigmented
areas. Longitudinal dark streaks under nails warrant biopsy.
Seborrheic Keratosis
Answer: Soft, round, “pasted-on” wart-like growth, tan to black, benign
Rationale: Common in older adults. Although harmless, it may mimic melanoma, so suspicious
lesions should be biopsied.
Bacterial Meningitis Overview
Most Common Bacteria
Answer: Streptococcus pneumoniae, Haemophilus influenzae, Neisseria meningitidis, E. coli
Rationale: These organisms are the leading pathogens across age groups. S. pneumoniae is most
common in adults; N. meningitidis often causes outbreaks.
Classic Triad of Bacterial Meningitis
Answer: High fever, nuchal rigidity (neck stiffness), rapid mental status change with headache
Rationale: Inflammation of meninges increases intracranial pressure and irritates nerves,
producing neck stiffness and altered mentation.
Characteristic Rash
Answer: Erythematous petechiae or purpura that are non-blanchable
Rationale: N. meningitidis releases endotoxins that damage capillaries, causing petechial or
purpuric rash — a medical emergency.
Is Bacterial Meningitis Reportable?
Certification Exam – Complete High-Stakes Study and
Practice Guide | 100% Verified Questions with Detailed Answers &
Rationales Covering Advanced Pathophysiology, Pharmacology, and
Physical Assessment (3P) for Nurse Practitioner (NP) Board Exam
Mastery
APEA 3P Exam
Most Common Type of Skin Cancer in the USA
Answer: Basal Cell Carcinoma
Rationale: Basal cell carcinoma (BCC) accounts for ~80% of all skin cancers in the U.S. It
arises from basal cells in the epidermis due to chronic UV exposure. It grows slowly and rarely
metastasizes, making it less deadly but still destructive locally.
Basal Cell Carcinoma (BCC) – Symptoms
Answer: Appearance varies; smooth, shiny bump, pink to pearly white
Rationale: The typical presentation is a pearly or waxy nodule with visible telangiectasia (small
blood vessels). Over time, the lesion may ulcerate or bleed (“rodent ulcer”).
Basal Cell Carcinoma – Common Locations
Answer: Cheeks, nose, face, neck, arms, back
Rationale: BCC develops in areas of chronic sun exposure—especially on the face and upper
body, where UV light damages DNA in basal cells.
Basal Cell Carcinoma – Gold Standard Diagnosis
Answer: Biopsy (refer to dermatology if not an option)
Rationale: A skin biopsy provides histologic confirmation by identifying nests of basaloid cells.
Referral ensures accurate diagnosis and treatment.
,Actinic Keratosis
Answer: Precursor to squamous cell carcinoma
Rationale: Chronic UV exposure causes dysplasia of keratinocytes, leading to actinic keratosis
(AK), which may progress to squamous cell carcinoma (SCC) if untreated.
Actinic Keratosis – Classic Appearance
Answer: Numerous dry, round, pink to red lesions with rough, scaly texture; slow-growing, non-
healing
Rationale: AK lesions often feel like sandpaper. Persistent non-healing lesions on sun-exposed
areas should raise concern for precancerous changes.
Actinic Keratosis – Gold Standard Diagnosis
Answer: Biopsy (refer to dermatology if not possible)
Rationale: A biopsy confirms keratinocyte atypia confined to the epidermis, distinguishing AK
from early invasive SCC.
Actinic Keratosis – Gold Standard Treatment
Answer:
Small lesions → Cryotherapy
Large/multiple lesions → Topical 5-Fluorouracil (5-FU / Efudex)
Rationale: 5-FU destroys precancerous cells by inhibiting DNA synthesis. The resulting
redness, crusting, and oozing indicate effective treatment. Sunscreen use is critical to
prevent recurrence.
Squamous Cell Carcinoma (SCC)
Answer: Chronic red, scaly, rough lesion with irregular borders, sometimes crusting or bleeding
Rationale: SCC arises from keratinocytes in the epidermis and can invade deeper tissues, unlike
AK. Lesions may ulcerate or become painful.
Squamous Cell Carcinoma – Common Locations
,Answer: Rims of ears, lips, nose, face, top of hands
Rationale: These sun-exposed areas are prone to UV-induced mutations leading to SCC
formation.
Precursor Lesion to SCC
Answer: Actinic keratosis
Rationale: Approximately 10% of untreated AK lesions may progress to SCC, emphasizing
early detection and management.
Squamous Cell Carcinoma – Gold Standard Diagnosis
Answer: Biopsy (refer to dermatology if not possible)
Rationale: Biopsy identifies keratin pearls and atypical squamous cells invading the dermis.
Risk Factors for Skin Cancer (Melanoma & Non-Melanoma)
Answer: Blistering sunburns in childhood, fair skin, chronic UV exposure, moles, family history
of skin cancer
Rationale: UV-induced DNA mutations accumulate over time, especially in individuals with fair
skin or genetic susceptibility.
Melanoma – ABCDE Symptoms
Answer:
A: Asymmetry
B: Border irregularity
C: Color variation
D: Diameter >6 mm
E: Evolution (change in size/shape/color)
Rationale: These features indicate malignant transformation of melanocytes. Early
recognition is critical because melanoma metastasizes quickly.
Acral Lentiginous Melanoma
, Answer: Most common melanoma in dark-skinned individuals (Black & Asian populations);
found on palms, soles, or under nails
Rationale: Unlike other melanomas linked to UV exposure, this variant occurs in less pigmented
areas. Longitudinal dark streaks under nails warrant biopsy.
Seborrheic Keratosis
Answer: Soft, round, “pasted-on” wart-like growth, tan to black, benign
Rationale: Common in older adults. Although harmless, it may mimic melanoma, so suspicious
lesions should be biopsied.
Bacterial Meningitis Overview
Most Common Bacteria
Answer: Streptococcus pneumoniae, Haemophilus influenzae, Neisseria meningitidis, E. coli
Rationale: These organisms are the leading pathogens across age groups. S. pneumoniae is most
common in adults; N. meningitidis often causes outbreaks.
Classic Triad of Bacterial Meningitis
Answer: High fever, nuchal rigidity (neck stiffness), rapid mental status change with headache
Rationale: Inflammation of meninges increases intracranial pressure and irritates nerves,
producing neck stiffness and altered mentation.
Characteristic Rash
Answer: Erythematous petechiae or purpura that are non-blanchable
Rationale: N. meningitidis releases endotoxins that damage capillaries, causing petechial or
purpuric rash — a medical emergency.
Is Bacterial Meningitis Reportable?
