APEA 3P / APEA 3P Exam | Comprehensive
Practice Questions & High-Yield Board Review
Most common type of skin cancer in USA - ANSWER-Skin cancer
Most common type of skin cancer - ANSWER-basal cell carcinoma
basal cell carcinoma symptoms - ANSWER-Appearance varies; smooth, shiny bump, pink to pearly
white
Basal cell carcinoma common locations - ANSWER-cheeks, nose, face, neck, arms, back
basal cell carcinoma diagnosis gold standard - ANSWER-biopsy. if not an option, refer to derm
Actinic keratosis - ANSWER-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 - ANSWER-Biopsy.
if not an option, refer to derm
Actinic keratosis treatment gold standard - ANSWER-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 - ANSWER-chronic red scaly rough textured lesion w/ irregular borders
crusting or bleeding may be present
Squamous cell carcinoma common locations - ANSWER-rims of ears, lips, nose, face and top of hands
precursor lesion to squamous cell cancer - ANSWER-actinic keratosis
squamous cell carcinoma diagnosis by? - ANSWER-biopsy gold standard. if biopsy is not an option,
refer to dermatology .
1
,Risk factors for skin cancer(melanoma and both non-melanoma) - ANSWER-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) - ANSWER-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 - ANSWER-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 - ANSWER-soft, round, wart-like growth that is light tan to black and looks pasted
on
asymptomatic &benign
Bacterial Meningitis Bacteria - ANSWER-Streptococcus pneumoniae- most common strain
Haemophilus influenzae
Neisseria meningitidis
Escherichia coli
*others
Bacterial meningitis symptoms (Classic Triad) - ANSWER-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 - ANSWER-yes!
Treatment for Bacterial meningitis-patient - ANSWER-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 - ANSWER-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) - ANSWER-Tests for meningeal irritation
2
, 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 - ANSWER-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 - ANSWER-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 - ANSWER-Give one dose of menactra or menveo if never
had either
Rocky mountain spotted fever (RMSF) symptoms - ANSWER-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) - ANSWER-R-Rash
M-Muscle aches (myalgia)
S-Stomach aches (nausea and vomiting)
F-Fever (>102 F)
Rocky Mountain Spotted Fever (RMSF): Located: - ANSWER-•Think "Rocky"- North Carolina,
Oklahoma, Arkansas, Tennessee, Missouri
Spring to Fall (April to September)
Rocky Mountain Spotted Fever (RMSF): DX - ANSWER-PCR assay by indirect immunofluorescence
antibody (IFA) assay for immunoglobulin G (IgG) for Rickettsia Rickettsii
Rocky Mountain Spotted Fever (RMSF): tx - ANSWER-Doxycycline is always first line for all ages
100 mg every 12 hours x 7-10 days
Can be fatal if not treated within the first 5 days
Erythema Migrans (early Lyme disease): Symptoms - ANSWER-Usually appears in 7-14 days after
being bitten by a deer tick; range 3-30 days
Target bull's-eye Rash is hot to touch with rough texture. Expanding red rash with central clearing •
Common locations are belt line, axillary area, behind the knees, and groin area • Positive for flu like
symptoms. Lesions and rash resolve within a few weeks with or without treatment
3
Practice Questions & High-Yield Board Review
Most common type of skin cancer in USA - ANSWER-Skin cancer
Most common type of skin cancer - ANSWER-basal cell carcinoma
basal cell carcinoma symptoms - ANSWER-Appearance varies; smooth, shiny bump, pink to pearly
white
Basal cell carcinoma common locations - ANSWER-cheeks, nose, face, neck, arms, back
basal cell carcinoma diagnosis gold standard - ANSWER-biopsy. if not an option, refer to derm
Actinic keratosis - ANSWER-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 - ANSWER-Biopsy.
if not an option, refer to derm
Actinic keratosis treatment gold standard - ANSWER-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 - ANSWER-chronic red scaly rough textured lesion w/ irregular borders
crusting or bleeding may be present
Squamous cell carcinoma common locations - ANSWER-rims of ears, lips, nose, face and top of hands
precursor lesion to squamous cell cancer - ANSWER-actinic keratosis
squamous cell carcinoma diagnosis by? - ANSWER-biopsy gold standard. if biopsy is not an option,
refer to dermatology .
1
,Risk factors for skin cancer(melanoma and both non-melanoma) - ANSWER-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) - ANSWER-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 - ANSWER-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 - ANSWER-soft, round, wart-like growth that is light tan to black and looks pasted
on
asymptomatic &benign
Bacterial Meningitis Bacteria - ANSWER-Streptococcus pneumoniae- most common strain
Haemophilus influenzae
Neisseria meningitidis
Escherichia coli
*others
Bacterial meningitis symptoms (Classic Triad) - ANSWER-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 - ANSWER-yes!
Treatment for Bacterial meningitis-patient - ANSWER-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 - ANSWER-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) - ANSWER-Tests for meningeal irritation
2
, 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 - ANSWER-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 - ANSWER-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 - ANSWER-Give one dose of menactra or menveo if never
had either
Rocky mountain spotted fever (RMSF) symptoms - ANSWER-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) - ANSWER-R-Rash
M-Muscle aches (myalgia)
S-Stomach aches (nausea and vomiting)
F-Fever (>102 F)
Rocky Mountain Spotted Fever (RMSF): Located: - ANSWER-•Think "Rocky"- North Carolina,
Oklahoma, Arkansas, Tennessee, Missouri
Spring to Fall (April to September)
Rocky Mountain Spotted Fever (RMSF): DX - ANSWER-PCR assay by indirect immunofluorescence
antibody (IFA) assay for immunoglobulin G (IgG) for Rickettsia Rickettsii
Rocky Mountain Spotted Fever (RMSF): tx - ANSWER-Doxycycline is always first line for all ages
100 mg every 12 hours x 7-10 days
Can be fatal if not treated within the first 5 days
Erythema Migrans (early Lyme disease): Symptoms - ANSWER-Usually appears in 7-14 days after
being bitten by a deer tick; range 3-30 days
Target bull's-eye Rash is hot to touch with rough texture. Expanding red rash with central clearing •
Common locations are belt line, axillary area, behind the knees, and groin area • Positive for flu like
symptoms. Lesions and rash resolve within a few weeks with or without treatment
3
