APEA PMHNP 3P EXAM PREP QUESTIONS AND ANSWERS
1. Enzyme immunoassay
2. western blot test (immunoflurorescence assay/ IFA)
Exam Tip: E before I
Will have increased ESR
✔✔Erythema Migrans (early Lyme disease): TX - ✔✔Doxycycline is always first line for
all ages
100 mg BID x 10-21 days
Remove ticks by grasping with tweezers or forceps close to the skin and pulling gently
with steady pressure. After removing the tick, clean area with rubbing alcohol, iodine
scrub, or soap and water. Dispose of the tick by flushing it into the toilet
✔✔Tick repellant skin use - ✔✔DEET
✔✔Tick repellant clothing use - ✔✔Permethrin
✔✔Brown Recluse Spider Bite: SX - ✔✔• Fever, chills • Nausea and Vomiting • Located
in the arms, upper legs, or the trunk • Bitten area becomes swollen, red, and tender, or
can be painless • Blisters appear within 24-48 hours • Necrotic in center, which kills the
tissue
**can be painless
✔✔Brown Recluse Spider Bite treatment - ✔✔Treatment: • Ice packs to wound as the
cold inactivates the toxin • Treat like cellulitis of the skin • Antibiotic ointment at first and
watch
✔✔Skin lesions - ✔✔primary skin lesions
Macule Vesicle Papule MVP Size: <1 CM
,✔✔Macule - ✔✔Flat, nonpalpable, but visually distinct areas on the skin surface with
color different from the person's normal skin; less than 1 cm
FRECKLE
✔✔Vesicle - ✔✔elevated, raised lesion filled with serous fluid (herpetic lesions)
✔✔Papule - ✔✔palpable solid lesion (acne, moles)
✔✔primary skin lesions >1cm in size - ✔✔Nodule
Plaque
Bullae (Blister)
Pustule
Wheal
✔✔Nodule - ✔✔raised solid lesion (BCC)
✔✔Plaque - ✔✔solid raised lesion with flat top (psoriasis)
✔✔Bulla/Bullae - ✔✔elevated superficial blister filled with serous fluid (2nd degree burn,
impetigo)
✔✔Pustule - ✔✔circumscribed elevated lesion containing pus (acne pustules)
✔✔Secondary Skin Lesions-Lichenification - ✔✔thickening of the epidermis with
exaggeration of normal skin due to chronic skin itching (eczema)
✔✔Secondary skin lesions- Scale - ✔✔flaking skin (psoriasis)
✔✔Secondary skin condition-crust - ✔✔dried exudate (impetigo)
✔✔Secondary skin condition-ulceration - ✔✔eroding of epidermis and dermis (if deep
can involve subcutaneous tissue)
✔✔Secondary skin condition-scar - ✔✔permanent fibrotic change following damage to
dermis (surgical scars)
✔✔Secondary skin condition-keloids/hypertrophic scars - ✔✔overgrowth of scar tissue
(more common in Black and Asian descent)
✔✔Rule of 9's - ✔✔Head and neck = 9%
Upper Ex = 9% each
Lower Ex = 9% each
Front trunk = 18%
, Back trunk = 18%
✔✔Rule of 9's =-child leg - ✔✔Chlid one leg=13.5%
One leg adult =18%
✔✔Rule of 9's =child head - ✔✔Child head- 18% (half of adult %)
✔✔First degree (superficial): - ✔✔Red to bright red skin and tenderness/pain
✔✔second-degree (partial-thickness) burns - ✔✔Painful red skin, bullae (blisters),
reddened/weepy skin
--> BLISTERS START AT SECOND DEGREE
✔✔third-degree (full-thickness) burns - ✔✔Pain sensation absent. Pale/white color,
charred skin, leather-like texture
✔✔Criteria for Burn Center Referral: - ✔✔Face, hands, feet, genitals, major joints
Electrical burns, lightning burns
Partial thickness burns >10% of total body surface area
Third degree burns in any age group
✔✔If pt. has a Sulfa allergy and can't use Silvadene what is the alternative? -
✔✔Bacitracin, Polysporin/Triple antibiotic cream or ointment
✔✔Cellulitis - ✔✔Bacteria (Gram Positive):
Streptococcus (beta hemolytic strep), Staph aureus (MRSA)
✔✔Cellulitis Symptoms: - ✔✔Diffused pink to red colored skin, warm to touch, and may
become abscessed
If red streaks radiating from infection it has spread to lymph nodes (lymphangitis)
Usually within the deep dermis and is poorly demarcated (poor boundaries)
Most common location is the lower legs
-->If pt. has DM and develops cellulitis watch for osteomyelitis
✔✔Cellulitis treatment - ✔✔First line: Abscess/cellulitis is I&D (if <5 cm no PO antibiotic
needed) • Check for tetanus vaccine status
Nonpurulent: Cephalexin (Keflex) 500 mg or Dicloxacillin q 6 hours for 5-10 days
Purulent (MRSA): Wound culture o Follow up in 48 hours Bactrim BS BID x 10 days o If
you suspect osteomyelitis order an MRI
If allergic to Penicillin: Azithromycin (Z-Pack x 5 days)
✔✔Erysipelas: - ✔✔Bacteria: Group A Streptococcus
1. Enzyme immunoassay
2. western blot test (immunoflurorescence assay/ IFA)
Exam Tip: E before I
Will have increased ESR
✔✔Erythema Migrans (early Lyme disease): TX - ✔✔Doxycycline is always first line for
all ages
100 mg BID x 10-21 days
Remove ticks by grasping with tweezers or forceps close to the skin and pulling gently
with steady pressure. After removing the tick, clean area with rubbing alcohol, iodine
scrub, or soap and water. Dispose of the tick by flushing it into the toilet
✔✔Tick repellant skin use - ✔✔DEET
✔✔Tick repellant clothing use - ✔✔Permethrin
✔✔Brown Recluse Spider Bite: SX - ✔✔• Fever, chills • Nausea and Vomiting • Located
in the arms, upper legs, or the trunk • Bitten area becomes swollen, red, and tender, or
can be painless • Blisters appear within 24-48 hours • Necrotic in center, which kills the
tissue
**can be painless
✔✔Brown Recluse Spider Bite treatment - ✔✔Treatment: • Ice packs to wound as the
cold inactivates the toxin • Treat like cellulitis of the skin • Antibiotic ointment at first and
watch
✔✔Skin lesions - ✔✔primary skin lesions
Macule Vesicle Papule MVP Size: <1 CM
,✔✔Macule - ✔✔Flat, nonpalpable, but visually distinct areas on the skin surface with
color different from the person's normal skin; less than 1 cm
FRECKLE
✔✔Vesicle - ✔✔elevated, raised lesion filled with serous fluid (herpetic lesions)
✔✔Papule - ✔✔palpable solid lesion (acne, moles)
✔✔primary skin lesions >1cm in size - ✔✔Nodule
Plaque
Bullae (Blister)
Pustule
Wheal
✔✔Nodule - ✔✔raised solid lesion (BCC)
✔✔Plaque - ✔✔solid raised lesion with flat top (psoriasis)
✔✔Bulla/Bullae - ✔✔elevated superficial blister filled with serous fluid (2nd degree burn,
impetigo)
✔✔Pustule - ✔✔circumscribed elevated lesion containing pus (acne pustules)
✔✔Secondary Skin Lesions-Lichenification - ✔✔thickening of the epidermis with
exaggeration of normal skin due to chronic skin itching (eczema)
✔✔Secondary skin lesions- Scale - ✔✔flaking skin (psoriasis)
✔✔Secondary skin condition-crust - ✔✔dried exudate (impetigo)
✔✔Secondary skin condition-ulceration - ✔✔eroding of epidermis and dermis (if deep
can involve subcutaneous tissue)
✔✔Secondary skin condition-scar - ✔✔permanent fibrotic change following damage to
dermis (surgical scars)
✔✔Secondary skin condition-keloids/hypertrophic scars - ✔✔overgrowth of scar tissue
(more common in Black and Asian descent)
✔✔Rule of 9's - ✔✔Head and neck = 9%
Upper Ex = 9% each
Lower Ex = 9% each
Front trunk = 18%
, Back trunk = 18%
✔✔Rule of 9's =-child leg - ✔✔Chlid one leg=13.5%
One leg adult =18%
✔✔Rule of 9's =child head - ✔✔Child head- 18% (half of adult %)
✔✔First degree (superficial): - ✔✔Red to bright red skin and tenderness/pain
✔✔second-degree (partial-thickness) burns - ✔✔Painful red skin, bullae (blisters),
reddened/weepy skin
--> BLISTERS START AT SECOND DEGREE
✔✔third-degree (full-thickness) burns - ✔✔Pain sensation absent. Pale/white color,
charred skin, leather-like texture
✔✔Criteria for Burn Center Referral: - ✔✔Face, hands, feet, genitals, major joints
Electrical burns, lightning burns
Partial thickness burns >10% of total body surface area
Third degree burns in any age group
✔✔If pt. has a Sulfa allergy and can't use Silvadene what is the alternative? -
✔✔Bacitracin, Polysporin/Triple antibiotic cream or ointment
✔✔Cellulitis - ✔✔Bacteria (Gram Positive):
Streptococcus (beta hemolytic strep), Staph aureus (MRSA)
✔✔Cellulitis Symptoms: - ✔✔Diffused pink to red colored skin, warm to touch, and may
become abscessed
If red streaks radiating from infection it has spread to lymph nodes (lymphangitis)
Usually within the deep dermis and is poorly demarcated (poor boundaries)
Most common location is the lower legs
-->If pt. has DM and develops cellulitis watch for osteomyelitis
✔✔Cellulitis treatment - ✔✔First line: Abscess/cellulitis is I&D (if <5 cm no PO antibiotic
needed) • Check for tetanus vaccine status
Nonpurulent: Cephalexin (Keflex) 500 mg or Dicloxacillin q 6 hours for 5-10 days
Purulent (MRSA): Wound culture o Follow up in 48 hours Bactrim BS BID x 10 days o If
you suspect osteomyelitis order an MRI
If allergic to Penicillin: Azithromycin (Z-Pack x 5 days)
✔✔Erysipelas: - ✔✔Bacteria: Group A Streptococcus
