APEA 3P Exam Questions With Complete Solutions
.1 risk factor for COPD – Answer -smoking
.Acanthosis Nigricans: symptoms – 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
.Ace inhibitors – Answer –pril: HTN, HF. AD: angioedema, cough,
hypotension, hyperkalemia, hepatotoxicity, neutropenia, agranulocytosis,
pancreatitis, SJS. Contra: pregnancy. Nursing: empty stomach, monitor for
infection, dry cough, use contraception (teratogenic), avoid sports
drinks/salt substitutes (extra K)
.Acne medications to avoid in pregnancy (category X &C) – Answer -
Category X: Topical tazarotene (Tazorac), Accutane
Category C: Topical retinoids (tretinoin, adapalene)
.Acne Rosacea – 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
.Acne Vulgaris (common acne): treatment – Answer -First line is always
topical retinoid such as tretinoin cream (Retin-A)
.Acne: Mild treatmetn – 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) – 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 – 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
.Acoustic Neuroma (Vestibular Schwannoma): Symptoms/DX/TX – Answer -
Symptoms: Ages 30-60
Gradual onset, one-sided
Sensorineural hearing loss, tinnitus that is insidious; CN 8
Facial numbness and pain if it compresses CN 5
Dx: Order an MRI o Benign tumor of CN 8 causing sensorineural hearing
loss and tinnitus.
If it compresses on CN 5 will have facial numbness and pain
Treatment: Surgery
,.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
.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!!**
.Acute Angle-Closure Glaucoma:symptoms and treatment – Answer -
Normal ICP: 8-21
Acute angle glaucoma ICP >21
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
.Acute Bacterial Rhinosinusitis (ABRS): bacteria & symptoms – Answer -
Bacteria: Streptococcus pneumoniae, H. Influenzae, Viral
Symptoms: Persistent URI symptoms for 10 days or more or a cold that
resolved but symptoms returned • Unilateral facial pain/pressure or a
toothache (upper molar pain) with nasal congestion • Purulent nasal
and/or postnasal drip (may have a cough when supine) Frontal sinusitis: §
Frontal headache or headache behind one eye Maxillary sinusitis: § Facial
pain and upper molar tooth pain
Transillumination: Compare each side. Affected side may be duller or
smaller
Treatment: Either immediate antibiotic treatment or observation First Line:
Augmentin 2000 mg/125 mg BID x 5-7 days Symptom relief: Saline
irrigations, nasal steroids, NSAIDs for pain
Do not use antihistamines or decongestants
Penicillin Allergy: Levofloxacin 750 mg QD x 5-7 days or Doxycycline BID x
5-7 days
.Acute Otitis Media (AOM)(Think of Media for Middle Ear): Strain &
symptoms & treatment – Answer -Bacteria: Streptococcus pneumonia
(others: Haemophilus influenza, Moraxella catarrhalis)
High rate of beta-lactamase resistance
Symptoms: Unilateral ear pain (otalgia)
Popping noises, and muffled hearing, Either afebrile or low-grade fever,
The tympanic membrane can rupture. Blood and pus can be seen on the
pillow upon awakening with relief of ear pain ,TM will be red. Bulging and
the cone of light will be abnormal or displaced ,Most objective finding:
Decreased mobility per the tympanogram which will be a flat line
.1 risk factor for COPD – Answer -smoking
.Acanthosis Nigricans: symptoms – 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
.Ace inhibitors – Answer –pril: HTN, HF. AD: angioedema, cough,
hypotension, hyperkalemia, hepatotoxicity, neutropenia, agranulocytosis,
pancreatitis, SJS. Contra: pregnancy. Nursing: empty stomach, monitor for
infection, dry cough, use contraception (teratogenic), avoid sports
drinks/salt substitutes (extra K)
.Acne medications to avoid in pregnancy (category X &C) – Answer -
Category X: Topical tazarotene (Tazorac), Accutane
Category C: Topical retinoids (tretinoin, adapalene)
.Acne Rosacea – 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
.Acne Vulgaris (common acne): treatment – Answer -First line is always
topical retinoid such as tretinoin cream (Retin-A)
.Acne: Mild treatmetn – 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) – 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 – 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
.Acoustic Neuroma (Vestibular Schwannoma): Symptoms/DX/TX – Answer -
Symptoms: Ages 30-60
Gradual onset, one-sided
Sensorineural hearing loss, tinnitus that is insidious; CN 8
Facial numbness and pain if it compresses CN 5
Dx: Order an MRI o Benign tumor of CN 8 causing sensorineural hearing
loss and tinnitus.
If it compresses on CN 5 will have facial numbness and pain
Treatment: Surgery
,.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
.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!!**
.Acute Angle-Closure Glaucoma:symptoms and treatment – Answer -
Normal ICP: 8-21
Acute angle glaucoma ICP >21
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
.Acute Bacterial Rhinosinusitis (ABRS): bacteria & symptoms – Answer -
Bacteria: Streptococcus pneumoniae, H. Influenzae, Viral
Symptoms: Persistent URI symptoms for 10 days or more or a cold that
resolved but symptoms returned • Unilateral facial pain/pressure or a
toothache (upper molar pain) with nasal congestion • Purulent nasal
and/or postnasal drip (may have a cough when supine) Frontal sinusitis: §
Frontal headache or headache behind one eye Maxillary sinusitis: § Facial
pain and upper molar tooth pain
Transillumination: Compare each side. Affected side may be duller or
smaller
Treatment: Either immediate antibiotic treatment or observation First Line:
Augmentin 2000 mg/125 mg BID x 5-7 days Symptom relief: Saline
irrigations, nasal steroids, NSAIDs for pain
Do not use antihistamines or decongestants
Penicillin Allergy: Levofloxacin 750 mg QD x 5-7 days or Doxycycline BID x
5-7 days
.Acute Otitis Media (AOM)(Think of Media for Middle Ear): Strain &
symptoms & treatment – Answer -Bacteria: Streptococcus pneumonia
(others: Haemophilus influenza, Moraxella catarrhalis)
High rate of beta-lactamase resistance
Symptoms: Unilateral ear pain (otalgia)
Popping noises, and muffled hearing, Either afebrile or low-grade fever,
The tympanic membrane can rupture. Blood and pus can be seen on the
pillow upon awakening with relief of ear pain ,TM will be red. Bulging and
the cone of light will be abnormal or displaced ,Most objective finding:
Decreased mobility per the tympanogram which will be a flat line
