NR 603 Week 4 APEA Predictor Exam;
(Board Examination Review)
Question that I was able to remember
• Basal Cell Cancer: Question description and the fact that it doesn’t have any
tx (Hints: Waxy, pearly, telangiectasia, ulcer center lesion
Basal cell- most prevalent skin cancer, pearly domed nodule with
overlying telangiectatic vessels, maybe plaque, maybe papule, may
see central ulceration and crusting, deepest layer of the epidermis, Dx
gold standard biopsy, TX chemo or immunotherapy
• Actinic Keratosis: Question about description (Scaly red to yellow located
in sun exposed area: precancerous
Actinic keratosis- rough flat, dry, crusty, erythematous papules or
plaques, scaly patch of red or brown skin caused by years of sun exposure,
evolving carcinoma, precursor to squamous cell carcinoma, Dx biopsy,
refer to dermatology, TX topical 5 fluoracil 5-FU, cryotherapy,
• Melanoma question: Know ABCDE
ABCDE- asymmetry, border is irregular, color variegation, diameter .6mm
size greater than pencil eraser, elevation above skin level
• Squamous cell- skin cancer develops in the outer layer of the skin, lower lip
common location, nodule, indistinct margins, surface is firm, scaly, irregular, and
may bleed easily, may metastasize
• Postherpetic neuralgia PHN- prophylaxis is TCA-Elavil Shingles
• Cellulitis- deep tissue, gram positive, gradual course over days, TX PCN,
macrolide
• Erysipelas-(strept infection)- acute onset, well demarcated and above the skin,
TX pcn or macrolide
• MRSA- TX Bactrim or tetracyclines
• Papule – solid elevated mass up to 1 cm
• Macule- flat small like a freckle
• Vesicle – filled with serous fluid and less than 1 cm
• Bullae- fluid filled and larger than 1 cm, can be found with 2nd degreeburns
• Xerosis- dry skin, use petroleum-based product, not lotions
• Psoriasis- pruritic erythematous plaque covered with fine silvery white scales,
scalp and elbows TX topical steroids
• Shingles- chicken pox, reactivation of varicella zoster virus involves single
dermatome, less likely several dermatomes, finding prodrome- itching burning
photophobia fever headache malaise, acute phase dermatomal rash 3-4 days,
unilateral, pain, possible severe, macupapular rash progresses to vesicles then
pustules 3-4 days, may appear for a week, convalescent phase- 2-3 week rash
resolves, pain Dx viral culture, polymerase chain reaction PCR, TX acyclovir,
zostrix cream, gabapentin amitriptyline
,• Varicella: Chicken pox, starts on the FACE, spreads to trunk, arms and scalp.
Prodrome of fever, pharyngitis, malaise., followed by 24, eruption of puritic
vesicular lesions. Exanthem, erthematous puritic maculars develop to papules and
fluid filled vesicles”drewdrops on a rose petal” Hairline and spread
• Shingles: herpes zoster: varicella virus infection: elderly. One dermatone
• Spider bite- TX abx on wound, cold packs nsaids
• Dog bite- treat with analgesia (Tylenol, nsaids, Demerol),
Augmentin/doxycycline/Bactrim, wound cleaning with soap and water,
betadine, local anesthesia (lidocaine), irrigated with 2000ml normal saline,
betadine, wound debridement, facial bites should be closed with sutures only,
pack wound, tetanus immunization, antibiotic therapy,
• Lyme disease- erythema migrans, (Borrelia burgdorferi) bulls eye rash, start
within 72 hours of exposure, TX with doxycycline or amoxicillin, or azithromycin
Dx two step test EIA and then western blot
• Lupus- multisystem autoimmune disease, characterized by remission and
exacerbations, affects organs, skin kidney, heart, and blood vessels, face butterfly
rash, avoid sunlight exposure, photosensitivity TX refer to rheumatologist, topical
and oral steroids, avoid sun and cover skin Less seen in Caucasians
• Pityriasis rosea- exanthem, Christmas tree pattern rash, herald patch, normally
on trunk, and limbs, oval erythematous-squamous scaly lesion. Pityriasis=bran,
rosea=pink, last 5weeks
• Anthrax-bacterial infection, from animals, spores inhaled, caused dark scabs
difficult to breath. TX doxycycline/ fluoroquinolones (Cipro)
• Tinea versicolor- trunk and extremities sun spots, lighten areas over
darker skin
• Tinea corporis-(ringworm) arms/legs or body, fungal, Tx: mupirocin ointment
• Tinea cruris- jock itch
• Tinea capitas- skin or scalp
• Tinea pedis-athletes foot
• Psoriasis- cause pitting in finger nails
• Erthema Multiforme- Bulls Eye Rash.Infection. erythematous macule evolves
into a papuleSX: skin, mouth lesions that ave pink-red center surrounded by pale
ring border, can be painful and puritic. Hands. Bulla on lips vesicle filled large
lesions, Causes:herpes simplex, or sulfa drugs.seborrhe
• Subungal Hematoma tx: Make a hole and drain the blood
• A subungual hematoma is a collection of blood (hematoma) underneath a
toenail or fingernail (black toenail). It can be extremely painful for an injury of its
size, although otherwise it is not a serious medical condition. TX make hole and
drain the blood (trephination)
, • Tx for moderate acne
Moderate acne- TX oral abx + topical retinoid +/- benzoyl peroxide
(tetracycline + tazarotene +/- Benz Pero Retin topical, oral tetracycline
then Accutane (isotretinoin)
• Left Ventricle Failure: SX; crackles bibasilar rales, cough, dyspnea, orthopnea,
• Right Ventricle Failure: Jugular Vein Distention JVD) enlarged spleen, and
liver, anorexia, nausea, abdominal px., lower extremity edema and cool. S3
gallop.
• Know Systolic and Diastolic Murmur (MR. ASS & MS. ARD). Mr. ASS
question was asked about heart murmur with high pitch holosystolic and
the other one is mid systolic.
• Systolic murmurs (audible between 1st and 2nd heart sound)
MR/mitral regurg (high pitch), heard at mitral area- radiates to left axilla
AS/aortic stenosis (medium pitch) heard at AORTA area- radiates to neck
MVP/mitral valve prolapse (midsystolic click) heard at mitral area
• Diastolic murmurs—ABNORMAL ASSOC WITH
AORTIC/PULMONIC VALVES (audible between 2 and 1 heart sound)
nd st
AR/aortic regurg (high pitch) heard at AORTA area
MS/mitral stenosis (low pitch with bell) heard at mitral area
• Mitral area- 5th ICS midclavicular, apex, apical area, PMI, apical pulse
• Aorta area- 2nd ICS to the right side of upper border of sternum,
• Grade of murmurs 1. Barely audible, 2 faints but audible, 3 Moderately loud no
thrill palpable, 4 LOUD WITH PALPABLE THRILL, 5 very loud
stethoscopes off chest, thrill palpable, 6 audible without stethoscope thrill
palpable
• S1- closure of atrioventricular valves , state of systole
• S2- closure of semilunar valves
• S3- heard in pulmonic, sign of CHF, S3 gallop heard in pregnancy
and thyrotoxicosis
• S4 – heard in elderly not associated with heart disease, normal
• Pulse deficit- apical/radial pulse taken at same time, find difference
• Hypertrophic cardiomyopathy- causes sudden death in young athletes
• Question about Grade III/VI Murmur: (Loud murmur easily heard)
Mitral regurgitation: holosystolic murmur-apex radiates to left axilla,
loud, does not increase in inspirations, S3, Pansystolic, pathologic
• Coarctation of Aorta: Know that systolic BP on lower extremities is
supposed to be higher compare to upper extremities. In COA case its vise
versa. Look for weak radial and bounding femoral pulse
