APEA 3P Exam (PMHNP 3P Exam Prep) Questions with Accurate Answers, Exams of Public Health

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APEA 3P EXAM(PMHNP 3P EXAM PREP) QUESTIONS

WITH ACCURATE ANSWERS

Most common type of skin cancer in USA Accurate Answer - Skin cancer Most common type of skin cancer Accurate Answer - basal cell carcinoma basal cell carcinoma symptoms Accurate Answer - Appearance varies; smooth, shiny bump, pink to pearly white Basal cell carcinoma common locations Accurate Answer - cheeks, nose, face, neck, arms, back basal cell carcinoma diagnosis gold standard Accurate Answer - biopsy. if not an option, refer to derm Actinic keratosis Accurate 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 Accurate Answer - Biopsy. if not an option, refer to derm Actinic keratosis treatment gold standard Accurate 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 Accurate Answer - chronic red scaly rough textured lesion w/ irregular borders crusting or bleeding may be present Squamous cell carcinoma common locations Accurate Answer - rims of ears, lips, nose, face and top of hands

precursor lesion to squamous cell cancer Accurate Answer - actinic keratosis squamous cell carcinoma diagnosis by? Accurate Answer - biopsy gold standard. if biopsy is not an option, refer to dermatology. Risk factors for skin cancer(melanoma and both non-melanoma) Accurate 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) Accurate 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 Accurate 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 Accurate Answer - soft, round, wart-like growth that is light tan to black and looks pasted on asymptomatic &benign Bacterial Meningitis Bacteria Accurate Answer - Streptococcus pneumoniae- most common strain Haemophilus influenzae Neisseria meningitidis Escherichia coli *others Bacterial meningitis symptoms (Classic Triad) Accurate Answer - High fever Nuchal rigidity

Rocky mountain spotted fever (RMSF) symptoms Accurate 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) Accurate Answer - R-Rash M-Muscle aches (myalgia) S-Stomach aches (nausea and vomiting) F-Fever (>102 F) Rocky Mountain Spotted Fever (RMSF): Located: Accurate Answer - •Think "Rocky"- North Carolina, Oklahoma, Arkansas, Tennessee, Missouri Spring to Fall (April to September) Rocky Mountain Spotted Fever (RMSF): DX Accurate Answer - PCR assay by indirect immunofluorescence antibody (IFA) assay for immunoglobulin G (IgG) for Rickettsia Rickettsii Rocky Mountain Spotted Fever (RMSF): tx Accurate 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 Accurate 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 Erythema Migrans (early Lyme disease): DX Accurate Answer - Dx: • First step is enzyme immunoassay (EIA) also knows as ELISA if negative no

further testing needed. If positive confirm with Western Blot test (aka indirect immunofluorescence assay (IFA) for Borrelia Burgdorferi

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 Accurate Answer - 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 Accurate Answer - DEET Tick repellant clothing use Accurate Answer - Permethrin Brown Recluse Spider Bite: SX Accurate Answer - • 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 Accurate Answer - 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 Accurate Answer - primary skin lesions Macule Vesicle Papule MVP Size: <1 CM Macule Accurate Answer - Flat, nonpalpable, but visually distinct areas on the skin surface with color different from the person's normal skin; less than 1 cm FRECKLE

Secondary skin condition-keloids/hypertrophic scars Accurate Answer

• overgrowth of scar tissue (more common in Black and Asian descent) Rule of 9's Accurate Answer - Head and neck = 9% Upper Ex = 9% each Lower Ex = 9% each Front trunk = 18% Back trunk = 18% Rule of 9's =-child leg Accurate Answer - Chlid one leg=13.5% One leg adult =18% Rule of 9's =child head Accurate Answer - Child head- 18% (half of adult %) First degree (superficial): Accurate Answer - Red to bright red skin and tenderness/pain second-degree (partial-thickness) burns Accurate Answer - Painful red skin, bullae (blisters), reddened/weepy skin --> BLISTERS START AT SECOND DEGREE third-degree (full-thickness) burns Accurate Answer - Pain sensation absent. Pale/white color, charred skin, leather-like texture Criteria for Burn Center Referral: Accurate Answer - 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? Accurate Answer - Bacitracin, Polysporin/Triple antibiotic cream or ointment Cellulitis Accurate Answer - Bacteria (Gram Positive): Streptococcus (beta hemolytic strep), Staph aureus (MRSA) Cellulitis Symptoms: Accurate Answer - 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 Accurate Answer - 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- 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: Accurate Answer - Bacteria: Group A Streptococcus Located: • Involves upper dermis and superficial lymphatics • Found on the cheeks and shins Erysipelas: Symptoms Accurate Answer - Symptoms: • Bright red plaque or induration with sharp or elevated margins on the face or lower legs

• If fever and chills present pt. is septic (hospitalization is recommended) Erysipelas: Treatment Accurate Answer - If treating facial erysipelas assume MRSA is present. Use appropriate antibiotics or refer to ER if septic Dicloxacillin QID, Cephalexin or Clindamycin x 10 days If allergic to Penicillin: Azithromycin (Z-Pack x 5 days) MRSA: Treatment Accurate Answer - Bactrim Doxycycline Minocycline Clindamycin --> If patient is allergic to Sulfa do not use Bactrim Human bites Accurate Answer - "Dirtiest" bite of all. Watch for closed- fist injuries of the hands (may involve joint capsule and tendon damage). Eikenella corrodens & numerous bacteria may be involved

Severe Case= Keflex or Dicloxacillin QID x 10 days Penicillin Allergy o Give Azithromycin 250 mg x 5 days or o Clindamycin x 10 days **If no blisters- topical mupirocin ointment (bactroban) 2% x 10 days Acne Vulgaris (common acne): treatment Accurate Answer - First line is always topical retinoid such as tretinoin cream (Retin-A) Acne: Mild treatmetn Accurate Answer - open comedones blackheads/closed comedones (whiteheads) w/ or w/o papules topical retinoid (Retin-A) Acne will worsen during first 4-6 weeks IF no improvement in 8-12 weeks, increase dose or ADD benzoyl peroxide and/or erythromycin Acne: Moderate (topicals plus antibiotics) Accurate Answer - papules and pustules with comedones (3 part treatment) Topical retinoid (Retin-A) AND topical benzoyl peroxide AND oral antibiotic (Tetracycline or Minocycline) x 3-4 weeks --> Exam usually asks about moderate Acne: Severe Accurate Answer - painful indurated nodule, cysts, abscesses, pustules Accutane- check Liver function tests (LFTS) must use 2 forms of contraceptives, monthly pregnancy testing only prescribe 1 month supply of medication

Usually, will refer to Dermatology Topical retinoid side effects Accurate Answer - Irritation, dry skin, flaking, redness during first 4 weeks due to increase in skin turnover After washing face wait 30 minutes before applying medication to help minimize irritation Acne medications to avoid in pregnancy (category X &C) Accurate Answer - Category X: Topical tazarotene (Tazorac), Accutane Category C: Topical retinoids (tretinoin, adapalene) Acne Rosacea Accurate Answer - Symptoms: • Chronic small acne like papules/pustules, and telangiectasias around nose, mouth, and chin symmetrically Treatment: First line: o (Avoid triggers of flushing (EtOH, excessive sun, spicy foods) Metro gel or Azelex gel QD-BID Low dose Tetracycline 250 mg QID or doxycycline 100 mg QD if gel not effective or the patient has pustular/ocular rosacea Psoriasis Accurate Answer - Symptoms: • Inherited condition (atopy) Pruritic erythematous plaques Fine silvery-white scales with pitted fingernails Occurs on scalp, elbows, knees, sacrum, and intergluteal folds (extensor surfaces) Migratory arthritis Psoriasis treatment Accurate Answer - Treatment: • Topical steroids o Seven classes of steroids 10 o Avoid class I-III on children, and sensitive skin (face, groin, etc.) o Class I- super potent o Class VII least potent • Tar preps (mild cases) • Anti-TNF (severe cases) or immunologics o Methotrexate, cyclosporine, etanercept, adalimumab Koebner phenomenon: Accurate Answer - New psoriatic plaques form over skin trauma Auspitz sign: Accurate Answer - Pinpoint bleeding when plaques are removed

Herald patch appears 2 weeks before full breakout Christmas tree pattern Rash on the hands or soles of the feet Pityriasis Rosea: Treatment Accurate Answer - Resolves on its own in about 4-6 weeks Test for secondary syphilis with RPR then VDRL as screening • If positive then do FTA-ABS if this is positive patient has syphilis; treat appropriately Tinea Corporis (body-think of core): symptoms Accurate Answer - Ring like itchy rash, slowly enlarges with central clearing Tinea Corporis (body-think of core): Treatment Accurate Answer - Most respond to topical antifungals, if severe do oral Lamisil Med ends with azole on exam Tinea Capitis (scalp-think of baseball cap): symptoms &Treatment Accurate Answer - Scaly round itchy patches on the scalp. Hair becomes fragile at the roots and breaks (black dot sign) Treatment: Oral meds only (Griseofulvin, terbinafine, fluconazole, or itraconazole) Obtain baseline LFT and repeat in 2 weeks o Gold standard: § Griseofulvin QD-BID x 6-12 weeks Avoid hepatotoxic substances (alcohol, statins, acetaminophen) Avoid sharing combs, headgear, towels, pillows, and clothes with others Tinea Cruris (groin):symptoms and treatment Accurate Answer - Erythematous annular (ring-shaped) rash located in the groin area which can sometimes extend to buttocks Usually associated with tinea pedis Treatment: • Azole topical cream (Lamisil, Lotrimin, Monistat-Derm) x 7- days Tinea Pedis (Hands/Feet- think pedicure):symptoms and treatment Accurate Answer - Symptoms: • Scaling of the soles • Skin feels wet, strong

odor, vesicles and bullae that rupture • "Two feet and one hand" disease (dominant hand used for itching the feet becomes infected) Treatment: Azole topical cream (Lamisil, Lotrimin, Monistat-Derm) x 7- days Onychomycosis aka tinea unguium (fingernail or toenail fungus): Symptoms and treatment Accurate Answer - Symptoms: Elderly with yellow- colored nails Thickened nails with debris Treatment: Mild cases fingernails: o Topical Penlac Toenails: Systemic antifungals either 6 weeks or pulse therapy (once per week for 3- 4 cycles) Tinea Versicolor: Cause/symptom/treatmetn Accurate Answer - Cause: • Yeast Pityrosporum orbiculare or P. ovale Symptoms: • Multiple hypopigmented round macules on chest, shoulders, and/or back that appear after skin becomes tan from sun exposure Condition is asymptomatic • KOH slide will show hyphae and spores ("spaghetti and meatballs") Treatment: • Topical selenium sulfide and topical azole antifungals (Nizoral) or terbinafine (Lamisil) cream BID x 2 weeks • Hypopigmented spots may take several months to fill in Herpetic Whitlow (caused by herpes simplex): symptoms and treatment Accurate Answer - Symptoms: HSV 1 or HSV 2 infection Abrupt onset of small red papules/bumps which become vesicular Extremely painful, tingling, and burning sensation. Usually on index finger or thumb Treatment: Rest, elevation, and NSAIDs -As this is a self-limiting infection If recurrent or severe infection can prescribe oral acyclovir DO NOT chose topical acyclovir as an option because it's expensive and does not work well Varicella Zoster Virus (VZV): symptoms/lab/treatment Accurate Answer - Symptoms:

eye rash that occurs abruptly • Hives and blisters • Petechiae and purpura • Necrosis with sloughing of tissue • Extensive mucosal involvement • Prodrome of fever with flu like symptoms Stevens-Johnson Syndrome (SJS)/Toxic Epidermal Necrolysis (TEN): Triggers Accurate Answer - Mnemonic: SANA(p)

• Sulfonamides
• Anticonvulsants
• NSAIDs
• Allopurinol
• PCN HIV patients are at a higher risk for SJS & TEN Acanthosis Nigricans: symptoms Accurate Answer - Velvety hyperpigmented patches most common on back of neck or skin folds • Usually associated with diabetes, metabolic syndrome, obesity, and cancer of the GI tract Scarlet Fever (Scarlatina): Symptoms Accurate Answer - "Sandpaper textured-pink rash with sore throat" Strawberry tongue, rash starts on head and neck, spreads to trunk. The skin THEN desquamates (peels/sheds) Associated with strep throat Lichen Planus: symptoms & Treatment Accurate Answer - Symptoms: • Small flat topped, red to purple bumps that may have white scales/flakes • Wispy grey white streaks called Wickham's striae • Found on the inner wrists, forearms, and ankles. If on scalp causes hair loss • Can be found in vulva and vagina with soreness, burning, and rawness Treatment: Topical Steroids (even in vaginal area for Lichen Sclerosus) Anthrax: Symptoms & treatment Accurate Answer - Symptoms: Animals/hides/hair/wool Lesions begin as papules that enlarges quickly within 24-48 hrs. Develop necrosis and ulceration (sort of like a recluse spider bite) Not contagious

Treatment: Doxycycline, Cipro, or Levaquin BID x 7-10 days If you suspect BIOTERRORISM treat for 60 days Prophylaxis antibiotics are Cipro and Doxy Hidradenitis Suppurativa: Symptoms & Treatment Accurate Answer - Symptoms: Recurrent episodes of painful large and tender red nodules, abscesses, and pustules in the axilla (most common), groin, perianal, and inframammary Due to occlusion of the hair follicles and pilosebaceous glands (apocrine glands) Treatment: •Avoid skin trauma, wear loose light clothing, avoid excessive heat, and friction Smoking cessation, lose weight if obese Avoid deodorant Doxycycline QD to BID x several months Blepharitis (inflammation of the eyelids): Symptoms/treatment Accurate Answer - Symptoms: Bilateral red and swollen edges of eyelids May have fine scales More common with seborrheic dermatitis Treatment: Scrub eyelids in warm water and baby shampoo Pterygium (Surfer's eye): Symptoms/Treatment Accurate Answer - Symptoms: Triangular-shaped white to yellow superficial growth On nasal side Caused by long term UV damage Treatment: Surgical remove if it grows into the pupil Prevention: wear sunglasses Pinguecula (think of Ping-Pong): Symptoms/Treatment Accurate Answer - Symptoms: White to yellowish small round superficial lesion on each side of the cornea Caused by long-term UV damage

Treatment: PO (oral) antihistamines Eye drops olopatadine (Patanol), Visine (short term or episodic use only) Cool compresses and avoid allergens *May be called keratoconjunctivitis on ANCC Bacterial Conjunctivitis: Symptoms and treatment Accurate Answer - Symptoms: • Acute onset of red eye • Dried yellow-green crusting on eyelids on awakening Treatment: Topical ophthalmic fluroquinolones (Ofloxacin) Q 2-4 hours x 2 days, then QID x 5 days Viral Conjunctivitis (Pink Eye): Symptoms and treatment Accurate Answer - Symptoms: • Acute onset of red eye • Complaint of itchy eyes; one or both eyes • Periauricular lymphadenopathy 18 • Very contagious Treatment: No treatment; frequent hand washing Keep away from school for 1 week Herpes Keratitis: Cause, symptoms, DX, TX Accurate Answer - Cause: Herpes Simples Virus or Shingles (Herpes Zoster) Symptoms: Abrupt onset of eye PAIN, blurred vision, and tearing, Vesicles and/or small rash on the temple on affected side Follows the V1 branch (ophthalmic branch) of the trigeminal nerve (CN V) Dx: Fluorescein dye o Shows "fern-like" lesion Treatment: Ophthalmologist or ER STAT Corneal Abrasion: Symptoms & DX & treatment & alternative meds Accurate Answer - Symptoms: Acute onset of severe eye PAIN Abrasion is round/irregular Foreign body sensation Dx: Fluorescein dye. Will help rule out herpes keratitis Treatment: • Erythromycin ointment QID x 3-5 days

DO NOT PATCH THE EYE

Alternative Meds: Sulfacetamide 10% Ciprofloxacin or ofloxacin Acute Angle-Closure Glaucoma:symptoms and treatment Accurate Answer - Normal ICP: 8- Acute angle glaucoma ICP > Symptoms: Acute onset of severe eye PAIN Decreased/Blurred Vision • Frontal Headache Nausea/Vomiting Cloudy cornea Mid-dilated oval/ovoid shape pupil and in a fixed position Pupil does not respond to light Treatment: ER STAT TIP: Disc cupping is only seen with glaucoma which is caused by increased ICP Papilledema: Symptoms & Treatment Accurate Answer - Symptoms: Optic disc swollen with blurred edges due to increased ICP (normal 8-21) secondary to bleeding, brain tumor, pseudotumor cerebri, etc. Treatment: ER Primary Open Angle Glaucoma: Symptoms & Treatment Accurate Answer - Symptoms: Affects CNII Gradual changes in peripheral vision which is LOST FIRST, then central vision Treatment: Check IOP (use tonometer) if elevated should refer to ophthalmologist Medications: beta-blockers (timolol), topical prostaglandin eye drops (Xalatan) Avoid beta-blockers in patients who have asthma, emphysema, COPD, 2nd or 3rd degree heart block, and heart failure